The Insomnia Blog by Sleep Doctor Michael Breus, Ph.D.

Melatonin: Miracle or Mistake?

In this day and age, when sleep rhythms can go haywire at the drop of bad news, questions about sleep aids are a hot topic. They are no longer confined to those who are presumed to have oddball sleep cycles, such as jet setters and shift workers.

I get a lot of questions about melatonin in particular, since many supplement companies and health food stores will tout that melatonin is a “natural” sleeping aid. Given the availability of this supplement today, you’d presume it’s safe and effective. But is it really?

What’s better, taking a melatonin supplement to help you go to sleep on a crazed Monday night or going for a “PM” version of a pain reliever? Melatonin is a hormone your body produces to help it regulate your sleep-wake cycles, but taking additional melatonin in the form of a supplement isn’t as good of an idea as you might think.

• And it’s not a regulated drug under the FDA.
• No other hormone is available in the United States without a prescription.
• In Europe, melatonin is only available by prescription.

So here’s the 101 on how natural melatonin—the kind produced by your body—works. When the sun sets and darkness sweeps over, a pea-sized structure located deep between the hemispheres of your brain called the pineal gland begins to secrete this hormone—preparing you for bed.

As melatonin levels in the blood rise, you begin to feel less alert and sleep becomes more inviting. Melatonin levels stay elevated for about 12 hours, falling back to low daytime levels by about 9 a.m. Daytime levels of melatonin are barely detectable.

The precise mechanism of melatonin secretion is not well-known. We do know, however, that melatonin isn’t just about sleep-wake cycles. It’s been shown to:

• Help regulate the female reproductive cycle and may also control the onset of puberty.
• Children who take melatonin can suffer a delay in sexual development. (So never ever give a child a melatonin supplement.)
• Studies have pointed to melatonin’s role in regulating blood flow, specifically in constricting coronary arteries.
• It’s been suggested that it can increase depression in people prone to the illness.

A hormone with all of these possible effects—even though it’s “natural”—isn’t something you should be taking without the specific recommendation of your doctor.

Most commercial products are offered at dosages that cause melatonin levels in the blood to rise to much higher levels than are naturally produced in the body. So taking a typical dose (1 to 3 mg) may elevate your blood melatonin levels to 1 to 20 times its normal state. If you take it at the wrong time of day, you may reset your biological clock in an undesirable direction.

How much to take, when to take it, and melatonin’s effectiveness, if any, for particular sleep disorders is only beginning to be understood. Remember Melatonin is a sleep regulator not a sleep inducer, so it really should not be used as a sleep pill. In the future, we may find several useful applications of melatonin.

You’re better off regulating your own sleep-wake cycles in a genuinely natural way by:

• exposing yourself to light during the day (preferably sunlight),
• engaging in physical activity regularly,
• practicing good sleep hygiene.

Remember: Your body will reset its own internal clock with the proper exposure to light at the right time. (And you shouldn’t need a PM formula, either, unless you truly do need an occasional fix for quelling muscle aches or other pains that can prevent you from going to sleep easily. Just don’t make this a habit every night.)

Bottom line: better sleep hygiene, better time going to sleep. And better moods the next day. Melatonin, on its own, is not a sleeping pill.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

Click here to see Dr. Breus's list of recommended sleep products. Click here to order Beauty Sleep on Amazon or Kindle.

Hope for Jet Setters and Shift Workers

Nothing is more frustrating than needing to be and feel awake and alert, but you just can’t for whatever reason. Although life is usually very busy for those who have regular 9 to 5 jobs and families to run, it’s quite different for people whose jobs have them covering odd shifts or traversing the country through different time zones and long journeys (ahem business travelers).

I admire the people who can continue to live “like that”—working when most of the world is sleeping or working mostly from the road or an airport. It’s very difficult not only to sleep well (and regularly), but also to eat well and find a routine that jibes with your family life, too.

And there are more people who fall under this category than you might think: According to U.S. labor statistics, about 20 percent of the workforce or about 19.7 million U.S. workers are early risers who begin work between 2:30 a.m. and 7 a.m.m.

That kind of timing can throw any body rhythm out of whack—a rhythm that’s essential to feeling sleepy or awake at the right time. Let’s not forget about others like traveling athletic teams, tourists, and experts in their field who are called to speak, consult, and interview across the country. Back when I was rigorously promoting my book, my schedule fit the bill! I’m thankful I don’t have to do that 365 days a year, so I’m sympathetic to those who do.

