[shiftingleft]

> Sleeping pills can cause dependence, and they often treat the symptom rather than the underlying cause.

I found gwern's take on Melatonin interesting: https://gwern.net/melatonin

A small excerpt:

> One might object that they do not wish to tamper with their natural sleep, even if melatonin is a normally-secreted hormone.

> Sad to say, I would point out to such readers that they are already profoundly tampering with their natural sleep cycle, and indeed, all of Western civilization is tampering with it; most of my readers do not even sleep multiple times during the day, as ‘Nature intends’ and as humans have usually slept through history, but rather in a single 7–9 hour long block.

> [...]

> Finally, there are multiple lines of research suggesting chronic sleep deprivation is prevalent among young adults (including historical comparisons). It is striking that unemployed adults sleep a full hour longer than the employed , and that when normal adults are placed in settings without artificial light like camping or without any time indicators, they sleep longer than before - exactly as if they were sleep deprived.

[corysama]

This is a very important paragraph from quern's article

> There are few to no side-effects to melatonin use in adults (there is uncertainty about the risks & benefits in children & adolescents28), and it is not addictive or habit-forming like caffeine is. The usual dose for a night is 0.5-3 mg and I take 1.5mg [29]; my dose is highly likely to be too high. High doses may well be responsible for why some people try melatonin and report that it does nothing or hurts them, since in one study, the best dose for old people was 10x smaller (0.1mg or 0.3mg) and for one blind person, 0.5mg [30 31 32] . Zhdanova et al 1996 found 0.3mg & 1.0mg to affect sleep onset similarly. A study of delayed-release melatonin found with their high dose of 4mg (but not 0.4mg) elevated melatonin levels 10 hours after bedtime ( Gooneratne et al 2011) - potentially interfering with waking time.

It is difficult to find doses as small as 1mg sublingual (dissolve under the tongue) in my area. Everyone is trying to sell you 5-30mg chewables. And, I expect everyone is buying them under the assumption that more is better. But, here it explicitly is not.

The way melatonin works well for me is to wait until I'm already settled into bed and should be asleep, but I'm not. Do a couple body scans to relax for real. Try to think about something mindless. Then if I'm still awake, pop 1mg under my tongue. I'll usually wake in the morning with half of it drooled on my pillow :P

[svachalek]

From your description it may be acting as a placebo -- the act of putting the pill into your mouth is what tells your subconscious to activate a sleep cycle.

[zeroonetwothree]

Placebos are actually very effective for improving sleep

[fc417fc802]

If you call it a ritual instead of a placebo it suddenly sounds much more credible.

[brewdad]

But a ritual sounds like something they practiced in the Middle Ages. Placebo sounds modern and scientific.

[echoangle]

Don’t jinx it

[VagabundoP]

placebo works whether you believe or not and even if you know.

They are very powerful.

[echoangle]

It’s less than if you don’t know though, right?

[mrnoname1000]

I've had the same problem finding low-dose melatonin in brick-and-mortar stores, but Natrol sells a 1mg dissolving tablet on Amazon. If I need a sleep aid, I break it in half for a ~0.5mg dose, chew it with my front teeth, then hold it under my tongue for a bit before swallowing what's left.

It usually takes 15-30 minutes before I get noticeably drowsy, but I feel no more groggy the next day than if I slept sober.

[webnrrd2k]

For low dose melatonin, try liquid melatonin. Around here Sprouts carries it, but you gotta look a bit to find it. The bottle says 30 drop equal 3mg. So you can take small doses easily, and it absorbs under your tongue pretty quickly.

[fittingopposite]

Yes. I agree. Liquid melatonin is the way to go for micro dosing. I also have good experiences with micro doses of 0.1-0.2 mg when waking up too early and having difficulties of falling asleep again. Taking a full 1 mg leaves after 3 or 4 am you very croggy in the morning.

[jorblumesea]

most bricke and mortar should have at least 1mg tablets, and you can break those in half. or break a 3mg into 3rds. not perfect but should work.

[xp84]

Natrol makes a 1mg gummy and Vitafusion has a peach flavored 1.5mg gummy (sold as “3mg” but the dose is “two gummies.” My kids use these. I get them on Amazon.

