Sleepy Yet?

 Sleepy Yet?

By Peter Galvin, MD

Melatonin is a hormone made in the brain. It is thought to aid in sleeping.

Brain levels rise at night and fall during the day, and levels tend to decrease with age. Many people use melatonin as a sleep aid. Commercial melatonin is made in a lab and is thought to be effective as a sleep aid at doses of 5 to 10 mg. While melatonin is thought to decrease the amount of time needed to fall asleep, its effect on the length and quality of sleep is unknown. Melatonin is often recommended for use in the following: circadian sleep disorder in the blind, delayed sleep phase (falling asleep later and arising later), insomnia, jet lag, and shift work sleep disorder. While melatonin is usually safe, it can cause headache, dizziness, nausea, drowsiness, and less commonly, depression, anxiety, tremors, irritability, abdominal cramps, and decreased alertness, confusion, and disorientation. Melatonin should not be used by those who drive or operate machinery for a living and those with autoimmune disorders. It interacts with many medications including anticoagulants, anticonvulsants, blood pressure medicines, CNS depressants, diabetic medicines, contraceptives, benzodiazepines (i.e., Valium), Luvox (used to treat obsessive/compulsive disorders), and immunosuppressants.

While it is not usually recommended for use in children, melatonin, like many CBD products, comes in the form of chewable gummies. And like CBD gummies, melatonin gummies have caused a surge in ER visits by children due to accidental ingestion and overdose. Calls to U.S. Poison Control Centers for pediatric melatonin ingestion increased by 530% from 2012 to 2021 and were associated with 27,795 ER and clinic visits, 4097 hospitalizations, 287 intensive care admissions, and 2 deaths. Like CBD products, melatonin products are not approved or regulated by the U.S. Food and Drug Administration (FDA). They are sold over the counter as dietary supplements or food, and some products contain prohibited drugs such as cannabidiol (CBD). A recent study done by Cambridge Health Alliance looked at the actual quantity of melatonin and CBD in these products (gummies only) and compared the results to the quantities declared on the products’ labels. They found and attempted to purchase 30 unique brands online whose labels claimed they contained melatonin. Four were unavailable and one product label did not contain “melatonin”, so they analyzed the remaining 25 products. Their results were startling. One product contained no melatonin but did contain 31.3 mg of CBD. In the remaining 24 products, the quantity of melatonin ranged from 1.3 mg to 13.1 mg per serving. In these products, the actual quantity of melatonin ranged from 74% to 347% of the labeled amount. Five products declared CBD as an ingredient, and the quantity of CBD ranged from 10.6 mg to 31.3 mg. The actual quantity of CBD ranged from 104% to 118% of the labeled quantity. Finally, some of the products claimed to contain serotonin, but serotonin was not detected in any of the products.

While this was a small study of gummies only, it is not known whether the same inaccuracies can be found in melatonin capsules and tablets and whether the actual amounts of melatonin vary from batch to batch. Needless to say, pediatric use of melatonin gummies may result in the ingestion of unpredictable amounts of melatonin.

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