Can’t sleep? You’re not alone, especially if you’re an older adult. According to Sleep Foundation, 40 to 70% of older adults have chronic sleep issues, and that may be just the tip of the iceberg, as many cases go undiagnosed.
Many turn to sleep medications for help, and one of the most common is melatonin. According to a recent study published in the Journal of the American Medical Association, the number of American adults taking melatonin as a sleep aid doubled from 1998 to 2018. The study also reported that since 2006, the number of adults taking higher than the recommended dose of 5 milligrams per day more than doubled.
Since 2006, the number of adults taking higher than the recommended dose of 5 milligrams per day more than doubled.
Melatonin use in the United States is still considered low, but the JAMA study of more than 55,000 adults showed an increased use rate from 0.4% in 1999 to 2.1% by 2018.
Because melatonin is natural, it sounds like a better choice than a sedative or hypnotic pharmaceutical. However, many people misunderstand melatonin—a substance that can be made synthetically in laboratories for supplements.
While many people lump melatonin into the category of herbal supplements or vitamins, it’s actually neither. Instead, it’s a hormone made naturally in the body’s pineal gland. Its purpose is to regulate sleep cycles, and certain conditions, like darkness, can trigger its production.
While many people lump melatonin into the category of herbal supplements or vitamins, it’s actually neither.
Melatonin is not a sleeping pill, noted Michael J. Breus, PhD, a clinical psychologist, diplomate of the American Board of Sleep Medicine and fellow of the American Academy of Sleep Medicine.
It’s a “circadian regulator,” he said, “meaning it does not make you fall asleep; it tells your internal clock it’s bedtime. These are very different things, and nobody seems to know it. Melatonin is a hormone. Would you walk down to the local health food store and get testosterone? No.”
Uses and doses of melatonin
Melatonin does have its uses. Breus said he recommends melatonin to help adults more quickly recover from jet lag, when there’s a known melatonin deficiency, and when someone is doing shift work and needs to adjust sleep patterns. Typically, these involve short-term use.
Melatonin is relatively safe for short-term use but, like any supplement, can have side effects like headaches, dizziness, agitation and more—especially with long-term use.
Melatonin is relatively safe for short-term use but, like any supplement, can have side effects.
What’s more, melatonin is regulated as a dietary supplement, so it’s not as carefully tested as a drug would be. A 2017 study found that many melatonin supplements contained a higher dose than what was listed on the label, and many contained serotonin, another hormone that can have harmful side effects. This means those adults using more than the recommended 5 milligram dose in the JAMA study might be taking even more melatonin than they realize.
For older adults, a safe dose of melatonin may be even lower than 5 milligrams. According to a Sleep Foundation article, melatonin levels decline as we age, making older adults more sensitive to melatonin. The foundation cites a study that found melatonin levels stayed higher in older adults taking supplements, resulting in daytime sleepiness.
Breus insisted the actual recommended dose is 0.5 to 1.5 milligrams, regardless of age. He cautioned against taking too much, noting the body continues making melatonin when taking supplements, so people could end up with an excess of the hormone in their systems.
Possible dangers of melatonin use in older adults
For seniors and people of all ages, melatonin can interact with certain medications for depression, migraines, blood pressure, birth control and diabetes. Taking too much melatonin or taking it with the wrong drugs can cause diarrhea, muscle rigidity, seizures and even death.
There’s also a tenuous relationship between melatonin and dementia: According to research revealed at the 2019 Alzheimer’s Association International Conference, a possible relationship exists between the use of sleep medications and the risk of dementia. Although the research includes all types of sleep aids and not solely melatonin, it does find an increased risk of dementia in older adults who frequently use sleep medications. Whether the link is due to the sleep problems themselves or the medications is unknown.
[Research] does find an increased risk of dementia in older adults who frequently use sleep medications. Whether the link is due to the sleep problems themselves or the medications is unknown.
For seniors already diagnosed with dementia, a 2015 American Academy of Sleep Medicine clinical practice guideline recommends against melatonin and other sleep medications due to increased risk for falls and other adverse effects.
Medication alternatives to melatonin
Sleep aids, melatonin included, can often help for short-term sleep problems, but there are always risks and possible side effects with medications.
Before reaching for a pill, it’s a good idea to explore these tips from Breus to help seniors sleep better, including:
- Maintain a regular sleep schedule. Try to go to bed and wake up at the same time every day. This can be difficult for retired people who are no longer on a schedule, but it does help maintain the body’s sleep and wake rhythms.
- Follow good sleep hygiene. This means avoiding caffeine and large meals at least a few hours before bed, avoiding electronic devices at least an hour before bed, and ensuring time to wind down before bed.
- Avoid naps—or at least naps late in the day. If your loved one can take a quick nap and still sleep at night, this is fine, but encourage them to stay away from naps longer than 90 minutes, and help them try to get a nap in before 3 p.m.
- Get enough sunlight. It’s a good idea to go outside or be near a window within 15 minutes of waking up. This gives your body the signal it’s time to be awake.
- Don’t stay in bed if you can’t sleep. Instead, get up and do something relaxing. Write in a journal, read a book or practice some relaxation techniques. Then, return to bed when you’re sleepy. This way, you keep your bed as a place of relaxation and sleep, rather than a place you lie awake and possibly stress about sleep.