The author even sort of notes that with the differences between teenagers, 25 year olds and the elderly.
There's also a wide variety of sleep disorders which are touched on in the article.
I've suffered with 2.5mg before for long enough to understand that it doesn't work for me, no matter how many studies you have with 95% CL that the dose is much lower. The 5mg tablets work much better for me.
If you get results at a lower dose, that's fine, I won't tell you to try using more.
I'm a 49 year old though with moderately severe DSPD and at least used to have non-24 hour disorder and would be happiest letting my schedule shift 1-2 hours every night during college for a few years. If you're a 25 year old and you've never quite had sleep that fucked up which wasn't entirely self-inflicted due to partying then you're not me (most young people who think they have bad sleep disorders are just actively doing things to fuck up their sleep and when they stop doing those things they're magically cured -- and then they turn into the most insufferable assholes because they think they understand sleep disorders when they don't).
And one thing to understand about melatonin is that its not really an anxiolytic and if stress/anxiety is keeping you up it may not work (it will not make the pandemic go away). I also find that I need to take it about an hour before bedtime, and rather than making me tired, it more allows me to get tired. I still need a nighttime ritual to unwind.
Melatonin is not like a sleeping pill where more will necessarily make you more drowsy. It is a hormone that signals to your body that it is time to sleep. I can't find it right now, but there was a study of different doses in a large number of people that determined that just 0.2mg was more effective than larger doses for most people. And I've found that's true for me too. When I use melatonin, I use 0.2mg, and I fall asleep within half an hour, sleep a full night, and wake up feeling refreshed. If I use a larger dose, I sleep even less well than I would without a supplement.
I suggest to anyone who is taking 1mg or larger doses to experiment with a "microdose" of 0.2mg and see how it affects you.
I always wonder if some of the self reported dosage variability for pills comes from differences in absorbtion of pills. Maybe some ppl's stomach acids or bacterial flora destroy particular molecules more or prevents absorption more than in other ppl?
Sublingual tablets are available which result in a much more reliably fast absorption. I recommend them for anyone who wants less variability from their melatonin use.
you can see this with pot edibles, if you take one on an empty stomach it takes forever to kick in and sometimes doesn’t work very well, but if you eat the same one after a large fatty meal it will kick in fast and strong
How do you dose it though? Lowest dose I can find is 1mg pills and even those are pretty rare in my country. Do you get 1mg pills, crush them and measure out on precision scales?
You can get 300mcg pills but they never seem to be the sublingual, dissolving type. The lowest I've found dissolving tablets is 1mg. I take a half or a quarter and dissolve it under my tongue. That works fine when it works. Sometimes it puts me to sleep and I sleep longer than my usual 5-6 hours while waking up with a hangover. Sometimes it just makes me sleepy for 15 minutes and then I'm wide awake. Melatonin is very hit or miss for me. I smoked a lot of pot though, and from what I hear that triggers a massive melatonin release, so maybe my homeostasis is a bit messed up.
Sleep is tough. There are so many confounding factors and issues which can affect it... it's hard to find a single thing that works or that works consistently without side effects.
the variation may be because the pill isn't uniformly distributed so one half pill doesn't necessarily mean half dose of melatonin, which is why I was wondering if he crushed them. Check out the other responses, there seem to be liquid alternatives which are easier to dose.
This is the way I do it now. I buy melatonin in a liquid and it has a dropper with measures on it. I don't sweat about a couple of drops too high or low, it's fine, much better than trying to chop up tablets into doses!
> . If I use a larger dose, I sleep even less well than I would without a supplement.
I stopped taking Melatonin because I noticed, on multiple occasions, that after a week of use my sleeping period became extremely easy to disrupt and resulted in a bad sleep.
I was taking a brand sold in costco, each pill being 5mg.
If I ever decide to try Melatonin agin I will try splitting it into 1/20 parts (0.25mg) and try again
There's no guarantee in general that a pill will have its active ingredients distributed evenly throughout. Although they're not often carried in stores, there are versions of melatonin that come in 0.5mg doses.
> not like a sleeping pill where more will necessarily make you more drowsy
> I suggest to anyone who is taking 1mg or larger doses to experiment with a "microdose" of 0.2mg and see how it affects you.
So the problem I have with this reasoning is that I have tried this and the higher doses make me way more sleepy. I take a lower "correct" dose anyway (most of the time), but it has nothing to do with what works better.
The trouble is that you know how much you're taking. How do you rule out a placebo effect?
Human have a pretty strong bias towards thinking that more equals better.
Sleeping is probably one of the most physiologically influenced physiological processes we undergo, so it's pretty easy to believe that placebos would have a powerful influence on it.
If it's placebo, then don't tell me to test it (because as you say, that doesn't work). That said, the effects are so strong and so consistent I don't really care if it is placebo. As long as it works :)
Yeah I am flabbergasted a psychiatrist of all people would entertain the idea of a “correct” dose. They should look at their own practice and see the range of lithium, SSRI, antipsychotics, antiepileptics doses their patients are on — and these are for medications with far more studies about dose response than melatonin.
They should also know better that serum levels of a supplement/medication that acts centrally can be misleading.
>A single correct dose is a myth. The author even sort of notes that with the differences between teenagers, 25 year olds and the elderly.
The author spends several paragraphs citing studies, different cases and populations, and says explicitly why they concluded to the specific mg dose:
"Based on a bunch of studies that either favor the lower dose or show no difference between doses, plus clear evidence that 0.3 mg produces an effect closest to natural melatonin spikes in healthy people, plus UpToDate usually having the best recommendations, I’m in favor of the 0.3 mg number. I think you could make an argument for anything up to 1 mg. Anything beyond that and you’re definitely too high."
