Oh, For a Good Night’s Sleep!

Stephanie, a 41-year-old female who recently came to see me, was constantly anxious and always felt stressed. She had trouble relaxing and her doctor recently put her on meds for high blood pressure.

She reported having a hard time getting to sleep; once she was finally asleep, she was easily awakened by noises. Her husband reported that she thrashed about a lot in her sleep.

As a result of this poor sleep, Stephanie looked and felt tired all the time. She realized it was a problem when she found trouble functioning at work without several cups of coffee throughout the day.

Stephanie’s problems are typical of a person with a melatonin deficiency. This important hormone not only induces sleep, but also has a relaxing effect on muscles, nerves and even the digestive tract, helping with heartburn due to reflux esophagitis. It’s a powerful antioxidant and because of its effect on the body’s biological clock, melatonin is very helpful with jet lag.

Melatonin deficiency is best diagnosed by history and 24-hour urine testing as its production by the pineal gland peaks during the night. Melatonin production, like that of several other hormones, declines with age.

Stephanie got a great deal of relief and reported much better sleep soon after starting melatonin supplementation at bedtime.

To get maximal effect, it is essential to get a high quality brand of melatonin and start with a small dose until maximal benefit is attained. I usually recommend my patients start with 0.1 mg sublingually (1.0 mg orally) and gradually, every 3-4 nights, increase the dose by 0.1 mg.

Stephanie found that 0.3 mg 15 minutes before bedtime was an ideal dose for her under normal conditions, but when she returned from a trip to Europe, I had her briefly increase her dose to 0.5 mg nightly for three nights.

Maximal benefit is reached when you fall asleep in less than 30 minutes and stay asleep all night-when patients have too much melatonin, they report waking up after 4 hours and not being able to fall back to sleep. Of course, it is always a good idea to stop drinking alcohol or coffee (or caffeine containing tea) after dinner, avoid eating sugary foods for dinner or desert, and read a good book before bedtime instead of watching stimulating TV shows