Melatonin and its Appropriate Use in Sleep Disorders
With OTC melatonin readily available and its product awareness high among consumers, many pharmacists may be interested in learning more about its safety and efficacy.
Sleep is often described as one of the foundations of good health, along with diet, exercise, and relaxation. Poor sleep can cause and intensify a myriad of health disorders for nearly one-third of all Americans, according to the CDC.1
Given the prevalence of poor sleep in contemporary society, it’s likely that pharmacists will come across patients with some sort of sleep disorder in their practice. One potential remedy is supplemental melatonin, which mimics the endogenous hormone that regulates our circadian rhythm.2 With OTC melatonin readily available and its product awareness high among consumers, many pharmacists may be interested in learning more about its safety and efficacy before feeling comfortable recommending it to patients who are experiencing poor sleep.
The best evidence for the use of melatonin exists for delayed sleep phase syndrome (DSPS), non-24-hour sleep wake disorder (N24), and jet lag. In the first case, a person’s sleep is delayed by 2 hours or more beyond what is considered an acceptable bedtime; for the second, a person’s biological clock fails to synchronize to a 24-hour day; and with the third, there is a mismatch between the sleep-wake cycle of the person’s internal clock to the external cues in their surroundings, often due to travel.
For patients suffering from any of these 3 conditions, taking 0.3 mg to 5 mg melatonin can reduce the length of time needed to fall asleep and improves overall quality of life.3 Although these benefits can dissipate within a year of stopping use of the drug, it has been shown to be safe and effective if taken regularly for up to 6 years.4
Specifically, in cases of jet lag, doses of 2 mg to 3 mg for those traveling eastward, when taken during the evening on the day of arrival for 2 to 5 nights, provides optimal benefit. However, studies have shown it may not be effective in decreasing the time to fall asleep or sleep efficiency, although it does improve alertness and psychomotor performance during wake time.5
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