[astrange]

Bulletproof has 0.3mg capsules, but it's a pricier brand. On the other hand, I'm not sure which other brands actually have the dose they say they do.

[fittingopposite]

Way too high in my experience. Can leave you croggy and dependent. Micro dosing using drops is more effective for me without feeling groggy in the morning. Anything above 1mg is way above the natural melatonin level of our body.

[xp84]

Interesting. Can you share any research tips that helped you arrive at that conclusion? I don't want to overdo it. Dosages in mainstream products are often even higher than the 1.5 so it's obviously easy to go way, way too high if what you're saying is true.

[tikhonj]

It's a bit harder to find, but I've had a good experience with liquid melatonin. Each drop contains like 0.1mg, so it's easy to dial in the small dose that you need.

[anon7000]

It’s wild to me you’re able to shut your brain down that fast!

[kbigdelysh]

Long-term use of high dosage (5-10 mg) of melatonin gave me painful stiff neck and shoulders and muscle spasm.

[anoojb]

Go get children's melatonin gummies and cut it in half. Problem solved.

[k8si]

fyi, Whole Foods sells liquid melatonin. bottle says 30 drops contains 3mg so I only take a couple drops at night and it does the trick for me.

[tcoff91]

it's easy to find 0.3mg melatonin online.

[AStrangeMorrow]

The evidence that humans would naturally be designed to sleep “multiple times a day” is quite mixed. “Multiple” does a lot of heavy lifting here, when basically most evidence points to two batches, following either of these patterns:

- a long uninterrupted night cycle and a short (20-60 mins) afternoon nap. Around 2pm. - a night cycle split into two halves. With a 1-2h break (maybe up to 3h) starting around midnight to 2am.

The former is still very common, and imho stretching the definition of multiple cycles. The latter is more historical (more common when there are long winter nights and no electricity).

Also making it a “Western” problem is kinda weird? There are other cultures where single cycle sleep has existed. Even hunter-gatherer groups with little to no contact with the west. And alternatively afternoon naps are still quite common is some western areas. I guess the main thing that prevent it would be the classic work day schedule.

[tedd4u]

An article exploring research and citations of "first sleep" and "second sleep"

https://www.patheos.com/blogs/geneveith/2013/08/first-sleep-...

[kraftman]

Doesn't multiple mean more than one?

[bityard]

Everyone is different so I'm not suggesting this as a general cure-all, however I'd like to relate my own personal anecdotal experience.

I've always had insomnia since I was a kid and I just chalked it up to "being a night owl." As a teenager, I mostly solved this by living in a permanent fog during the week and "catching up" by sleeping in on the weekend. As an adult, I was suffering greatly from chronic sleep deprivation because adults (mostly) don't have much control over when they can wake up to start the day.

Around 10 years ago, I started taking 5mg melatonin. It's going to sound like I'm overselling it, but it changed my life. It _very reliably_ makes me sleepy 1-2 hours after I take it. If I forget to take it, I am fully awake until the wee hours of the morning. Is it important to note that (for me), after I take it, I have to engage in some passive activity like (calm, non-shouty) YouTube repair videos or reading. Also, the "window of sleepiness" is at most about 30 minutes and if I decide to power through it, I will come out the other side fully awake again. Melatonin does not "force" me to sleep, only highly encourages it.

I was skeptical of melatonin for the longest time. Generally, I rarely see much if any positive effect from supplements. But (for me!) this stuff really works. If anyone reading this is on the fence, I highly recommend giving it a try. (With the acknowledgement that it takes about a week to get into a solid sleep schedule if yours is currently disorganized.)

[munksbeer]

Melatonin works well to help me get to sleep, but it doesn't keep me asleep. My issue is waking multiple times in the night, mostly because I'm just uncomfortable, but my brain will immediately be thinking of some work or personal task and spinning. I solve this by putting on an audiobook each time, and that focuses my attention, and I'm asleep again in 5 minutes. So, I have developed "solutions" to my sleep problems, but they don't really fix the underlying issues.

Also, I don't take melatonin often, only when I seem to need to reset my sleep cycle, and I only take about 200-300 micrograms.

Why do you take so much? 5mg is a lot, according to the studies.

