A different approach to melatonin

[Shore Snorer]

tl;dr: "low-dose melatonin 5-7 hours before bedtime"

This approach is described by Eliezer Yudkowsky (http://en.wikipedia.org/wiki/Eliezer_Yudkowsky), a fellow probably best known for his Harry Potter pastiche Harry Potter and the Methods of Rationality (http://hpmor.com/). HPMoR is sometimes hilarious, sometimes ploddingly pedantic, sometimes horrifying. (You know how J.K. Rowling killed a significant character at the end of Book 4? Yudkowsky does a lot worse in Harry's first year.)

In HPMoR, Harry suffers from an interesting sleep affliction (http://hpmor.com/chapter/2):

"My sleep cycle is twenty-six hours long, I always go to sleep two hours later, every day. I can't fall asleep any earlier than that, and then the next day I go to sleep two hours later than that. 10PM, 12AM, 2AM, 4AM, until it goes around the clock. Even if I try to wake up early, it makes no difference and I'm a wreck that whole day."

In real life, Yudkowsky says he has a sleep cycle "around 24 hours and 30 minutes long ... my sleep cycle [advances] 3 hours per week (until my bedtime was after sunrise, whereupon I would lose several days to staying awake until sunset, after which my sleep cycle began slowly advancing again)."

Yudkowsky closes his latest Author's Note (http://hpmor.com/notes/98/) by describing how he commissioned:

... a long summary of extant research on non-24 sleep disorder, which I skimmed, and concluded by saying that -- based on how the nadir of body temperature varies for people with non-24 sleep disorder and what this implied about my circadian rhythm -- their best suggestion, although it had little or no clinical backing, was that I should take my low-dose melatonin 5-7 hours before bedtime, instead of 1-2 hours, a recommendation which I’d never heard anywhere before. And it worked. I can’t *#&$ing believe that #*$%ing worked.

(bowdlerism in original)

Currently I’m taking 0.2mg 5.5hr in advance, and taking 1mg timed-release just before closing my eyes to sleep. However, I worked up to that over time – I started out just taking 0.3mg total, and I would recommend to anyone else that they start at 0.2mg.

(The original has Yudkowsky's Amazon affiliate links for three different brands of melatonin.)

I don't recommend HPMoR (or recommend against it). I don't recommend melatonin (or recommend against it, though it didn't overall work for me when I took it many years ago). I know absolutely nothing about the group Yudkowsky turned to. Please do your own research.

I have no idea how this might work for others, but I thought this knowing about this approach might inform members of this forum.

[49er]

Thanks for sharing this. As one who is unable to stay asleep on the machine for any significant amount of time no matter what I do, I am interested in any out of the box solution that could be helpful.

I tried taking 1mg of sub-lingual to get back to sleep and it gave me a total of 30 minutes. But ambien has given me only an hour with alot of centrals as a gift so I shouldn't complain.

Anyway, I might try the sub-lingual before going to sleep just to see what happens.

49er

tl;dr: "low-dose melatonin 5-7 hours before bedtime"

This approach is described by Eliezer Yudkowsky (http://en.wikipedia.org/wiki/Eliezer_Yudkowsky), a fellow probably best known for his Harry Potter pastiche Harry Potter and the Methods of Rationality (http://hpmor.com/). HPMoR is sometimes hilarious, sometimes ploddingly pedantic, sometimes horrifying. (You know how J.K. Rowling killed a significant character at the end of Book 4? Yudkowsky does a lot worse in Harry's first year.)

In HPMoR, Harry suffers from an interesting sleep affliction (http://hpmor.com/chapter/2):

"My sleep cycle is twenty-six hours long, I always go to sleep two hours later, every day. I can't fall asleep any earlier than that, and then the next day I go to sleep two hours later than that. 10PM, 12AM, 2AM, 4AM, until it goes around the clock. Even if I try to wake up early, it makes no difference and I'm a wreck that whole day."

In real life, Yudkowsky says he has a sleep cycle "around 24 hours and 30 minutes long ... my sleep cycle [advances] 3 hours per week (until my bedtime was after sunrise, whereupon I would lose several days to staying awake until sunset, after which my sleep cycle began slowly advancing again)."

Yudkowsky closes his latest Author's Note (http://hpmor.com/notes/98/) by describing how he commissioned:

... a long summary of extant research on non-24 sleep disorder, which I skimmed, and concluded by saying that -- based on how the nadir of body temperature varies for people with non-24 sleep disorder and what this implied about my circadian rhythm -- their best suggestion, although it had little or no clinical backing, was that I should take my low-dose melatonin 5-7 hours before bedtime, instead of 1-2 hours, a recommendation which I’d never heard anywhere before. And it worked. I can’t *#&$ing believe that #*$%ing worked.

