Concise advice on using melatonin to aid sleep

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Due to sleep rhythm problems such as jet lag, shift shift, and temporary staying up late, many people have the need to improve sleep in the
short term.
The safety of melatonin (eg, affecting the endocrine system) has received increasing attention and is not recommended for long-term use, but may be used as an option for temporary sleep rhythm adjustment in the short term, especially for consumers with contraindications to sleep aids
.

However, foreign experts clearly pointed out that even the short-term use of melatonin products should be based on its known physiological effects, and should not be simply used as a "universal sleeping pill"
.

Short-term, early, low dose

Melatonin, an endogenous neurohormone involved in circadian rhythm regulation, is often described as a sleep-promoting neurotransmitter, but it may be more accurate
to call it a "dark hormone.
"

The reason is that the secretion of melatonin is active from dusk and weakens at sunrise - retinal neurons containing melanopsin are sensitive to blue light, perceive a decrease in evening light, and transmit this cue to the hypothalamic suprachiasmatic nucleus (SCN) through the retina-hypothalamic pathway; Subsequently, the inhibition of the pineal gland by SCN is weakened, which releases melatonin into the blood and cerebrospinal fluid
.
This point in release is called the Dark Melatonin Initial Release Time (DLMO).

Studies conducted in the lab and at home consistently show that DLMO typically falls asleep about
2-4 hours earlier.
Therefore, it is recommended to take melatonin 2-4 hours before the scheduled bedtime to mimic physiological processes, rather than immediately before
bedtime.

In addition, lower doses of melatonin can better replicate its physiological levels and are less likely to have impairment of rhythmic pull processes or induced sleep phase delays
due to the persistence of melatonin.
In addition, if high-intensity melatonin signals appear much later than ideal DLMO, a sleep phase delay effect may occur; Using high doses of melatonin before bedtime can also induce sleep, but it may delay rhythms and cause new problems
.

Therefore, it is recommended to use a low dose (0.
5-1 mg) of melatonin 2-4 hours before the scheduled bedtime instead of a high dose (≥5 mg)
before going to bedtime.
However, the latter practice is not only common in clinical practice, but also recommended by manufacturers
.

In conclusion, low doses of exogenous melatonin can better mimic the natural release and function of melatonin, establish a biological night, and avoid potential rhythmic timing delay side effects
.
Considering physiological effects can help optimize the duration and dose
of melatonin.

Sources: Julia Ridgeway-Diaz, Joshua J.
Rodgers.
Melatonin as a sleep aid: Are you prescribing it correctly? Current Psychiatry.
2022 September; 21(9):46,48 | doi: 10.
12788/cp.
0269