Sleep and melatonin
Sleep-disruption and circadian rhythm-disruption problems are quite common in people with mood disorders, and insomnia is one of the most common symptoms we help patients deal with. Far and away the best treatment for any kind of insomnia is Cognitive Behavior Therapy (CBT), which we use in a wide variety of situations. In the case of sleep disruption specifically caused by problems in circadian rhythm adjustment, we have found over many years of practice that light is a critical factor: blue-blocking at night, and intense blue light, preferably sunlight, upon waking.
However, a recent article in the New York Times reminds us that melatonin is popular, especially in the USA, where it can be obtained without a prescription. Many people are attracted by the simplicity of taking a pill rather than trying more complicated lifestyle modifications (but come on… how hard is it to step outside every morning?)
How to use melatonin
If you are determined, consider these factors first:
- Using melatonin may cover up the symptoms (wakefulness) without addressing the underlying cause which, if found, could be treated to remove the need for further interventions. It’s better to consult a doctor about your sleep problems before starting melatonin use.
- Melatonin works on the body clock, telling your body that sunset is coming and the day is almost over. It doesn’t work immediately, and it may take some experience to figure out when taking it works best for you.
- Melatonin has not been found to have short term side effects, but there is not much research on possible long-term side effects of taking an artificial hormone (your body’s pineal gland produces natural melatonin, a hormone that depresses the levels of cortisone, and convinces your system to prepare for rest.)
Morning light – evening light
In our experience, blocking blue light in the late evening before bedtime is the best approach to sleep disruption. If you take a melatonin pill but continue to watch TV or face electronic screens late into the night, it won’t do as much good. Turn off the TV and electronics an hour before bedtime and check out the blue-blocking glasses reviewed here.
The next-best thing is to get up early, even if your sleep has been restless, and get outside, or use an artificial source of blue light in the morning. The combination of blue light in the morning and no blue light at bedtime is what will establish a healthy circadian rhythm that will allow you to sleep at night and be wakeful during the day. The New York Times has just come out with an interesting update on some of the technologies used for increasing morning blue light exposure and decreasing it at night.
Melatonin may be a third choice for some people, assuming that CBT has determined that disrupted circadian rhythm is a cause of your insomnia. But we urge you to consult a medical practitioner before beginning melatonin use. They can help you determine dosage, timing and duration of treatment without guesswork. In many countries, melatonin is only available under prescription, so if you are travelling, be sure to check on the rules in the place you are going.
Sourcing melatonin
Because it is not a prescription medication, melatonin supplements are not tightly regulated in the USA. Check your product for a GLP (Good Laboratory Practice) or GMP (Good Manufacturing Practice) label to be sure that you are getting the melatonin content in each capsule that the manufacturer claims. For all supplements, we recommend subscribing to Consumer Labs, a service that tests and monitors supplements that are not under Federal regulation.