Comment by petilon

This is a very important paragraph from quern's article

> There are few to no side-effects to melatonin use in adults (there is uncertainty about the risks & benefits in children & adolescents28), and it is not addictive or habit-forming like caffeine is. The usual dose for a night is 0.5-3 mg and I take 1.5mg [29]; my dose is highly likely to be too high. High doses may well be responsible for why some people try melatonin and report that it does nothing or hurts them, since in one study, the best dose for old people was 10x smaller (0.1mg or 0.3mg) and for one blind person, 0.5mg [30 31 32] . Zhdanova et al 1996 found 0.3mg & 1.0mg to affect sleep onset similarly. A study of delayed-release melatonin found with their high dose of 4mg (but not 0.4mg) elevated melatonin levels 10 hours after bedtime ( Gooneratne et al 2011) - potentially interfering with waking time.

It is difficult to find doses as small as 1mg sublingual (dissolve under the tongue) in my area. Everyone is trying to sell you 5-30mg chewables. And, I expect everyone is buying them under the assumption that more is better. But, here it explicitly is not.

The way melatonin works well for me is to wait until I'm already settled into bed and should be asleep, but I'm not. Do a couple body scans to relax for real. Try to think about something mindless. Then if I'm still awake, pop 1mg under my tongue. I'll usually wake in the morning with half of it drooled on my pillow :P

Everyone is different so I'm not suggesting this as a general cure-all, however I'd like to relate my own personal anecdotal experience.

I've always had insomnia since I was a kid and I just chalked it up to "being a night owl." As a teenager, I mostly solved this by living in a permanent fog during the week and "catching up" by sleeping in on the weekend. As an adult, I was suffering greatly from chronic sleep deprivation because adults (mostly) don't have much control over when they can wake up to start the day.

Around 10 years ago, I started taking 5mg melatonin. It's going to sound like I'm overselling it, but it changed my life. It _very reliably_ makes me sleepy 1-2 hours after I take it. If I forget to take it, I am fully awake until the wee hours of the morning. Is it important to note that (for me), after I take it, I have to engage in some passive activity like (calm, non-shouty) YouTube repair videos or reading. Also, the "window of sleepiness" is at most about 30 minutes and if I decide to power through it, I will come out the other side fully awake again. Melatonin does not "force" me to sleep, only highly encourages it.

I was skeptical of melatonin for the longest time. Generally, I rarely see much if any positive effect from supplements. But (for me!) this stuff really works. If anyone reading this is on the fence, I highly recommend giving it a try. (With the acknowledgement that it takes about a week to get into a solid sleep schedule if yours is currently disorganized.)

The evidence that humans would naturally be designed to sleep “multiple times a day” is quite mixed. “Multiple” does a lot of heavy lifting here, when basically most evidence points to two batches, following either of these patterns:

- a long uninterrupted night cycle and a short (20-60 mins) afternoon nap. Around 2pm. - a night cycle split into two halves. With a 1-2h break (maybe up to 3h) starting around midnight to 2am.

The former is still very common, and imho stretching the definition of multiple cycles. The latter is more historical (more common when there are long winter nights and no electricity).

Also making it a “Western” problem is kinda weird? There are other cultures where single cycle sleep has existed. Even hunter-gatherer groups with little to no contact with the west. And alternatively afternoon naps are still quite common is some western areas. I guess the main thing that prevent it would be the classic work day schedule.

I take melatonin to sleep on a redeye, but otherwise don't use it. I find the effect is similar to taking a weed edible to fall asleep— basically, my wearable registers a lengthy period of deep sleep but instead of waking up feeling refreshed and ready for action, I'm groggy and fog-headed for several hours, or dependent on coffee to reverse the lingering effects.

As someone who has never been a regular coffee consumer, I really didn't want to end up with the dual dependence of melatonin at night and then caffeine in the morning.

This thread is stimulating me to want to get my magnesium checked, but barring that I've found the most effective sleep interventions are the basic ones: get some exercise earlier in the day, and don't do screens for the last few hours before bed.

The comment above just said “sleeping pills” which is ambiguous. Melatonin is an OTC supplement. True “sleeping pills” are usually controlled substances and few doctors would prescribe them as first-line options for a patient who shows up with first time complaints of sleep problems. They won’t be prescribed long-term either. The part of the post that says doctors (plural) tried to prescribe the pills makes me think it’s not traditional sleeping pills, because in this environment you would be unlikely to find one doctor willing to prescribe scheduled sleeping pills long term at all, let alone multiple doctors pushing them.

