Melatonin

Melatonin (also sold under the brand names Syncrodin or Circadin) is a hormone produced by the body to help regulate your natural sleep-wake cycle. The level of melatonin in your body increases in the evening and is triggered by lower light levels. Before waking, the melatonin level in your body drops at the end of your natural sleep cycle, helping you to feel more awake and alert.

Melatonin is used to treat sleep disorders. It can be used to treat jet lag or for the treatment of chronic insomnia. However, the dosage and type of melatonin prescribed for jet lag is different from the type prescribed for chronic insomnia. When melatonin is prescribed to treat chronic insomnia in people under the age of 55, it’s known as off-label use.

Jet lag is a disruption of your usual sleeping rhythm caused by travelling across multiple time zones. Your body has difficulty adjusting your sleep cycle to a new time zone and you may find that you have problems staying awake in the day or falling asleep at night.

Chronic insomnia is a sleep disorder where you have difficulty falling asleep or staying asleep on 3 or more nights each week for at least 3 months. Unlike other types of sleep disorders, chronic insomnia can’t be fully explained by another health condition or by an external cause such as a change in shift work.

For more information on different types of sleep disorders, visit the Sleep Charity’s website.

The Sleep Charity: Sleep Disorders Explained

Melatonin is a hormone which is produced naturally in the brain and helps to regulate sleep patterns. It does this by synchronising the body’s biological day-and-night rhythm so that you fall asleep more quickly in the evening at a normal bedtime.

Melatonin is taken at night to help you sleep. Melatonin comes in two strengths and different formulations, depending on what it’s being used to treat. Do not take melatonin prescribed for jet lag to treat insomnia, or the other way round.

When using melatonin to treat jet lag, once you’ve arrived at your destination, take one or two melatonin tablets one to two hours before bedtime, for up to five days.

For the treatment of chronic insomnia, take one tablet, one to two hours before you go to bed.

When taking melatonin to treat jet lag, it should be taken with water or liquid two hours after or two hours before eating. However, when taking melatonin for chronic insomnia, it should be taken with or right after food. This allows for a steadier absorption and action over the night, and reduces side effects such as dizziness.

You should always avoid drinking alcohol when taking melatonin as this can cause impaired balance and coordination.

The usual prescribed dose to treat jet lag is one 3mg tablet taken one to two hours before bed after you’ve arrived at your destination. You can continue this treatment for up to five days.

For chronic insomnia, the usual prescribed dose is one slow-release 2mg tablet taken one to two hours before bedtime for up to 3 months. If it’s not having any effect over 4 weeks, you should stop taking it.

If you forget to take melatonin at the usual time, do not take it later during the night. Taking melatonin later than recommended, such as if you wake up in the middle of the night, can leave you drowsy in the morning and can potentially cause problems with activities where you need to be alert, like driving. You might find it helpful to set an alarm on your phone to remind you to take your tablet at the right time.

Important: Do not take a double dose of melatonin to make up for a missed dose. If you miss a tablet, wait until the next night to take your usual dose.

Melatonin has been found to help with recovery from symptoms of jet lag. For most people, it can help reduce recovery time after a long flight by a day to a day and a half.

When used to treat symptoms of chronic insomnia, melatonin is most effective in older adults above the age of 55. Younger adults might also find that taking melatonin can help to reduce the time it takes to fall asleep in the evening. However, how effective melatonin is in treating chronic insomnia varies from person to person.

Melatonin is generally well tolerated by most people. As with any medicine, there are some side effects.

These can include:

• nausea
• drowsiness
• headache
• runny nose
• sore throat
• back pain and joint pains

Side effects can affect around 1 in 10 people and usually improve over time as your body gets used to the treatment.

For more information, please read the Patient Information Leaflets:

For melatonin to treat jet lag: Patient Information Leaflet: melatonin 3mg to treat jet lag

For melatonin to treat chronic insomnia: Patient Information Leaflet: melatonin 2mg slow release tablets

You should stop taking melatonin and speak to your GP or healthcare provider if you experience any of the following:

• chest pain
• blurred vision
• obstructive sleep apnea or increased breathing difficulty
• low mood/anxiety, deterioration, depression or thoughts of harming yourself. If you’re struggling with your mental health please contact your GP, local mental health service or emergency services for support

You should avoid smoking when taking melatonin. Smoking may make melatonin less effective, because chemicals in tobacco smoke can speed up the breakdown of melatonin by the liver.

