Ah, sleep. These days it seems a lot of people aren’t doing it particularly well. So, how do millions of people ‘remedy’ the problem? Mostly with popular prescription sleep meds, like Ambien, Lunesta, Sonata and so on, which, though they are good for helping sleep come a little faster, they’re also terrible for your health. They’re habit-forming, have a raft of side-effects in the here and now – think sleep-walking, sleep-eating, brain fog – and long-time usage has been linked with increased incidence of degenerative brain diseases like Alzheimer’s. In all, a pretty lousy trade-off for a few more nightly winks.

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However, the good news is that increasingly, people are becoming more aware of the dangerous downsides of prescription sleep meds and switching to non-pharmaceutical alternatives. Enter melatonin supplements, a safer, drug-free alternative which can certainly play a helpful role in your good-sleep program, that is, if you understand the pros and cons, how it works in the body, and what it can and can’t do.

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But, with all the attention that melatonin has been receiving in the mainstream health press of late, for the sleep-deprived, there’s a temptation to think of it as a sleep panacea or a cure-all, and that’s it’s OK to pop a pill every night without giving it a second thought. Not so – you need to manage your dose. Here’s the top-line on what every sleep-seeker needs to know about whether to use melatonin, and if you do, how to do it skillfully:

Melatonin is everywhere.

Melatonin certainly isn’t hard to get hold of these days, and the stuff you buy at the pharmacy or health food store is non-prescription, relatively cheap, and feels like a more natural sleep aid. It is, after all, the synthetic version of the hormone produced by the pea-sized pineal gland in your brain that helps regulate our sleep-wake cycle. When our bodies are exposed to daylight, especially in the morning, our adrenal glands increase the production of our primary energy hormone, cortisol, to get us out of bed and get us moving. Then as the day progresses, evening falls, cortisol levels drop and sleep-promoting melatonin enters the picture, helping to mobilize a raft of changes in the body that set the stage for sleep, including a drop in body temperature and blood pressure. So, what’s not to like about melatonin? Nothing, when it comes to the hormone your own body produces. The store-bought variety however warrants a closer look and a bit of strategy.

It’s a rhythm thing, so tap in wisely.

Inside the body, melatonin works to keeps us in synch with our circadian rhythms, and ready for sleep in the evening. And that’s the most effective use of melatonin supplements – as a corrective to a temporarily out-of-whack sleep-wake rhythm. Older people are more prone to these problems and, of course, jet lag affects travelers of any age. Your body may be running on New York time, say 6 p.m., but you’re in London where it’s 11 p.m. Even the one-hour-shift going on or off daylight savings time can throw a wrench into the sleep rhythm works. An extra dose of over-the-counter  melatonin can help remind the body that it’s time to go to bed.

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Likewise, if you’ve hit a stressful rough patch at work or at home, with the attendant problems getting or staying asleep, melatonin can serve as mild corrective to help the body shut down in preparation for sleep. I advise my patients who find themselves in this boat to consider taking a melatonin supplement every night, or most nights, for no longer than a month, then taper off for two weeks. Think of it as a set of sleep training wheels. Once you recover your balance, you shouldn’t need ‘em any more. If the sleep problems persist, then you need to address them head-on. Maybe it’s an underlying medical condition or depression or some other emotional issue that might benefit from therapy, cognitive-behavioral, for instance. Melatonin is not going to address the root problem, much less solve it.

Take hormones seriously.

People often forget (or don’t realize) that melatonin is a hormone which means it has wide-ranging effects throughout the body. In fact, there’s interesting preliminary evidence that melatonin may have anti-inflammatory and anti-aging effects, which I’ll be talking more about in an upcoming post, but in the meantime, you need to treat the hormone melatonin with respect and approach dosing conservatively. (Keep in mind that the U.S. is one of only two countries in the world that treats it as a loosely-regulated supplement, not a prescription drug.)

