Natural strategies for individuals who have difficulty falling asleep at night and getting up in the morning

Sleep has important benefits for health and wellbeing, but not everyone is able to get as much sleep as they’d like. For some individuals, sleep does not come easy. One particular problem encountered by a few unfortunates is what is termed ‘delayed sleep phase syndrome’ (DSPS). Here, individuals can take hours (literally, hours) to get off to sleep. They, perhaps not surprisingly, find it difficult to get up in the morning too. Someone with DSPD can find trying to do a job with ‘normal’ work hours very challenging indeed.

I’ve found in practice that individuals with DSPS can often be helped using quite-natural strategies. One of these concerns the use of bright light. Sunlight-simulating devices are the most practical option here, and the light is best administered in the morning (around the time the individual usually gets up) [1]. In addition, it makes sense not get too much light exposure in the evening (light suppresses the secretion of the chief sleep hormone melatonin). With regard to this, someone recently alerted me to a free piece of downloadable software which automatically dims one’s computer screen around the time the sun goes down. See here for more details.

Another useful treatment for DSPS is melatonin. This can promote sleep, and there’s some thought that it might even help to ‘re-set’ the sleep-wake cycle. It requires a prescription in the UK, but is available over-the-counter in some other parts of the world including the US.

One of the reasons I like melatonin (other than the fact that it often helps promote sleep in those who have difficulty getting off) is that it is, to my mind, quite a natural treatment. It is, after all, a natural body constituent. One could argue that in that sense, it’s even more natural than, say, a medicinal herb such as valerian: Sleep problems may be due to insufficient melatonin at the right time, but won’t be due to a valerian deficiency. I have written about the use of melatonin for the treatment of insomnia here.

Disorders of melatonin secretion may not just impact on sleep either – there is evidence that they can be a factor in depression[2].

I was interested to come across a recent study in which the impact of melatonin in individuals with DSPS was assessed [3]. Individuals in this study were treated with both melatonin and, at another time, placebo. Each treatment period lasted 4 weeks, and there was a week of no treatment between these. Melatonin treatment was found to improve sleep as evidenced by tests conducted by polysomnography.

Some of the participants in the study had depressive symptoms, while others did not. And interestingly, those with depressive symptoms saw improvement in those symptoms as a result of treatment with melatonin.

This study was small (20 participants), but its results suggest that melatonin therapy has the capacity to improve sleep and mood in those suffering from DSPS.

References:

1. Gooley JJ. Treatment of circadian rhythm sleep disorders with light. Ann Acad Med Singapore 2008;37(8):669-76.

2. Srinivasan V, et al. Pathophysiology of depression: role of sleep and the melatonergic system. Psychiatry Research;165(3):201-14

3. Shadab A, et al. Antidepressant action of melatonin in the treatment of Delayed Sleep Phase Syndrome. Sleep Medicine 2010;11(2):131-136

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31 Responses to Natural strategies for individuals who have difficulty falling asleep at night and getting up in the morning

  1. Bill 18 February 2010 at 4:41 pm #

    I have slept much better since using melatonin.
    6mg probably 4 nights a week for the past 3 months.
    Apparently melatonin is also anti-oxidant and may help prevent dementia as it crosses the blood/brain barrier.

  2. Willa Jean 18 February 2010 at 8:07 pm #

    I just downloaded that software… I’ll let you know if it seems to make a difference.

    Any suggestions as to what dosage of melatonin to start with? I tried it once, and it seemed to make me cranky (crankier?) during the daytime. Just sort of irritable, like sand on the nerve endings. Dosage too high? All in my head?

  3. Dr John Briffa 18 February 2010 at 8:17 pm #

    Willa Jean

    I can’t give you personal health advice, but if someone appears to be sensitive to melatonin I generally recommend that they try 0.5 mg and work up from that dose gradually if necessary as long as there are no ill-effects.

