Melatonin: Worth Losing Sleep Over?
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Nov 17, 2022.
What Is Melatonin?
Melatonin - you've probably seen it in the vitamin section of your pharmacy.
But melatonin is not a vitamin. Melatonin is the hormone your body naturally secretes that tells you when it's time for bed. It's available as a supplement, too.
Natural melatonin is formed from the amino acid tryptophan in our bodies and then released to our melatonin receptors in the brain. It helps to control our sleep and wake cycles. In fact, nighttime melatonin hormone levels are roughly 10 times higher than in the daytime.
Natural melatonin release is increased each day in response to darkness, peaking at about 2 to 3 AM.
Melatonin has gained wide popularity in recent years.
Synthetic melatonin tablets have been used:
- to help minimize jet lag
- to help adjust sleep cycles in the blind
- for shift-work sleep disorders in people with alternating work schedules
- for other sleep disorders.
Studies are also looking at its use in seasonal affective disorder (SAD).
But how effective is melatonin and what about its safety?
- The regulation of melatonin products varies by country.
- In the U.S., melatonin is can be purchased without a prescription in retail stores and at the pharmacy.
- Strengths range from 1 milligram (mg) to 10 mg, and they come most commonly as gummies, tablets, capsules, quick-dissolve, and timed-release forms. Liquid formulations may contain alcohol, so check labels.
- On average a 120-count, store brand bottle costs about $7 to $10, but this can vary widely around the country and depending on which product you buy.
How Safe Is Melatonin?
Melatonin generally does not cause serious side effects, but there is little data on its long-term safety. In general, melatonin seems to be a safe supplement when used for short periods of time. Have your pharmacist check for drug interactions before use, and if you have medical concerns, check with your doctor.
Because it is a dietary supplement, its ingredients, dose and contents are not regulated by the FDA. It may be safer to buy these products from an established pharmacy than from an unknown source on the Internet. Speak with your pharmacist if you questions about products.
To be assured of product quality, look for the "USP Verified" mark on dietary supplement labels. This ensures the product contains listed ingredients and strengths, lacks contaminants and follows quality manufacturing principles.
Some people can have side effects from melatonin that can include:
- feeling sleepy, weak, confused in the daytime
- vivid dreams
- depressed mood
- loss of appetite, diarrhea, nausea
- minor blood pressure changes
- back pain, joint pain
Jet Lag Is A Drag
Jet lag is one of the most common uses for melatonin.
Jet lag is much more likely if you cross over several time zones, getting worse with the number of time zones you cross. It may be more difficult for you to fly east (for example, US to Europe), when you "lose" time, than to fly west (for example, US to Australia), when you gain time.
Jet lag is a travel problem that causes:
- difficulty in falling asleep or staying asleep, early awakening
- trouble concentrating
- constipation or diarrhea
- mood disturbances
- generally feeling unwell
Given enough time (3 to 5 days), jet lag will usually resolve on its own. This is not always optimal for everyone, especially for busy professionals or eager tourists on the go.
What is the Dose of Melatonin For Jet Lag?
For jet lag minimization, there is a specific way you should take melatonin.
- If you are traveling east over several time zones, say from the US to Europe, take the melatonin after dark, 30 minutes before bedtime in the new time zone or if you are on the plane. Then for the next few nights in the new time zone, take it again after dark, 30-60 minutes before bedtime or until you feel adjusted.
- Appropriately timed light exposure therapy can also be helpful when combined with melatonin for eastward travel.
- Westbound travel does not always require melatonin use, and it may not be helpful. For travel crossing more than 12 time zones to the west, melatonin may provide some benefit.
Either way, do not drive or operate machinery while you are taking melatonin.
Initial doses for insomnia or jet lag should start on the lower end of melatonin dosing (0.5 to 1 mg), and range upwards to 5 mg. Different doses may be effective for different people. Doses of 3 to 5 mg at bedtime are commonly used. The 0.5 mg dose is not commonly found on U.S. retail shelves.
Are There Drug Interactions With Melatonin?
