By Karyn Odway

Melatonin is the supplement of choice for an increasing number of people suffering from a lack of sleep. Nearly seven million Americans are using melatonin as a sleep aid— a five-fold bump from 20 years ago, according to a new JAMA study. But the increase is concerning to sleep specialists who question its effectiveness and see potential health risks with long-term use.   

“Generally, more than 5 mg of melatonin per night does not add many benefits overall,” says Joya Paul, M.D., neurologist and sleep medicine specialist at the NorthShore Neurological Institute. “Taking a low dose (0.5 to 1 mg) three to four hours before the desired bedtime can help regulate the sleep cycle and help promote better sleep.” She said this over-the-counter sleep aide, like others, should be used as directed and only in moderation. “They are generally meant to be used as needed and not regularly for longer periods of time.”

In the JAMA study, Mayo Clinic researchers reported: “Although melatonin is generally regarded as safe, adverse effects have been reported, and data on long-term use and high-dose use are scarce.”

Melatonin is a hormone naturally produced in our bodies and is key in regulating circadian rhythm. Melatonin supplements can help in treating circadian rhythm sleep disorders, but the study indicates formulations—the accuracy and purity of the product—as well as the dosage needs to be understood further.

“Since many of them have not been studied in a meaningful way, we do not clearly know the risks and benefits of them,” Dr. Paul said. “Most supplements may help one relax and fall asleep but are generally not the greatest at keeping us asleep.” 

When buying supplements, she recommends you research the brand. Dr. Paul trusts Nature Made and the melatonin supplements it produces. But even with a good supplement, she warns to keep the frequency of use and dosage in check.

“In general, it’s important to note that sleeping pills—herbal, over-the-counter, or prescription—are meant for short periods of time, less than 3 weeks out of a month, and as needed, such as when you travel across various time zones.  Long-term use of sleep aids can cause undesirable side effects such as headaches, fatigue, cognitive and memory deficits, dizziness or daytime drowsiness. They can also change sleep architecture and provide an unnatural quality of sleep.”

These side effects are more concerning for the elderly, she said. Of course, there are exceptions to this warning, and it is a case-by-case decision by a physician on what’s best for the person.

“If one is needing the use of sleep aides regularly,” Dr. Paul said, “there may be an underlying condition that needs to be addressed, such as sleep apnea or anxiety, and they should seek the help of a healthcare provider.”

Dr. Paul also suggests improvements in sleep hygiene. Check your lifestyle to make sure it promotes good rest and creates a bedroom environment conducive to a solid 6 to 8 hours of sleep.

The NorthShore Neurological Institute provides comprehensive, personalized treatment for patients. From the most advanced diagnostic imaging to specially trained physical therapists and expert physicians including neurologists and sleep medicine specialists like Dr. Paul, the Institute offers convenient access and expert care.