By: Dr Shanna Ndong Insomnia, or difficulty initiating or maintaining sleep, is a common complaint and approximately 1 in 3 American adults experience it over the course of a year. Sleeping less than seven hours per day is associated with an increased risk of developing chronic conditions such as obesity, high blood pressure, diabetes, heart disease, stroke, and mental disorders. The southeastern United States reports the least amount of sleep of any region and not surprisingly, it also has the highest prevalence of obesity and associated medical conditions. Many people turn to sleep aids, both over-the-counter and prescription, to help with their sleeping issues. A 2015 Consumer Reports survey found that one-third of U.S. adults had tried a sleep drug in the past year. Prescription sedatives are the most popular treatment for insomnia in the U.S. Although they are meant for temporary use in most people, they are often taken indefinitely. Long-term use of sedatives such as Ambien, Lunesta, and Restoril have been shown to decrease the ability to think clearly, worsen memory, and increase risk of falls. There is also a significant risk of developing drug dependence and a high abuse potential. Melatonin is a hormone produced in the brain in response to darkness. It helps to regulate the body’s sleep and wake cycle (i.e. circadian rhythm). Melatonin levels decrease with age and may contribute to the increase in sleep issues in elderly populations. Studies suggest that melatonin supplements may help people with disrupted circadian rhythms (such as people with jet lag or those who work the night shift), and those with low melatonin levels (such as the elderly) to sleep better. Melatonin has been touted as a natural sleep aid and in the U.S., unlike many other Western countries, it’s production and sale is completely unregulated. As a result, over-the-counter doses of melatonin range from 0.3 mg to as high as 20 mg. The dose that most closely resembles what the human body makes is 0.3 mg (300 micrograms). When melatonin receptors in the brain are exposed to too much of the hormone, they become unresponsive. This happens with high initial doses of hormone and may happen after several weeks of melatonin usage leading to loss of effect. As a result, melatonin should be used for short periods of time (a few weeks). A 2001 MIT study comparing treatment of insomnia in patients over age 50 with 0.3 mg, 1 mg, and 3 mg doses found that while all three doses improved sleep, the 1 mg and 3 mg doses were associated with side effects including low body temperature and the levels of melatonin in the blood remained elevated into the daylight hours. An important first step for anyone with insomnia is improving ‘sleep hygiene’ which means that bedtime and awakening should be consistent everyday, including weekends. Quit smoking and avoid caffeine and alcohol in the evening. Avoid taking naps and decrease the amount of time spent lying in bed. This will increase the likelihood that sleep will be achieved at the appropriate time. Do not watch TV, read, write, eat, or lie awake for an extended period in bed. Keep the sleeping environment quiet and dark; there should be no TV, radio, or lights on while sleeping. Develop a relaxing routine before getting ready to sleep such as taking a warm shower, reading (in another room), or meditating. The most effective treatment for insomnia after sleep hygiene is cognitive behavioral therapy (CBT), which involves talking to a therapist to learn a new set of behaviors regarding sleep. CBT is as effective as sleeping pills and has been shown to help up to 80 percent of chronic insomnia sufferers. The positive effects of CBT can be long lasting. CBT is offered through licensed counselors and other mental health professionals. Here are some important tips to remember prior to beginning melatonin: 1) Due to the potential for side effects and interactions with medications, talk to a health care provider first. 2) If melatonin is used for insomnia, generally the dose should be within the 0.3 mg to 1 mg range. 3) The dose should be taken 90 minutes before bedtime, if possible. Melatonin can cause drowsiness if taken during the day. 4) If drowsiness occurs the morning after taking melatonin, try taking a lower dose. 5) Pregnant or nursing women should not take melatonin because it can interfere with fertility and pregnancy. 6) Melatonin use should be avoided in children. By: Dr. Shanna Ndong

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