Melatonin/Is it useful/ Is it safe?

Melatonin is a hormone that occurs naturally in the body. It is produced in an area of the brain known as the pineal gland. Melatonin is released and helps control the body's circadian rhythm. It is not a sedative, but works in combination with light to get the body drowsy when it is time for sleeping. It is not habit forming. It is interesting to note that melatonin production tends to decline with age.

Some studies suggest that melatonin may help adults and children fall asleep faster and improve the quality of sleep. It is best to give it about 30-60 minutes before bedtime. There are no known ill effects but there is little research into the safety of long-term melatonin use in children. Ongoing studies are taking place to see if it is useful for treatment of migraines. The neurologists don’t seem to have concerns about safety, but until study results are available, many people are reluctant to give it an official recommendation as a routine sleep aid.

Melatonin is becoming more widely available with various pediatric friendly options. This makes melatonin easier to access but unfortunately there are no clear dosage or safety guidelines in place. For routine sleep I would start my focus on some common sense tips

Have a regular bedtime routine. Do some soothing activities, make the room progressively darker and darker. Don’t include any electronic devices as part of the bedtime ritual. The blue lights that are emitted are disruptive and should be avoided for at least an hour before bedtime.

Going to bed and waking up at the same time can get the body into a healthy rhythm. You may hear this referred to as 'sleep hygiene'.

Keep the bedroom cool. According to the National Sleep Foundation the ideal bedroom temperature is actually between 60 and 67 Fahrenheit. You can bump that up a bit for infants and toddlers to 65-70, but cooler rooms are better for sleeping.

If you have low iron or vitamin D levels, that can impact sleep, so if you are having insomnia, that is another factor to check out. A couple of nights of melatonin to help get into a good habit is probably quite safe. I would just avoid having it become a habit.

Not a day goes by these days without getting a call or email asking if melatonin is a viable option. Most of the families calling about it are planning travel and have seen it mentioned out there in parent chat rooms.  All of the package directions have that ‘hot potato’ phrase “Please check with your doctor.” The problem is that many doctors have different opinions and those are generally based on gut instinct. Studies are ongoing, but we simply don’t have solid data.

In our office, Dr. Schwanke feels that a few doses are likely safe but not uniformly effective. Dr. Hurd agrees with him that she isn’t sure that it is the magic wand that parents are hoping for.

Dr Anne would skip the melatonin and try the natural calm gummies, which are simply magnesium. These help get you a good night sleep (as well as a great poop): I am a big fan of these as well.

Dr. Kaplan, over at Town and Country Pediatrics, says that it is fine for her patients who want to use it to get over a few days of jet lag. If there are longer term sleep issues, it is worth seeing the doctor or being referred to a specialist.

Nurse Judy’s two cents:

The best approach to beating jet lag is to focus on hydration, and get as much light as possible when you land. If you are arriving someplace after 2 pm, try hard to stay awake and then crash early. If you are getting in earlier than that, a short nap might be necessary.

I tend to agree with Dr Kaplan here and wouldn't worry too much about using the melatonin for a night or so. According to many of my patients who have tried it, giving a dose of melatonin before the new bedtime does seem to be helpful. I would not suggest it for kids under 3 years old or for breastfeeding moms. For kids 3-5, start with 1 mg 30 minutes before bedtime. Ages 6-12 can take 2 mg and over 12 can take 3 mg

Melatonin might interact with some medications, so for you grown ups out there I am going to pass the hot potato and have you check with your adult physician. Medications that you need to pay attention to include some contraceptives, blood pressure medications, diabetes medications and most sedatives.

Thank you to the wonderful Dr Rothman, my 'go to' pediatric dentist, for sharing this additional tidbit.
In the anesthesia literature it has been shown that giving melatonin does not increase depth of sedation during a procedure and therefore may be helpful in getting a good night's sleep prior to dental work, thereby decreasing anxiety.
Keep this in mind and chat with your dentist if you have a procedure coming up.