Which is why I was happy to read about a new study this week that offers hope for the lagging jet-setters and people dedicated to irregular job hours. Turns out that an insomnia drug that helps the body produce more melatonin, the sleep hormone that starts pumping when night falls to signal your body that it’s time to go to sleep, may improve Zs for jet-lagged travelers and shift workers. The drug is called tasimelteon, or VEC-162, and it’s just been shown to help people sleep longer and more deeply than a placebo.  

So why not just take melatonin as a supplement instead? Given the availability of this supplement today, you’d presume it’s safe and effective.

It’s true that melatonin is a hormone your body produces to help it regulate your sleep-wake cycles, but taking additional melatonin in the form of a supplement can be difficult. It’s not a regulated drug under the FDA, so without knowing your source, it could be trouble.

Having to take a drug at all to maximize sleep quality isn’t ideal, but in many cases it’s better than the alternative. If only the entire world could keep operating if everyone slept at night and work and played during the day. Maybe the cavemen—who didn’t live in a global  24/7 society—really did have it better. 

Women Watch Out: Poor Sleep Could Be Worse for You

No more excuses, please. Seriously. A new study that just came out, which I read about in an online article from an industry magazine, is bad news for women who don’t sleep well. I think it’s bad news for all of us.

Researchers at Duke University Medical Center have discovered that poor sleep is linked to greater psychological distress (no surprise there) and higher levels of biomarkers that increase your risk for heart disease and type 2 diabetes. No surprise there, either, because it’s long been reported that sleep deprivation can have tremendous health consequences.

But here’s the surprising part about the study. These associations are discriminating—they are much stronger in women than in men. So it’s riskier to be a sleepless woman than a sleep-deprived man.

Warm Milk, True or False?

I just love it when some old piece of advice proves totally absurd, false, or, in the case of drinking a glass of warm milk before bed as a sleep inducer, TRUE!

Last month New York Times writer Anahad O’Connor settled the claim about milk as a sleeping aid in a great, short article that put to bed some old assertions about milk… with a twist.

YES, warm milk can help you get to sleep. But it’s not because it contains the enzyme tryptophan, which urban legend has it will lull you to sleep (and which is often the talk at Thanksgiving when people drop like flies after a large meal heavy in tryptophan-rich turkey).

When Life Gets “Crazy-busy,” Even a Little SLEEP Goes a Long Way

Everyone loves a good confession. They are typically much more fun to listen to than someone’s boring, unrealistic New Year’s resolution. Catherine Lloyd Burns’s had an entertaining write-up for Self magazine last week, available here. Her piece is titled “Confessions of a Lapsed Exerciser,” with the subtitle, “When life gets crazy-busy, even a little exercise goes a long way.”

Burns, an avid exerciser in years past, chronicles how life gets in the way of her ability to take regular time to exercise, and how she struggled to get back on track by joining a local gym. She writes, “My life, it seems, is a balancing act perpetually on the verge of tipping over. Exercise is one of the items on the scale, along with work, chores, eating and making contact with other humans; all of these things threaten to throw everything off kilter. What’s changed is that now I accept this idea. My foray back to the gym has made me more flexible, physically and mentally.”

Sound familiar?

What Do Sleep and Baseball Have in Common this Week?

Aside from the exciting Sox vs. Cardinal baseball that went on last week leading up to the World Series, the drama surrounding Cleveland Indians pitcher Paul Byrd caught my attention in particular. Byrd acknowledged using human growth hormone for a medical condition, but what got my eye wasn’t related to the fact HGH is a banned drug in professional baseball (since 2005) without a doctor’s prescription. It’s about something else I read that I bet most people didn’t stop to think about.

Is There an Anti-Age Doctor in the House?

I don’t have to give you a ton of statistics to prove how hard we try to stay young, energetic, and beautiful. Just consider the number of energy drinks on store shelves, the popularity of Starbucks (which, just this week announced plans to add new drinks or drink sizes that better meet the needs of kids or teens), dramas like Nip/Tuck, and reality TV shows like Extreme Makeover and the newer Dr. 90210, which definitely fulfills a few stereotypes about women seeking the perfect, buxom body in a city like L.A.

In a new book I scanned last week called Microtrends by Mark J. Penn, I read some incredible reports on the extent of plastic surgery going on today. The author devotes an entire chapter to “Surgery Lovers,” claiming that “Cosmetic procedures, both invasive and noninvasive, have become so popular in America lately that between liposuction, Lasik, nose jobs, and tummy tucks—and the latest favorite, eyelash transplant surgery [what is that?!]—it seems like it’s the rare American who hasn’t volunteered to go under the knife.”

