Does Melatonin do Sh*t ? – PART 2

Studies show melatonin supplements improve some sleep latency but not total sleep time. In other words, useful to fall asleep but not always for staying asleep. It is even more useful in certain sleep disorders such as REM disorder and in blind people. And a 2021 Meta-analysis showed mild evidence of delirium prevention in post-surgical and ICU patients . A small feasibility study published in 2021 found no improvement in delirium with melatonin supplementation

Be mindful of 4 things when you use or prescribe melatonin supplements:

1. Mind the Age: As we saw in Part 1, our natural melatonin levels significantly drop only after age 55 onwards. In fact in Europe & New Zealand, Melatonin is approved only for ages 55 & above. So melatonin might not be useful for improving sleep in younger people since natural levels are good already. However one can argue it might help sleep in situations where melatonin levels can be suppressed such as such as: Late night exposure to white or blue light, To normalize sleep-cycle reversal after a night shift stretch & Jet Lag, To build a natural rhythm in visually impaired (since light controls the natural melatonin cycle).
   
2. Mind the Formulation: In Part 1, we also saw how the peak of natural melatonin is closer to dawn than bedtime , followed by a rapid decline to waking time. This rapid decline could also be a cue to wake up. This graph shows levels of melatonin in immediate v/s ‘sustained release’ or slow-release formulations. The rapid rise and fall in melatonin levels and short duration can cause earily awakenings if not using a sustained release supplement.
   
3. Mind the Timing: Since its not a typical sedative and rather preps body for sleep, it is ideally taken 1-2 hours prior to intended bedtime to be effective. Encourge patients to still follow good sleep habits (avoid late caffeine, exercise & supper, use dim yellow lights in evening, avoid high volumes, etc.)
   
4. Mind the Dose : Since we are merely supplementing the naturally produced melatonin, a small 2-3 Mg (milligram) dose can be effective when used right. I would advise start even lower to begin with. A higher dose can come with increased risk of side-effects. For the same dose, melatonin levels go up more in elderly than the young.

Melatonin side-effects are not dangerous but can be distressing and people may not realize its due to melatonin, such as Nightmares (esp. with higher doses) , daytime sleepiness and fatigue, headache and GI upset. In countries where melatonin is regulated as a medication unlike in the US, it is advised to use it not more than 12-13 weeks at a time since long term studies are lacking.

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