Editor’s Note: Dr. Jennifer Martin is a licensed clinical psychologist, professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles and immediate past president of the American Academy of Sleep Medicine. The views expressed in this commentary are her own. View more opinion on CNN.
You may know someone who has taken melatonin to help them sleep. Perhaps you’ve even taken it yourself. According to a study published in the medical journal JAMA, Americans took more than double the amount of melatonin in 2018 than they took in 2008.
This dramatic increase in use of melatonin reflects our inclination to try “shortcuts” to get a good night’s sleep. Melatonin isn’t the first one and it surely won’t be the last.
As a clinical psychologist, I treat people with chronic insomnia disorder, which is defined as poor sleep at least three nights per week for at least three months. When I ask patients why they use melatonin, many tell me they want something that is “natural” and doesn’t have side effects. Sometimes, they mention a friend who recommended a specific brand that’s supposed to be “really strong.” Then I ask them if taking melatonin has worked for them. Sometimes they say no – but sometimes they respond with an emphatic “Yes!”
I take those “yesses” with a grain of salt for a few reasons:
First, if melatonin supplements are working, a patient shouldn’t need to see a psychologist like me for help with sleep.
Second, there is a strong placebo effect when it comes to insomnia treatment. Believing that melatonin will improve sleep can help people feel more relaxed when they get into bed and they stop trying so hard to fall asleep. This means the melatonin itself isn’t helping them sleep and this initial benefit typically doesn’t last over the long term.
Finally, people can become psychologically dependent on taking the supplement and become afraid of what will happen to their sleep if they stop taking melatonin. This can make it extremely hard to sleep because they feel anxious if they don’t take the supplement.
After we discuss their specific sleep concerns, many of my patients start to realize they have been spending a lot of money on something that isn’t solving their problem.
To understand how melatonin supplements work (and why they often don’t), it’s important to look at how the hormone naturally functions in the human body. Melatonin is linked to our 24-hour circadian rhythm. Natural melatonin production occurs in darkness and is suppressed by light. This makes melatonin pills useful for helping the body acclimate to a different time zone or for people who have circadian rhythms that don’t line up with social norms, like extreme night owls who can’t get up in time for work. However, it is not recommended as a sleep aid for insomnia.
In the US, melatonin, like all dietary supplements, is largely unregulated, and it can have side effects.
As CNN has reported, melatonin has been “linked to headaches, dizziness, nausea, stomach cramps, drowsiness, confusion or disorientation, irritability and mild anxiety, depression and tremors as well as abnormally low blood pressure.” It can also have serious drug interactions that can lead to problems such as fever, muscle rigidity or seizures. This makes consulting a sleep specialist before taking melatonin all the more important.
What’s more, a study published in April in JAMA found that some over-the-counter preparations contained higher levels of melatonin than the dose indicated on the label and many included cannabidiol (CBD). While this study focused on gummies, prior studies found similar problems with melatonin pills.
This is concerning because 1-2 mg of melatonin or less is all it takes to achieve normal levels of melatonin in the blood.
On a recent trip to my local drug store to pick up a prescription, I was shocked to see that 1mg is labeled as a “pediatric dose,” while some “adult doses,” were labeled 3-5mg and sometimes even higher. Because of similar irregularities, several countries—including the United Kingdom, Japan and Australia—and the European Union no longer allow melatonin to be sold as a dietary supplement and instead treat it as a prescription medication. This might be the right solution in the US as well, as it would force manufacturers to adhere to stringent rules about purity and dosing.
In addition to regulating melatonin supplements, we need to dispel the myth that melatonin is an effective sleep aid and instead spread awareness about a treatment that is proven to help with insomnia: cognitive behavioral therapy for insomnia (CBT-I). While few have probably heard of this specialized therapy, it can be a game-changer for people with insomnia disorder. CBT-I involves systematically targeting thoughts and behaviors that negatively impact sleep. It usually requires four to eight in-person or telemedicine sessions with a trained therapist, but online programs also exist. However, some insurance companies deny coverage for psychotherapy for insomnia even though they cover similar treatments for depression and anxiety. To prioritize health while providing relief from insomnia, insurance companies must recognize the need for this therapy and cover it.
Finally, we need to be honest with ourselves about how we live. We don’t prioritize sleep as an essential aspect of health. We prioritize work and recreation at the expense of basic healthy sleep habits like having a regular schedule, avoiding technology in the bedroom and limiting caffeine and alcohol, and we fail to reach out for help when sleep problems start to impact our daily lives. There is no dietary supplement that can fix chronic struggles with insomnia, but there are steps that can be taken to help you get a good night’s sleep—and cognitive behavioral therapy for insomnia is a better option for most insomnia sufferers.
Correction: A previous version of this piece incorrectly listed Canada among some of the countries not allowing melatonin to be sold over-the-counter.
