At the recent conference of the American Psychiatric Association, Dr Noah Freedman attended a course on the use of melatonin in the treatment of sleep disorders. Here is a summary of what he learned.
Do you have difficulty falling asleep at night, and then difficulty getting up in the morning? Many people, especially younger people, have this problem of “delayed sleep phase.” If instead you rise much too early in the morning, and feel ready for bed hours before others do, you have “advanced sleep phase,” common especially in older people.
When your sleep schedule is off in this way, it can feel like your “body clock” just isn’t working like the clock everyone else follows. In fact, that is exactly what is happening. The body’s “circadian rhythm”, or body clock, is out of kilter. Our body temperature cools at night, when we are asleep, and rises during the day. A hormone called cortisol, produced by the adrenal glands, tends to rise early in the morning, helping us to wake up. If these changes happen at the wrong time, the rhythm of sleeping and waking will be out of sync. The circadian rhythm is triggered in part by sunlight, and in part by melatonin, a hormone produced in the pineal gland.
To re-set your body clock, you can use melatonin in tiny doses of 0.5 mg (500 micrograms). This amount will generally not cause sleepiness directly, but will help re-set your body clock. If you want to fall asleep earlier, start by taking 0.5 mg of melatonin, not at bedtime, but rather 8 hours after you wake up each day. Then, gradually move back the time you take the pill, if possible taking it about 15 minutes earlier each day. You will begin to find that you gradually get sleepy earlier in the evening.
If you find yourself waking up much too early and would like to get some more sleep, you can try taking this same small dose (0.5 mg) when you awaken (as long as it’s after 2 a.m.), and you may be able to fall back to sleep more easily.
Melatonin in larger amounts, such as the 3 mg pills typically sold over the counter, can also be used to induce sleep at bedtime, and will help some people. However, the long-term safety of this use has not been determined. To buy the smaller doses, a good source is Trader Joe’s, where they carry 500 mcg (0.5 mg) peppermint-flavored, chewable tablets of melatonin. This amount is “physiologic,” equivalent to what the body naturally produces, and is a good way to help regulate your sleep cycle if used as described above.
Melatonin is only one natural remedy for insomnia. Other natural remedies for sleep difficulties include the herbs lemon balm, chamomile, valerian, and passionflower. The links will connect you to more information about these herbal supplements on the WebMD website.
This article does not constitute medical advice, and you are encouraged to talk with your doctor or nurse practitioner about your specific sleep problems.