What is melatonin and how does it work?
Melatonin is a hormone produced by our pineal gland (epiphysis) in the brain. When it gets dark, the gland starts producing the hormone. The body reaches its highest melatonin level - i.e. the highest secretion - between 2 and 4 a.m. When the day begins, melatonin production drops again because it is regulated by the amount of light entering the eye and light inhibits the production of the hormone. In winter, when daylight only lasts a few hours, the rhythm of production can also shift. The result can be increased tiredness and winter depression . This is why it is recommended, among other things, to use the daylight phase for walks in winter.
So far, so good. But what is melatonin actually for? The hormone controls our day-night sleep rhythm and our internal clock. When it gets dark, the body produces more melatonin, which makes us tired. So the assumption that melatonin taken with medication can help us fall asleep doesn't seem so far-fetched. However, whether melatonin really helps with sleep and sleep disorders is a controversial topic. Why? More on that in a moment.
How useful is it to take melatonin to help you sleep?
In Canada, there are so-called guidelines for the treatment of numerous illnesses. These contain systematically developed recommendations for treatment that doctors or psychotherapists, for example, use as a guideline. There is also such a guideline for insomnia - that is, difficulty falling asleep and staying asleep. In this guideline, which was drawn up by leading experts from science and practice, melatonin is generally not recommended for the treatment of insomnia. Melatonin is only recommended for patients over the age of 55 who have difficulty falling asleep and staying asleep. In addition, melatonin is only recommended for the treatment of disorders in the sleep-wake rhythm that are triggered by a depressive episode.
Why is melatonin not recommended for the treatment of sleep disorders?
Melatonin taken as a tablet imitates the effect of the body's own melatonin. It is therefore reasonable to assume that melatonin as a medication could make you tired and help with insomnia. However, the scientific studies available to date on the effectiveness of melatonin for insomnia have not yet produced a consistent picture.
Some studies suggest that melatonin shortens the time it takes to fall asleep, but so far no meaningful (scientifically "significant") and consistent result has been found. A 2016 study showed that melatonin reduced the time it took to fall asleep significantly, but the study participants treated with melatonin only fell asleep 5 minutes faster on average - not very much. Another study from 2020 was able to show that some aspects, such as waking up too early in the morning, can be reduced with melatonin. However, this study could not prove any effect on falling asleep.
Overall, there is currently no conclusive scientific evidence on the benefits of melatonin as a sleep aid. This is why melatonin is not recommended for the treatment of insomnia.
However, melatonin is important in the treatment of sleep-wake rhythm disorders - that is, when you are tired during the day and awake at night. These include jet lag or sleep problems caused by night work. However, the studies here are often very small and the results are therefore not reliable.
What is different for older patients?
Melatonin is approved as a drug for treating sleep disorders in people over 55. Why is that? Sleep can change significantly in old age. The body's own melatonin levels actually decrease with age, so older people generally have less melatonin in their blood in the evening. In this case, it makes sense to increase the levels slightly with melatonin tablets. This can improve the subjectively perceived quality of sleep and shorten the time it takes to fall asleep. Here, too, there are still controversial studies, but it seems more sensible for older people to try melatonin.
Can melatonin be dangerous as a sleep aid?
Some research has looked into the question of unwanted side effects and has come to the conclusion that melatonin is relatively safe - at least in the doses usually prescribed. The drug sometimes causes stomach pain, heartburn or dry mouth. Weight gain, dizziness, mood swings or an increase in blood pressure are also possible in individual cases.
It is unclear what side effects long-term use of the hormone can have, as studies usually only last a few months. There are also no studies on sleep during pregnancy or while breastfeeding, which is why melatonin should not be taken during this time.
It is also important not to take melatonin together with alcohol, as this reduces the effect of the hormone - and alcohol also has a negative effect on sleep. Melatonin also interacts with various other medications, such as the antidepressant fluvoxamine or the antibiotic ciprofloxacin. If you are unsure whether it is possible to take it together with your regular medication, it is best to ask your family doctor.
What helps you fall asleep instead of melatonin?
If you suffer from sleep disorders, it can be helpful to familiarize yourself with the 10 rules of sleep hygiene and relaxation exercises. Even small changes can significantly improve your sleep. You can also find lots of tips and useful information about sleep on our Empowerment Avenue sleep blog. All of our tips for falling asleep are based on techniques from cognitive behavioral therapy. According to the guidelines, this form of therapy - specifically cognitive behavioral therapy for insomnia (CBT-I) - is the best treatment for sleep disorders in order to improve your sleep in the long term and sustainably.
Psychotherapy for sleep disorders
Are you still unable to get your sleep problems under control despite many attempts? Then it is advisable to seek professional support, for example in the form of psychotherapy. Unfortunately, the waiting times for a therapy place in Canada are currently long. Perhaps you do not feel comfortable with the idea of going to therapy or other things are preventing you from doing so. We offer you a quick way to learn all the basic techniques of cognitive behavioral therapy for insomnia (CBT-I) and to treat your sleep disorder effectively with our online therapy course Empowerment Avenue Sleep. The guideline recommends both - both on-site and digital psychotherapy.
In the effective online therapy course, you will gain new knowledge every week, learn to monitor your sleep with a sleep diary and integrate the newly acquired knowledge step by step into your everyday life. Simply get the therapy course prescribed by a therapist or doctor - then your health insurance will cover the full costs.
Healthy sleep is an important part of a healthy life. If you suffer from sleepless nights, you don't have to go through it alone - we are here for you!