Yes, there can be some important drug interactions with melatonin; melatonin is structurally similar to serotonin, a neurotransmitter (nerve chemical) found in the brain and other areas of the body.
Check with your doctor before you take melatonin with any medication. Also, do not stop using any medications without first talking to your doctor.
Avoid alcohol use with melatonin.
Melatonin may have a important drug interactions with some medications, possibly increasing the blood levels of melatonin or causing other side effects:
- Fluvoxamine - avoid with melatonin
- Sedative-type medications, like zolpidem, triazolam, or lorazepam - may enhance impairment of memory and sedation, ask your doctor before use with melatonin
- Blood-thinner medications like warfarin: talk to your doctor before you use melatonin with warfarin. Melatonin has been reported to increase the effects of warfarin in some patients and may increase bleeding risk.
- Caffeine may blunt your ability to fall asleep more easily, either on its own or when used with melatonin. There are also reports that caffeine may inhibit the breakdown of melatonin leading to elevated melatonin blood levels, but the clinical significance of this interaction is not known.
This is not a full list of melatonin drug interactions. See a detailed list here.
Tell your doctor or pharmacist about all medicines and vitamins you take, including prescription, over-the-counter (OTC) drugs, dietary supplements, vitamins and herbal products.
Liver Enzymes and Melatonin
Melatonin is broken down in the liver (metabolized) by enzymes known as cytochrome P450. Many other drugs are also metabolized by these enzymes.
Theoretically, when melatonin is combined with certain drugs, drug levels of one or both drugs may be altered. This can lead to a host of effects, including either increased or decreased blood levels of the drugs. It can result in worse side effects or lower drug effectiveness.
This is another good reason to have a drug interaction screen even with OTC supplements like melatonin, and talk to your pharmacist when drugs are added or removed from your regimen.
Some drugs that might cause these types of interactions with melatonin include:
- ciprofloxacin (Cipro)
- deferasirox (Exjade, Jadenu)
- olaparib (Lynparza)
- warfarin (Coumadin, Jantoven)
See a detailed list of melatonin drug interactions here and their explanations.
Melatonin Use in Children
Although melatonin products exist over-the-counter (OTC) for use in children, it is best to only use melatonin for your child under the direction of a pediatrician or other medical specialist. Doses for children vary in studies and should be determined by your child's doctor.
Causes of insomnia (inability to fall asleep or stay asleep) should always be evaluated in children to determine if there is an underlying medical or behavioral cause. Melatonin should not be used to "force sleep" in otherwise healthy children. Use for children with developmental disorders should also involve behavioral interventions.
According to a meta-analysis published in Archives of Disease in Childhood, children with developmental disorders such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and intellectual disability can have sleep disturbances and may benefit from melatonin treatment when compared to placebo; however, more study is needed, as noted by the researchers. In this study reviewing 541 children from 9 studies, the authors note that:
- melatonin significantly improved sleep onset latency, with a mean difference of 28 minutes
- melatonin increased total sleep time, with a mean difference of 48 minutes
- melatonin did not significantly decrease nighttime awakenings
- no serious side effects were reported.
Side effects are infrequent with melatonin, but use in children over the longer-term is not well studied. Reported side effects with melatonin use in children include morning sleepiness, “fogginess", increased enuresis (bed-wetting)
Melatonin and Epilepsy
You should seek advice from your doctor before you use melatonin in your child who has epilepsy, or if they take a drug that may increase their risk for a seizure.
In one small but well-controlled study, researchers looked at the effects of sustained-release melatonin on sleep and seizure control in children with epilepsy.
Eleven children aged 6 to 11 years with epilepsy received a 9-mg sustained release (SR) melatonin formulation or placebo for four weeks, followed by a one-week washout and a four-week crossover.
- In data from 10 children, melatonin decreased sleep latency (the amount of time to get to sleep) by 11.4 minutes and wakefulness after sleep onset (WASO) by 22 minutes when compared to a placebo (an inactive pill).
- No worsening of seizure frequency was seen, but the study was too small to draw conclusions.
