M E L A T O N I N AND I N S O M N I A

IT’S THE HORMONE OF THE DARKNESS

IT MAY BE THE BEST MEDICINE FOR OCCASIONAL SLEEPLESSNESS.

“Sleep is that golden chain that ties health and body together.” – Thomas Dekker

One of my most popular articles has been about sleep (sleep: why is it more important than food?) and I have received many questions, specifically inquiring what is the best medicine to take for occasional  insomnia? I’m not a sleep specialist but I strongly oppose taking OTC or prescription sleep medications. They are only partly effective, soon lose their effectiveness, have many side-effects and can be addictive.

To me, the best sleep medicine to take is a naturally produced hormone, melatonin. It is created by our brain’s pineal gland in the darkness and at night to make us fall asleep. 

Our sleep pattern (we sleep at night and remain awake at daytime) is called circadian rhythm. It is created and shaped by the interactions of the earth and the sun. The earth is spinning around its own axis while orbiting around the sun, with the effects of cosmic gravitational forces and centrifugal forces of spinning. This interaction creates our days and nights and our circadian rhythm.

Circadian rhythm and a good restful sleep are very important for our health. Insomnia suppresses our immune system, causes fatigue and many other health problems. Therefore, paying attention to sleep hygiene and sleeping an average of seven to eight hours at night is very important not only for our physical health, but also our mental health.

So, what should we do for occasionally broken circadian rhythm and ensuing insomnia? I think we should do the following:

1.     We should establish a proper sleep – and – wake time as a routine, to imitate our circadian rhythm. Our body likes routines. It is important that we expose our body in the morning to enough sun/daylight, to acquaint our circadian rhythm with the light of daytime. Before bedtime, we should avoid any strong lights, especially blue light from TV, smart phones or similar gadgets as it prevents melatonin production. When our circadian rhythm is broken, either by oversea travels, jet lag, night shift work or not following our routine sleep schedule, again the timing of melatonin production is disrupted and sleeping becomes difficult, until our circadian rhythm reestablishes itself. A melatonin supplement is most helpful in this type of insomnia.

2.     Since melatonin production by our brain is necessary to initiate sleeping, our brain has to be quiet when we go to bed. It shouldn’t be occupied with negative thoughts, fear, anger or anxiety. These things keep our brain active and prevents melatonin production. In these situations, meditation, prayer or trying to occupy our brain with pleasant and positive thoughts could be very helpful.

3.     Avoiding caffeinated drinks before bedtime. Alcohol and snacking prevent falling asleep and disrupts sleep quality. For example, alcohol makes us sleepy, but it disrupts sleep stages and wake us often to urinate. Sometimes taking a warm shower before bed, keeping our bedroom cool and dark, helps us to sleep better. Nightlights should imitate moon lights.

4.      In case of occasional insomnia, taking some synthetic melatonin supplements could be very helpful. Melatonin is a natural hormone, it is not a sleep medication. It works in tandem with our circadian rhythm, telling our body that it is time to fall asleep, by inducing drowsiness, reducing alertness and dropping the body’s core temperature. Synthetic melatonin supplements are safer than organic melatonin, they are non-habit forming than OTC medications. It is best to start with lower doses - 0.5 mg about 30 to 45 minutes before bedtime, gradually increasing up to 5 mg. and trying for at least two to three weeks before deciding whether it does or doesn’t work for you.

If you still have problem with insomnia, it is time for you to see a sleep specialist to be evaluated in a sleep laboratory before attempting to take any OTC or prescription sleep medications. They are all habit forming and not effective in the long run. 

PS : Prone positioning can help to prevent hypoxemic respiratory failure in non - intubated COVID-19 patients (JAMA Intern Med 2020, e- pub).