Articles - Su-Laine Yeo on DSPS

MELATONIN

Melatonin is the newest treatment for sleep/wake timing disturbances. It is a hormone whose concentration in the blood rises as the body prepares for sleep. It has been synthesized and can be taken orally, as a pill, at night to induce sleepiness and a seemingly natural sleep.

Melatonin has two effects which are of interest to individuals with DSPS. For many people, it advances the timing of sleep in the short-term, making them feel sleepy soon after they take it. Melatonin is also believed to have a chronobiotic effect - it actually helps reset circadian rhythms. Melatonin is the only known drug which resets circadian rhythms at safe doses. Ordinary sleeping pills, such as benzodiazepines (Flurazepam, Valium, and others), do not have this chronobiotic effect. Although in the popular press melatonin has received more attention than light therapy as a chronobiotic treatment for jet lag, recent research has indicated that bright light is a more powerful circadian phase-resetter than melatonin.

Advantages of Melatonin

• It is easy to take melatonin. Sleep deprivation isn't necessary, although if you take too much you will feel tired or hung-over the next day.

Disadvantages of Melatonin

• Although melatonin is widely considered to have low toxicity, long-term human testing has not been done. Melatonin could have side effects which appear after years of use, but which have not been discovered yet because melatonin is a new drug.
• Most people, if they could, would rather sleep without taking sleeping pills. It is possible for people with even severe DSPS to sleep at night without using melatonin at all. Ask yourself whether you are willing to take melatonin every night for many years. Would use of a sleeping pill make you lose the skill of falling asleep without medication?
• Buying, selling, or importing melatonin is restricted in some countries. If you do not know how to obtain melatonin, or whether you can legally bring it into your country, ask your local authorities.
• Some melatonin users have reported:
  • increase in vivid dreaming and nightmares
  • tiredness the following day
  • restlessness instead of sleepiness after taking melatonin
  • mood changes
• Melatonin has been shown to affect reproductive cycles and inhibit sexual development in animals. Its effects on humans are not known. Do not take melatonin if you are:
  • a child or adolescent
  • pregnant or breastfeeding
• There is some evidence to suggest that melatonin may have cardiovascular effects, and therefore might be detrimental in patients with cardiovascular disorders.
• Consult your doctor before taking melatonin if you:
  • are depressed
  • have an autoimmune disease, diabetes, leukemia, or a lymphoproliferative disorder
  • are taking MAO inhibitor drugs or corticosteroids

Dosage and Timing of Melatonin

If you decide to take melatonin for DSPS, take it at least 30 minutes before you want to fall asleep. Individuals vary widely in how much melatonin they need to take to bring about sleep. Start with a low dose of about 100 or 200 mcg (pronounced "micrograms"; 1000 mcg = 1 mg = 0.001 g), and if necessary work up to higher doses gradually.