Melatonin 101: A Beginner’s Guide – Part 2

Melatonin can be used to support sleep, but there are some important things for you to know. First, the dosage can range from less than 1 mg to several mg. As a general rule, start with the lowest dose possible, and if that dose is ineffective, slowly increase it.

There are very few side effects to using melatonin—the most common “side effect” is drowsiness! Timing can be important in the altered sleep-phase disorders, as you will see. But in this statement from a review of melatonin use in sleep disorders, research on melatonin has a long way to go:

“Melatonin supplementation has been shown to be a safe and effective method to improve sleep onset latency, duration, and quality in children, adolescents, older adults, and postmenopausal women. Furthermore, consistent melatonin use produces a very low rebound rate.”(3)

In generalized insomnia—that is insomnia that is not phase altered (see below), a person can benefit by taking 1-3 mg of melatonin about 2 hours before you want to go to bed. Practice healthy sleep hygiene as well. So, you may want to consider taking your melatonin, turning down the lights, avoiding electronic media and listen to calming music, read a book or just sit back and relax a bit. Also, remember to keep your bedroom as dark, cool, and quiet as possible.

Insomnia can have many “faces”. It is the most common sleep disorder and can be short-term or long-term. Long-term insomnia can be associated with obesity, heart disease, aging, poor work/school performance, high blood pressure, and mood disorders. It is very common in postmenopausal women, the elderly, in those with flexible work schedules and during times of stress. It can also be caused by medication, pain, use of stimulants, eating too much too late in the evening, and the constant late-night use of electronic devices.

General insomnia is usually treated with a combination of CBT, improvement in sleep hygiene, and melatonin. Sleep medications are less used—and used for shorter periods of time because of the risk of abuse, tolerance, and misuse.(4)

To prevent jet lag, try starting to take melatonin about 2 hours before your preferred bedtime at your destination for about 2-3 days before you leave. Let’s say you live on the West Coast, and your normal bedtime is 10pm. Your destination is Istanbul Turkey, 11 hours ahead. In this case, you would start taking 1-3 mg melatonin at around 8pm in Istanbul-time. That converts to 9am, PST. Be aware that this may make you drowsy while still on the west coast—so get your bags packed already!

In Delayed Sleep-Wake Phase Sleep Disorder (DSWPSD), the individual generally goes to sleep late and gets up late. This is not like generalized insomnia because you don’t have trouble falling asleep or staying asleep—you just shift your sleep schedule, so it is later than most. However, DSWPSD can look like insomnia because if you have to be at work at a specific time—before you would normally wake—you still will lose total sleep time. Also, it may look like insomnia because you will have difficulty falling asleep if you try to go to bed before you would normally and consequently may have trouble falling asleep. In DSWPSD, if you take melatonin starting about 2 hours before your new earlier bedtime, you can, over a period of time, shift back into a more normal sleep pattern. There may be a period of trial and error before you find the right time and the right dosage you need to nudge you back into a pattern that works best for you. Some physicians may start by having you take melatonin at 30 minutes, 1 hour, 1.5 hour and 2 hours before your desired bedtime, with the timing changed over a period of weeks. This is best discussed with your own physician and pharmacist. Following healthy sleep hygiene guidelines in addition to using melatonin will benefit you as well and possibly speed up or ease the entire process.(5)(6)

Advanced Sleep-Wake Phase Sleep Disorder (ASWPSD) is a sleep disorder where people tend to want to go to sleep early (between 6-9pm) and tend to get up early (between 2-5 am). The sleep itself is normal and refreshing, just “out-of-sync”. It is much less common than DSWPSD. It is usually not treated with melatonin but treated with bright light therapy during evening hours in an effort to try and reset the body clock. There IS, however, a rationale, according to an American Academy of Sleep review, to use low-dose melatonin immediately after early-morning awakening to slowly shift the melatonin levels. There have been no clinical trials of this approach.(7)