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Everyone these days wants more sleep, better sleep, or both. So when a supplement like melatonin—a natural hormone made by the body—cements itself as a popular sleep aid, it seems like a no-brainer. After all, it claims to improve the trifecta of sleep issues: sleep latency (how long it takes to fall asleep), sleep duration, and sleep quality. Initially explored for its effectiveness for the elderly, shift workers, and those suffering jet lag, melatonin has become a commonplace supplement for people with undiagnosed sleep issues.

What many people may not know is that melatonin, available over the counter in the United States, is not an herbal remedy, but a synthetic hormone. In fact, as of 2012, it was the only synthetic human hormone available without a prescription in Canada. In many other countries it is only available when prescribed. In some European nations, it’s not available at all. 

All this begs the question: Should melatonin be in your medicine cabinet?

Why Is Melatonin Used as a Sleep Aid?

The pineal gland in the brain regulates our sleep and wake cycles, also known as our circadian rhythm. Circadian rhythm is influenced by the sunlight and and our hormones—including melatonin. “Melatonin starts very, very low in the morning and raises when the sun sets to help us go to sleep,” says Liz Calabro, registered diet tech nutritionist, National Academy of Sports Medicine certified personal trainer and behavior change specialist. The theory is that increasing melatonin, the way our body should naturally, will help you get a good night's sleep. But there's more to melatonin than just helping you fall asleep.

Why Melatonin Matters (Especially for Women)

In addition to regulating circadian rhythms, melatonin helps regulate female reproductive hormones. It plays a role in when menstruation begins, how long it lasts, and when a woman will begin menopause. Because natural melatonin is an active component of female fertility, it's recommended that pregnant and nursing women should not use it synthetically. Side effects of melatonin on the reproductive system's hormones can cause fluctuations in progesterone, estradiol, luteinizing hormone, and thyroid levels. It can also lower libido and cause irregular cycles, which can make it difficult to predict ovulation. For men, the supplement can reduce sperm count and motility. 

So, yes, studies have shown that melatonin can be effective in improving that trifecta of sleep issues (latency, duration, and quality) in the short term—three months or less—with few side effects, but the long-term effects are unclear. Thus, Calabro warns, “Melatonin is a Band-Aid.” Without consulting a doctor about the severity of sleep problems and their causes, she says, “no one should take melatonin.”

If You Do Take It, Keep This in Mind

Consumers should keep in mind that melatonin is not considered a drug, and therefore dosing and ingredients are not regulated in the same way as medications like allergy pills or cough syrup. You’ll need to do your own research to know what exactly you’re ingesting and how much of it.

Recommendations vary, but most sources suggest starting with 1 to 3mg per night, about 90 minutes before you turn out the lights. For faster absorption, Dr. Eric Braverman recommends using the liquid form which is deposited under the tongue compared to the pill/capsule. You should take the lowest dose that is effective and not for longer than three months at a time.

Because melatonin is a hormone, it may stimulate reactions in other systems that you don’t intend to come with a full night’s rest. Some may experience side effects like “strange dreams and waking up groggy,” says Calabro. It may also interfere with the effectiveness of other medications. 

Other Options to Consider

The pineal gland in the brain produces and secretes the melatonin that signals to your brain that it's time to go to bed. On the other end of the hormonal spectrum is cortisol, our stress hormone, which rises in the morning to get us going and goest down at night. While adding more melatonin may seem a logical solution to sleep difficulties, decreasing cortisol levels (i.e., reducing stress) is actually a healthier solution.

Calabro explains, “Typically, people have trouble falling asleep, staying asleep, or both, due to excess stress (high cortisol) from being sedentary, mental or emotional stress, poor dietary habits, especially skipping breakfast or meals, or taking certain medications." Fluctuations in blood sugar, sleep apnea, magnesium deficiency, and more, can also negatively impact your snoozing. While it doesn't reduce stress hormone levels, melatonin does slow cortisol response in humans, but instead of shelling out cash for melatonin pills, Calabro recommends that troubled sleepers instead invest some money money discovering and treating any underlying root cause to poor sleep.

Trouble sleeping is a sign that something is off. Take the hint and make a sustainable change to get the most out of your nights—and your days—before you immediately resort to not-so-natural sleep aid. 

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Photo Credit: Elizabeth Lies