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If you’ve ever struggled with sleep and have tried using over-the-counter supplements like melatonin to help you get some shut eye, rest assured you’re not alone.
A new study published by the Journal of the American Medical Association (JAMA) analyzed data relating to melatonin use from the National Health and Nutrition Examination Survey between the years 1999 and 2018. Researchers found that by 2018, U.S. adults were taking more than twice the amount of melatonin than they did a decade earlier.
Jonathan Charest, a sleep expert with the Canadian Sleep Society tells Yahoo Canada he isn't surprised by the findings, but says many people don't understand what melatonin is— or what it does to the body.
What is melatonin?
According to the U.S. National Center for Complementary and Integrative Health, melatonin is a natural hormone your body produces in response to darkness. Your body produces more of it at night and less during the day when you're awake.
Melatonin supplements (synthetic or made from animals or microorganisms) are available and can be used as a short-term remedy to treat jet lag or disorders like delayed sleep-wake phase disorder.
Charest says people should stop thinking of melatonin supplements as the "holy grail of sleep." He considers them to me more of a "Trojan horse" that can lead people to take stronger sleep aids when they realize the supplement isn't working.
“That’s why I see melatonin being dangerous," the director of Athlete Sleep Services at the Centre for Sleep and Human Performance explains. "Not from a lethal point of view, but from the cascade of events that will follow the consumption of melatonin because most people don’t know how to use it and don’t know what it is."
What are the safety concerns with melatonin?
Even though melatonin isn' lethal, possible side effects include nausea, dizziness, headaches, mild anxiety and depression. It can also interact with various medications.
The recent JAMA study also found that since 2006, a growing number of adults are taking more melatonin than the daily 5 milligram recommended dose.
Dr. Mark Berber, an assistant professor of psychiatry at the University of Toronto, says he doesn’t see an issue with taking melatonin to help with sleep, but urges anyone who takes it to follow dosage guidelines.
“I think when it comes to choosing any medication or herb or melatonin, using the recommended dose is key,” Berber tells Yahoo Canada. “Sometimes more is not more effective, it’s just more toxic.”
In Canada and the U.S., melatonin is considered a dietary supplement. However, in some countries throughout Europe and other parts of the world, it can only be acquired through prescription.
Some supplements may also contain more melatonin than what's listed on the label. In a 2017 study published by the Journal of Clinical Sleep Medicine, researchers analyzed 31 melatonin supplements and found some dosages to contain up to 478 per cent higher than what was listed on the bottle.
What should melatonin be used for?
People often use melatonin supplements as a sleep aid, but for the wrong sleep disorders.
The American Academy of Sleep Medicine advises people against self-medicating with melatonin for issues like chronic insomnia and lists conditions for which it should be used for.
According to the academy, melatonin can be effective when it's used to treat circadian rhythm disorder, which is when your “body’s biological clock is out of sync with societal norms.” These disorders include people who are travelling and will experience jet lag, night owls and shift workers.
Charest says that melatonin is also a short-term solution and shouldn’t be used for longer than one to two months.
“Melatonin was never meant to be used in the long-term, melatonin is only to be [used] to shift a circadian phase, and to retrain your circadian rhythm [24-hour cycle part of your body's internal clock],” he says.
The COVID-19 pandemic is causing more sleep problems
Having trouble with sleep is a common problem and it may be getting worse. The American Sleep Foundation shows up to 30 per cent of adults struggle with chronic insomnia.
Berber believes the ongoing pandemic may be contributing to a spike in sleep-related problems.
“Over the last two years, the COVID-19 restrictions have made life miserable for most people. There is an epidemic of depression and anxiety related to the lockdowns and other restrictions and these depressive and anxiety illnesses are often associated with poor sleep,” he explains.
As for the increase in melatonin use, Berber says physicians have moved away from prescribing typical sleeping pills over the last few years because of how addictive they can become. He adds that more doctors are choosing more natural solutions for their patients, including melatonin.
Alternative methods to help get a good night’s rest
People who struggle with sleep should take a closer look at their nighttime routine and their sleep environment.
Sleep On It Canada has a list of key actions to prioritize a healthy sleep cycle. The recommendations include going to bed and getting up at the same time every day of the week, turning off your phones when going to bed to preserve sleep quality and creating a comfortable environment. Eliminating screen time before bed and caffeine after 12 p.m. are also advised by experts.
If these changes don't help and your sleep is not improving then it's time to get help.
Getting professional help
Although Charest says he recommends melatonin for certain patients, like athletes travelling to the 2022 Beijing Olympics for their jet lag, he will most often steer patients towards Cognitive Behavioral Therapy for Insomnia (CBT-I), which focuses on identifying thoughts, feelings and behaviours that contribute to someone's problems with sleep.
Charest says it “works 100 per cent more efficiently than any melatonin in the world.”
“I would do the non-pill route first and foremost," he adds. "Here [at the clinic] we stick with CBT-I and we work with sleep physicians of course when pharmacological approaches are needed we use them with the physician.
Both Berber and Charest agree, as soon as you notice your quality of life decreasing due to lack of sleep, you should seek professional help.
“Sleep is at the core centre of your mental health and your physical health. It requires and deserves as much care as any other things around your health,” Charest says.