  4. Jack Billingsly 19 February 2010 at 3:39 am #

    Dr. Briffa,

    As odd as it may sound, would there be any benefit to wearing “Blue-blocker” sunglasses in the evening to limit the amount of visible blue light reaching the suprachiasmatic nucleus?

    I’ve read that the amount of blue light reaching the SCN is a major factor in inhibition of melatonin.

  5. Dr John Briffa 19 February 2010 at 11:06 am #

    Jack

    Don’t think that’s an odd idea – think it’s a very good idea, actually. Blue-blocking goggles were recently used in a study to demonstrate effect of lack of blue light in the morning. See here: http://www.eurekalert.org/pub_releases/2010-02/rpi-lom021610.php
    Theoretically, for people with DSPS might benefit from using such goggles in the evening (as you suggest), but should not use them earlier in the day.

  6. Lynda Ginart 19 February 2010 at 12:17 pm #

    I have used melatonin for short periods to help prevent jet lag, and it did seem to have some effect. When you recommend using it for DSPS, would this be on an open ended basis, or short term until symptoms improve? And would you agree with Bill, an earlier contributor, who suggeted 6mg 4 nights a week as an appropriate dosage?

  7. Dr John Briffa 19 February 2010 at 12:33 pm #

    Lynda

    When I use melatonin in practice for DSPS (or something similar) the idea, if possible, is to use it until the body-clock (circadian rhythm) as ‘re-set’ which, in my experience, generally takes 2-6 weeks. My personal preference is to use melatonin daily, on the basis that this consistency may speed the re-setting process more rapidly than less consistent dosing.

  8. Julie Hirst 19 February 2010 at 12:48 pm #

    How can I get hold of melatonin? Do I have to go to my GP?
    Thanks
    Julie

  9. Nadia Mason 19 February 2010 at 2:49 pm #

    Good ‘sleep hygiene’ is also essential to see continued benefits from treatment.

    If practiced regularly, simple changes – exercise during the daytime, heavy bedroom curtains to block out light, keeping a regular time for going to bed, removing the TV from the bedroom, soaking in the bath before bed, using progressive relaxation techniques – can help those with DSPS, and can enhance the benefit of melatonin supplementation.

  10. Matthew 19 February 2010 at 5:35 pm #

    Are there any good herbal remedies you could recommend that would help as well.

    Many thanks,
    Matt.

  11. Jennifer 19 February 2010 at 5:44 pm #

    Melatonin causes depressive symptoms in me. Everyone is different.

  12. Paul C. Murray 19 February 2010 at 7:48 pm #

    What is the best time to take melatonin? Bedtime or some time earlier?
    Dosage? I’ve read from 0.3 to 6 mg.
    Regular tablet or time release?

    Love all your helpful unbiased columns!

    Paul

  13. Ernestine 19 February 2010 at 8:32 pm #

    If you wear amber glasses in the evening that block the blue light spectrum (you can get the kind that fit over ordinary glasses), this will also prevent household lights, computers, TV from suppressing melatonin. I put mine on about two hours before sleep and they have improved both my ability to fall asleep and sleep quality.

  14. Alicia 19 February 2010 at 8:42 pm #

    Dr Briffa, would you have any idea why in a cooler drier climate I can usually fall asleep faster and earlier in the night (from 9.30pm onwards) and wake up at 6am easily whereas in a hotter more humid climate it takes me longer to fall asleep, and my best sleep hours seem to be between 2am and 10am?

    I have been having sleep problems for a long time.. maybe DSPS.. I don’t know. It takes awhile to fall asleep, I wake up a few times at night, and on bad days I am tossing and turning and it seems in the morning as if I didn’t sleep at all. I noticed that this is worse in tropical countries than in dry countries like Australia.

    I tried melatonin and valerian for a few years and they seemed to gradually become less effective. ZMA and Natural Calm make my sleep worse. The only thing that knocked me out was valium but that turned me into a zombie and I stopped taking it.

