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.

Foods for Sweet Dreams

Pop Quiz: Which is the better bedtime snack—an oatmeal raisin cookie with milk or another serving of the pasta with meat sauce you ate at dinner?

Answer: go for the cookie and milk.

It’s common knowledge that caffeine and alcohol can ruin a good night’s sleep if consumed too close to bedtime. But what about foods? Which ones will keep you up and which ones will work in sync with your dreams of sleep?

Headaches and Insomnia Go Hand in Hand

Headaches come with the territory these days. Any look at the news can give you one of the most common types around: the tension-type. But if you suffer from chronic tension headaches and resort to sleeping them off, you may want to listen up: a new study out of Rush University just emerged showing a behavioral link between these kinds of headaches and insomnia.

In other words, you could be worsening your headaches—and the quality of your sleep—by snoozing them off.

Oh Canada, Get Some Sleep!

A recent study I read showed some interesting aspects about the sleep of our friends to the north, and they seem to be as bad as ours here in the US! The study recently published in the journal Sleep explained the economic cost associated with sleep disorders in Canada. Here are the bullets (all in Canadian $):

• total annual cost of insomnia (direct and indirect) in the province of Quebec was estimated at $6.6 billion
• prescription medications ($16.5 million)
• over the-counter products ($1.8 million)
• alcohol used as a sleep aid ($339.8 million)
• The total estimated annual cost of alcohol used for promoting sleep was $51.1 million spent by people with insomnia syndrome, $211.2 million by those with symptoms of insomnia and $77.5 million by good sleepers.

What everyone seems to be making a big deal about is the alcohol consumption number.  My question is WHY?

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. 

Good News for People with Insomnia

It’s one o’clock in the morning and you’re exhausted. The alarm will herald a new day in fewer than five hours and you’re staring into the dark room (maybe listening to your spouse sleeping soundly). You can’t fall sleep. You’ve done everything you’re supposed to do in order to enter dreamland easily, such as relax before bedtime, cast away negative thoughts, and avoid work, caffeine, and stimulating activities like being on the computer. But now you’re at your wit’s end trying to figure out the problem. Why can’t I fall asleep?

Well, insomnia just got a brighter light shined on it.

Sleep… and Get Rich

Okay, so I know that sounds like a gimmick. If anyone could get rich automatically through sleeping, we’d all be filthy wealthy after a few priorities changes. But here’s what I mean: how may of you have arrived at a solution, invention, or great idea during dreamful sleep?

I’m wondering this because of a music site reporting how Kid Rock attributes many of his successes to insomnia. He claims that he came up with the idea for his hit song “All Summer Long” thanks to a restless night… and that he “can’t stop dreaming up new tunes.”

Did you catch that? He claims he “dreams” up his tunes during “restless sleep.” The two don’t really go hand in hand, do they? If you have insomnia, you’re not sleeping. If you’re dreaming, you’re very much enjoying a special stage of sleep. According to Kid Rock, he hasn’t a full night’s sleep in years. He says his brain “never stops” and that he keeps a notepad by the bed to record his mid-night thoughts.

It’s common to experience a night of dreams so vivid and memorable that you feel awake for most of it. People who say they “don’t sleep” actually do, and if you were to get them in a sleep lab you’d watch them sleep for several more hours than they think they do.

Wall Street Got Your Sleep?

I feel like I blogged on this topic just a few weeks ago. And I probably did. The depressing news is inescapable. You can’t turn the TV on without getting punched in the stomach—even if you don’t work in financials or own stock in them.

There are plenty of nervous people out there, especially seniors who have retirement funds falling with the whims of the market. Articles like this one show the extent of the damage leaking through the older communities. But you don’t have to be retired or thinking about it soon to feel the heat. How many people are losing sleep over the state of affairs?

It wouldn’t surprise me to learn that sleeping pill prescriptions are on the rise as the economy is on the decline, or at least in a temporary ditch. About one in five people take non-narcotic sleep aids now. Even though those who take something to help them fall and stay asleep are not advised to use them every single night. But my bet is that people who can’t get a handle on their stress load or learn how to cope with the constant noise from the news and media are reaching for them routinely.

