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Millions of Americans use melatonin pills to help themselves sleep at night.
Despite the growing popularity of melatonin (recent research finds use of the supplement has grown as much as 500 percent in the past two decades), it’s unclear how many people are using it correctly or getting the results they’re seeking.
“It’s great that people are focusing on their sleep, and melatonin may help,” says Michael Grandner, PhD, director of the Sleep and Health Research Program at the University of Arizona College of Medicine in Tucson. “But it’s often not used correctly,” he adds.
Melatonin is a hormone naturally produced by the brain in response to darkness, and it helps regulate the body’s sleep-wake cycles, or circadian rhythm. Dietary supplements that many people use to help themselves sleep contain synthetic versions of melatonin made in a lab, according to the National Institutes of Health.
While melatonin supplements have long been recommended by the American Academy of Sleep Medicine to help treat certain sleep disorders caused by circadian rhythm disruptions — such as jet lag or sleep issues caused by shift work — recent guidelines also caution against taking it for insomnia or in other situations where it is difficult to fall asleep or stay asleep.
Melatonin may help with jet lag or shift work–related sleep disorders because those situations are typically caused by disruptions to the body’s internal clock, or circadian rhythm. Melatonin (the natural kind your body produces and supplement versions) is one of the hormones that helps set your body’s internal clock and keep body functions on schedule. The supplement doesn’t tend to help with insomnia or other sleep disorders because the underlying causes of those issues are different.
“Insomnia — especially chronic insomnia — is rarely a problem that can be fixed by melatonin,” Dr. Grandner says. “That is not what it’s for.”
Many people still try melatonin for insomnia, Grandner says, in part because they’re worried about the potential for addiction and dangerous side effects with several types of prescription sleeping pills.
Melatonin does tend to have less risky potential side effects than certain prescription sleep aids, Grandner says, but he adds that “melatonin is not a good alternative to prescription sleep medications. It does not work as a sedative and it is ineffective in most cases of insomnia.”
Prescription sleeping pills that are sometimes used to help treat insomnia can come with some serious side effects, like prolonged drowsiness, hallucinations, and addiction, according to Mayo Clinic. In 2019, the U.S. Food and Drug Administration (FDA) added a black box warning to the packaging of certain sleeping pills, including eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien), because of the risks of sleepwalking, sleep driving, and engaging in other activities while not fully awake, which had resulted in deaths among patients taking the medications.
Melatonin is thought to be a safer option, because there is no evidence of such risks. But it’s worth noting that, because it’s a supplement, melatonin hasn’t been tested or regulated as stringently by the FDA, compared with prescription drugs.
Common side effects associated with melatonin use can include headache, dizziness, nausea, and drowsiness, according to Mayo Clinic. Less often, it can cause depression, anxiety, confusion, and disorientation. Melatonin can also lead to potentially dangerous interactions with a wide variety of medications including drugs to manage blood pressure and diabetes, oral contraceptives, blood thinners, and certain antidepressants.
Those side effects are based on short-term usage at low doses, says David Neubauer, MD, an associate professor in the department of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine in Baltimore. And many people today are taking higher doses over longer periods of time, he explains.
Many studies that have found melatonin safe and effective looked at doses of no more than 5 to 10 milligrams at most, one recent study suggests.
“Low doses typically are optimal,” Dr. Neubauer says. People should be taking 3 milligrams at most, and doses as low as 0.5 milligrams to start with, he adds.
Anyone considering melatonin should still talk to their doctor first, says Muhammad Rishi, MD, a sleep disorders specialist at the Indiana University School of Medicine in Indianapolis.
“Like other medications, melatonin use needs to be supervised by a practitioner with experience in treating sleep disorders,” Dr. Rishi says. “Like any other medication, there are certainly appropriate uses of melatonin — and similarly, possible adverse effects if not use appropriately.”
Avoid These 7 Melatonin Mistakes
Doctors are growing increasingly concerned about melatonin because so many more people are using it — often at high doses for long periods of time — without ever seeking medical advice about their sleep issues. Some other common melatonin mistakes doctors see include:
1. Popping a Supplement Without Paying Any Attention to Sleep Hygiene
Turning to melatonin if you notice you’re not sleeping well shouldn’t be your first play, Neubauer says. Try things that don’t involve taking any pills (whether they’re over-the-counter supplements or prescription sleep aids) first.
We can make changes to our routines that help increase our body’s natural melatonin levels, Neubauer says. Bright light suppresses melatonin production, so dimming the lights a few hours before bedtime helps. Avoiding electronic screens, including smartphones, tablets, and laptops, during that time also helps natural melatonin levels rise in the evening.
2. Thinking Melatonin Makes You Sleepy
This is the most common misconception about melatonin, Grandner says. Unlike many prescription sleeping pills, melatonin isn’t a sedative. It works by signaling to your body that it’s nighttime and encouraging your body’s natural sleep-wake cycles to help you power down for the night.
That is why it can help shift your sleep patterns if you’re struggling with things like jet lag or an irregular sleep schedule because of shift work — and it is also why it’s not going to do as much good for insomnia caused by other things.
3. Taking Melatonin Just Before Your Head Hits the Pillow
To facilitate sleep, take melatonin one or two hours before bed.
“It tells your body it’s nighttime,” Grandner says. But that process of your body powering down takes a little bit of time, just like when you naturally start to feel sleepy before bed (because of natural melatonin in the body), it’s not an immediate effect. Take it too close to hitting your pillow, and the effect will start too late.
4. Trying Melatonin in the Middle of the Night
It may be tempting to take this when we wake up and can’t fall back to sleep, but this timing is ineffective because our naturally occurring melatonin hormone levels are at peak levels already, says Naima Covassin, PhD, a sleep researcher at the Mayo Clinic in Rochester, Minnesota.
5. Using Melatonin Every Day
Unless it is prescribed by a physician, melatonin should only be used for temporary problems falling asleep, Dr. Covassin says.
Long-term use typically isn’t recommended, and it can increase the risk of side effects without solving the underlying cause of sleep issues. Other approaches, such as cognitive behavioral therapy, might be better for people with persistent sleep problems, Covassin adds. Rare, more serious side effects can include depression, blurred vision, dizziness, and unexplained bleeding, according to England’s National Health Service.
6. Increasing the Dose if It Doesn’t Work
“More is not necessarily better,” Covassin says. Just like long-term daily use, high doses can increase the risk of side effects. If you don’t get results with lower doses, you should talk to a healthcare provider to sort out what is causing your sleep problems and to determine a more effective treatment plan.
7. Leaving It Out in Plain Sight
People don’t always keep dietary supplements out of reach of children — and that’s a dangerous mistake, says Rishi.
More and more kids are being treated in emergency rooms and hospitalized for melatonin overdoses, and a few have died, Rishi warns. (That’s also according to recent data reported by the Centers for Disease Control and Prevention.)
The Bottom Line
Small doses of melatonin for problems like jet lag or a shifted sleep schedule are fine for a short period of time and with a go-ahead from a healthcare provider, Rishi says.
But taking high doses night after night hasn’t been proven safe or effective in clinical trials, and the health effects of long-term exposure to melatonin supplements are unclear, he adds.
“Melatonin use is becoming more common, as it is widely available as a supplement, it is cheap, and it is available without a prescription,” Rishi says. “It is often mistakenly thought to be absolutely safe — I certainly find it very alarming.”
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