    Am at my wit’s end and am hoping you might have some ideas?

  15. Debra Rowlands 19 February 2010 at 8:59 pm #

    Julie, you can get melatonin at a health food store or online. My daughter has found it to be very helpful with her autistic son, who was not sleeping. I mean this child would stay up all night!! They found the liquid online and since he has been taking it maybe an hour before bed time, the difference is like night and day.

  16. Anne 19 February 2010 at 11:43 pm #

    Since melatonin is made in the body, surely melatonin will only be beneficial IF you are deficient in its manufacture? Delayed sleep could be due to a lot of other causes and this may explain why some people find it doesn’t work for them or have side effects if they take it.

  17. Dr John Briffa 20 February 2010 at 1:27 am #

    Alicia

    I have no idea, but you might want to reflect on whether this association has anything to do with day length: longer days mean more light later in the day and more suppression of melatonin secretion as a result. Just a thought.

    Debra/Julie

    Melatonin is not permitted as an over-the-counter remedy in health food stores in the UK.

    Paul

    Thanks for your kind words. I generally recommend that someone take melatonin about an hour before they want to sleep if the problem is getting off. I use dosages ranging from 0.5-3.0 mg generally, depending on response. If someone has a problem with waking in the night, we might try a sustained release preparation to see if this helps (it often does, in my experience).

  18. pat falconer 20 February 2010 at 2:14 am #

    I fall asleep quite easily, but wake soon after midnight and have difficulty getting back to sleep, some nights worse than others. Have been awake until 4 or 5am often, Usually get up about 2.30 and make tea & take herbal sleeping pills. Would love to get some timed release melatonin – could I buy from US?

  19. yvonne waits 21 February 2010 at 7:45 am #

    I fine melatonin gives me a hangover effect in the morning. Sometimes it doesn’t work at all for me.

    I have been making a tea out of 2 tspns of dry basil in 1 cup of water 1 hr before bedtime and I fall asleep very nicely.

    Love your emails and blogs.!

  20. linda webster 21 February 2010 at 12:08 pm #

    My 15 yr old son has been having major getting to sleep problems for about a year, – since exams and something like glandular fever. He will periodically go 24/36 hours without sleep which obviously has a bad effect on him. Someone recommended melatonin but my GP said that only a paediatrician could prescribe it and even then he would probably have to see the mental health team! Should I try and get some online? He has recently started putting the alarm clock the other side of his room so that he has to get up even if he’s only had a couple of hours sleep, so we’re hoping that will gradually re-set his system.

  21. ethyl d 23 February 2010 at 2:24 am #

    Melatonin worked wonders for me. I used to have such difficulty either falling asleep or waking up in the middle of the night. Since I started taking 3mg of melatonin about 30 minutes before bedtime each night a few months ago, now almost every night I fall asleep soon and stay asleep until morning.

    Two questions:
    All the formulations I find for melatonin (I’m in the US) also contain B6. Do you know why?
    Why does Great Britain not sell this over the counter?

  22. Dr John Briffa 23 February 2010 at 2:55 am #

    Ethyl D

    “All the formulations I find for melatonin (I’m in the US) also contain B6. Do you know why?”

    Vitamin B6 is believed to help insomnia – I suspect it’s something to do with this.

    “Why does Great Britain not sell this over the counter?”

    It used to be until about 15 years ago when classified as a ‘nutritional’ supplement. Then I think what happened is that is got re-classified as a ‘medicinal’ product and that meant it could only be obtained by prescription. But I might be wrong.

  23. Willa Jean 24 February 2010 at 4:32 am #

    Thanks for the info on the dosages you most often use… that’s all I needed.
    I downloaded the F.lux computer program, and I think it’s helping a little. It could be a placebo effect, of course, but I don’t care.
    I might also try some blu-blockers. I need some new sunglasses anyway. Couldn’t hurt.
    This has been an extremely valuable thread. Thanks.

