Clearing Up Confusion: Melatonin Dosing

Krista Anderson Ross, ND | May 12, 2021

How to effectively and safely dose melatonin is an often-asked question, largely due to the abundance of misinformation available on the internet. One of the reasons for the misinformation is that melatonin is classified as a dietary supplement. Because the FDA doesn’t regulate dietary supplements, the onus is on supplement makers to acquire third party certification of a product’s label. Poor quality control in many over the counter products, including melatonin, leads to an inconsistency between stated versus actual dosage.

A 2017 study of 31 different over the counter melatonin preparations found that, when analyzed, the dosage of 71% of the products didn’t match what was stated on the label. Melatonin content varied from −83% to +478% of labeled melatonin, and 70% had a melatonin concentration that was less than 10% of what was claimed. 1 In 2015, the New York State Attorney General’s office conducted an investigation that revealed four out of five products pulled from the shelves of major retailers such as GNC, Target, Walgreens and Walmart didn’t contain any of the herbs listed on the supplement’s label. 2

Pharmaceutical grade supplements (also referred to as “physician grade” and “provider grade”) are only available through a board certified physician/provider. These products have been vetted by a third party lab providing unbiased assurance of quality control, ensuring that no unlisted additives are present, and that dosages claimed match analyzed dosages. Once standards are met, the products bears the seal of approval from the certifier.

Because of this inconsistency in OTC stated dosages, patients will often claim that they used melatonin in the past and “it didn’t work.” When you hear this from a patient ask where the product came from, what was the dosage, and whether it was a fast acting or timed-release product. Very likely your patient won’t be able to answer these questions and decided that melatonin is not for them. Reassuring them that they may have received a much lower or higher dose than expected may make them feel better about trying melatonin again.

The jury is out as to whether melatonin has somnogenic or sleep-promoting properties, or if it merely sends a signal to the suprachiasmatic nucleus to phase-advance the diurnal rhythm. Either way, melatonin has been shown to have sleep promoting and sustaining effects.

What dosage to offer your patients is another frequently asked question. First assess whether your patient is struggling with falling asleep or staying asleep, or both. Fast acting formulations for sleep are usually in the .3-5mg range, with low dosages such as .3 and .5mg shown to be as effective as higher dosages in reducing sleep latency and age-related insomnia. 3 Fast acting products are taken anywhere from 30-90 min before desired bed time. Chewable, liquid and liposomal formulations seem to be faster acting as they bypass the digestive tract. Sustained or time- released formulas that release over a 3-5 hour time frame tend to be higher doses, starting in the 2-3mg range. These are taken at bedtime and are fine to take in capsule or tablet form. Some patients will need help with both falling and staying asleep and will need both. Keep in mind melatonin’s temperature lowering effects, making it a great choice for menopausal women and anyone experiencing night sweats.

Starting with a low dose and watching for effects before working up to a higher dose is a good strategy. Keep in mind there may be some initial variability in response rates depending on one's medical history. A 2014 study on postmenopausal women found that 64% of subjects reported immediate improvement in sleep, but 35% claimed no significant improvement in the first month of supplementation. The latter group was comprised of women who had previously used hypnotic drugs, reporting significant improvement with melatonin usage after 6-8 weeks of administration. 4

 

Doctor’s Data offers several testing strategies to assess levels of melatonin and its opposing hormone cortisol. A three-point diurnal melatonin test may be helpful for those patients reporting sleep difficulties. For patients on melatonin supplementation, it’s recommended to pause for at least 36 hours prior to testing to obtain an accurate endogenous level. Cortisol levels can provide insight into one’s sleep issues because melatonin increases in the evening suppressing cortisol, and the opposite is true as cortisol levels reach their peak in the morning, suppressing melatonin production. The three-point melatonin and diurnal cortisol panels are a consideration to help determine what’s interfering with your patients’ sleep.

 

References

1 Grigg-Damberger MM, Ianakieva D. Poor Quality Control of Over-the-Counter Melatonin: What They Say Is Often Not What You Get. J Clin Sleep Med. 2017;13(2):163-165. Published 2017 Feb 15. doi:10.5664/jcsm.6434

2 https://well.blogs.nytimes.com/2015/02/03/new-york-attorney-general-targets-supplements-at-major-retailers/

3 Zhdanova IV, Wurtman RJ, Regan MM, Taylor JA, Shi JP, Leclair OU. Melatonin treatment for age-related insomnia. J Clin Endocrinol Metab. 2001 Oct;86(10):4727-30.

4 Walecka-Kapica E, et al. The effect of melatonin supplementation on the quality of sleep and weight status in postmenopausal women. Prz Menopauzalny 2014;13(6):334-338.


The Epigenetics of Pain and Inflammation - Natural Methods of Reversing:

How stress, depression, nutrition, and inflammation increase nociceptive sensitivity in the brain and body

Brandon Lundell, DC

May 19, 2021 | 11 AM Pacific

Pain causes chromatin-structure epigenetic changes. Learn how to reverse these changes with nutrition and functional medicine treatments to aid in pain reduction and healing.

Addiction induces epigenetic changes that can be altered in recover from substance abuse and behavioral issues. Learn how to support patients with addictions using NT testing and inflammatory assessments.

The gut and immune system may be the source of chronic pain in extra-intestinal organs and tissues. Learn how evaluating neurotransmitter, hormonal, GI, and nutritional testing can aid in the management and resolution of pain.

Chronic pain causes epigenetic changes in glial cells that can be addressed with natural medicine.

Balancing neurotransmitters may help patients with chronic pain not only experience less nociception, but actually recover from chronic illness.

Wellness Wednesday Webinar

Comprehensive Hormone Health for Women

Ruth Hobson, ND

June 2, 2021 at 9:30 AM and 12 PM Pacific

Each session is approximately 60 minutes with Q&A

  1. Review the role of major hormones
  2. Gain state of the art testing and assessment strategies
  3. Obtain condition-based treatment protocols to include; PMS, Peri-Menopause, Post Menopause, Estrogen dominance and Androgen deficiency
  4. Discover research and literature supporting use of natural hormone balancing therapies
  5. Summary, cases and clinical pearls
 
 
 

Disclaimer: All information given about health conditions, treatment, products, and dosages are for educational purposes only and do not constitute medical advice.

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