The usual suggestions from doctors for first line treatment are more mild medications that have drowsiness as a side effect, prescribed at low dose. I would actually prefer many of these low dose options over some of the high dose melatonin supplements. Melatonin is a hormone and taking it can throw off natural production

I find it impossible not to reflect on my personal experience whenever this comes up. I spend 8+ hours a day on a computer, looking at screens. Probably more. I am looking at a screen literally 10 minutes before falling asleep (watching stuff on my iPad).

I can easily sleep 8+ hours. Today slept 10.5.

I'm either not convinced screens are an issue, or they simply are not an issue for me personally, but if thats true -- WHY?

The problem with that take is that the evidence for melatonin is quite poor outside of jet-lag and certain more serious sleep disorders, and there can be unexpected effects elsewhere in the body when supplementing hormones, e.g. increased rates of depression for melatonin in particular.

I agree with Gwern in that I think for the vast majority of people, short-term melatonin supplementation is useful and can cause little harm, and it is extremely safe as far as supplements go.

But I don't think it does anyone any favors to oversell the idea that it has "few" or "no" side effects -- it has mild side effects, most commonly reported in the literature are daytime fatigue, headaches and GI symptoms, and also nightmares. Mild doesn't mean it isn't a nonstarter for some people.

It's also important to remember that there are major gaps in what we know about melatonin; notably the effects of chronic supplementation are not well-studied, but earlier final awakening has been documented and this is quite commonly reported in anecdata -- I can contribute a datapoint there, as can most people in my circles who have used it.

To be clear, melatonin is great and useful, but as someone with a rare lifelong chronic sleep disorder who is intimately familiar with this substance, I think it's most useful when we're clear on what we know, what we don't know, and what actually are the limitations on a substance.

Just because downing a bottle of it probably won't cause systemic organ failure or otherwise any kind of medical emergency in most people doesn't mean there aren't tradeoffs to consider when using it, especially if you are sleep-challenged

Eh, I was prescribed 2mg of slow-release melatonin to help with insomnia (baby-related).

Man, were these the worst nights of my life! I’d get 2-3 hours of shut-eye and then be FULLY awake. Ready to go, couldn’t sleep the rest of the night. I was dead tired by day 7 and gave up.

Tried 0.3mg. Tried 5mg. Nope. There’s some evidence that melatonin can mess you up if you’re sensitive to cortisol/have too much of it. I’m not touching it again. No side effects? Sure.

N=1, but if it’s not working for you, don’t push it. My doctor instead prescribed a bit of therapy (CBT-i) and my sleep went back to normal after a couple of sessions.

Not sure why I would trust the opinions of this random person?

Your report matches my experience as well!

Funny how it's basically do all the things you're supposed to do - exercise, diet, stress management - then sleep is then easier.

Mg or melatonin have 0 effects on me, Mg helps if I over-exercise but thats for muscles regeneration.

I dont have problems normally, just cant sleep in high altitude, 3000m is already showing mild effects. Guess what, I do/did quite a bit of mountaineering, its easy to get above 5000m in himalayas, highest I've been in tent attempting to sleep before summit push was 6000m on Aconcagua. Tried both Mg and melatonin up there over multiple nights, 0 improvements. I had highest O2 blood level measured in 5500m by doctor (mandatory there) from whole group.

Physical effort makes better sleep for literally everybody, thats age old knowledge and I havent met a single exception yet.

I've tried both Magnesium Glyconate and Magnesium L-Threonate and both have helped my sleep, Magnesium Citrate did very little. Which makes sense, the latter is known to not be absorbed very well.

I've not noticed any significant difference between the other two.

Magnesium Glycinate has been a game changer. My legs used to be tense to the point of cramping at night, and they’re now relaxed, enabling better sleep. I also use L-theanine as an additional supplement for a long duration deep sleep, and think it helps.

Magnesium Glycinate worked well for me, take it an hour before bed or so. L-Threonate is too expensive, citrate gave me diarrhea.

Much more deep sleep with Glycinate, some folks don’t like it because they feel too groggy after waking.

I find that Magnesium Glycinate works well for me. Magnesium Taurate also works.

Yep, I've been taking glycine and magnesium for years. I am not as consistent as I should be but it makes a big difference when I use them.

Good point about L-threonate. It is indeed expensive. I use some of it, but mostly I rely on Magnesium Glycinate.

Even a simple ZMA worked wonders for me when my fitness coach recommended it. Got some of the deepest sleep of my life

Never taking a supplement for too long is great advice. Always cycle things in and out to avoid some potential for accumulating too much in the body.

