COVID-SOMNIA - A BETTER SLEEP GUIDE FROM THE NEW YORK TIMES
It’s understandable that you may be struggling to fall asleep these days. Our world has been turned upside down, so it is especially hard to unplug from the day and get the high-quality sleep your body needs.
“Almost every single patient I’m speaking with has insomnia,“ said Dr. Alon Y. Avidan, a professor and vice chair in the department of neurology at the David Geffen School of Medicine at the University of California, Los Angeles, and director of the U.C.L.A. Sleep Disorders Center. “Especially now with Covid-19, we have an epidemic of insomnia. We call it Covid-somnia.”
An increase in anxiety in both children and adults is affecting our ability to fall asleep. Additionally, our lifestyles have changed drastically as people observe sheltering in place guidelines. With more people staying indoors, it can mean they are not getting enough light exposure.
“Without light exposure in the morning,” Dr. Avidan said, people “lose the circadian cues that are so fundamentally important in setting up appropriate and normal sleep-wake time.”
There are nonmedical ways to help you sleep better: Meditation, turning off screens early in the night, warm showers and cool bedrooms can help your body rest better. But if these options don’t work, or if you are ready for the next step, you may have considered trying melatonin supplements. These pills are commonplace enough that you have most likely heard of them and seen them in your local pharmacy.
Here’s what you need to know about the pros and cons of using melatonin supplements for sleeping difficulties.
What is melatonin?
Melatonin is a hormone that helps regulate sleep timing. It is produced in the pea-size pineal gland, which is nestled in the middle of your brain and syncs melatonin production with the rising and setting of the sun. According to the National Sleep Foundation, the gland remains inactive during the day but switches on around 9 p.m. (when it’s generally dark) to flood the brain with melatonin for the next 12 hours.
Melatonin itself doesn’t make you fall asleep; it just tells your body that it’s time to fall asleep by lowering alertness and reducing your core body temperature. It works in tandem with the body’s circadian rhythms to let you know when you should rest and when you should be awake.
“Melatonin is the hormone of darkness and you need it to start falling asleep,” Dr. Avidan said. “The reverse also happens. If you expose yourself to too much light at night, you actually delay the production and release of melatonin.” This is why experts suggest you avoid computers and smartphones before bedtime.
You can buy synthetic melatonin supplements over the counter. They are generally considered safe and nonhabit-forming. Dr. Avidan says melatonin supplements can be effective for most people: “For all practical purposes, it probably helps.”
However, he cautions, melatonin’s success depends on three things:
When you take it.
How much you take.
If the amount you take is the actual dose written on the box.
These products work best for two kinds of short-term sleep problems.
First, melatonin supplements are useful when you have a circadian rhythm disorder such as jet lag or sleep pattern disruptions resulting from shift work. When used to treat these conditions, melatonin supplements signal to the brain that it is nighttime and the body should start winding down.
In these instances, said Dr. Bhanu Kolla, an associate professor in psychiatry and psychology and a consultant in sleep medicine at the Center for Sleep Medicine at the Mayo Clinic, it is best to use low doses of melatonin supplements. Consult with a doctor if you have any questions or concerns.
The second use for melatonin supplements is when you have difficulty falling asleep and staying asleep. Over all, Dr. Kolla said, melatonin supplements, if taken before bedtime, reduce the time to fall asleep. In one study published in PLOS One, people who took melatonin supplements fell asleep seven minutes faster and increased overall sleep time by eight minutes. Researchers found that overall sleep quality was improved too.
For those addressing sleep regulation issues, experts suggest taking 0.5 milligrams two to three hours before bed. For people with insomnia who need help falling asleep, you can take 5 milligrams 30 minutes before bedtime.
“We try to recommend low doses,” said Dr. Rachel Marie E. Salas, an associate professor of neurology and nursing at Johns Hopkins Medicine. “Again, this is not a prescribed medication, so there is a great deal of variability.”
Most people end up taking melatonin supplements without consulting a physician, Dr. Kolla said. “If you have any major health conditions such as liver failure, renal failure or are pregnant,” he said, it is always best to consult your physician before taking melatonin supplements.
Melatonin supplements can cause dizziness and headaches. Occasionally, people might feel a little groggy during the day, but over all, Dr. Kolla said, melatonin is safe to take. Because melatonin can cause daytime drowsiness, the Mayo Clinic warns that you shouldn’t drive or operate machinery within five hours of taking it.
In contrast to most available sleep medications, melatonin seems not to be habit-forming and typically produces no hangover effects.
Make sure you are getting what the label says
Before you buy melatonin, it’s important to make sure you are getting it from a reputable place. “The F.D.A. does not regulate supplements,” Dr. Kolla said. “So you’re trusting the manufacturer in terms of the dosing.”
A 2017 study in the American Academy of Sleep Medicine found that the melatonin content of dietary supplements often varies widely from what is listed on the label. The study found that even within the same batch of product, variability of the melatonin varied by as much as 465 percent.
Without governmental oversight, there really isn’t a way to ensure the levels of melatonin advertised on the package are accurate. Therefore, Dr. Kolla recommends looking for a GLP (good laboratory practice) or GMP (good manufacturing practice) label on the product. Both labels refer to federal regulations designed to affirm a product has the quality and purity that appear on its label. He says this provides “some assurance that you are getting close to what the label says you’re getting.”
Next steps if you’re not getting relief
Taking melatonin supplements alone to treat insomnia won’t be as effective as taking melatonin and also working on improving your sleep hygiene, Dr. Avidan said. Sleep hygiene refers to creating an ideal environment that promotes conditions good for sleep.
Powering down electronics and avoiding the news two hours before bedtime.
Maintaining a regular sleep schedule.
Eschewing alcohol and caffeine at night.
Trying to get as much natural sunlight during the day as possible to orient your internal clock.
Dr. Avidan suggests that people both try these habits and take melatonin for two to three weeks to see if it helps.
While melatonin “can help with the promotion of sleep, for many it does not,” Dr. Salas said.
If you are stumped as to why melatonin isn’t working for you, Dr. Salas recommends talking to your physician. She says it may also be time to contact a sleep specialist, as there could be other, more serious sleep issues. Dr. Avidan says he and his colleagues are currently taking virtual appointments for anyone living in the United States, so it’s worth inquiring whether a sleep specialist can see you remotely.