[htek]

Have you been checked for sleep apnea? If you keep waking up throughout the night, it's a good idea to get checked.

[munksbeer]

What exactly is sleep apnea?

[bijowo1676]

When your tongue relaxes during sleep, it can fall back into the throat and block your airway. This triggers the breathing pauses, gasping, and loud snoring characteristic of obstructive sleep apnea

[munksbeer]

Thanks. I haven't been checked. People always mention this though, so maybe it's common. But some people are just bad sleepers even without sleep apnea?

[cestith]

I’m not saying it will work for you, but it may be worth trying GABA or 5-HTP to help you stay asleep. As a chronic insomniac of many years, I take both and not melatonin. Sometimes if my sleep schedule gets bad enough I’ll take 25mg of diphenhydramine HCL to get to sleep, but it gives me strange dreams and makes me a little foggy the next morning.

[bityard]

I honestly didn't know you could buy less than 1mg.

I started with 5mg arbitrarily because that seemed to be the most common dosage sold at the time. I think about lowering the dosage sometimes but at the end of the day, I know 5mg works well for me. I don't notice any side effects, and it's not any cheaper.

I also started with the special "slow release" formulas but couldn't tell any difference from the normal generic stuff.

[ragall]

My family doctor in Italy strongly recommended taking 0.3-0.5mg of melatonin maximum saying that more won't have a good effect and risks having bad effects such as drowsiness the whole day after waking up. And yes, in Italy most melatonin you'll find in pharmacies is <=1mg.

[Weryj]

The Netherlands sells 500x0.1mg pills, so you can always get the perfect dose.

[mikepurvis]

I take melatonin to sleep on a redeye, but otherwise don't use it. I find the effect is similar to taking a weed edible to fall asleep— basically, my wearable registers a lengthy period of deep sleep but instead of waking up feeling refreshed and ready for action, I'm groggy and fog-headed for several hours, or dependent on coffee to reverse the lingering effects.

As someone who has never been a regular coffee consumer, I really didn't want to end up with the dual dependence of melatonin at night and then caffeine in the morning.

This thread is stimulating me to want to get my magnesium checked, but barring that I've found the most effective sleep interventions are the basic ones: get some exercise earlier in the day, and don't do screens for the last few hours before bed.

[terribleperson]

This sounds like you may be taking a very high dose. What dose do you take?

[mikepurvis]

The tablets in my OTC jar are 10mg, and they're pretty small already, not easily divisible, and certainly not to 1/100th of a dose as the sibling comment is suggesting. This is an interesting suggestion though, maybe I'll try just licking one some night and see if that has a noticeable positive effect sans the downsides.

[terribleperson]

Pretty much all the melatonin in physical stores is hilariously overdosed, yes. If you're in the U.S., you'll have to look for products from specialty supplement brands. I take a tiny 300mcg capsule.

[fittingopposite]

This. Try with smaller doses starting from 0.1 mg (liquids are best for this) and work your way upwards to reach the optimal dosage. Tablets are often overdosed which leaves you drowsy in the morning.

[fsckboy]

"and don't do screens for the last few hours before bed" because that will help you fall asleep more quickly? or because that will help you sleep later in the morning 6 or 7 hours later? People never seem to mention that key aspect.

[ambicapter]

For me most things I do on a screen are fairly mentally stimulating (like video games), and even the ones that aren't (like watching a movie) inhibit the feeling of sleepiness I get when I abstain. So, it's better for falling asleep quickly.

[zhengyi13]

I believe it's much to do with blue light emitted by screens:

https://pmc.ncbi.nlm.nih.gov/articles/PMC9424753/

[RugnirViking]

I had heard that that wasn't as much of an effect as some people think - https://www.bbc.com/future/article/20260407-the-blue-light-f...

or rather, that its less about blue light specifically, and more about activity and bright light in general - the times where we are active are shifted later, and a profound lack of exposure to bright light during the day is the issue. Even with the massive amount of screen time the average person gets in a day, that much light adds up to less than a single minute of the equivalent of sunlight.