Don’t get me wrong: I’m a big proponent of prescription sleep aids when the time and circumstance calls for them. The jury is still out, however, on their long-term effects when used frequently. For example, just last week my industry journal reported on a review of several studies showing a link between prescription sleeping pill use and skin cancer.  But don’t panic: a direct causal link has not been proven between sleeping pills and skin cancer, and this report simply opens the door for more research and data-gathering.

It’s worth noting, though, that sleeping pills are not the magical end-all be-all for people with sleep troubles. Given the volume of sleep troubles today, I’d love to see more people attempting to nix their sleep problems in the bud naturally before resorting to long-term use of prescription sleep aids. And that starts with turning off the media’s noise. TODAY!

How to turn off the media noise with the lights at night:

• This may sound obvious, but it bears repeating: turn off the news and stop reading all forms of current media at least two hours before bedtime.
• Do something out of the ordinary before bed that takes your mind off the ordinary stress, such as taking a warm bath, getting a Swedish massage, taking a yoga class, or going for a light walk.
• Avoid heated conversations about world affairs at dinner or anytime after 3 pm for that matter!
• See if you can go at least a day—and three if you can do it—during which you avoid all sources of news and media. Pretend you’re on a deserted island and have no access to newspapers, the Internet, or the stock ticker on CNBC.

Stress is inevitable and in many ways, unavoidable. But it’s MANAGEABLE if you take charge of it.

A sign that you may not be managing stress well is if you find yourself going more than two weeks and you’re using a sleep aid every single night. If that’s the case, then it may be time to call a time-out and examine why you’re unable to get a good night’s sleep naturally.

Think of it this way: the news will ALWAYS be there no matter what. But your happy, vibrant self will not. I’d pick the latter over the former every day.

How Sleep Smart Are You?

A new campaign called Sleeping Smart is about to happen as a joint project between the National Sleep Foundation and Sanofi-Aventis, a pharmaceutical company and the makers of the popular sleep aid Ambien.  The goal is to educate people about the value of sleep, and help those who suffer from insomnia understand its consequences.

I’m all for campaigns like this, because I think insomnia is sorely underestimated. What’s also highly underestimated is the effect insomnia can have on a person—from mood swings and irritability to decreased capacity to function at optimal levels, get things done, and generally feel good. I challenge anyone who looks and feels worn-out to prioritize sleep for one week and see the difference.

There are numerous health-related risks associated with insomnia, too. But perhaps the most stunning realization of all is the fact so few people even recognize they have insomnia. And those who think they do never mention it to their healthcare professional. In fact, two-thirds of those at increased risk for insomnia don’t consider themselves to have the condition, which may further perpetuate reasons for not seeking help.

Here’s a few questions to ask yourself (especially if you have trouble sleeping):

The Heat Factor: Warm Skin, Cozier Sleep

There are lots of things you can try to enhance the quality of your sleep and avoid waking up at night. But here’s something you probably haven’t heard of before: warming up your skin.

The news just came in from the Netherlands in a study published in the journal Brain. Turns out that increasing the temperature of your skin—but not your core body temperature—just a little bit can help you achieve deeper, more restful sleep and avoid waking up too early in the morning.

These types of sleep problems are common among older folks. The reasoning behind the phenomenon is that skin warming has been shown to stimulate areas in the brain that are involved in regulating sleep. Studies on skin in recent years have been turning up all sorts of fascinating discoveries. We’ve learned a great deal about how skin is like the brain’s twin. It can create messages for the brain to respond to without needing the brain to act first.

To think that a little warmth on your skin can effect change in the brain and plunge you into top-quality sleep is, well…amazing. Gives a whole new meaning to wrapping yourself up in a blankie. It’s not always easy to find sure-fire ways to solve sleep problems, especially in people who suffer from insomnia or who can’t seem to get through the night and early morning hours without waking. The elderly are famous for their lack of quality sleep and inability to stay asleep for long periods of time.

So can this recent study offer a new way to promote better sleep? I think it may be worth trying. Keep the ambient bedrooms temps cool but keep the blankies close. Sleep tight.