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While many of the products on the market are in the 3-5 mg. a tablet range, I recommend starting small, in the 0.5-1 mg range, and for longer-term use, say for a month, staying small. Because the effects are fairly subtle, at least compared to the knock-out effect of a prescription sleep drug or an antihistamine-loaded OTC product like Benadryl, you may feel like upping the dosage beyond 3 mg. or so, which I advise against.

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Why? Because there is a risk that over-supplementing with melatonin could tamp down the natural production of the hormone, which is the last thing you want, to handicap your body’s natural capabilities and become dependent on outside help, similar to the way that supplemental sex hormones (especially testosterone) can shut down the home factory. While short-term use of melatonin seems generally safe, as with a lot of things, we don’t have any data on long-term usage, so avoid taking it nightly for months or years on end. Whatever your dose of melatonin though, if you find yourself waking up groggy, you’ve taken too much.

Timing is everything.  

The effect of melatonin is relatively short-lived so it makes the most sense to take a time-released pill right before bedtime so you spread the sleep-enhancing effect over a longer period of time. An alternative: if you wake up in the middle of the night, pop one of those near-instantly dissolving sub-lingual tablets to nudge you back to sleep.

As with all supplements, buyer beware.  

That holds true for any supplement, melatonin most definitely included. One study in an academic sleep journal found that the amount of melatonin in the 31 products they tested ranged from 83% less than what the label claimed to 478% more! As always, go with the most reputable brands, like Thome, Metagenics and Designs For Health, or the plant based HerbatoninPro by Symphony Natural Health. And avoid combo products that add in melatonin as a kind of bonus, often delivering a bigger-than-needed dose of 5 mg (or more).

The over 50-set may experience extra benefits.

Another reason to consider melatonin’s for sleep support? If you’re over 50, it can extend sleep times, which is good news for the sleep-deprived. The thing is, as we age, hormone levels tend to decrease, including melatonin, the lack of which has a negative impact on your sleep-wake cycle with night and day. The good news is that some studies have shown supplementation can help combat the natural melatonin slide in older adults, and support increased sleep time by as much as 15 minutes for nighttime sleep and by half an hour for daytime sleep.

Melatonin is good for most people, but not for all.

It’s a good idea to check with your health-care provider if you’re considering melatonin for more than occasional use, especially if you’re dealing with a chronic disease. For example, The Arthritis Foundation advises people with an auto-immune condition not to use it at all. And those who are pregnant or trying to become pregnant, have issues with depression, high blood pressure, bleeding or seizure disorders should also get professional advice before taking.

Don’t get (psychologically) hooked.

We have no evidence that taking melatonin creates a physiological dependence. But I can tell you from conversations with many patients that people can convince themselves that they’ll never get a good night’s sleep unless they pop their nightly melatonin. But their minds have exaggerated the potency of the hormone. One study that crunched the numbers from 19 different individual studies found that people who took melatonin on average fell asleep 7 minutes faster and stayed down 8 minutes longer. Not a huge difference, although some people got considerably more (or less) benefit and, generally, the melatonin did seem to promote a more refreshing sleep. And keep in mind, the melatonin users were being compared with people who thought they were taking something to help with sleep, a placebo, and when it comes to sleep, believing that something will help tends to relax the mind, the perfect prescription for untroubled sleep. The moral of this story: while melatonin does have its uses, as I’ve described, when it comes to night-in, night-out, year-in, year-out use, you’d be better off investing that belief in something completely harmless like a bedtime cup of chamomile tea.

Do everything else right.

Before you lose too much sleep worrying about whether to take melatonin, and how much and for how long, make sure you’ve got the non-hormonal good-sleep basics covered. You should know the drill by now: no caffeine after the morning; seriously cut back or lose the alcohol and forget about it before bed; increase your physical activity as much as you can, nothing is better at promoting deep sleep; power down in the evening, lose the screens within a couple of hours of bedtime; make use of relaxation techniques, be it stretching, yoga, sitting meditation, a bath or shower before bed (lowers the body temperature). Or all of the above! For more ideas on getting high quality shut eye, check out my 9 Tips for Better Sleep.