Melatonin Drugs: When Sleep Supplements Can Be Dangerous

sleep supplements
Experts Warn: When Melatonin Drugs Can Be Dangerous

by Gerrit-Freya Kleber
2/7/2022 8:33 p.m

The remedies have enticing names and promise what many people are looking for: healthy and restful sleep. Melatonin products are available in pharmacies without a prescription and are advertised excessively. But do they keep what the leaflet promises? Where are the risks? What could help better? stern.de spoke to two sleep experts. Here are their answers:

professor dr Christoph Schöbel (Professorship for Sleep Medicine at the University of Duisburg-Essen): “In Germany, melatonin is only available in a pharmacologically pure form on prescription. With non-prescription products, especially from abroad, we know that what is in it is not always what it says. So: You don’t know how much effective melatonin is really in there,” says Schöbel. It is also not certain how well the synthetically produced over-the-counter melatonin can really dock to the body’s own receptors and fit there.

He also says that melatonin itself is on the low end when it comes to effectiveness. There are much more potent sleeping pills. In practice, he prescribes melatonin to people who have persistent problems falling asleep and sleeping through the night or who have a disturbed sleep-wake regulation. “Most people can make enough of their own melatonin. I also find it dangerous when people in a self-optimization mania have to compulsively improve their sleep as well.”

In older patients, it can occasionally happen that the body no longer produces enough of its own melatonin. In general, the preparation is only prescribed for two to three months. It is intended to stimulate the body to produce melatonin again at the right time. However, there are no reliable studies on use in younger people.

Here the preparation can only be used “off label”. There is also a difference to the over-the-counter preparations: “With the prescription drug, there is a delayed, i.e. a retarded release of melatonin, so it works the whole night. This is not guaranteed with over-the-counter preparations. Since melatonin is a protein, it can break down fairly quickly.”

Professor Schöbel warns

“It is positive that melatonin in the usual dosage in Germany does not have any major side effects.” For over-the-counter products, it is therefore up to 1mg as a dosage, for the prescription preparation it is 2mg. Nevertheless, the package leaflet lists rare side effects: nightmares, dry mouth, drowsiness and gastrointestinal problems. It is different in the USA. Doses between 3 and 10mg are freely available there, which is why there can be more severe side effects. It is also here as with other active ingredients: Every body reacts a little differently to it.

But Professor Schöbel also warns: “If you take melatonin in higher doses at the wrong time, you can mess up the entire sleep-wake cycle.” Anticipation helps when falling asleep, why not? After all, whoever heals is right.” However, there is no reliable study.

“Sleep can only be as good as the day was”

Instead of the preparations, the expert recommends a regular sleep-wake cycle with sufficient exercise in the light in the fresh air: “When sunlight falls on the retina, serotonin is formed in the brain. And the more serotonin you produce during the day, the more melatonin you can produce in the evening. So sleep can only ever be as good as the day was. And vice versa…”

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“There is no sleep drug that can mimic sleep as it naturally occurs. Many brain messenger substances are released differently during sleep. There are different sleep phases and the different brain messenger substances also interact with each other. A drug cannot replicate this dynamic. And: if you permanently intervene in the brain messenger substances, this can also have a negative impact on other areas.”

Also Professor Dr. Peter Young from the board of the German Society for Sleep Research and Sleep Medicine speaks out against the replacement preparations.

There are more useful methods than melatonin as a mouth spray. “It is not certain whether it will be absorbed into the body at all.” In medicine, there is a relatively strict and precise way of dosing. “Sprays are completely imprecise, the spray device alone dispenses different amounts. That depends on how hard you press on it or how big the spray device is.”

He doesn’t think much of the other preparations like lavender and valerian either. “People can also tolerate not sleeping well for a few days or weeks. That’s not dangerous. You don’t have to take medication right away.” But if it lasts longer, you should go to the doctor and start investigating the causes.

Too risky

“A preparation for 25 euros would be too risky for me. Medically, it cannot be seen as a drug either. Mankind can do without melatonin sprays, they are far too expensive.”

Professor Young also says: “We know that changing behavior is much more effective than medication. Many sleep disorders can be overcome simply by changing the daily routine or rearranging the evening hours.”

For example, not staying on your cell phone until the end and reading more online articles…