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Product Review: Melatonin Supplements Review
 

Initial Posting: 5/15/15  Last Update: 1/13/17
Melatonin Supplements Reviewed by ConsumerLab.com Sections: Jump to a section by clicking on its name.
Summary: What You Need to Know About Melatonin Supplements
  • Melatonin supplements can help you fall asleep when taken about 45 minutes before bedtime. (See "What It Does")
  • Melatonin is a hormone; use it only as needed, not every night. Try the lowest dose that will work for you, starting with about 1 mg or less. If that doesn't work, try 3 mg. Some products contain greater amounts, such as 5 or 10 mg, which may be more than you need. Timed-release products may help you not just fall asleep but also stay asleep better, but they won't help you stay asleep as well as a prescription sleep medication. (See ConsumerTips: "What to Consider When Using").
  • ConsumerLab.com's most recent tests identified many high-quality products, although the cost of obtaining an equivalent amount of melatonin ranged 100-fold, dosage ranged 30-fold, and there are several forms (tablet, liquid, lozenge) — so it is important to compare products and prices. See the top choices of products "Approved" by ConsumerLab.com.
  • Short term use of melatonin supplements appears to be safe for adults. However, melatonin can potentially affect blood pressure in some individuals and may affect testosterone and estrogen levels (See "Concerns and Cautions").

What It Is:
Melatonin (N-acetyl-5-methoxytryptamine), is a hormone produced by the pineal gland in the brain from the amino acid tryptophan. Some foods contain extremely tiny amounts of melatonin. The melatonin in dietary supplements is generally manufactured synthetically or extracted from plants; however, it is chemically identical to the melatonin in your body.

What It Does:
For Trouble Falling Asleep and Related Conditions:
Melatonin is known to play a role in regulating the body's natural wake-sleep cycle (circadian rhythm), triggering sleep. Levels of melatonin increase as exposure to light decreases, and decrease as light exposure increases. On this basis, it has been proposed as a treatment for people whose natural sleep cycles have been disturbed.

Melatonin has shown promise in the treatment of children with chronic sleep problems, children with autism, and in people withdrawing from sleeping medications. It has been shown to improve sleep in people with diabetes, schizophrenia, Alzheimer's disease, Parkinson's disease, and in those who are hospitalized.

Some benefit has been seen in sleep disorders relating to blindness, delayed sleep phase syndrome (DSPS, a condition in which people cannot fall asleep until early morning), and delayed weekend sleep pattern (difficulty falling asleep Sunday night after staying up late Friday and Saturday night).

Inconsistent evidence suggests that it may aid sleep in jet travelers who have crossed several time zones. Results have not been impressive in treatment of sleep disorders related to shift work, general insomnia for adults, or insomnia in seniors.

There is some evidence that melatonin may be helpful in reducing anxiety and aiding sedation before medical procedures. Two reviews of published clinical studies concluded that melatonin taken around 1 to 1 ½ hours before surgery reduces anxiety and enhances sedation compared to placebo, and, in some cases, as well the medication midazolam. In the studies reviewed, doses ranged from 3 mg to 15 mg of melatonin, and no adverse events associated with taking melatonin were reported (Yousaf, Anesthesiology 2010; Hansen, Cochrane Database Syst Rev 2015). In a clinical study (only the abstract appears to be available) in children age of 14 and younger, a dose of between 0.5 and 5 mg (0.5 mg/ per kg) taken 30 minutes before a blood draw was found to significantly reduce anxiety and pain levels compared to placebo (Marseglia, J Biol Regul Homeost Agents 2015). 

There is some evidence that melatonin may help improve sleep in people with tinnitus. One clinical study also suggests it may improve symptoms of tinnitus. The study compared melatonin to drug treatment (sulpiride) or placebo and found that people who took 3 mg of melatonin daily for one month had a 40% reduction in perception of tinnitus, compared to a 56% reduction in those taking the drug and a 22% reduction in those taking a placebo (Lopez-Gonzalez, J Otolaryngol 2007). Those who took sulpiride and melatonin had an 81% reduction in perception of tinnitus, suggesting that melatonin may enhance the effects of the drug.

Melatonin was also shown to help women fall asleep during the three months after having breast cancer surgery. Those who received melatonin (6 mg each night, one hour before desired bedtime) had 4% greater sleep efficiency (the percentage of time asleep while in bed for sleep) and slept an average of 37 minutes longer per night than those who received placebo — although there was no significant difference in self assessments of sleep quality. Interestingly, only 1 out of the 28 patients treated with melatonin dropped out of the study, compared to 10 out of the 26 given placebo. The study also aimed to assess cognitive function (which has been known to decline) during the post-surgical period, but there was no decline in either group (Hansen, Intl J Breast Cancer 2014).