(bowdlerism in original)

Currently I’m taking 0.2mg 5.5hr in advance, and taking 1mg timed-release just before closing my eyes to sleep. However, I worked up to that over time – I started out just taking 0.3mg total, and I would recommend to anyone else that they start at 0.2mg.

(The original has Yudkowsky's Amazon affiliate links for three different brands of melatonin.)

I don't recommend HPMoR (or recommend against it). I don't recommend melatonin (or recommend against it, though it didn't overall work for me when I took it many years ago). I know absolutely nothing about the group Yudkowsky turned to. Please do your own research.

I have no idea how this might work for others, but I thought this knowing about this approach might inform members of this forum.

[robysue]

A small dose of melatonin 6 hours before bedtime was suggested by my sleep doc as a way of trying to rein in the current, ongoing nasty bout of insomnia + circadian rhythm problems. Unfortunately it still seemed to increase the clenching problems I have with my TMJs. So I had to abandon it after about 2-3 weeks. It was promising in terms of helping my sleep problems when I was on it, although the fact that I was teaching a night class made it difficult to take the melatonin on schedule on MWs.

[49er]

A small dose of melatonin 6 hours before bedtime was suggested by my sleep doc as a way of trying to rein in the current, ongoing nasty bout of insomnia + circadian rhythm problems. Unfortunately it still seemed to increase the clenching problems I have with my TMJs. So I had to abandon it after about 2-3 weeks. It was promising in terms of helping my sleep problems when I was on it, although the fact that I was teaching a night class made it difficult to take the melatonin on schedule on MWs.

Very interesting Roby Sue. How much did he suggest you take and what kind? Sorry TMJ prevented you from being able to stay on it.

49er

[robysue]

Very interesting Roby Sue. How much did he suggest you take and what kind? Sorry TMJ prevented you from being able to stay on it.

He didn't specify the kind. He said find the smallest dose possible and stressed that it needed to be less than 3mg---1mg sublingual tabs was the smallest does I could find.

I'd tried melatonin (1 mg) right at bedtime back during the First War on Insomnia in spring of 2011 at the suggestion of the PA who was working with me at the time. Same thing: It caused some pretty severe clenching at night and hence a lot of TMJ pain in the daytime.

Notably, the melatonin at bedtime caused more circadian rhythm problems than it solved sleep maintenance problems with multiple wakes in the second half of the night.

The melatonin 6 hours before bedtime appeared to be possibly positively affecting the circadian rhythm problems, but didn't really take the edge off the number of wakes in the second half of the night. But I couldn't tolerate the clenching problems, so I was not on it long enough to see if it would bring the circadian rhythm problems under control.

[49er]

Thanks!

Yeah, I have heard that you should take as little as possible. Taking the extended release before bedtime did nothing for my ability to stay asleep on the machine and in fact might have greatly worsened thing.

But I was thinking about trying the sublingual form to see what happens before going to sleep since it is 1mg vs. the 2mg for the extended release. When I took it get back to sleep last night, this has preceded 3 previous blocks of sleep in which I had wakes and couldn't get back without eating celery which amazingly works almost as well as ambien for me and without central apneas. So I really can't make a determination based on last night.

Because I have a very hard time staying awake after dinner even when it is light which often times necessitates that I stand up in front of the TV or a wall to avoid falling asleep (exercise just makes it worse), probably taking melatonin 6 hours ahead of time is a bad idea.

By the way, an outside the box thinking MD whom I corresponded with on another issue, liked Magnesium Orantate and Melatonin for insomnia.

49er

Very interesting Roby Sue. How much did he suggest you take and what kind? Sorry TMJ prevented you from being able to stay on it.

He didn't specify the kind. He said find the smallest dose possible and stressed that it needed to be less than 3mg---1mg sublingual tabs was the smallest does I could find.

I'd tried melatonin (1 mg) right at bedtime back during the First War on Insomnia in spring of 2011 at the suggestion of the PA who was working with me at the time. Same thing: It caused some pretty severe clenching at night and hence a lot of TMJ pain in the daytime.

Notably, the melatonin at bedtime caused more circadian rhythm problems than it solved sleep maintenance problems with multiple wakes in the second half of the night.

The melatonin 6 hours before bedtime appeared to be possibly positively affecting the circadian rhythm problems, but didn't really take the edge off the number of wakes in the second half of the night. But I couldn't tolerate the clenching problems, so I was not on it long enough to see if it would bring the circadian rhythm problems under control.

