Should I use melatonin to fall asleep?

Another title for this blog post could be “why doesn’t melatonin work for me?”

Before we can answer these questions, we should take a step back to understand what melatonin is (and is not).

Melatonin is a naturally occurring hormone produced by a part of your brain called the pineal gland (located in the center of your brain right above the brainstem). The pineal gland receives direct input from another region of the brain important for sleep - the suprachiasmatic nucleus, which is the master clock in your body. These two brain regions work together to help your body understand night and day – and when to be awake and when to be asleep. Melatonin serves as that chemical messenger to communicate throughout your body when it is time to relax enough to start sleeping.

Over-the-counter melatonin is not a sleep aid – or at least not an effective one. Over-the-counter melatonin is a chronotherapy – meaning that it intervenes upon your circadian clock to advance or delay the time (think of how we move up or back the clocks for Daylights Savings). Melatonin does not make you sleepy, but rather tunes your body’s clock to set the stage for sleep. Sleepiness and timing often go hand-in-hand, but they are different biological processes playing out in different parts of your brain.

To put it differently, melatonin does not increase your appetite for sleep, but makes you more ready to sleep at intended times. Melatonin is like a dinner reservation – and hopefully your dinner reservation matches when you’re hungry enough to eat!

If you take it at bedtime in hopes to fall asleep faster at your normal bedtime, the American Academy of Sleep Medicine notes you would not benefit much – but there’s little harm in using it either (citation). However, you would get much more bang for your buck using doing psychotherapy or pharmacotherapy that has much more convincing data.

Over-the-counter melatonin use may be your best friend when you experience shifts between your biological clock and the real clock – like overcoming jetlag, or a shift worker transitioning from night shift back to day shift, or even those trying to break out of a late or irregular sleep schedule. This use is where melatonin thrives, and when really the only times I recommend patients take melatonin.

Melatonin has its place, but you have to use it under the proper conditions to reap its benefits.

Citation:

Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(2):307–349.