Does Melatonin Actually Work? Experts Say It's Complicated
Illustration by Michael Houtz
Not to brag, but I’ve kind of perfected my bedtime routine. Every night, about an hour before I actually want to be asleep, I’ll put my phone on the charger—out of reach from my bed, crucially—signaling that I’m done with it for the night. I’ll turn off the lights in favor of candles and a much dimmer shelf lamp, pop five milligrams of melatonin, and usually watch TV or read on the couch until I’m ready to get in bed. It works like a charm. But recently, through mild introspection, genuine curiosity, and feedback from friends, I’ve begun to wonder: Is the melatonin really doing anything?
It started to dawn on me that the general routine—the nightly rituals that tell my body we’re getting ready to sleep—might be doing most of the heavy lifting, and the melatonin is just along for the ride. That, plus countless people in my life confidently positing that melatonin’s effectiveness is purely placebo, made me want to get to the bottom of this.
Audrey Wells, MD, a board-certified sleep medicine physician and founder of the online platform Super Sleep MD, began our conversation by assuring me that melatonin definitely does work. “Yes, of course, it works,” Dr. Wells says. “That’s why your body produces it!” Melatonin is, in fact, a hormone stimulated by the darkness that the body creates and the brain naturally releases every night, which was news to me.
According to Joshua Tal, PhD, a sleep and health psychologist whose work focuses on getting people to sleep without medication, people who claim that melatonin doesn't work aren't using it properly. It's not a pill that will put you swiftly to sleep, it's a pill that cues your brain that it's time to get sleepy.“In the morning, your body releases alerting hormones to help you stay awake during the daytime,” Tal told me. “Then at nighttime, your body releases melatonin, which signals to the body that it’s time for sleep by turning off those alerting hormones. Melatonin was not developed as a sleeping pill. It was developed as a time shifter.”
It’s true that melatonin is meant to trigger sleepiness, not tuck you in like a sleeping pill—that part I understood. But I’ve also noticed that when I go without it—either when I’m sleeping somewhere else and forget to bring it or when I’m just running personal science experiments on myself—I don’t wake up feeling as refreshed as I do when I have the five milligrams of sleepytime comfort swirling through my body.
“If you’re taking it every night, there can be a psychological expectation,” Dr. Tal says. “What can happen is, then, you have rebound insomnia. When you don’t take it, your body is like, ‘Where is it?’ That’ll keep you awake. The more you use it, the more it can become a placebo and a little useless.” In other words, melatonin hasn't been definitively proven to help you fall asleep quicker, stay asleep through the night, or leave you bright-eyed and bushy-tailed in the morning. But, as I can attest, it feels like it does. So what gives?
“Even if it’s not ‘doing anything,’ or there’s no biological change, it still has that association, so you can feel like it’s doing something,” says Dr. Tal. For Dr. Wells, who also puts medication way down the list of things she’ll recommend to people having sleepless nights, sleep hygiene—the practice of creating both a physical and mental environment specifically conducive to slumber—is much more important.
Her first step is encouraging people to take control of their minds and body through a combination of cognitive behavioral therapy and a method she calls cognitive emotional restructuring. “Sleep is an emotional experience,” says Dr. Wells. “For anyone who can’t shut off their brain at night, I work with them to examine those thoughts that produce high-intensity feelings that inhibit sleep.” According to her, anxiety, depression, and stress are major suppressors of sleep drive, which is the body’s internal drive to sleep, similar to hunger, which is the body’s internal alert to eat. Dr. Wells believes that retraining the brain is the best possible sleep aid.
“Let’s pretend you talk to your neighborhood sleep doctor, and they say, ‘Come on, melatonin doesn’t work at all. You’re fooling yourself!’ That night, you’re going to pop the pill and say, ‘Uh oh, melatonin doesn’t work!’ Then, your emotions are angst, worry, and doubt, something that will swim around in your mind and interfere with your sleep. Most of the people I work with tell me they’ve been having sleep problems for decades—it’s all the story they have in their heads. Once I can break their story and get them to see that they can sleep without a sleep aid, they can have that life skill.”
This phenomenon of being unable to turn their brain off has led many people to prescription sleep aids, which possess sedative qualities that make it much harder to do any thinking at all. But, as Dr. Wells informs me, mild cognitive decline has been shown among people who take these chronically. The main side effects melatonin users report are much less severe (nightmares, dizziness, perhaps a slight hangover effect) and less researched, as melatonin is a supplement rather than a regulated medication.
So, what have we learned? When taken as a supplement, all melatonin does is stimulate its natural secretion that’s already occurring within you. That is to say, you’re basically cueing your body that it’s time for bed. With sleeping pills, you’re forcing your mind to knock out. But, because of our modern lifestyles—screens, bright lights, cold brew at 4 p.m.—that hormone can be suppressed. In this regard, experts say that taking it via a supplement does help to stimulate the melatonin hormone, which cues your brain that it's time to downshift into sleep mode. But it doesn't put you to sleep.
In Dr. Wells’ opinion, anyone hoping to get a restful eight hours per night should stop using their phone to Google sleep tricks (“I hate the word ‘tricks,'" she says. "Pardon the pun, but they’re tired.”) in the middle of the night. “In today’s age—I mean, I don’t even wear clothes anymore that don’t allow me to carry my cell phone,” Wells admits. “But you have to draw a boundary at your bedroom. Light is the very thing that inhibits melatonin production. So, it doesn’t make much sense to take melatonin as a supplement and then look at a handheld electronic device until bedtime. Those two things are incompatible, and it violates the common sense rule!”
Originally Appeared on GQ