[robysue]

Because I have a very hard time staying awake after dinner even when it is light which often times necessitates that I stand up in front of the TV or a wall to avoid falling asleep (exercise just makes it worse), probably taking melatonin 6 hours ahead of time is a bad idea.

Have you ever done lightbox therapy in the morning? Since fall 2011 I've been using a light box in the winter time (only) to help stabilize my sleep cycles. Even though your problem is staying awake after dinner as opposed to not being able to get up at a decent hour because of not getting sleepy until the wee hours of the AM, it could be that a lightbox might help with the evening sleepies. Or so I've heard.

[RandyJ]

The tricky thing about melatonin (which is a hormone, not a drug) is that you can't know if you have a deficiency without a blood or urine test.

If you are deficient, a corrective dose would be between 0.3 mg to 1mg.

Since commercial melatonin is available in up to 3 mg dosage, a dose of 1 to 3 mg could flood your body with up to 10x normal dose of excess melatonin (depending on your level of deficiency), resulting in side effects from restlessness to anxiety, etc.

Another issue is that there is a lot of cheap, substandard melatonin out there. I would research a good pharmaceutical grade brand before purchasing.

[49er]

Because I have a very hard time staying awake after dinner even when it is light which often times necessitates that I stand up in front of the TV or a wall to avoid falling asleep (exercise just makes it worse), probably taking melatonin 6 hours ahead of time is a bad idea.

Have you ever done lightbox therapy in the morning? Since fall 2011 I've been using a light box in the winter time (only) to help stabilize my sleep cycles. Even though your problem is staying awake after dinner as opposed to not being able to get up at a decent hour because of not getting sleepy until the wee hours of the AM, it could be that a lightbox might help with the evening sleepies. Or so I've heard.

Funny you should mention that as I have done quite a bit research on light therapy. According to what I have read, since I go to bed early and wake up in the wee hours of morning, I should be using the lightbox in the evening to delay my sleep cycle.

But if my problems are due to blood sugar issues which I am finally going to follow up on, that that may not be relevant. Also, I have found that being out in the sunlight earlier in the day does not prevent my from falling asleep prematurely later in the day if I eat something.

I am also reluctant to use a lightbox because at my recent eye exam, the optometrist mentioned that my cataract was starting to worsen. Until I have health insurance, I don't want to take that risk.

But thanks, it is a great suggestion.

49er

[49er]

The tricky thing about melatonin (which is a hormone, not a drug) is that you can't know if you have a deficiency without a blood or urine test.

If you are deficient, a corrective dose would be between 0.3 mg to 1mg.

Since commercial melatonin is available in up to 3 mg dosage, a dose of 1 to 3 mg could flood your body with up to 10x normal dose of excess melatonin (depending on your level of deficiency), resulting in side effects from restlessness to anxiety, etc.

Another issue is that there is a lot of cheap, substandard melatonin out there. I would research a good pharmaceutical grade brand before purchasing.

Great points Randy. I think Trader Joes has one in .5mg that I might look into. And Life Extension has melatonin that is less than 1mg.

Don't know if I can cut a sub lingual pill and of course, cutting a 2mg slow release pill would not be fun.

49er

[robysue]

I am also reluctant to use a lightbox because at my recent eye exam, the optometrist mentioned that my cataract was starting to worsen. Until I have health insurance, I don't want to take that risk.

I've been told that I *can* use my polarized sunglasses when using my lightbox. (The lightbox can trigger migraines in me.). I've been told that if the forehead and sinuses get the light, that's enough to do the trick.

You are right about the timing of the lightbox: For someone with your problems, late afternoon or evening would be a better choice than morning.

You could also do "poor-man's light therapy"---try to use broad spectrum light bulbs that mimic the (light) temperature of daylight rather than the warmer, more yellow light that most of us prefer in indoor lighting. Getting the temperature of the light to be closer to daylight may help even though the bulbs you use don't come close to providing the same intensity of daylight.

[49er]

I am also reluctant to use a lightbox because at my recent eye exam, the optometrist mentioned that my cataract was starting to worsen. Until I have health insurance, I don't want to take that risk.

I've been told that I *can* use my polarized sunglasses when using my lightbox. (The lightbox can trigger migraines in me.). I've been told that if the forehead and sinuses get the light, that's enough to do the trick.

You are right about the timing of the lightbox: For someone with your problems, late afternoon or evening would be a better choice than morning.

You could also do "poor-man's light therapy"---try to use broad spectrum light bulbs that mimic the (light) temperature of daylight rather than the warmer, more yellow light that most of us prefer in indoor lighting. Getting the temperature of the light to be closer to daylight may help even though the bulbs you use don't come close to providing the same intensity of daylight.

Thanks Roby Sue, those sound like great suggestions. I will look into them.

49er