Probably the best thing you can do is go outside as soon as you can from when you wake up, and stay outside as long as you can. Failing that, get some good BRIGHT sunlight lamps. way brighter than you think could possibly be necassary

[Aurornis]

The comment above just said “sleeping pills” which is ambiguous. Melatonin is an OTC supplement. True “sleeping pills” are usually controlled substances and few doctors would prescribe them as first-line options for a patient who shows up with first time complaints of sleep problems. They won’t be prescribed long-term either. The part of the post that says doctors (plural) tried to prescribe the pills makes me think it’s not traditional sleeping pills, because in this environment you would be unlikely to find one doctor willing to prescribe scheduled sleeping pills long term at all, let alone multiple doctors pushing them.

The usual suggestions from doctors for first line treatment are more mild medications that have drowsiness as a side effect, prescribed at low dose. I would actually prefer many of these low dose options over some of the high dose melatonin supplements. Melatonin is a hormone and taking it can throw off natural production

[voxic11]

Lots of people take diphenhydramine products as sleeping pills and they are advertised as such OTC in the US. Long term Diphenhydramine use is associated with many negative health outcomes and despite the warning labels many people become dependent on them.

[Aurornis]

The parent post was talking about doctor prescribed medications.

The reason diphenhydramine Is associated with a slight increase in dementia risk is the anticholinergic properties. This risk increase is from correlational studies on other medications with anticholinergic medicines being taken for many years by elderly people, so the risk of taking Benadryl occasionally is low to none.

The prescription alternatives like doxepin have the same antihistamine properties without the anticholinergic properties when used at the prescribed dose.

This is an example where people can get themselves into the wrong outcome by assuming anything their doctor prescribes is a last resort quick fix, but anything they can source by themself is safer and superior.

[xp84]

Yes - I saw a very interesting video the other day that educated me a lot on Benadryl - apparently it has a lot of side effects, can cause dementia, and is probably best avoided.

[Aurornis]

Occasional Benadryl is fine. The dementia risk is from correlations found in other medicines that share some of the same properties, when taken for many years.

It’s not a good idea to take Benadryl for many years, but occasional use or even for months while going through a difficult period isn’t going to cause dementia.

[ragall]

The dementia risk is from disrupting the circadian rhythm and suppressing the REM phases.

[bigmadshoe]

It's worth keeping in mind that melatonin is also prescription-only in many countries e.g. UK, Canada, Japan, Australia.

[derekja]

OTC in canada

[bigmadshoe]

My bad, apparently it's prescription-only for children in particular.

[lII1lIlI11ll]

> True “sleeping pills” are usually controlled substances and few doctors would prescribe them as first-line options for a patient who shows up with first time complaints of sleep problems. They won’t be prescribed long-term either.

Modern orexin antagonist sleep medications are not addictive and can be taken long-term.

[astrange]

Trazodone is also not addictive and doesn't have bad side effects afaik.

[lII1lIlI11ll]

Trazodone does little to improve objective sleep quality [0] when used off-label for treating insomnia. From my n=1 experience it it useful as an adjunct to an orexin antagonist in special cases when I stressed/annoyed out of my mind by work or something else, but not as a primary "sleeping pill".

[0] https://pubmed.ncbi.nlm.nih.gov/29680424/

[Gluber]

In Austria a lot of times as second line ( after melatonin etc ) quetiapine is prescribed for its off label effects.

[fc417fc802]

> They won’t be prescribed long-term either.

Tramadol is routinely prescribed long term where I live. I know someone with a massive bottle good for something like 6 to 12 months of daily use. (I don't know if that's a good thing but it is certainly a thing.)

[Aurornis]

Tramadol is a pain medication, not a sleep medication.

It has opioid effects and can cause drowsiness but would never be prescribed for sleep.

It’s also typically a controlled substance. I don’t know where you live but I’d be surprised if anyone was handed a 12 month supply in a bottle.

[girvo]

There are a wild amount of countries where it’s not treated like the opioid that it is, for what it’s worth. Mostly not western ones, though.

[bluedevil2k]

You sure you don’t mean trazodone?

[vector_spaces]

I agree with Gwern in that I think for the vast majority of people, short-term melatonin supplementation is useful and can cause little harm, and it is extremely safe as far as supplements go.

But I don't think it does anyone any favors to oversell the idea that it has "few" or "no" side effects -- it has mild side effects, most commonly reported in the literature are daytime fatigue, headaches and GI symptoms, and also nightmares. Mild doesn't mean it isn't a nonstarter for some people.