- A worsened headache occurred in one child with migraine and using melatonin.
A Hard Day's Night
A hard time getting to sleep at night and staying asleep is a common complaint for many adults. Plus, it can get worse after age 55 as melatonin levels drop drastically as we age. In fact, the CDC has reported that over a third of US adults don't get a good night's sleep.
Insomnia can be due to any number of causes such as:
- Excessive caffeine, smoking, alcohol use, or late night meals
- Travel, late-night exercising, mid-day napping
- Pain, acute or chronic
- Medication side effects
- Depression, anxiety
- Need to urinate
- Sleep apnea
- Temperature or humidity
- Blue light from electronics at night
Electronics and Bedtime
Electronic devices, like iPhones, iPads, and TVs often find their way into the bedroom at night, emitting blue light from their screens. This can be especially problematic for kids.
Researchers have found that the bright light of these devices may lower levels of natural melatonin. The effect was most significant for children just entering puberty, with nighttime melatonin levels suppressed by up to 37% in certain cases. The study shows that bright light can alter melatonin levels which may be the culprit to a bad night's sleep. Avoid light-emitting electronics 30 to 60 minutes before bed.
Recommendations from the Sleep Foundation to improve the quality of your sleep include:
- Decrease your daytime and nighttime electronics use, if possible
- Enage in relaxing activities the hour before bed; keep the bedroom lights dim
- Remove all of your electronic devices from your bedroom, including TVs. Use "nightime mode" on your mobile phone.
- Invest in some “blue blocker” glasses - orange-tinted eyeglasses specifically designed to shield your eyes from blue light emissions
Eliminating the fixable causes for your insomnia is the first goal, and referral to a sleep specialist is recommended if there is no success.
Studies have found melatonin doses ranging from 0.5 to 10 mg given 30 to 60 minutes before bedtime to be effective. It's best to start with a lower dose and increase if needed. A trial of melatonin may be worthwhile for insomnia or jet lag, but check with your doctor first and start with low doses.
Higher melatonin doses may be associated with more side effects such as headache, next day grogginess, or vivid dreams. According to a Cochrane review, doses over 5 mg appear to be no more effective than lower doses. It is important to note that higher doses than 5 mg are available for sale in the U.S., but these doses may result in excessively high levels of physiologic melatonin.
Timed-release melatonin are also available. However, don't drink alcohol with the time-release preparation; it can disrupt the time-release mechanism. And don't forget, excessive alcohol use at night can lead to early awakening, dehydration and be disruptful to sleep in general, too.
To stay up-to-date and ask questions related to melatonin and sleep-disorders, join the Drugs.com Melatonin Support Group.
Recap: Clinical Use of Melatonin
In the US, melatonin is commonly used for:
- jet lag
- sleep disorders and other insomnias.
- sleep disorders in the blind
- workers with odd shifts that are disruptful to sleep
- short-term relief of general insomnia.
Melatonin may be preferable to other sedatives due to lower risk of side effects and addiction.
In the US, melatonin is easily accessible at the pharmacy for a relatively low cost. Dosing should start low (0.3 to 0.5 mg about 30 minutes to one hour before bed) and increase only if needed. One milligram (mg) tablets can be cut in half to get a 0.5 mg dose, if needed (but do not cut the timed-release product).
Side effects are minimal, but drug interactions may go undetected unless a drug interaction review is performed with all over-the-counter, herbal and prescribed drugs.
Studies looking at long-term use of melatonin, especially in children, are not widely available, raising concerns about use in this population. Always seek a pediatrician's advice before giving melatonin to any child. Undiagnosed sleep disorders in children should always be addressed by your health care provider.
Finished: Melatonin: Worth Losing Sleep Over?
Trouble falling or staying asleep is one of the most common medical complaints. Sometimes, just a few simple changes in lifestyle can make a big impact so you can get the shut-eye you need.
Society tends to treat menopause as a disease; something to be avoided at all costs. But menopause can be positive. No more monthly mood swings, period accidents, or pregnancy worries. Self-confidence and self-knowledge...
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