Supplements are an unregulated market so doses can vary wildly, even with melatonin.
‘A study published in 2017 tested 31 different melatonin supplements purchased from pharmacies and grocery stores. For most of the supplements tested, the amount of melatonin in the product did not match what was listed on the label.”’
Looks like it was within 10% of described for 71% of supplements (which sounds pretty okay) but there were some big outliers for the rest.
It also suggests the biggest variance was in mixed-supplement pills while pure melatonin pills were mostly within the normal range. Definitely good to know but I wouldn't worry too much if you are just getting basic pure melatonin from a well-known manufacturer.
Sure but if that's mostly the mix of supplements in one tablet versions. If you buy pure melatonin from a respected brand it's going to be a pretty high chance you are getting the right dose.
On the anxiolytic side - a warning for those susceptible to such things, when I was taking melatonin it caused me horrible anxiety, something I’d never experienced before. It stopped not long after I discontinued it.
"mental health conditions" is rather broad along with the intersection between insomnia and depression. you probably just suggested that nobody should take melatonin because you had anxiety.
Suggesting that people with mental health conditions do not self medicate with supplements that can be particularly harmful to those with mental health conditions is entirely reasonable.
Self-medication for quality of life is broadly all you have if you don't want to be put on the hefty big guns immediately. The alternative to the big guns is being told that there's nothing wrong with you. As such, saying "don't self-medicate" is extremely unproductive and only serves to push such practices out of view.
You are vastly exaggerating the risks of attempting to self medicate with something as safe as melatonin while underappreciating the potential benefits.
NY state used to warn against it. It wasn't for nothing.
But yes, I definitely recommend people not to take hormones unless they know exactly what they are doing. Just because something is for sale over the counter, doesn't mean it's safe or good for you.
"Never" is a strong word here. Perhaps cautiously and/or with guidance of a professional? Anecdotally, I have anxiety and OCD, and melatonin has never given me problems.
I’m 30, with sleep disorder that fits exactly what you are describing. I’ll share my own anecdote.
I've taken melatonin in 0.3mg sublingual doses, it worked perfectly. It’s incredible the control it gives me over my sleep after having none for decades.
However it leaves me unmotivated the next day, like I don’t want to get out of bed and if I do, I don’t want to get out of the house or do anything. I thought it was coincidental but it’s systematic. Very annoying.
So I stopped taking it. I now only take it on days where I know I’ll be doing nothing the next one anyway. Curious if anyone has had a similar experience.
Concur. My sleep issues are not severe enough to risk the "do nothing" next day. Only on exceptional bad trends do I use melatonin now. but I may try some of the variants in this.
The "correct" dose happens to be 0.3 to 0.4mg for me. How did I determine that? I started with 3mg, got knocked out way too fast. Then went to 1.5mg, got knocked out way too fast. Rinse and repeat with 0.8mg. On 0.4mg I felt it was just about enough, and then I noticed 0.3mg sometimes helped and sometimes didn't.
> I started with 3mg, got knocked out way too fast.
Yeah, you see that doesn't happen with me with 5 mg.
I take it at least an hour before my planned time to go to sleep and it takes at least that long to kick in for me.
People responding to me still don't understand that there's significant interpersonal variation.
I literally don't understand this concept of melatonin "knocking me out". It doesn't do that to me at all. If I really wanted to just plug myself into a computer game or something I could easily power through the 5mg of melatonin and stay up until >3am.
Ok, in the context of commercial supplements being 10-30x the "correct dose" the significant point is that the commercial doses are stupidly high for anyone. People needing +/- 50% of the dose isn't the important part here.
No, some people need more than the commercial supplements provide. That's the point. The effective range varies by an order of magnitude. The author denies the actual variety of human needs.
3mg is not the correct starting dose. If you need to adjust up, fine, but for most people that won’t be required. Starting too high and adjusting down is not the correct approach (a general rule, not just for this drug).
Only thing that helped for me was finding a job that didn't care what time I showed up.
I still sleep weird times but at least I'm no longer laying there frustrated and extremely stressed at 5am that after laying there for 5 hours I'm not asleep and worried about oversleeping or just having to go to work without sleep to not risk being scolded about showing up late again.
As someone who was stuck on a 26 hour schedule for years, I just... grew out of it.
One day around age 26 it just went away after having been a problem since early high school. No clue why. If you're still young, your "problem" may simply be youth.
A single correct dose is a myth.
The author even sort of notes that with the differences between teenagers, 25 year olds and the elderly.
There's also a wide variety of sleep disorders which are touched on in the article.
I've suffered with 2.5mg before for long enough to understand that it doesn't work for me, no matter how many studies you have with 95% CL that the dose is much lower. The 5mg tablets work much better for me.
If you get results at a lower dose, that's fine, I won't tell you to try using more.
I'm a 49 year old though with moderately severe DSPD and at least used to have non-24 hour disorder and would be happiest letting my schedule shift 1-2 hours every night during college for a few years. If you're a 25 year old and you've never quite had sleep that fucked up which wasn't entirely self-inflicted due to partying then you're not me (most young people who think they have bad sleep disorders are just actively doing things to fuck up their sleep and when they stop doing those things they're magically cured -- and then they turn into the most insufferable assholes because they think they understand sleep disorders when they don't).
And one thing to understand about melatonin is that its not really an anxiolytic and if stress/anxiety is keeping you up it may not work (it will not make the pandemic go away). I also find that I need to take it about an hour before bedtime, and rather than making me tired, it more allows me to get tired. I still need a nighttime ritual to unwind.