It's also important to remember that there are major gaps in what we know about melatonin; notably the effects of chronic supplementation are not well-studied, but earlier final awakening has been documented and this is quite commonly reported in anecdata -- I can contribute a datapoint there, as can most people in my circles who have used it.

To be clear, melatonin is great and useful, but as someone with a rare lifelong chronic sleep disorder who is intimately familiar with this substance, I think it's most useful when we're clear on what we know, what we don't know, and what actually are the limitations on a substance.

Just because downing a bottle of it probably won't cause systemic organ failure or otherwise any kind of medical emergency in most people doesn't mean there aren't tradeoffs to consider when using it, especially if you are sleep-challenged

[bigmadshoe]

The problem with that take is that the evidence for melatonin is quite poor outside of jet-lag and certain more serious sleep disorders, and there can be unexpected effects elsewhere in the body when supplementing hormones, e.g. increased rates of depression for melatonin in particular.

[gloryjulio]

This. Melatonin is a hormone. You should always be extra careful when dealing with any kind of hormone as it might affect your own body's regulations.

[swasheck]

yeah. that’s been my experience as well. my doctor gave me the impression that melatonin helps set the cycle but magnesium glycinate is what calms the body.

[deepvibrations]

This. And maybe anecdotal, but my experience of people who have used melatonin is that they sleep very deeply, but for a shorter amount of time. But likely they will wake up after around 6/7 hours sleep, rather than the recommended 8 hours of sleep. And once woken up, it's very hard to go back to sleep.

[fsckboy]

>rather than the recommended 8 hours of sleep

for people getting 7 hours of sleep you're good. Improve your sleep hygiene, ok, but artificial interventions to get 8 may not be worth it for you.

[wetpaste]

7 is enough for a lot of adults. especially 7 hours of quality sleep. After seeing a sleep doctor I realized that stressing out about not getting exactly 8 hours each night was part of my problem! I did a lot of experimentation to find my optimal hours and it was not quite 8. Trying to force extra hours doesn't really work.

[DrammBA]

AFAIK 7-9 hours is the commonly used range, anything less than 7 hours or anything more than 9 can have detrimental effects on how well rested you feel after waking up. Where did you get the notion that adults need exactly 8 hours on the dot?

[anticorporate]

It really is variable. My number is closer to 9, so even nights I get my "good 8 hours" I still end up with a sleep deficit by the end of the week.

[newsoftheday]

That's what my wife and I sleep for, 7 hours. 8 and we wake up with a headache.

[TingPing]

I specifically take a timed release melatonin, really improved my sleep. Otherwise I did have inconsistent sleep on regular melatonin.

[testing22321]

>and that when normal adults are placed in settings without artificial light like camping or without any time indicators, they sleep longer than before - exactly as if they were sleep deprived.

I’ve been on a few multi-year camping trips, and it never stops amazing me that I feel like a different person after six months or so of sleeping with the sun. 10+ hours of sleep for many months is incredible.

[jr3592]

I find it impossible not to reflect on my personal experience whenever this comes up. I spend 8+ hours a day on a computer, looking at screens. Probably more. I am looking at a screen literally 10 minutes before falling asleep (watching stuff on my iPad).

I can easily sleep 8+ hours. Today slept 10.5.

I'm either not convinced screens are an issue, or they simply are not an issue for me personally, but if thats true -- WHY?

[port11]

Eh, I was prescribed 2mg of slow-release melatonin to help with insomnia (baby-related).

Man, were these the worst nights of my life! I’d get 2-3 hours of shut-eye and then be FULLY awake. Ready to go, couldn’t sleep the rest of the night. I was dead tired by day 7 and gave up.

Tried 0.3mg. Tried 5mg. Nope. There’s some evidence that melatonin can mess you up if you’re sensitive to cortisol/have too much of it. I’m not touching it again. No side effects? Sure.

N=1, but if it’s not working for you, don’t push it. My doctor instead prescribed a bit of therapy (CBT-i) and my sleep went back to normal after a couple of sessions.

[zeroonetwothree]

Not sure why I would trust the opinions of this random person?