Insomnia has been increasing among children, adolescents, and adults in the U.S. More and more people are taking melatonin to sleep better. Does that work? Is it safe? How about kids? These questions were answered in a recent article in JAMA Network.
Judith Owen, MD, MPH is the director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital and Professor of Neurology at Harvard Medical School. She expressed concerns about the dramatic increase in the use of melatonin for insomnia. This is true in children, adolescents, and adults. She is worried about potential harm, especially at high doses.
The national Poison Control Center has seen an increase in children taking an overdose. Over the past 10 years they have been called 260,435 times; most kids did OK, but some were hospitalized, some required care in an ICU, 5 needed a ventilator, and 2 died. Please keep melatonin out of reach of children, and do not tell them it’s candy when you give it to them at bedtime.
Melatonin is a hormone secreted by the pineal gland in the brain. It “helps synchronize the body’s daily circadian rhythms with the light-dark cycle.” Dr. Covarsin from the Mayo Clinic noted that melatonin normally is slowly released hours before bedtime. Over-the-counter (OTC) melatonin can be used to treat abnormalities in the sleep-wake cycle but is not intended for all forms of insomnia.
Most studies show limited benefit for insomnia, usually only reducing the time it takes to fall asleep by 5-8 minutes. People who regularly take melatonin and find it helped them may have a medical condition that can benefit from melatonin (e.g., childhood ADHD, Autism Spectrum Disorder, and other neurodevelopmental disorders) or it may be a placebo effect (you expect to sleep better and you do).
There are 3 other conditions that can disrupt sleep. They are jet lag, shift work, and a sleep disorder in which the person acts out their dreams and remains awake. Melatonin can be used successfully in many of these individuals.
If you have insomnia, it is best to see your doctor to determine the cause and fix that, if possible. Insomnia can result from anxiety, depression, stress, a side effect of some medications, general medical conditions such as pulmonary disease or pain, and specific sleep disorders such as a circadian rhythm disturbance.
In most countries, melatonin requires a prescription. In the U.S., melatonin is an over-the-counter pill treated as a food supplement. So, there are limited quality control requirements. One Canadian study showed the pills can contain up to 478% more melatonin than is listed on the bottle, and the dose varied depending on when it was made.
Also, about one in four pills had “significant levels of serotonin.” An excess of serotonin can cause serious illness including death. Most such cases occur in people taking more than one drug that raises serotonin levels. I do not know if any serious illness or deaths have occurred in someone mixing melatonin with a medication that causes an increase in serotonin.
Melatonin is generally safe when taken in doses no greater than 5 mg per day in adults and even smaller doses in children. However, side effects can occur as mentioned earlier. They include headaches, fatigue, dizziness, daytime sleepiness, and it can interfere with some medications for diabetes or high blood pressure. Long term safety is unknown.
The bottom line in my estimation is that melatonin is usually safe to take, but for most cases of insomnia will have limited benefits. Children can safely take it when low doses are given, e.g., 0.5 mg. Melatonin should only be taken before bedtime. If taken earlier in the day, it can disrupt the sleep-wake cycle. It is recommended that people seek guidance from their personal doctor before starting it.
