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
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.
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?
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.
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.
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.
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?
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.
How can I get hold of melatonin? Do I have to go to my GP?
Thanks
Julie
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.
Are there any good herbal remedies you could recommend that would help as well.
Many thanks,
Matt.
Melatonin causes depressive symptoms in me. Everyone is different.
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
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.
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?
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.
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.
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).
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?
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.!
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.
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?
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.
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.
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
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
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.
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
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?