Melatonin Every Night?
Is It Bad to Take Melatonin Every Night?
Can you take melatonin every night? Here’s what a sleep expert wants you to know about routinely popping the supplement before bed.
After a particularly nerve-wracking month at work or, heck, an anxiety-inducing year of living through a pandemic, taking a melatonin supplement might have become as routine as brushing your teeth before bed. With so many worries and to-dos racing through your mind, a melatonin gummy or capsule might feel like the only way to cut out that mental chatter, drift off to sleep, and stay that way.
But is it bad to take melatonin every night? It’s not as straightforward of an answer as you’d think. Here, Nathaniel Watson, M.D., co-director of the University of Washington Medicine Sleep Center and former president of the American Academy of Sleep Medicine, breaks down the safety concerns that come with this nightly supplement practice — and what you can do to catch zzzs without the sleep aid.
First off, what are melatonin sleep aids?
Before answering the question “can you take melatonin every night?” you need to know what, exactly, you’re consuming. Melatonin is a hormone produced by your brain’s pineal gland in response to darkness, and in people who have a healthy circadian rhythm, levels naturally peak between 2 a.m. and 4 a.m. It’s then secreted into your blood and the fluid surrounding your brain and spinal cord and works to inhibit the stimulation of your suprachiasmatic nucleus, a tiny region in the brain that acts as a “master circadian clock” and tells your body to wake up or chill out. At that point, you’ll start to feel drowsy and ready for some shut-eye. “It helps bring on sleep, and it helps to entrain our circadian rhythm,” says Dr. Watson.
The melatonin your body naturally produces and the synthetic (or in some cases, animal- or microorganism-derived) melatonin found in over-the-counter sleep aids are the exact same chemical compound, but those gummies and pills might not have the same level of efficacy as the stuff your brain makes, says Dr. Watson. “When you consume melatonin orally, it’s going through your liver, and the issue is a lot of melatonin is deactivated and removed by the liver,” he explains. “Whereas if it’s secreted in your brain, it has more of a robust effect because it doesn’t have to deal with the liver issue right off the bat.” ICYDK, the liver converts nutrients from your diet into substances the body can use and filters out toxic substances. When a drug or supplement enters the liver, natural chemicals significantly alter the substance, which reduces its bioavailability (aka the amount of the substance your body can absorb and put to use). For oral melatonin, in particular, this process cuts its bioavailability to just 3 percent, according to a study published in the journal BMC Pharmacology and Toxicology. (Another way to score melatonin: diffuser pens.)
While you might pick up an over-the-counter melatonin product to help you fall asleep on a restless night, sleep professionals typically recommend melatonin sleep aids only to treat people who have circadian rhythm sleep disorders, says Dr. Watson. Those who have delayed sleep-wake phase syndrome, for example, go to bed and wake up much later than the average person, and taking melatonin one to three hours before bedtime can help reset their circadian rhythm, he explains. This is typically a long-term treatment, and one study found that the majority of participants who had delayed sleep-wake phase syndrome and took melatonin daily for six weeks actually reverted to their pretreatment sleeping patterns within a year after treatment ended. People who have irregular sleep-wake disorder — a rare disorder that occurs in people with a brain function problem who also don’t have a regular routine (think: always working different hours and eating at different times) during the day — don’t sleep with any real schedule. Melatonin can help anchor their circadian rhythm and help establish regular sleep and wake times, says Dr. Watson. Though this treatment (potentially in combination with using bright light therapy and sticking to a daily routine) can often help a person get back to a normal sleep-wake cycle, some people may continue to have symptoms, according to the U.S. National Library of Medicine.
“There’s no real reason to take melatonin unless you have one of these disorders,” he adds. “It wouldn’t be recommended [otherwise].” To treat difficulty falling asleep and staying asleep, the AASM advises clinicians not to use melatonin “because the overall evidence available was weakly against melatonin’s efficacy.” Not to mention, there are often more effective methods to treat the sleep troubles you’re experiencing. And that includes insomnia. “If you look at clinical guidelines around treatment for insomnia you’re not going to see melatonin really included,” says Dr. Watson. “It’s also not an FDA-approved treatment of insomnia.”
Is it bad to take melatonin every night?
If you’re guilty of taking melatonin sleep aid every now and then and you don’t have one of those sleep disorders, you’re probably OK, says Dr. Watson. The National Institutes of Health backs this up too, stating that “short-term use of melatonin supplements appears to be safe for most people.”
