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Melatonin for Insomnia: When It Works, When It Won’t

Lots of people with insomnia dismiss melatonin supplements as useless, and with good reason. Taken to combat garden-variety insomnia, melatonin is little better than a placebo.
But depending on your situation, it may be likely to resolve your sleep problem or at least worth trying. Genetic factors and age, as well as the time you take the supplement, will affect whether it works or not.
Melatonin for Unhappy Night Owls
Melatonin is a key player in the sleep system. It helps put you to sleep and keep you sleeping through the night. 
Melatonin secretion typically starts a few hours before bedtime and ends about the time you wake up.
But genetic factors determine the timing of secretion, and in some people it begins late at night. These people–night owls–don’t even start to feel sleepy until 2 a.m. or even later. 
The medical name for the condition is Delayed Sleep Phase Disorder, or DSPD.
If you’ve got DSPD and you want to shift your sleep to an earlier hour, there’s a good chance a melatonin supplement will help. 
But taking it as advised on the label–at or around bedtime–will not do the trick. By this time your internal melatonin secretion is under way. Adding to it with a supplement is redundant.
To shift your sleep cycle to an earlier hour, you’ve got to take the melatonin well before your natural melatonin secretion begins. 
Studies of melatonin have shown that taking 0.5 mg five hours before your normal bedtime, and 3 mg seven hours before your normal bedtime, will produce the greatest shifts. 
Take the supplement daily to keep your circadian rhythms from reverting to their natural cadence. (Because of its phase-shifting properties, melatonin also helps lessen jet lag and can reset the body clock in people who do shift work.)
Melatonin for Age-Related Insomnia
Melatonin production tends to fall off with age. This occurs because of the degeneration of neurons associated with the body clock, says RĂ¼diger Hardeland in a review of melatonin in aging and disease, and changes in the pineal gland. Insufficient melatonin may cause trouble sleeping in older adults.
If this is your problem and your insomnia occurs at the beginning of the night, using melatonin as a replacement therapy may help. 
Over-the-counter melatonin is chemically identical to the melatonin produced in your body. It’s generally effective at low doses [such as those mentioned above] and is the best option for people with sleep onset problems caused by melatonin deficiency, Hardeland says.
But typically, aging brings about not trouble falling asleep but rather trouble staying asleep. At low doses, OTC melatonin is not up to the task of reducing middle-of-the-night wake-ups. 
The half-life of melatonin is just 20 to 45 minutes. It doesn’t have enough staying power to keep you sleeping through the night. 
Higher doses of melatonin–50 or 100 mg taken at bedtime–may be helpful for older adults with trouble staying asleep but have yet to be tested for safety.
Ramelteon (brand name Rozerem), a prescription drug similar to but more powerful than natural melatonin, is an alternative. But its track record at keeping people asleep at night is mixed. 
Circadin, a time-release formulation of melatonin, is available by prescription in several countries outside the US. But in studies of this drug, too, improvements on sleep maintenance have been shown to be modest.
All things considered, trying some formulation of melatonin as a replacement therapy in age-related insomnia is probably worth a bid.
When to Pass
But melatonin is not a sleeping pill. If you’re young or middle-aged, and if you’re generally asleep by midnight or soon thereafter, look for some other way to woo the Sandman.
Lois Maharg is a health journalist who writes about sleep, exercise, and food. Lifelong insomnia gave rise to her new book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep
The book is available on her website, http://ift.tt/1bZpMeD, where she blogs about insomnia and sleep, and from Amazon and other online booksellers. 
Find her on Facebook at http://ift.tt/1bZpMeF.
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Melatonin for Insomnia: When It Works, When It Won’t

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