Melatonin may be of some help to people with atopic dermatitis -- a common type of eczema characterized by itchy inflammation of the skin and affecting up to 10% of adults and 30% of children. A placebo-controlled study in children and adolescents with atopic dermatitis found that taking 3 mg of melatonin at bedtime every night for 4 weeks resulted in about a 20% reduction in symptoms and a 21.4 minute decrease in the time to fall asleep, with no adverse effects. It is unclear if or how melatonin may have modulated inflammation, as it did not affect measures of immune function, such as immunoglobulin E levels (Chang, JAMA Pediatr 2015). (See the Eczema article for more about this condition and other supplements used to treat it.)

Other Uses:
Other potential uses for melatonin include reducing
symptoms of tardive dyskinesia (a potential long term side-effect of anti-psychotic medications), nicotine withdrawal symptoms, irritable bowel syndrome, dyspepsia, and cluster headaches. There is preliminary evidence that melatonin may also be useful as an adjunct to conventional therapy in treating some forms of cancer, reducing side effects or enhancing drug efficacy. 

Melatonin also has antioxidant properties. It has been said that melatonin levels drop with age and, on this basis, melatonin has been recommended as an "anti-aging" supplement. However, evidence suggests that melatonin levels do not, in fact, decline with age.

Several small studies suggest melatonin may help reduce certain symptoms of irritable bowel syndrome (IBS), although, interestingly, it does not appear to reduce sleep disturbance. A small study among women with IBS found that 3 mg of melatonin taken every night before bedtime for two months reduced abdominal distension and pain, and abnormal sensations (urgency, strain, incomplete bowel movement) compared to placebo, although there were no changes in stool consistency or frequency and no improvements in sleep or mood (Lu, Aliment Pharmacol Ther 2005). Two other studies using the same dose of melatonin taken at bedtime found similar results, with significant improvements compared to placebo in overall IBS scores (45% vs. 17% improvement) and quality of life scores (44% vs. 15% improvement) (Saha, J Clin Gastroenterol 2007), and reductions in abdominal pain scores (2.35 vs 0.70) (Song, Gut 2005), but no improvements in sleep.

A placebo-controlled study among 178 men and women diagnosed with migraine (with or without aura) found that 3 mg of melatonin taken daily for three months was modestly effective in reducing the number of days of migraine headache per month (from an average of 7.3 prior to treatment to 4.6 during the last month of treatment; placebo fell from 7.3 to 6.2 days). As part of the study, a group of patients received 25 mg daily of amitriptyline, an antidepressant used to prevent migraine. This was also modestly effective (7.2 days of headache falling to 5.0 days) but not statistically better than melatonin and it caused more side effects, including weight gain (Goncalves, J Neurol Neurosurg Psychiatry 2016).

Research has begun to suggest that melatonin may have a positive effect on the skeleton. A placebo-controlled study in Denmark among post-menopausal women with bone loss given 1 mg or 3 mg of melatonin every night for one year, showed small, but significant, improvements in bone density of the leg and spine. Most notably, at the 3 mg dose, bone density in the neck of the femur in the hip increased relative to placebo by 2.3%, and inner bone thickness in the tibia (lower leg) and lumbar spine increased by 2.2% and 3.6%, respectively. All participants were also given calcium (800 mg) and vitamin D (800 IU) daily; while this increased calcium loss in the urine among those receiving placebo, it did not among those receiving melatonin (Amstrup, J Pineal Res 2015). The study did not determine the effect on fractures (see Concerns and Cautions); more research is needed to determine if daily melatonin is beneficial for women experiencing bone loss. Interestingly, further analysis of this year-long study showed that, in women with a good quality of sleep, melatonin had no effect on sleep quality; however, in poor quality of sleep, small doses of melatonin trended towards improving quality. There was no effect on overall quality of life. The study also found no hangover effect affecting balance and muscle function (Amstrup, Nutrition J 2015).

See the ConsumerTips section of this review for more information about suggested dosage and concerns and cautions. More information about the clinical uses of melatonin can be found in the melatonin article in the Natural Products Encyclopedia on this web site.

Quality Concerns and What CL Tested For:
A study of 30 melatonin supplements from Canada found that the majority (71%) were not within 10% of the amounts claimed on labels. Products with the most variability were chewable tablets (one contained 478% of the labeled amount), combinations with herbs (one contained 83% less than claimed), and capsules. Products least likely to vary from labels were melatonin-only, particularly in the form of regular or sublingual tablets, or as liquids
. Tiny amounts of serotonin were found in 26% of the products, in most cases likely due to natural phytoserotonin in herbal ingredients (Erland, J Clin Sleep Med, 2017). (Note: None of the products selected by ConsumerLab.com for this Review (below) are chewable tablets or include herbal ingredients.)

Neither the FDA nor any other federal or state agency routinely tests supplements for quality prior to sale. Consequently, ConsumerLab.com tested melatonin products to determine if they contained listed amounts of melatonin and did not contain unacceptable levels of lead, a potential contaminant. Standard tablets and caplets were also tested to be sure that they would disintegrate ("break apart") properly (See Testing Methods and Passing Score for more information).

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