Melatonin can be a nightmare if used incorrectly, experts say

NEW YORK, Oct. 19 (UPI) -- For up to 1 in 5 adults in the United States, falling asleep at night is a challenge, a recent survey from the Ohio State University Wexner Medical Center found, with about half of the respondents citing stress over world events as the root cause.

A separate survey found that up to two-thirds of people across the country rely on sleep aids to address trouble sleeping. That includes melatonin, a hormone produced by the body when the sun goes down as part of that sleep-wake cycle.

A melatonin supplement appears to be effective at helping people who take it fall asleep, but it may also cause nightmares and potentially disrupt the body's natural clock when used inappropriately, experts told UPI.

"We are seeing more cases of sleep problems and insomnia since the start of the COVID-19 pandemic, and many of these patients are turning to melatonin to help," sleep expert Brant P. Hasler told UPI in a phone interview.

"Generally, melatonin is safe, but it needs to be used appropriately, and I'm not sure that's happening across the board," said Hasler, an associate professor of psychiatry, psychology and clinical and translational science at the University of Pittsburgh's Center for Sleep and Circadian Science.

Won't help staying asleep

This means understanding what the supplement does. It helps users fall asleep, but won't help them stay asleep, Hasler said.

Melatonin may be safer than some prescription sleep medications, which can be addictive, but it should not be used without taking certain precautions, Hasler said.

"Melatonin is called the hormone of darkness because it has the opposite effects of light on our internal clocks" -- meaning, it essentially tells the body that it is time to sleep, he said.

Melatonin supplements are designed to mimic the effects of the hormone, boosting its levels within the body to induce sleep, said Jeannie K. Lee, assistant dean and associate professor of pharmacy at the University of Arizona in Tucson.

Bottles of the supplement, which comes in tablet and flavored gummy form, in doses of up to 20 milligrams each, sell for as little as $4, but powdered mixtures containing it can cost up to $100 or even $200.

But because the supplements are designed to boost the body's natural approach to sleep, they also can alter it in ways with which users may not be comfortable. Or they can benefit, Hasler said.

Effects differ

Although an analysis by Lee and her colleagues published by the Journal of Clinical Medicine on Aug. 31 found that melatonin, at doses of up to 3 mg., taken 30 minutes before bedtime, was "moderately effective" at inducing sleep, its effects differed from person to person.

Katie Donovan, a nurse in her 30s who lives and works in Denver, used melatonin to help her sleep during the day when she worked night shifts at the hospital, taking 5 mg dissolvable tablets.

Now the mother of a 4-year-old and a 2-year-old, she still occasionally uses the supplement when she experiences insomnia, she told UPI in an email.

"It's not always effective, but most of the time it helps if I take a high enough dose," Donovan said.

"I sometimes feel groggy if I take it in the middle of the night when I can't sleep, if it's too close to the time I'm supposed to wake up," she said.

Meanwhile, Nicole Palma, an account manager with a communications company in New York, tried melatonin once to manage her insomnia.

When she experienced "crazy nightmares" after taking the supplement, though, she decided to stop, she said.

Dosing questions

Supplements such as melatonin are widely advertised and readily available as an over-the-counter product in most pharmacies, health food stores and supermarkets nationally.

However, unlike drugs approved by the Food and Drug Administration, they cannot be marketed as products designed to treat, diagnose, prevent or cure diseases.

Still, the FDA only evaluates supplements to ensure they contain the ingredients listed on the label, and the agency does not have any dosing requirements for supplements.

As a result, a lack of standardization exists in regard to the ingredients in products labeled melatonin, as well as little clarity as to what constitutes a "healthy" dose, they add.

Anecdotal reports of nightmares and/or strange dreams are among the few side effects associated with melatonin, Hasler said.

However, "the quality of the research data looking at the safety and effectiveness of melatonin is not great," he cautioned.

Unlike some prescription sleep aids, melatonin is not addictive, meaning there is no evidence that users can become physically dependent on the supplement, Hasler and Lee said.

In addition, users won't develop withdrawal symptoms if they stop taking it or feel a "physical need to take more," Hasler said.

Still, if users become convinced that taking melatonin is crucial for their sleep, they may struggle when they do not take it, he added.

"You can become psychologically dependent on anything," Hasler said.

Caution for older adults

Melatonin also may not be safe for older adults with insomnia, he said.

Taking a supplement at the wrong time could make them feel drowsy and increase their risk for falls.

He said he has seen an increase in adolescents and teens using melatonin, particularly since the start of the pandemic to get to sleep earlier so that they can get up the next morning for school.

Although generally safe for young people, studies in animals have found that melatonin, at "doses below what we would give kids," can have "profound effects on reproductive systems," Hasler said.

"We just don't know what the long-term effects are," he added.

In September, the American Academy of Medicine issued a health warningregarding melatonin use in children, citing a rise in overdose-related emergency room visits nationally.

For users of all ages, part of the safety concern with melatonin is linked with dosing, said Hasler, who said he occasionally uses the supplement.

For his patients who want to try it, he recommends starting at a dose of 0.5 mg to 1 mg and "topping out" at 3 mg if that does not work.

This is well below the dosage listed on many over-the-counter melatonin brands, he said.

"You should take the lowest dose that is effective, and I would say that with all medications, including prescription drugs," Hasler said.

"That is what you should be using, but what's being marketed out there tends to be much higher than what's needed," he said.

Some users compensate by only ingesting a portion of a melatonin tablet or gummy, but there is no way of knowing how much of the supplement you are actually getting this way, he added.

Consult a doctor

Because it's not regulated by the FDA, Lee advises checking the ingredient list carefully before trying any supplement and, as with any product, consulting with your doctor before using it.

Hasler also recommends avoiding so-called "extended-release" formulations because that is not how melatonin is produced by the body naturally, and it may lead to "unwanted effects."

For example, some travelers use melatonin as a remedy for jetlag, but if they take the supplement at the wrong time, or at too high a dose, it can lead to sleep cycle disruptions and extreme grogginess, Hasler said.

Lee recommends using the supplement "for eastward travels" from and within the United States only.

"There is always the risk for someone using melatonin at the wrong time, in a way that causes their circadian clocks to shift in the wrong direction and making them acutely sleepy in a way that puts them at risk during daily activities, like a driving car," Hasler said.

Still, for those who have trouble falling asleep, he knows from personal experience that users "get sleepy pretty acutely," he said, adding, "I would just emphasize that people should use it thoughtfully."