Still, melatonin is considered a dietary supplement, so the Food and Drug Administration regulates it less strictly than a prescription or over-the-counter drug. Because of this leniency, your supplement might not contain exactly what the product label states. Case in point: A 2017 study of 31 melatonin supplements found that, in many of the supplements, the actual melatonin content was anywhere from 83 percent lower to 478 percent higher than what was listed on the label.
Problems can also arise if you take a melatonin supplement with too high of a dosage, says Dr. Watson. “Typically, 0.5 milligrams of melatonin should be plenty,” he explains. “Melatonin receptors can get oversaturated pretty quickly, so when you hear people taking 10 milligrams or something, that’s just unnecessary.” Pop a melatonin supplement with more than 1 milligram of the hormone, and you could develop headaches, nausea, dizziness, confusion, sleepiness, and sleep disruptions, he says. So much for a restful night of zzzs.
So if it’s fine to take some on particularly rough nights of sleep, is it bad to take melatonin every night? The NIH notes that “information on the long-term safety of supplementing with melatonin is lacking,” and although Dr. Watson says that taking it daily is “probably safe,” he also advises keeping your doses at just 0.5 milligrams to avoid those potential side effects. (Related: Can NyQuil Cause Memory Loss?)
Even if you take melatonin at low doses every night and don’t suffer any side effects, you might be better off saving your money. In studies on FDA-approved treatments for insomnia, the placebo is often more effective at treating the condition than the actual medication, says Dr. Watson. “There’s a strong placebo effect with any sedative-hypnotic medication prescribed for insomnia,” he says. “So I think we have to ask the question how much of an effect melatonin, in any given individual, would be related to the placebo effect, and it’s uncertain.”
But the biggest issue with taking melatonin every night is that you could be putting a Bandaid on a serious sleep problem that requires professional treatment, says Dr. Watson. “If somebody does have chronic insomnia, they need to raise the issue with their health care provider because that can be an indicator that obstructive sleep apnea, restless leg syndrome, or some other cause is present that melatonin would not have any effect on,” he explains. “It would be important to get to the root cause of the problem, as opposed to covering it up with an over-the-counter supplement.”
FTR, the American College of Physicians recommends cognitive behavioral therapy for insomnia (CBT-I) as treatment regardless of the reason behind the chronic issue; the therapy gives patients a toolkit to manage their condition without the need for sedative-hypnotic drugs or supplements such as melatonin, says Dr. Watson.
What You Can Do to Fall Asleep Without Melatonin
It’s easy to gulp down a melatonin supplement and call it a day (literally) if you’re struggling to fall asleep, but it’s just as easy — not to mention, free — to use sleep expert-approved tactics to help you drift off. The first step is an easy one: Realize that no one’s a perfect sleeper, says Dr. Watson. “Everyone has a challenging night of sleep every now and then — that’s not abnormal, so they shouldn’t view it as such,” he says. “It’s just a part of being human. Expectation setting can allow some people to calm their minds to allow sleep to happen.” (Related: Could Sleep Anxiety Be to Blame for Your Tiredness?)
Beyond that, Dr. Watson recommends you avoid looking at the clock if you wake up in the middle of the night. If you do take a peek, you might automatically start thinking about the work you have to do tomorrow and other worries — none of which will help you get back to your dreams, he says. If you wake up and feel like you’ve had your eyes wide open for a while, move into a different area of your home, keep the lights dim, and do something that would make you drowsy, such as listening to calming music or reading a dull book, he suggests. Once you’re feeling sleepy, head back to bed, he suggests.
To keep these sleepless nights to a minimum, practicing sleep hygiene is key. “People just need to understand we are creatures governed by our circadian rhythms,” says Dr. Watson. “We’re supposed to be going to bed and sleeping when it’s dark out, and we’re supposed to be awake during the day. It’s supposed to be predictable.” Get snuggled into bed at about the same time every night, get yourself out from under the covers at roughly the same time every morning, and keep the rest of your daily routine pretty consistent, he suggests. This will get your circadian rhythm into a groove, and your body will start to expect sleep by a certain time, ultimately making it easier to fall asleep, he says.
If you’re still having trouble getting shut-eye after testing all these techniques for days on end, talk with your health care provider to investigate any potential underlying conditions — don’t just start taking melatonin every night, says Dr. Watson. If you’re someone who occasionally spends the better half of the night tossing and turning, taking melatonin to get to sleep is probably harmless. But know that a supplement is just a quick fix, and though it may be beneficial in the moment, it won’t keep restless nights from occurring in the future. “The rhythmicity of life is an important thing people should pay attention to if they’re trying to optimize their sleep,” says Dr. Watson. “A healthy sleep life is something that takes a little forethought, planning, and prioritization.”