Welcome to the another installment of our Ask An Expert series on the Tuck Sleep Blog. For this question, we’re working with Dr. Jeff Clark, a psychiatry resident and the founder of a new CBT-i app called Slumbercamp. If you have a question you’d like us to answer, please reach out to us at [email protected] and we’ll put it in our queue.
Many people turn to melatonin, and for some, the effects are nothing short of miraculous. The rest of us tend to have a more complicated relationship with the drug.
Now you’ll note that I called melatonin a drug. Because although melatonin is sold as a natural supplement in the United States, there is no reason to believe that there is an epidemic of melatonin deficiency. Melatonin is a potent, naturally occurring hormone. And like all hormones, it’s important to treat it with respect. In fact, some countries are so concerned about the long-term consequences of melatonin use that they only dispense it with a prescription.
Unfortunately, we don’t have great data describing the problems of long-term melatonin use, but most doctors rightfully believe that occasional treatment with low-dose melatonin is fairly safe.
But here’s the bad news: melatonin isn’t a great treatment for insomnia. Yes, some people do get much better. But on average, melatonin tablets don’t work much better than sugar pills. It might be worth a shot before considering other sleep medications, but it is not recommended as a treatment for insomnia by the American Academy of Sleep Medicine.
Now because some people do respond well to melatonin, I do occasionally use it in my clinical practice. And before you give up entirely on melatonin, it might be worthwhile to troubleshoot a few common melatonin-related mistakes. Because with melatonin, the dose, timing, and way you take it are very important!
The Right Dose
Melatonin is sold in a variety of strengths. In most brick-and-mortar stores, melatonin only comes in 1, 3, or 5 mg tablets. But if you look online, it is easy to find doses as low as 0.3 mg or as high as 20 mg.
The right dose will vary from person to person, but most research suggests that doses should be similar to the actual amount your body produces–something scientists call a physiologic dose. For most people, a physiologic dose is just 0.3 to 0.5 mg of melatonin daily.
If the dose is too high, you may have trouble waking up in the morning. In addition, high dose melatonin may turn down your body’s natural melatonin production–which could make insomnia much worse in the long run. With melatonin, less really is more!
The Right Timing
When I prescribe sleep medications like Ambien and Klonopin, I often tell people to take them right before they get into bed. Those medications act quickly, and there is a serious risk of falls if you get out of bed while under their influence.
Melatonin is different. At physiologic doses, it shouldn’t make you sleepy. Melatonin’s job is to help your body prepare for a restful night of sleep, and that takes time!
When I discuss melatonin with my patients, I specifically tell them to take it 2-3 hours before bed. This gives your body time to wind down and prepare for sleep.
The Right Way
When medications are swallowed, only a certain percentage of the active chemical makes it into the blood stream where it can begin influencing your body. If only a small portion of the drug makes it into your blood, that drug is considered to have a low oral bioavailability.
Melatonin has a relatively low oral bioavailability, but that’s not the worst of its problems. Melatonin absorption also varies dramatically from person to person. Some people take up only 10% of the active drug they swallow, while others absorb as much as 50%!
In other words, there is no good way to know how much melatonin you actually receive after swallowing a pill. And since lower doses tend to be better than higher doses, you can’t just increase the dose until you start sleeping better.
Thankfully, there is a reasonable workaround: place the melatonin pill you have under your tongue, and wait for it to dissolve. Melatonin can then directly enter your bloodstream through capillaries in your mouth, providing a more consistent, predictable dose. In the medical world, we call this sublingual administration, and it’s a tried and true method for delivering poorly absorbed medications. (Talk to your doctor before taking any other drug this way, as it can lead to dangerously high blood levels!)
In short, melatonin does not work well for everyone. But before you write it off completely, make sure that you take the right dose (0.3-0.5 mg), at the right time (2-3 hours before bed), and in the right way (dissolved under the tongue). That will give you the best chance of experiencing melatonin-enhanced slumber.
Jeff Clark, MD is the founder of SlumberCamp.co, and a resident psychiatrist in Seattle, Washington. This column is for educational/entertainment purposes only and should not be taken as personal medical advice. Have a question you’d like answered on the blog? Let us know at [email protected].