Many people are tossing and turning all night long. Some experience wild, vivid dreams that startle them into consciousness. Others find themselves wide awake in bed for hours. Sleep feels elusive to many right now.
“Now is the time that people are really going to struggle with their sleep and we're already seeing that people are getting more prescription medications (to sleep),” Marissa Bowman, a doctoral student in clinical health psychology at the University of Pittsburgh, told TODAY.
While many turn to prescription sleep aids, others take melatonin, an over-the-counter supplement believed to be a helpful sleep aid.
But what is melatonin? And more importantly — does it work?
What is melatonin?
The pineal gland in the brain produces melatonin, a hormone that regulates the body’s circadian rhythm or internal body clock. When it becomes dark, the body naturally releases the hormone, preparing us for sleep.
“It regulates your sleep-wake cycle,” Bowman explained. “If it’s completely dark that increases melatonin, signaling to your body that it’s time for bed, and you might start to feel a little bit more sleepy.”
When the sun rises (or people are exposed to bright lights), the body produces less of it, making them feel more awake.
In supplement form, people take a synthetic version of the hormone. The U.S. Food and Drug Administration does not consider supplements the same as over-the-counter medications or prescription drugs, so there's less oversight and regulation regarding what goes into them. That might mean that the melatonin one picks up in the pharmacy doesn't have the same ingredients in it that the bottle listed. The potency of the pills could also be less than the label claims. A few studies have examined what’s in some of these melatonin supplements and found that there are discrepancies.
“The dose that is listed on the bottle is not the dose (in the pill),” Philip Richard Gehrman, an associate professor of clinical psychology at the Hospital of the University of Pennsylvania in Philadelphia, told TODAY about some of the findings in studies published about melatonin. “More concerning, it was not unusual that it contained other things, such as diphenhydramine, which is in Benadryl.”
While diphenhydramine does make people sleepy, there aren’t enough studies evaluating it as a sleep aid, he added. People often report feeling groggy after taking it and he said it is “notorious for next-day 'hangovers.'”
Additionally, some studies suggest that melatonin just doesn’t work. Participants have said it doesn't help them doze off more easily.
“There have been quite a few clinical trials, and most of them fail to find melatonin is better than a placebo,” Gehrman said. “If it has any effect as a sleeping pill they are very modest.”
One area where it may help is with sleep difficulty from jet lag. “Melatonin is generally recommended if a person’s sleep problems are due to something like their circadian rhythm," said Gehrman. "If you are jet lagged, your body’s rhythm is out of sync with the environment and melatonin taken at that time can help.”
How to take it
Many people take melatonin like a sleeping pill, meaning they pop it right before bed. But melatonin doesn’t quite work like that. It regulates the internal clock. People taking a supplement should take it a few hours before bed. That will give the supplement a better chance to work with the body to gradually reset one's circadian rhythm.
“Most people don’t feel sleepy after they take it. Our bodies produce melatonin one to two hours before we go to sleep,” Gehrman said.
Bowman stressed that over-the-counter doses are much higher than what experts recommend. Only a half milligram to 1 milligram of melatonin will shift one’s clock, but doses of melatonin are often sold in 3 milligram tablets.
“So it’s a lot higher dose than you actually need to create that change in your sleep schedule,” she said.
Gehrman noted that people can bolster their circadian rhythms naturally by waking up at the same time every morning and exposing themselves to light. Then a few hours before bed they should engage in only relaxing activities preferably without devices and lights, which will ease the body into sleepiness.
“Our circadian clock functions best when our internal clock is in sync with the external environment,” Gehrman said. “The strongest cue in regulating our clock is light exposure.”
When people wake in the middle of the night, they make take melatonin. But Bowman cautions people against that.
“It might actually delay your clock,” she said. “It might make your body start to go to sleep later and later.”
While going to bed and waking up at the same time every day can lead to better working internal clocks, there are other behavioral modifications that can lead to improved sleep. They include:
- Exercising regularly
- Eating daily meals at the same time
- Using the bedroom for only sleep
- Going to bed when sleepy
- Skipping news at bedtime
- Avoiding devices, such as phones, tablets and laptops before bedtime
- No staring at the clock after waking in the middle of the night
For people who have insomnia, cognitive behavioral therapy can help with sleep. Anyone who has experienced an inability to sleep or stay asleep for three months should talk to their physician for help.
“Sleep plays an important role in regulating your emotions. When you are not getting a good night’s sleep it can lead to you being more responsive to stress and that can further worsen your sleep,” Gehrman said. “You can get stuck in a downward spiral.”
So should people take it? Yes, in certain situations.
"It's good if you're trying to help your body to go to bed earlier," Bowman said. "We use it a lot of times for people are experiencing jet lag."