Can you take ‘melatonin’ if you can’t sleep? Is it safe to take it long-term? You’ll understand after reading this.

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Many friends who come to the insomnia clinic have tried taking melatonin supplements to help them fall asleep, but such feedback is particularly common:

Behind this, there is actually a very common misconception—melatonin supplements are regarded as “sleeping pills without toxic side effects.” However, in reality, it is not a sleeping pill, and there is currently no convincing evidence to support its effectiveness in treating insomnia.

What is Melatonin and How Does It Work?

In simple terms, melatonin is actually the “nighttime signal hormone” in the brain. This is a hormone secreted by the pineal gland in the brain, and its secretion is mainly affected by “light”:

Melatonin and melatonin receptors(MT1, MT2, MT3)bind, the brain will receive such a signal:

The body’s own secretion of melatonin, including its secretion rhythm,is actually regulated by the“human body’s biological clock center”, and is one of the output signals of the circadian rhythm.

And exogenous melatonin(for example, the supplements people buy)can act as a “supplement to the night signal,”indirectly affecting the circadian rhythm.

But whether endogenous or exogenous, melatonin plays a role in “reducing alertness and switching sleep-wake rhythms,”it cannot “force people to fall asleep.”

It needs to be discussed on a case-by-case basis. The main factors affecting the body’s own melatonin secretion include the following categories:

Jet lag caused by travel across time zones is a relatively clear application scenario for melatonin.Melatonin supplements can be used as a short-term means to “calibrate the biological clock,” but it is not recommended for long-term use.

However, it needs to be emphasized that there are currently only 2 situations where there is clear evidence that melatonin can be used as an auxiliary measure for the treatment of insomnia:

• Children and adolescents with developmental disorders

• Elderly people with cognitive disorders

Moreover,the research on the long-term safety of melatonin is not sufficient,and currently there are only 3 pediatric studies and 2 studies on elderly patients with Alzheimer’s disease that provide safety data on the long-term use of melatonin.

For insomnia issues, the American Academy of Sleep Medicine clearly does not recommend
physicians and mental health professionals to prescribe melatonin supplements as a prescription drug to treat insomnia.

“Using electronic devices before bed” is therefore often listed as one of the factors that need to be managed. In addition to changing light exposure, it also increases emotional and attentional arousal and may condition the brain to “stay awake” in bed.

For these disturbances,it is recommended to intervene from “sleep environment, behavioral habits,”rather than relying on melatonin supplements to “remedy” them.

Why Melatonin Doesn’t Make You Drowsy?

On the one hand, the mechanism of melatonin does not directly make us “drowsy,” and there is currently no internationally recognized clear dosage range for the appropriate dosage of melatonin supplements to improve sleep.

On the other hand, many friends who can’t sleep are not unaware that “night has come,” but their brains are always in a state of “high-speed operation,”unable to stop, so they cannot switch to “rest mode.”

The transition between “wakefulness” and “sleep” is related to these two systems in our body:

The central circadian clock usually gives more support to the “arousal system” during the day and more support to the “sleep promotion system” at night. But it can only provide “support,” not a decisive role—if the arousal system is “forcibly activated,” even if the biological clock thinks it’s time to sleep, we will still remain awake.

Here are a few common examples:

In the “tug-of-war” between the arousal system and the sleep promotion system, when the arousal system takes the upper hand, insomnia occurs. The causes of chronic insomnia are more complex, such as:

• Conditioned Arousal Enhancement:
  After long-term insomnia, the brain gradually associates “bed, bedroom, pre-sleep routine” with “wakefulness, tension, trying to fall asleep,” causing even when very tired, upon entering the sleeping environment, one immediately becomes alert.

• Excessive Worry About Sleep:The more afraid of not sleeping well, the more worried about being tired the next day, the more tense the brain becomes,the more difficult it is to fall asleep,because “worry” itself activates the arousal system.

How Can We Calm the “Arousal System” Down?

There are mainly two types of common measures:Cognitive Behavioral Therapy for Insomnia (CBTI), and sleep-promoting medications.

Also known as “sleeping pills,” their principle is to promote the activity of the brain’s inhibitory system or reduce the brain’s level of arousal(similar to “pressing the brake of the brain”), making it easier for the body to enter a state of sleep.

However, medication cannot change the root cause of insomnia, especially the causes of chronic insomnia, such as the conditional arousal and excessive worry about sleep mentioned above, etc.

Therefore, sleep-promoting medications are usually not the only measure taken to treat insomnia, and doctors often do not recommend long-term use of sleep-promoting medications(for more than 4-6 weeks). To date, only a few sleep-promoting medications have been approved for long-term use, such as for more than a year.

This is the first-line treatment for chronic insomnia in adults. Simply put, it is a set of specific, executable, verifiable, and adjustable trainings to realign the disrupted sleep system.

The treatment goals of CBTI include:

During the treatment process, doctors or therapists will take corresponding measures based on sleep records and feedback, such as:

In simple terms, it is to train the brain to learn to “sleep well” again.

In summary, melatonin supplements are not “sleeping pills”; moreover, “sleeping pills” cannot solve all “can’t sleep” problems.

Trying to improve sleep by relying on a method that makes you drowsy after taking it is actually not very feasible.Identifying the main reasons for “staying awake”is the key to solving sleep problems.