Comment by shiftingleft

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?