Melatonin is one of the most popular natural products in North America. It’s easy to see why: The inexpensive supplement, which is a synthetic version of the hormone your body produces to make you feel sleepy, is available on drug-store shelves and seems like an easy way to treat insomnia. And parents are increasingly turning to it as an answer for their children’s sleep issues, too – a recent study from the Canadian Pediatric Society surveyed the families of 350 children and found that 19% had used melatonin to help their kids sleep.
But it might not be as effective as you think. “Anecdotally, people swear by melatonin, but if you look at more rigorous studies, there seems to be an effect there, but it’s not as impressive as people believe,” says Scott Gavura, a pharmacist and blogger at Science Based Medicine.
Melatonin works best for fighting jet lag and for those with “delayed sleep phase syndrome” — people who are extreme night owls. It might also work for people who work shifts, as well as the elderly, since you naturally produce less melatonin as you get older.
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The recommended dose for adults is between 0.3 and 5 mg of melatonin, taken less than two hours before bedtime if you’re battling insomnia, and right at bedtime if you’re trying to overcome jet lag. But it’s hard to know exactly what’s in a bottle of melatonin: since it’s technically classified as a supplement, it’s not regulated in the same way drugs are.
A recent study from researchers at the University of Guelph found that the amount of melatonin in pills varied widely from what was advertised on the bottle, from 83% less than the amount stated to 478% more. Some also had serotonin in them, which wasn’t on the label and can interact with other medications. “That makes it really difficult for consumers,” says Gavura. “You just have no idea what’s in these products at all, so how do you know the dose you’re taking?”
For people with general sleep issues, or insomnia, melatonin doesn’t seem to be very effective. A 2014 review of the evidence found that, on average, melatonin only made people sleep 15 minutes longer a night. Whether it works varies from person to person. Only about 20% of people find melatonin makes them sleep better, says Katherine Rasmussen, a naturopathic doctor and the clinical sleep educator for the Centre for Sleep and Human Performance in Calgary. And it has a very short half-life, so it doesn’t help with middle-of-the-night wakeups.
Because of that, insomniacs might have better luck with treatments with more evidence behind them, like cognitive behavioural therapy, tailored for insomnia. And there are no long-term studies on the safety of melatonin, so it hasn’t been proven safe to use for more than three months. “People think you can use melatonin like water, that it’s innocuous because it’s natural,” says Shelly Weiss, a pediatric neurologist and an associate professor of pediatrics at the University of Toronto. “But you’re giving 50 times what your body makes, so that’s not really natural.”
That’s one reason why melatonin isn’t recommended for kids who are just bad sleepers, says Weiss. Rather, she suggests creating better sleep habits: practicing good sleep hygiene — including things like keeping to a regular sleep schedule, sleeping in a cool, darkened room, getting exercise in during the day — and making sure kids are able to fall asleep by themselves, without you in the room. Giving kids melatonin can also create the idea that they will always need a pill to fall asleep.
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Weiss says there are also some concerns that melatonin might affect puberty in some way, because it’s a hormone. That said, there are also reassuring animal studies that seem to show its safety. That’s why the benefits seem to outweigh the risks in specific cases. “The one that’s the most studied is children with autism — and there’s definitely evidence that melatonin helps them fall asleep,” she says. Kids with ADHD also sometimes take melatonin to help them sleep – because the stimulant medication for ADHD can cause insomnia. But Weiss says she would start by changing what type of stimulant is given or the time it’s given first. If you’re using or considering using melatonin with your child for any reason, be sure to loop your doctor in first.
In healthy children and adults, we don’t really have enough information yet to say whether melatonin is a good choice, says Gavura. “If people find it’s beneficial, it’s probably safer than using sleeping pills,” he says, adding that most people he’s seen tend to use it for jet lag. “But we don’t have enough information to say yes or no to whether it’s safe to use long-term yet.”