While sleep can seem like ‘wasted time’ to a lot of us, the reality is that it plays a critical role in health and wellbeing. Not so long ago I wrote about a study that found a correlation between reduced sleep over time and an increased risk of death, particularly from cardiovascular disease. Other studies have linked lack of sleep with an increased risk of diabetes. Adequate sleep does seem to be something worth prioritising for those of us who plan of having a long and healthy life.
However, valuing sleep more will not necessarily ensure we get enough of it to meet our needs, and one major reason for this is insomnia. Some individuals can have great difficulty dropping off to sleep. And one relatively common reason for this concerns some disruption in the secretion of melatonin ” the brain chemical secreted that essentially puts us to sleep at night.
There is a thought that melatonin secretion can become disrupted as we age, which can make us prone to insomnia later in life. It is not uncommon to find that melatonin levels (measured through saliva samples) is lower than it should be at night in individuals who have difficulty falling asleep until the small hours of even later.
One obvious potential approach in such cases is to try some melatonin in these individuals. While melatonin is no panacea for insomnia, I have to say I’ve generally found it to be very useful in practice, particularly for those that find getting off to sleep can be a struggle.
I was therefore interested to read about a study published in the Journal Of Sleep Research which assessed the effectiveness of melatonin in a group of insomniacs aged 55 or over . This randomised controlled trial found that treatment with melatonin (2 mg of prolonged release melatonin taken at night). Treatment lasted for 3 weeks.
Compared to placebo, treatment with melatonin led to significant improvements in both quality of sleep, and morning alertness. Side-effects were rare and judged to be minor.
In addition, the researchers assessed what happened to individuals when they stopped taking the melatonin. There was no evidence of ‘rebound’ insomnia or symptoms of ‘withdrawal’.
These findings mirror my own experience in practice: melatonin often helps sleep, but individuals tend not to have any difficulty getting off it either. In fact, I generally find that 3-6 weeks of melatonin therapy can have a long-lasting effect on individuals’ ability to sleep soundly. Some have theorised that this is because melatonin treatment may help re-set the body’s sleep-wake cycle, perhaps by helping to normalise melatonin secretion.
This re-setting of the sleep-wake cycle idea is thought to be one of the reasons why melatonin can be of use in the treatment of jet-lag. For those interested in this topic, I’ve pasted in an earlier piece below.
Availability of melatonin varies according to country. For instance, while it is available over-the-counter in North America, in the UK a prescription is required.
Lemoine P, et al. Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res, 2007;16(4):372-80
Is there a natural way to combat jet-lag? – 5 October 2003
One of the spin-off benefits of my line of work is occasional invites to give a talk in some far-flung place or other. I have, as it happens, just returned from a short stint of lecturing in Vancouver. On my way over there it occurred to me how much I relish long-haul flying, specficlly how it insulates me from the outside world. With no phone to answer or emails to catch up on, the cocoon of an aircraft cabin affords me valuable thinking time and an opportunity to make some decent headway with the research reading that is part and parcel of my job. However, the high-life has its downside too: the flying start I get on a plane can so easily unravel on the ground as jet-lag takes a hold and my energy levels come down to Earth with a bump.
Over the years, I have learnt a few little tricks that can be quite effective in combating the undesirable effects induced by time-travel. One simple strategy that often pays off here is to choose flight times with some care. While some of us may be tempted to opt for very early or late flights in an effort to eke the most out of our schedule, this may cut into the amount of sleep we get before or after flight. Adding the insult of acute sleep deprivation to the injury of jet-lag increases the risk of our brain and body energies taking a nose-dive. If possible, flight times should be selected to ensure no shortage of sleep at either end of the journey.
Another factor that may influence our sense of well-being around the time of intercontinental travel is the food and drink we take in. The consumption of the often-unhealthy and additive-laden plane food will generally do little to feed our levels of energy. Complimentary caffeine and alcohol only add to the toxic load on the body, also tend to worsen the dehydration that the arid atmosphere of an aircraft cabin tends to induce. Drinking plenty of water before, during and after a flight will help to combat undue toxicity and dehydration, and packing a big bottle of this most basic fluids in our hand luggage will help to ensure we get enought to meet our needs in this respect. Another useful tactic is to travel with with a stock of healthy snacks such as fresh or dried fruit and nuts. Grazing on these can allay our appetite and help us to make more controlled choices about what and howmuch plastic plane food we eat.
One specific remedy that may help in the treatment of jet-lag is melatonin – the hormone we secrete at night to put us to sleep. Studies have shown that taking supplemental melatonin can significantly increase the speed of recovery after long-haul flying in about half of individuals who take it. Melatonin (at a dose of about 3 mg) should be taken before bed for several days after both the outbound and homeward flights. It may also aid sleep on fly-by-night journeys such as those from North America to the UK. While melatonin is available over-the-counter in the USA, it requires a prescription in the UK. Melatonin, in combination with some canny flight time and food choices, can ease the effects of jet-lag and keep our energy levels soaring around the time of international travel.