There are some horrifying case studies where people took like too much zinc, or copper, or some other thing for years and got really really messed up.

I don’t think it’s AI-generated, but it is repeating a lot of the points that are commonly repeated in supplement ads: The claim that Mg L-threonate is special originates from the person who patented it and sues anyone else who produces it. The claims that multiple doctors tried to push “sleeping pills” and they’re all bad is a common theme in communities that accept supplement research and claims unquestionably (like patented magnesium forms being superior) but have an innate distrust of doctors and medicine.

I think this is just what happens if you read a lot of supplement forums and listen to the supplement podcasts a lot: You start developing elevated beliefs about the supplements, disdainful beliefs about doctors, and think you’re making superior choices having done your own research. That last point is some times critical for the supplements working, because if you believe you’re taking something special after having cracked the mystery by listening to 50 hours of Huberman or Rhonda Patrick (as examples) then the placebo effect will supercharge the result. Having belief that you’ve solved the problem makes the effects much stronger, especially for cases like this where the underlying problem was already pointed out as being stress related.

So where's the advert link to his favourite supplement, search those phrases and there will be 200 different brands selling this same commodity so which one is paying him commission ? All?

Hmmmmmmm

People sharing their experience doesnt immediately mean AI-generated advert

Why AI-generated? Because the quality of his writing is better than that of his critics?

Interesting, my doctor recommends doing a blood panel every 5 years.

Blood tests are pretty useless for magnesium. The deficiency is in cells, magnesium level in blood is not a good test for that deficiency.

From my experience, it took about a month of 150mg magnesium supplementation per day to see effects, two months for my insomnia to go away entirely.

Doing a quick search for magnesium-rich foods, it seems like it would take either an unsustainable focus on eating these foods to see results on a similar timeline or an extremely prolonged timeline to see similar results.

That said, I am not a doctor or nutritionist. But my instinct is that you can get so far in the hole with a lifetime of magnesium deficiency that supplementation is by far the most time- and lifestyle-efficient to digging yourself out. Whether or not switching to magnesium-rich foods can sustain you being at correct levels will end up depending on what the size of the deficit was in the first place, but is probably worth a try.

In some people they can do ths.

Most magnesium doesn't cross the blood brain barrier, such as the one you tried.

Try magnesium threonate, which does.

Histamine has different pools, functions, and receptors in the body. You’re reducing it all to one single level that goes up or down with diet but that’s not how it works.

The brain histamine in your neurons is primarily synthesized from an amino acid. The histamine levels in neurons are different than the levels in mast cells.

There are a lot of degrees of hand waving in your theory that don’t work.

I don’t know anything about the specifics of this case. I do know there are lots of bad doctors. Doctors routinely make mistakes or overlook things, especially relatively trivial things like this.

I don’t know what people think you learn in medical school that makes you an infallible source of health knowledge.

Those invoking Dunning-Kruger are, with high probability, an instance of just that :) (also, see the comment below that touches upon the many gaps in the original paper, which is at this point just garbage invoked by midwits). Finally, there’s a thing called heterogeneous treatment effects, which really is hard to detect at medical research scale … and placebo effects, if they help with the underlying issue without breaking the bank, and still helpful.

> Holy Dunning-Kruger effect…

Do you know they’re wrong? Please don’t invoke Dunning Kruger like this, it’s cliché and also wrong to do. There’s no indicator for whatever it is Dunning & Kruger showed, you cannot know if it applies to a single person. Their main plot showed a positive correlation between confidence and competence. Their paper has problems, their methodology has been rightly questioned, and some attempts to reproduce have failed. Plus keep in mind that, ironically, for people who are intimately familiar with the debate over DK, using it to essentially name-call someone backfires and has the opposite of the intended effect, it makes the name caller look confidently ignorant.

Trained doctors pushed opiates and benzos on me when they were very much not needed and in both cases led to dependancies and horrific withdrawals. I'm sure many others can chime in with their own similar experiences. Medical professionals are incredibly crucial to the wellbeing of society, but they have also been responsible for much suffering because they are human just like us.

In Mice!!!!

I am a brogrammer and I fix problems, bro. Magnesium for life.

Why?

You are absolutely right about that. It is important to reduce stress. Insomnia is only one of the ways excessive stress shows up.

I get what you’re saying, but I think it’s fair to view it as equivalent to drinking a protein shake after a workout. You used the resources in a productive and healthy way, now you need to replenish them.

The magnesium deficiency would probably still exist if you removed the stressful job. Unfortunately switching jobs or careers is not an option in this current job market.