The use of melatonin for sleep is increasing, side effects can be dangerous

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New research shows that in 2018, adults in the US took twice as much melatonin for sleep as they did a decade ago. stock_colors/GettyImages
  • A good night’s sleep is essential for good physical health, cognitive performance, and emotional functioning. Numerous sleep studies have documented these facts over time.
  • More adults are taking over-the-counter (OTC) melatonin supplements to get a better night’s sleep, but some of them may be taking the substance at dangerously high levels, a new study shows.
  • Experts fear the negative impact of the coronavirus pandemic on sleep has further increased dependence on melatonin and other sleep aids.

In the most recent study, the researchers obtained data from ten cycles of the National Health and Nutrition Examination Survey (NHANES), covering the years 1999 to 2018. This study involved 55,021 adults, 52% of whom were women. The participants had an average age of 47.5 years.

The results showed that in 2018, adults in the United States were taking more than double the amount of this sleep aid than they were a decade earlier, which may pose a health risk to some individuals.

The study found that melatonin consumption increased from 0.4% in 1999-2000 to 2.1% in 2017-2018, with the increase beginning in 2009-2010.

The study was published in Journal of the American Medical Association (JAMA)and the lead author is Dr. Jingen Li, Ph.D., of Beijing University of Chinese Medicine.

The study evaluated adults taking melatonin at the recommended dosage of 5 milligrams per day (mg/d) and those who exceeded that dosage. Before 2005-2006, the authors noted that users did not report taking more than 5 mg/day, but the prevalence of taking more than 5 mg/day increased from 0.08% in 2005-2006 to 0.28 % in 2017-2018.

Although overall melatonin use in the US is still relatively low, the study documents “a significant increase in melatonin use by a multiple over the last several years,” according to one sleep specialist. Rebecca Robbins, Ph.D.who is an associate professor in the Department of Sleep Medicine at Harvard Medical School and was not involved in this study.

dr Robbins told Medical news today:

“The use of sleeping pills has been linked to the development of prospective studies dementia and early mortality. Melatonin is one such sleep aid.”

The body’s biological clock regulates hormonal fluctuations that develop over the course of a person’s life. As a result, aging often impacts activities such as sleep and wake patterns, which in some cases become increasingly disrupted and fragmented.

Melatonin is a key hormone that regulates the body daily rhythm. Circadian rhythms play an influential role in certain aspects of our bodily functions and behavior. They also play an important role in sleep regulation and general human health, and disrupting them can have numerous consequences.

The negative consequences of sleep deprivation may include lower energy, a less positive mood, and feeling stressed, cold, or sleepy. These effects can occur in people of any age.

MNT spoke with dr Richard Castriotta, a sleep medicine specialist at USC’s Keck Medicine in Los Angeles, who was not involved in the study. When we asked what the real world implications of this study are, he said:

“Not much, except that the increasing use of melatonin, like any non-FDA-approved drug sold as a ‘dietary supplement’, increases the risk of unwanted side effects from a ‘bad batch’ of unsupervised manufacturing or extraction (e.g. L -tryptophan).”

According to dr Castriotta, “Low-dose (1-3 mg) melatonin is safe and effective in treating circadian rhythm disorders in certain circumstances, but is not a very good hypnotic.”

A hypnotic is a drug that induces sleep. Currently, evidence that melatonin helps relieve insomnia is patchy. according to a review published in February 2020, “there is a statistically significant improvement in sleep latency and total sleep time, although there is no consensus on whether these are clinically meaningful.”

For jet lag, however, the benefits of melatonin appear to be more pronounced. ONE Cochrane review closes:

“Melatonin is remarkably effective at preventing or reducing jet lag, and occasional short-term use appears to be safe. It should be recommended for adult travelers flying across five or more time zones, particularly eastbound, and particularly if they have experienced jet lag on previous trips.”

In addition, Dr. Castriotta states that “melatonin in higher doses (6-12 mg) may be useful in REM behavior disorders and may play a role in cancer prevention/treatment.”

With regular use of melatonin, you may experience several unpleasant side effects, including:

  • dizziness
  • Stomach cramps
  • a headache
  • nausea
  • confusion or disorientation
  • depression
  • irritability
  • fear
  • low blood pressure
  • Tremble

An older study that also appeared in JAMA proposed an association between mutations at the melatonin receptor sites and both insulin resistance and the development of type 2 diabetes. The study found that lower melatonin levels in study participants may have been a precursor to type 2 diabetes. However, no direct causality could be established.

MNT spoke with dr Christopher Schmickl, Ph.D., Specialist in Sleep Medicine at UC San Diego Health in California and Assistant Professor of Medicine at the UC San Diego School of Medicine. dr Schmickl explained:

“Patients can use it to self-treat ‘sleep disorders’, thus delaying or forgoing an evaluation and thus appropriate/tested treatments of the underlying cause – z-term health problems. Even for actual insomnia, first-line therapy is generally (non-pharmacological) cognitive-behavioral therapy for insomnia (CBT-I), which is similar to sleep aids in the short-term and more effective in the long-term.”

Currently, the Food and Drug Administration (FDA) does not regulate the manufacture of melatonin supplements. There is concern that the levels of melatonin in OTC supplements could exceed the label claims by up to 478%.

According to Prof. Schmickl:

“This raises concerns about ‘overdosing’ – that is, flooding the body with levels that impair melatonin’s many important biological functions – and makes it difficult to assess the effect of melatonin on sleep in a specific patient, given that the actual dose can vary significantly from tablet to tablet or at least bottle to bottle.”

“OTC melatonin products may also contain varying amounts of other substances such as serotonin (a precursor to melatonin that can even cause life-threatening side effects in excess), which may further contribute to different effects/side effects.”

He continues, “[b]Based on my clinical practice, many patients consider melatonin to be “natural” because it is a dietary supplement and are therefore not overly concerned about taking even very high doses (>5 mg) that are of medical concern. Similarly, many people have a low threshold for giving their children over-the-counter melatonin products, which may leave them even more vulnerable to adverse outcomes.”

“It is noteworthy that melatonin receptor agonists, e.g. B. Ramelteon, which could theoretically solve some of these problems. However, these patented drugs are very expensive, which means few insurance companies cover these drugs. Therefore, these drugs are rarely used in clinical practice.”

Evidence shows that melatonin has beneficial anti-inflammatory and antioxidant properties, and may have other therapeutic potential. It is currently being studied for its value in treating diseases unrelated to sleep.

It’s also important to note that the study had several limitations. These include:

  • self-assessment of usage
  • Heterogeneity of the preparations
  • the low number of melatonin users in some subgroups
  • no reliable estimates of trends across different ethnic and racial groups
  • sparse data on long-term and high-dose use of melatonin

So far, it appears that short-term use of melatonin is safe for people who work rotating shifts, suffer from jet lag, or have trouble falling asleep. However loud National Center for Complementary and Integrative Health (NCCIH)Part of the National Institutes of Health (NIH), the long-term effects are unknown.

Due to the increasing use of melatonin by the US population and the resulting public health implications, more studies are needed to educate consumers about the potential health risks and possible benefits of continued use of melatonin.

For the future, Dr. Schmickl suggested that changing the status of melatonin from OTC to prescription would be a positive approach. Additionally, he suggests that regulating melatonin to accurately reflect its levels, including the absence of contaminants, would be of great value.

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