Struggling to sleep? If so, you're not alone. According to the American Academy of Sleep Medicine, around 30% of U.S. adults have trouble falling asleep, and 1 in 5 report using sleeping aids. One of the most common choices: melatonin.
Is Melatonin a Good Choice?
Melatonin is a hormone that occurs naturally in your body and helps control how and when you sleep. Many people turn to synthetic melatonin supplements that come in a variety of forms: liquid, gummy or pill and their popularity has grown tremendously. According to the Centers for Disease Control and Prevention (CDC), U.S. melatonin sales grew from $285 million in 2016 to more than $821 million in 2020.
Insomnia is a sleeping disorder that can make it difficult for people to fall asleep or stay asleep. It’s often caused by issues such as racing thoughts, anxiety, a learned association between the bed and wakefulness or disrupted sleep due to caffeine or napping. Because melatonin addresses sleep timing but not the underlying causes of insomnia, it is not a recommended treatment.
“Most insomnia is a hyperarousal problem, not melatonin deficiency,” said Nathaniel Gordon, MD, assistant professor of Medicine and sleep medicine specialist at Macon & Joan Brock Virginia Health Sciences EVMS Medical Group at Old Dominion University. “It is not recommended at all as a treatment for acute or short-term insomnia. And for chronic insomnia, research also shows that it has little effect on sleep onset, quality or duration.”
Studies show melatonin has a minimal effect on helping people fall asleep, just 7 minutes faster on average than a placebo. However, many people continue to use melatonin simply because it's easy to find, inexpensive and feels low-risk.
What are the Risks of Using Melatonin?
Though considered relatively safe to use, melatonin is not without risks or potential side effects. “Dosage is a common issue. As little as 0.5 mg can be effective for shifting sleep timing, but many over-the-counter melatonin products come in doses as high as 5–10 mg,” said Dr. Gordon.
Higher doses often leave people feeling groggy the next morning. Other reported side effects include headaches, dizziness, nausea, nightmares and vivid dreams. There are also concerns about long-term use of melatonin and whether it can affect the brain's natural ability to regulate sleep timing on its own.
Melatonin is not regulated by the U.S. Food and Drug Administration the same way medications are, meaning the dose on the label may not reflect what's actually in it. A JAMA study tested 25 brands of melatonin and found that 88% of melatonin gummy products were inaccurately labeled, and actual melatonin content ranged from 74% to as high as 347% of the advertised amount.
Safety is also a concern. Children can often mistake gummy melatonin for candy. According to the American Academy of Sleep Medicine, accidental melatonin ingestions reported to poison control centers increased by 530% between 2012 and 2021, and pediatric emergency department visits related to melatonin rose 421% between 2009 and 2020.
What is the Better Treatment for Insomnia?
The most effective treatment for chronic insomnia is a structured program called Cognitive Behavioral Therapy for Insomnia, or CBT-I. It works by targeting the thoughts and habits that keep the brain in "awake" mode. CBT-I is recommended as a first-line treatment for insomnia and performs as well as sleep medications, without any of the side effects.
"CBT-I works to build 'sleep pressure,' or the drive to sleep," said Dr. Gordon. "We work with patients on consistent scheduling, reclaiming the bed for sleep and breaking the cycle of anxiety that keeps people up at night. The goal is to make sleep feel automatic, so people can stop struggling and get back to living a full, healthy life."
If you are struggling with insomnia, make an appointment with Dr. Gordon by calling 757-446-5908 or request a referral to see a sleep specialist through your doctor.