It’s also important that you avoid driving or using machines at least 9 hours after taking melatonin as it can affect your performance. This is especially important during the first few days of treatment until your body becomes used to the treatment.

If you’re pregnant or trying to get pregnant, speak to your healthcare provider before taking this medicine. Melatonin is not advised to use while pregnant unless essential.

If you’re breastfeeding, speak to your midwife, nurse or doctor about the best way to treat your insomnia as melatonin will probably not be appropriate for you.

Note: Before taking melatonin it’s important that you let your healthcare provider know about your complete medical history as well as any medicines or supplements, including herbal supplements, that you’re taking. This is so they can make sure melatonin is safe for you to take.

Different treatments are available for insomnia depending on the root cause of your lack of sleep. Please speak with your healthcare provider to find out about possible alternative treatments that might be suitable for you.

If you do not want to take melatonin to treat insomnia or jet lag, there are things you can do to help yourself fall asleep and stay asleep for longer. These tips are often referred to as “sleep hygiene” and can often go a long way to solving sleep problems.

Try not to consume substances that can interfere with sleep.

• Avoid food, drink or medicines containing caffeine for six hours before bedtime
• Avoid alcohol for six hours before bed. Alcohol can make you feel sleepy but interferes with the body’s natural sleep rhythms, resulting in disturbed sleep
• Avoid heavy meals before bedtime
• Stop smoking six hours before you go to bed. Nicotine interferes with the body’s natural sleep rhythms by making it harder to fall asleep, causing you to wake up more often, and reducing the amount of sleep you get

Make the bedroom a place of rest and relaxation.

• Keep the bedroom cool and dark
• Avoid watching television or looking at screens before bed
• Try to stick to the same time every day to wake up and go to sleep so that your body becomes used to the routine
• Avoid napping during the day, or trying to “catch up” on your sleep over the weekend

If you’re going to be travelling and are worried about jet lag, there are steps you can take to help yourself adjust to a new time zone.

Before departure:

• consider arriving a day or two earlier at destination to give yourself more time to adjust.
• gradually adapt to the new time zone before departure by going to bed an hour earlier or later than normal each evening, depending on the direction of travel.
• try to make sure you’re well rested before travelling. Being sleep-deprived to begin with can make jet lag worse.

During the flight:

• stay hydrated. Dehydration can make the symptoms of jet lag worse.
• try to get some sleep at the normal bed time of your destination. Use an eye mask and earplugs.
• limit caffeine and alcohol consumption as they can make the symptoms of jet lag feel worse.

After arrival:

• stay on the new time schedule. Try to go to bed at a time that would be normal for that time zone.
• consider setting an alarm in the morning so you don’t sleep too late.
• get out and about during the day. Natural light is one of the most important parts of resetting sleeping and waking cycles. Exposure to morning light can help adapt when traveling eastward, while exposure to evening light can help when traveling westward.

One of the most effective alternative insomnia treatments which is also available through the NHS is cognitive behavioural therapy for insomnia (CBTI). This can be done either face-to-face or online using apps such as Sleepio or Sleepful. This could help you manage the intrusive thoughts and behaviours that keep you from sleeping.

To explore online resources that offer CBTI, take a look at these websites:

Sleepio

Sleepful

For more tips and advice on what you can do to improve your sleep, visit the Boots Health Hub: Sleep Hygiene Tips

Melatonin is not available in the UK without a prescription.

You should not drink alcohol when taking melatonin. Alcohol and melatonin together can make you sleep very deeply, which can increase the risk of not breathing properly at night. It can also make you feel drowsy in the morning, making it more difficult to wake up and be alert when operating machinery or driving.

Unlike some sleeping aids, there is no evidence that melatonin is addictive.

You should not drive or operate heavy machinery within 9 hours of taking melatonin for the first 5 days of treatment.