Written by: Jacob Liu and Edited by Kevin Liu
A pill that treats insomnia, whether to recover from jet lag or to fix some other alteration to one’s sleep schedule, sounds like some miracle remedy, right? Ever since it was discovered in 1958, melatonin has been sold over the counter in the United States and Canada as a dietary supplement with intentions of assisting people with controlling their circadian rhythm cycles [1]. However, melatonin is not approved by the US Food and Drug Administration (FDA) for any medical usage [2]. To this day, there exists a questionable murkiness on the efficacy of melatonin and its role in correcting human sleep patterns and cycles, as melatonin is continually still utilized and marketed as a sleeping aid. Thus, if there is the possibility that melatonin does not actually help us get to rest faster, better, and for longer, then why do we still find it in supermarkets and pharmacies all over the country?
In order to evaluate the efficacy of melatonin and its evidence of benefit, one must first possess a basic understanding of the mechanism behind melatonin and how it works in the body. Melatonin is a hormone that is produced naturally by the pineal gland, a small pea-shaped structure deep in the center of the brain. It signals the hypothalamus, which is the coordinator of the body’s circadian rhythm [3]. The natural production of melatonin is dependent on the signalling of low light from the retina. Blue light from electronics such as phone devices have been shown to disrupt the retina’s detection of low light and by extension, the beginning of natural melatonin production [4]. That being said, the product that is sold over the counter is indeed the same molecule naturally produced by the pineal gland. As such, it serves the same purpose; as it is absorbed into the bloodstream, it signals the hypothalamus to run its course of influencing sleep patterns.
To this end, some research has been conducted into determining the effectiveness of melatonin, and a study published in 2017 concluded that the average onset of sleep with the use of melatonin compared to prescribed medications such as Zolpidem and temazepam demonstrated a difference of mere minutes. People using melatonin supplements had an onset of sleep of about six minutes, Zolpidem at 18 minutes, and temazepam at 30.9 minutes [2]. Furthermore, the National Institutes of Health (NIH) has conducted investigations into the possible adverse side-effects of melatonin supplements, revealing issues such as headaches, dizziness, nausea, and even drowsiness [5].
With the difference being mere minutes, it creates the question of if we are creating more problems through the synthesis of a different supplement. With minimal benefit and potentially dangerous side effects, scientists are studying alternative paths. Weighing the benefits of a drug and its side effects is not a new process; cough syrup in the past contained dangerous amounts of the opioid codeine, previously a “gold standard” for cough suppressant at the cost of deadly opiate addictions [6]. Concerns about melatonin should be considered as well in order to bring it under further review and conduct additional research, which has been underway in order to reevaluate and direct it in a more controlled manner for those who elect to utilize it for its advertised positive effects.
References:
- Auld, F., Maschauer, E.L., Morrison, I., Skene, D.J., Riha, R.L. (2016). Evidence for the efficacy of melatonin in the treatment of primary adult sleep disorders. Sleep Medicine Review, 34:10-22.
- Matheson, E., Hainer, B.L. (2017). Insomnia: Pharmacologic Therapy. American Family Physician, 96: 29-35.
- Savage, R.A., Zafar, N., Yohannan, S., Miller, J.M. (2021). Melatonin. StatPearls Publishing, 15:12-21.
- Tähkämö, L., Partonen, T., Pesonen, A. (2019). Systematic review of light exposure impact on human circadian rhythm. Chronobiology International, 36:151-170.
- “Melatonin: What You Need to Know.” National Center for Complementary and Integrative Health, National Institutes of Health, Jan. 2021, www.nccih.nih.gov/health/melatonin-what-you-need-to-know/. Accessed 11 Oct. 2021
- Bolser, D.C., Davenport, P.W. (2007). Codeine and cough: an ineffective gold standard. Current Opinion in Allergy and Clinical Immunology, 7:32-36.