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Melatonin: A Trusty Travel Companion?

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 11 - NOVEMBER 96


For the past year and a half, many people have been using melatonin, a hormone sold as an over-the-counter dietary supplement, to self-treat a host of problems varying from insomnia and jet lag to heart disease and acquired immunodeficiency syndrome (AIDS). Athletes and business travelers in particular are using melatonin to try to avoid jet lag and stay in top form.

Melatonin, which is secreted by the pineal gland, helps induce sleep as the eyes register nightfall. Over-the-counter melatonin is produced synthetically.

Medical experts say melatonin doesn't deliver on all of manufacturers' claims, but it does seem to improve sleep (1) and help fight jet lag (2). Dale R. Grothe, PhD, a psychopharmacologist at the National Institutes of Health in Bethesda, Maryland, urges caution when interpreting manufacturer information. "It's considered a nutritional or dietary supplement, and since the Food and Drug Administration doesn't regulate these products, manufacturers can promote it pretty much any way they want," Grothe says.

Al Lewy, MD, PhD, a professor of psychiatry at Oregon Health Sciences University in Portland, has studied melatonin's use in "phase shifting," the practice of changing the body's sleep cycle. "There are no reasons for taking melatonin other than shifting your clock and, in some people, promoting sleep," he says. "The other claims for melatonin have not been substantiated in humans."

Meanwhile, some physicians report seeing their patients benefit from melatonin. Among them is Ray Sahelian, MD, a family practice physician in Los Angeles and author of Melatonin: Nature's Sleeping Pill, who is enthusiastic about melatonin's benefits and sees the craze continuing. "I've probably talked to and surveyed more people than anyone in the world on this topic," he says. "I have no doubt melatonin use will increase. It works very well and is safe for occasional use." Sahelian discourages the use of melatonin by patients who are pregnant, breast feeding, or depressed.

The manufacturers' recommended dose for mild to moderate sleep disorders is 0.5 to 3 mg 1 hour before bedtime. Adjusting the body clock, however, is more complex. For west-to-east flights, Lewy suggests taking a small (0.5 mg) dose in midafternoon on the day before and the day of travel to simulate an earlier sunset. For east-to-west flights, he suggests taking the same dose in the morning to delay the dawn. For after arrival, bedtime is often, but not always, the correct time of administration. Patients should be monitored when beginning the use of melatonin, when dosages are increased, and when they report any side effects.

Since the price of melatonin is relatively low—60 pills generally sell for anywhere from $5 to $10—consumers are likely to side-step the physician's office and treat themselves. With melatonin, 2 mg is considered a "hefty" dose. Sahelian says that in his office experience, common side effects have included morning grogginess and vivid dreams with occasional nightmares. Single-dose forms as high as 10 mg are currently available on the market.

When advising patients about melatonin use, caution is essential, says Grothe. "There are multiple companies making melatonin, and we can't be sure that every lot number or every batch is pure and safe," he says. "Right now, it's more hype than science."

References

  1. Zhadanova IV, Wurtman RJ, Lynch HJ, et al: Sleep-inducing effects of low doses of melatonin ingested in the evening. Clin Pharmacol Ther 1995;57 (5):552-558
  2. Claustrat B, Brun J, David M, et al: Melatonin and jet lag: confirmatory result using a simplified protocol. Biol Psychiatry 1992:32(7):705-711

Sharon Grafius
Wayzata, Minnesota


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