Use of melatonin for sleep is increasing, side effects can be dangerous

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New research reveals that American adults consumed twice as much melatonin for sleep in 2018 as they did a decade ago. stock_colors/Getty Images
  • A good night’s sleep is essential for good physical health, cognitive performance and emotional functioning. Many sleep studies have documented these facts over time.
  • More adults are taking over-the-counter (OTC) melatonin preparations to help them sleep better at night, but some may be taking the substance at dangerously high levels, according to a new study.
  • Experts fear that the negative effect of the coronavirus pandemic on sleep has further increased addiction to melatonin and other sleeping pills.

In the recent study, the researchers obtained data from ten cycles of National Health and Nutrition Examination Survey (NHANES), covering the years 1999 to 2018. This study included 55,021 adults, 52% of whom were women. The participants had an average age of 47.5 years.

The results showed that in 2018, adults in the United States took more than twice the amount of this sleep aid compared to a decade earlier, which may pose a health risk for some people.

The study found that melatonin use increased from 0.4% in 1999-2000 to 2.1% in 2017-2018, with the increase beginning in 2009-2010.

The study was published in the Journal of the American Medical Association (JAMA)and the lead author is Dr. Jingen Li, Ph.D., of Beijing University of Chinese Medicine.

The study evaluated adults who took melatonin at the recommended dose of 5 milligrams per day (mg/d), as well as those who exceeded that dose. Before 2005-2006, the authors observed that users did not report taking more than 5 mg/d, but the prevalence of taking more than 5 mg/d fell from 0.08% in 2005-2006 to 0, 28% in 2017-2018.

Although overall melatonin use in the United States is still relatively low, the study “documents a significant and multiple increase in melatonin use over the past few years,” according to a sleep specialist. Rebecca Robbins, Ph.D.who is an instructor in the division of sleep medicine at Harvard Medical School and was not involved in this study.

Dr Robbins said Medical News Today:

“The use of sleep aids has been linked in prospective studies with the development of dementia and early mortality. Melatonin is one of these sleep aids.

The body’s biological clock regulates hormonal fluctuations, which change throughout a person’s life. As a result, aging often affects activities such as sleeping and waking patterns, which in some cases become increasingly disrupted and fragmented.

Melatonin is a key hormone that regulates circadian rhythms. Circadian rhythms play an influential role in certain aspects of our bodily functions and behaviors. They also play an important role in regulating sleep and general good health in humans, and their disruption can have many consequences.

The negative consequences of sleep deprivation may include less vigor, less positive mood and feeling stressed, cold or drowsy. These effects can occur in people of any age.

DTM speak with Dr. Richard Castriotta, a sleep medicine specialist at Keck Medicine of USC in Los Angeles who was not involved in the study. When we asked him what the real implications of this study were, he said:

“Not much, except that the increasing use of melatonin, like any non-FDA approved drug sold as a ‘nutritional supplement’, increases the risk of adverse side effects from a ‘wrong batch’ of manufacturing or unsupervised extraction (for example, L-tryptophan).

According to Dr. Castriotta, “Low dose (1-3mg) melatonin is safe and effective in some circumstances for managing circadian rhythm disorders, but is not a very good hypnotic.”

A hypnotic drug is one that induces sleep. Currently, the evidence that melatonin helps relieve insomnia is spotty. According to a review published in February 2020, “there is a statistically significant improvement in sleep latency and total sleep time, with a lack of consensus on their clinical relevance”.

For jet lag, however, the benefits of melatonin seem more pronounced. A Cochrane Review concludes:

“Melatonin is remarkably effective in preventing or reducing jet lag, and occasional short-term use appears to be safe. It should be recommended for adult travelers traveling across five or more time zones, especially eastbound, and especially if they’ve experienced jet lag on previous trips.

Additionally, Dr. Castriotta explained that “at higher doses (6-12mg), melatonin may be helpful in REM behavior disorder and may play a role in cancer prevention/treatment.”

Several unpleasant side effects can occur with regular use of melatonin, including:

  • dizziness
  • stomach cramps
  • headache
  • nausea
  • confusion or disorientation
  • depression
  • irritability
  • anxiety
  • Low blood pressure
  • tremors

An older study also published in JAMA suggested a link between melatonin receptor site mutations and insulin resistance and the development of type 2 diabetes. The study found that lower melatonin levels in study participants may have was a precursor to type 2 diabetes. However, he could not establish direct causation.

DTM speak with Dr. Christopher Schmickl, Ph.D., a sleep medicine specialist at UC San Diego Health in California and assistant professor of medicine at UC San Diego School of Medicine. Dr. Schmickl said:

“Patients can use it to self-medicate ‘poor sleep’ and thereby delay or forgo evaluation and therefore appropriate/proven treatments for the underlying cause – for example, obstructive sleep apnea can cause insomnia-like symptoms and, if left untreated, can lead to serious, long-lasting problems. – term health problems. Even for actual insomnia, the first-line therapy is usually (non-pharmacological) cognitive-behavioral therapy for insomnia (CBT-I), which is just as effective as sleeping pills in the short term and more effective in the long run. term.

Currently, the Food and Drug Administration (FDA) does not regulate the manufacture of melatonin supplements. It is feared that the amounts of melatonin in over-the-counter preparations will exceed what the label says until 478%.

According to Professor Schmickl:

“This raises concerns about ‘overdose’ – that is, flooding the body with levels that interfere with the many important biological functions of melatonin – and makes it difficult to assess the effect of melatonin on the sleep in any given patient, as the actual dose can vary considerably from tablet to tablet or at least bottle to bottle.

“Over-the-counter melatonin products may also contain varying levels of other substances such as serotonin (a precursor to melatonin, which in excess can even cause life-threatening side effects), which may besides contributing to varying effects/side effects.”

He keeps on, “[b]From my clinical practice, many patients consider melatonin to be “natural” since it is a supplement and therefore don’t worry too much about taking even very high doses (>5mg), which is of medical concern. Likewise, many people have a low threshold for giving over-the-counter melatonin products to their children, who may be even more vulnerable to adverse consequences.

“It should be noted that melatonin receptor agonists, for example ramelteon, have been developed and require a prescription, which in theory could solve some of these problems. However, these patented drugs are very expensive, which means that few insurances cover these drugs. Thus, in clinical practice, these drugs are rarely used.

Evidence shows that melatonin has beneficial anti-inflammatory and antioxidant properties and may have further therapeutic potential. It is currently being studied for its value in treating non-sleep related medical conditions.

It is also important to note that there were several limitations to the study. These include:

  • self-declaration of use
  • heterogeneity of preparations
  • the small number of melatonin users in certain subgroups
  • no reliable estimate of trends among various ethnic and racial groups
  • few data on long-term, high-dose use of melatonin

So far, short-term use of melatonin appears to be safe for people who work shifts, suffer from jet lag, or have trouble falling asleep. However, according to the National Center for Complementary and Integrative Health (NCCIH)which is part of the National Institutes of Health (NIH), the long-term effects are unknown.

Due to the increasing use of melatonin by the US population and the resulting public health implications, further studies are needed to inform consumers of the potential health risks and possible benefits of continued use of melatonin. melatonin.

Going forward, Dr. Schmickl suggests that changing the status of melatonin from OTC to prescription-only would be a positive approach. Furthermore, he suggests that regulating melatonin to accurately reflect its content, including the absence of impurities, would be of great value.

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