Is Melatonin Safe for Sleep?

How Melatonin Works

Melatonin is a hormone that our bodies naturally produce in response to darkness. It signals to our brain that it's time to sleep and helps regulate our sleep-wake cycle. As sunrise approaches, melatonin levels drop, indicating that it's time to wake up. The synthetic version of melatonin available as a supplement is often used to address sleep issues related to circadian rhythm disturbances, such as jet lag or shift work sleep disorders.

Generally speaking melatonin is considered safe for short term use. Long term use currently seems to be acceptable in adults, but it is not recommend if better sleep hygiene practices can resolve sleeping issues. You should see a doctor before comitting to long term melatonin use. It is considered safe to use melatonin for up to 3 months, but studies on it's use beyond that are limited.

The Effectiveness of Melatonin

Research suggests that melatonin supplements can be effective for certain sleep conditions. A review of studies found that melatonin was better than a placebo at improving both the time it takes to fall asleep and total sleep duration. However, the effects on behavior and daytime functioning were not consistently clear across studies.

For specific conditions, melatonin has shown promising results. In children with autism spectrum disorder (ASD), melatonin helped them fall asleep earlier and sleep longer. Similarly, children with attention deficit hyperactivity disorder (ADHD) experienced improvements in sleep onset and duration with melatonin supplementation. Melatonin has also been found to be beneficial for individuals with atopic dermatitis and chronic sleep-onset insomnia.

Short-Term Use and Safety

While melatonin supplements can be effective for short-term use, it's important to exercise caution. The appropriate dosage for adults is typically between 0.3-1 milligram, and it should be taken an hour or two before bedtime. However, some individuals may mistakenly take higher doses, leading to side effects such as grogginess and severe nightmares. 

Typical dosages range from 1 to 5 milligrams for adults, but it is advisable to start with a lower dose and gradually increase if needed. Doses below 1 milligram may also be effective for certain sleep problems. Adults taking melatonin can often take 6-10mg after they have built some tollerence to the supplement, but it's generally recommended to start small.

The timing of melatonin intake is crucial for its effectiveness. It is recommended to take melatonin approximately 30 minutes to an hour before the desired bedtime to align with the natural rise in melatonin levels. Taking melatonin at bedtime or later than the usual bedtime can disrupt the sleep-wake cycle and potentially lead to increased sleepiness in the morning.

It's crucial to follow the recommended dosage and consult with a healthcare provider before starting melatonin supplementation.

Managing Side Effects and Dosage

To manage potential side effects and ensure optimal results, it is important to consider melatonin dosage and timing. The appropriate dosage of melatonin can vary based on individual factors, such as age and specific sleep issues. 

Melatonin and Children

The safety and long-term effects of melatonin use in children require further research. While melatonin has been used to address specific sleep issues in children, such as insomnia or delayed circadian rhythm, it should not be used as a general sleep aid for otherwise healthy children or adolescents. Lifestyle and behavioral changes should be explored before considering melatonin supplementation for children. It is advisable for parents and caregivers to consult their child's pediatrician before using melatonin in children.

One area of concern regarding long-term melatonin usage is its impact on puberty onset in children. Because melatonin levels naturally decrease at the beginning of puberty, there is some speculation that prolonged melatonin use in children may delay the onset of puberty. However, current research on this topic is limited and inconclusive.

Potential Melatonin Side Effects and Interactions

Melatonin supplements are generally well-tolerated and considered safe for short-term use. However, like any supplement or medication, they can have potential side effects. It is essential to be aware of these side effects and consult a healthcare professional if they persist or worsen. Commonly reported side effects of melatonin include:

  1. Headache: Some individuals may experience headaches after taking melatonin supplements.
  2. Daytime sleepiness: The sleep-promoting effects of melatonin can extend into the daytime, leading to feelings of tiredness.
  3. Dizziness: Dizziness can occur as a side effect of melatonin, and it is advisable to avoid alcohol when taking melatonin supplements.
  4. Nausea: While nausea can be a side effect of melatonin use, it is important to consider other factors that may contribute to it, such as timing of supplements and meals.
  5. Vivid dreams or nightmares: Melatonin use has been associated with vivid dreams or nightmares in some individuals.
  6. Stomach cramps: Studies have suggested a potential link between melatonin use and stomach cramps or discomfort.
  7. Mood changes: Melatonin may cause brief bouts of depression and irritability in some individuals.

It is worth noting that these side effects are typically rare, mild, and self-limiting. However, if any concerning symptoms occur, it is advisable to discontinue melatonin use and seek medical advice.

Additionally, melatonin can interact with certain medications, including blood thinners, diabetes drugs, immune system-suppressing drugs, and contraceptives. It's crucial to consult with a healthcare provider if you are taking any medications to ensure there are no potential interactions.

Lack of Regulation and Quality Control

One important consideration is that melatonin supplements are not regulated by the U.S. Food and Drug Administration (FDA) in the same way as prescription and over-the-counter medications. This means that there is no guarantee of their safety, efficacy, or accurate labeling. A study analyzing melatonin supplements found significant variations in the amount of melatonin they contained, as well as the presence of other substances such as serotonin. This lack of regulation highlights the importance of carefully selecting reputable brands and consulting with healthcare providers. As a minimum you should make sure to only purchase melatonin supplements from companies that produce products in FDA registered facilities that follow CGMP guidelines.

A study examining different melatonin supplements found that the actual melatonin content of 71 percent of the products did not match the claim on the label. Additionally, 26 percent of the products contained serotonin, which can be potentially harmful even in small doses. We do have a list of melatonin supplements that have been safety tested here.

Long-Term Effects and Unknowns

While short-term use of melatonin appears to be generally safe, there is limited research on the long-term effects of melatonin supplementation. The National Center for Complementary and Integrative Health has stated that there is insufficient evidence on its long-term safety. Although currently it is considered "mostly" safe.

Furthermore, the potential impact of long term melatonin use on hormonal development, including puberty and menstrual cycles, is still not fully understood. Pregnant and breastfeeding individuals should avoid melatonin due to the lack of data on its safety in these populations.

Considering Underlying Sleep Issues

It's important to recognize that melatonin is not a solution for all sleep problems. Chronic insomnia, sleep apnea, restless legs syndrome, and anxiety may require a more comprehensive approach that addresses the underlying causes. These conditions may benefit from a combination of lifestyle changes, cognitive-behavioral therapy, and, if necessary, medication. It's recommended to consult with a healthcare provider to identify and address any potential underlying issues contributing to poor sleep.