Well, I’m happy to report that I keep the carving knives on my food plate and am not one of the one million men who seek the help of a surgeon. Ten years ago, a man wouldn’t be caught dead sitting in the waiting room of a cosmetic surgeon for purely vanity reasons. But today, the tides apparently have changed. Penn predicts a boom in so-called Aesthetic Medicine, as well as some mighty turf wars among doctors who want to practice it.

I wish the same could be said for Sleep Medicine. I’d welcome the turf war and more opportunities to expound the benefits of sleep—that free asset we all have an opportunity to capture every night sans the sharp edges and bruising. Let me repeat: it’s free; there are no risks involved; and it can potentially benefit you in more ways than one. Clearly, a breast augmentation targets one area; sleep can cover an array of areas by virtue of the hormones it releases to repair and rejuvenate the entire body.

Ask the Sleep Doctor: Cortisol and Early Morning Awakenings

This question from a reader came in recently:

Q:

Not sure if this is the right way to ask a sleep-related question (as mentioned on your blog) or if this will be an appropriate question but thought I'd send it anyway.

A little background in case there is a better way to phrase my question. Pre-steroid treatment (for hypoadrenal function), I regularly would wake up between 3am and 4am and be unable to fall back asleep. With steroid treatment, this stopped. However, when I taper my dose, this happens again until I acclimatise to the new dose.

So the question is... Is there any connection between cortisol and early morning (3-4am) awakening?

A:

The answer is YES, but it's quite complicated.

Looking at natural cortisol hormone curves over a 2 day period, we see a natural circadian rhythm, meaning that there are natural ebbs and flows of this hormone with spikes occurring at between 4-6 a.m. each morning.

What I do not know is if administration of cortisol at particular times of day would indeed produce an awakening; but if, at the height of normal cortisol levels, many people are waking up for the day, it would make sense that the changes in dosage are hitting a peak and waking someone up.

Sleep, Testosterone, Baldness and Libido

In a recent issue of the Journal Sleep, there was a fascinating new study, once again showing the importance of sleep in all areas of health.  This time it was referring to men’s health -- specifically testosterone levels.

We have known for a while that men’s levels of testosterone vary with age and usually decline. Some men seem to have higher levels of testosterone well into their 80s. High levels of testosterone have been thought to be linked to hair loss, while low levels have been linked to lack of energy and libido. There is now evidence to suggest that these testosterone variations may be linked to sleep.

Researchers found that the amount of sleep that older men in their study got was significantly related to the amount of testosterone in their a.m. blood samples. More sleep lead to higher levels of testosterone.

What does this mean? It is really hard to say.

First, the results may need to be re-confirmed. Next, we would want to look not just at the total minutes of sleep, but also at the actual quality of the sleep these men are getting.

But what is quality sleep? Is it more delta sleep or slow wave sleep (that "wake up and feel great" sleep!)?

Another good question, but I would say that since we know that the elderly have lower wave amplitude (meaning that their brainwaves do not have as much power to the punch as they may have had when younger... but again we do not yet know what this may mean), we would want to see if those with higher testosterone at 80 have not only more minutes, but also higher amplitude.

How can this study have any effect on our real world thinking?

Here is how I see it:  the more sleep you get at 80, the less hair you may have, but the more sexual drive is likely to stay with you.

So ask yourself:  do you want to be bald and hot to trot, or do you want to have a head full of hair but not be that interested?

Sleep Article Roundup, 4/2/07

On the sleep-friendly foods front:

Newsweek continues its Up Close and Edible series by shining a light on peanut butter. It turns out that peanut butter can lower triglycerides and help reduce the risk of heart disease.   Peanut butter, like sleep, can also help with waistline management. Says Newsweek:

Penn State researchers found that peanut eaters had lower body mass indexes (BMIs), compared to non-peanut eaters. The higher your BMI (25 and lower is considered optimal), the greater your risk of obesity-related problems like heart disease or diabetes.

But don't fall prey to eating too much of a good thing. Peanut butter is high in calories. A single serving, or two tablespoons of low-fat or regular peanut butter, has about 190 calories. "The point is not to go through the whole jar in one sitting," says Dr. Penny Kris-Etherton, distinguished professor of nutrition at Penn State. She recommends peanut butter as a snack alternative or as a meal, such as a PB&J on whole-wheat bread. Good news for those of us who like our foods comfortable and sticky.

This is also good news for people searching for an ideal pre-bedtime snack: peanut butter and jelly on whole wheat is a high-glycemic snack that may help one fall asleep faster.

Regarding women and sleep:

Over at the Chicago Tribune, Julie's Health Club shares tips for overcoming insomnia. (She likes Yoga Nidra.)