  24. Donald 2 March 2010 at 12:33 am #

    I have been using time release melatonin 30 mins before trying to sleep & find it very helpful , I get mine from IHerb in the USA , big selection of brands/dosages & good prices.
    You will usually have to pay VAT before package gets delivered.
    Donald

  25. Laura K 9 March 2010 at 3:10 am #

    Dr. Briffa,

    My husband and 2 of my children take melatonin each night to get to sleep. The boys, ages 11 and 7 take 1.5mg (on occasion the older one needs a 2nd dose). Are there any long-term effects to worry about? Someone told me they had heard that if you take for too long, your body won’t produce melatonin anymore. Their issue is DSPS (I am assuming this is hereditary).
    Thanks for your help!
    Laura

  26. Dr John Briffa 9 March 2010 at 10:56 am #

    Laura K

    I’m not aware of any long-term effects of melatonin to be concerned about. That is not to say there aren’t any – I’m not aware of any long-term safety studies that would be able to tell us for sure. No management strategy is entirely risk-free, though the fact that melanonin is a natural body constituent means that it is, at appropriate dose, likely to be relatively safe in the long term.

  27. Wail 25 October 2010 at 7:02 pm #

    Hello ALL,

    I am very involved with health and natural supplements in the past five years,
    I had a friend who has a big problem sleeping and this has been going for years.

    He did try melatonin with no luck.
    Finally I was able to get to a formula that worked the magic.

    100 mg 5htp (you could do 200 mg)
    1 mg melatonin
    500 mg Choline

    This formula did wonder.

    Regards
    Wm

  28. Christine Wallace 4 March 2011 at 3:10 am #

    My six year old grandson has no problem getting off to sleep but wakes very early in the morning – often 4.30 – wide awake. He does however get very tired as the day goes on and is often bad tempered as a result.
    Any ideas?

  29. Jaki 25 March 2012 at 11:49 pm #

    Hi all

    I used Melatonin 3mg Sunday through Thursday 30 mins before sleep time for 8 weeks. The results were excellent from first dose, I awoke ABLE TO COPE with the day. I tried stopping after 8 weeks and found that I just kept on sleeping well. I actually wake up 10 mins before my alarm goes off so when it does I just get up and get on with it.

    In the 6 months since doing this I have used the 3mg about once a fortnight on average. This has been when I’ve known I had to get up early or have had a few nights where I can’t ‘get off’
    Generally I have learned that 7 hours is my optimum sleep requirement. By making sure I have 7hrs before I need to get up I can continue what Melatonin showed me was right for me.

    This stuff, used correctly can change your life. It has for me :)

    What I noticed most when I started this therapy was the very vivid dreams. They weren’t bad in any way – just very vivid. That’s tailed off – maybe it was the experience of sleeping well I remember :)

  30. Jaki 26 March 2012 at 12:08 am #

    I have also used the LUX program – it dims the light from ones PC. I have found this useful.

    It’s funny when I go on line during the day at weekends as everything seems so sharp and bright :) I do think that the softer tones of light from my computer have helped. Usually – like most on here – I’ve been used to brash bold and bright things all day.

    When I get home it’s all soft and mellow. That’s nice actually. I don’t know if it’s helped me sleep but it does calm things somewhat. My evening computer stuff is fun and much less stressing than the day stuff. To have this reflected in mellow is cool.

    I recommend it :)

Trackbacks/Pingbacks

  1. Difficulty getting up in the morning in the winter? It might be SAD | Dr Briffa's Blog - A Good Look at Good Health - 11 October 2011

    [...] This study in question, published in the Journal of Affective Disorders, assessed individuals who exhibited evidence of what is known as ‘delayed phase sleep phenomenon’ (DPSP). This condition is characterised by individuals have difficulty falling asleep at night, and having difficult rising in the morning too. I have written about DPSP previously here. [...]

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