Melatonin is Misunderstood (Especially By Those Who Use It Most)
When I was in my early teens I had some trouble falling asleep. A combo of overactive thoughts and poor sleep hygiene led me to melatonin, an easy answer that was natural and available easily over the counter (so I thought). I took it most nights for a while. Some nights I took a lot, probably over 30mg. I was young and naïve with the thought ‘more equals better sleep’. I wish someone had told me then what I know now; that melatonin isn’t a sleep drug. It’s a hormone and I was using it wrong like so many others currently still do.
So, whether you use melatonin yourself, have thought about it, or are just curious about the gummy supplements your roommate or significant other pops like candy before bed, this post is for you.
I’m not trying to write a hit piece or an ad for anything. If anything, it’s similar to my recent creatine post about helping people understand when taking a supplement actually makes sense. It’s about who could benefit most from this and when, who should stay away, and who straight up won’t benefit by using this specific intervention to help with their sleep in the long term.
Melatonin is a Hormone, not a Sleep Drug
This might be one of the most important things to understand before going further. Many of you may already know this, but melatonin isn’t a sedative. It’s not like Ambien or Benadryl where it makes you drowsy or knocks you out. It’s really not even designed to help you fall asleep faster.
Melatonin is a circadian signaling hormone that tells the body that it’s nighttime. Not bed time, just that the day is winding down. In healthy people melatonin levels begin rising naturally a couple of hours before bed when the lights dim (the process is light sensitive). This basically helps to get the body ready for the nightly process of lowering the core body temperature a couple degrees and slowing the metabolism.
This means melatonin tends to work best when it’s used to shift or reinforce that internal circadian clock, not as a last-minute fix taken after midnight because a person can’t fall asleep. It seems particularly helpful for those with delayed sleep phase syndrome (night owls who can’t sleep til after 2-3am but need or would like to sleep earlier), shift workers, and people experiencing jet-lag1,2.
Outside of those uses, the evidence for efficacy honestly starts to look fuzzier. That’s where the problem is, because most people are popping melatonin for general or transient insomnia, which is really a misuse of it. In clinical trials, the average improvement in sleep onset is only about 5-10 minutes in difference from placebo, and total sleep increases by less than 20 minutes per night1,2. Which isn’t quite nothing, but definitely isn’t what people expect. And that effect is also highly variable. Someone more prone to expectation effects or placebo effects may knock out quickly, but that’s not the melatonin.
To make things worse for the average user, the timing and dosages in commercial products are often inaccurate, with some doseges being off by as much as 478% from the label3. Melatonin production in the body comes with a small peak (about 0.1 to 0.3mg per night), but many gummy supplements start around 3mg and go up to 10mg. This can result in levels staying elevated into the morning, in turn worsening sleep by shifting their circadian rhythm in the wrong direction from what was desired3,4.
If you’re looking to shift your internal clock, like adjusting to a new time zone or trying to sleep a bit earlier after years of gaming til 2am, melatonin might help. A low dose of about 0.3-1.0mg taken a couple of hours before bedtime is your best bet5. But even then, this is just a gentle nudge in the right direction and is not the type of supplement to use daily for a long time.
It Won’t Help Everyone, but Something Else Might Help You
First and foremost, fixing a deep-seated sleep issue is very much a conversation to have with a doctor. I can lay out the evidence as I see it and say who does and doesn’t seem to benefit, but this next section is less of a “try this at home” and more of a guide of what’s worth bringing up to a healthcare provider. This post is not prescriptive beyond saying “melatonin won’t help general insomnia.”
If you’ve got insomnia that is chronic or tied to anxiety, racing thoughts, or stress, something like CBT-I (Cognitive Behavioral Therapy for Insomnia) has quite a bit of evidence as a successful option. It’s a structured, behavioral treatment that has a person work on changing the thought patterns and habits that interfere with their sleep. And it seems to work better than most pills6!
There are also going to be cases where a person can benefit from medications (this is very much a conversation to have with your doctor, not an internet stranger). But for a bit of context, drugs like gabapentin are sometimes used when anxiety, restless legs, or chronic pain are part of the issue with falling asleep. In a double-blind, placebo controlled trial of transient insomniacs, gabapentin was shown to increase total sleep time, reduce nighttime awakenings, and increase time in deep sleep without any impairment to function during the following day7. It also doesn’t show the kind of abuse profile of something like Ambien.
Fixing Sleep Hygiene Might Not Be a Cure-All
Plenty of influencers throw around the term sleep hygiene along with things to do like avoiding blue light and screen time, having a cold room, and not having caffeine too late in the day. Some of this matters (especially the caffeine part), but none of it will work if your actual problem isn’t just tied to circadian timing. Anxiety, chronic pain, or a completely off-track circadian rhythm require much more than sleep hygiene or melatonin. But for a simple, low-effort place to start with getting your sleep schedule in order, try to protect a nightly time to start winding down. Come up with a schedule, maybe reading a couple of chapters of a book. That’ll likely do more for your sleep than a 5mg melatonin gummy.
And if it’s really messing with your life, please go see a doctor and try to be referred to a sleep specialist. There are options to help better understand your specific problem like sleep studies and take-home overnight EEGs. Sleep isn’t a luxury, you deserve better than facing exhaustion day after day.
Citations
1. Ferracioli-Oda E, Qawasmi A, Bloch MH. Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders. PLoS ONE. 2013;8(5):e63773. doi:10.1371/journal.pone.0063773
2. Hamel C, Horton J. Melatonin for the Treatment of Insomnia: A 2022 Update. Can J Health Technol. 2022;2(5). doi:10.51731/cjht.2022.338
3. Cohen PA, Avula B, Wang YH, Katragunta K, Khan I. Quantity of Melatonin and CBD in Melatonin Gummies Sold in the US. JAMA. 2023;329(16):1401-1402. doi:10.1001/jama.2023.2296
4. Gooneratne NS, Edwards AYZ, Zhou C, Cuellar N, Grandner MA, Barrett JS. Melatonin pharmacokinetics following two different oral surge-sustained release doses in older adults. J Pineal Res. 2012;52(4):437-445. doi:10.1111/j.1600-079X.2011.00958.x
5. Cruz-Sanabria F, Bruno S, Crippa A, et al. Optimizing the Time and Dose of Melatonin as a Sleep-Promoting Drug: A Systematic Review of Randomized Controlled Trials and Dose−Response Meta-Analysis. J Pineal Res. 2024;76(5):e12985. doi:10.1111/jpi.12985
6. Walker J, Muench A, Perlis ML, Vargas I. Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer. Klin Spetsialnaia Psikhologiia Clin Psychol Spec Educ. 2022;11(2):123-137. doi:10.17759/cpse.2022110208
7. Rosenberg RP, Hull SG, Lankford DA, et al. A Randomized, Double-Blind, Single-Dose, Placebo-Controlled, Multicenter, Polysomnographic Study of Gabapentin in Transient Insomnia Induced by Sleep Phase Advance. J Clin Sleep Med. 10(10):1093-1100. doi:10.5664/jcsm.4108