melatonin

[tater pie]

I have started taking melatonin the last couple of weeks because I've had such trouble staying asleep. I can fall asleep pretty quickly but I wake up 2 or 3 times during the night and have a lot of trouble falling back to sleep after the second or third time. I know melatonin is only supposed to help you fall asleep but I thought I would try it anyway. I started out with 1 3mg. tablet and didn't notice much difference so I tried two 3 mg. tablets last night and only woke up once and was able to go right back to sleep. I just wondered what dosage other people took and if there were any dangers in taking two 3 mg. tablets.

[Sparchitect]

Is there a maximum dosage range?

Though I've no experience dealing with Melatonin, it is supposedly a rather safe substance with next to no first-hand side effects.

Sleep-inducing chemicals, however, do have the unfortunate inherent curse of worsening a person's apnea while the drug is in their system. This may or may not be an issue with low doses of Melatonin, but I would of course suggest you see your doctor about that. Also make note to your doctor if you see a significant increase in the amount of dreaming you're doing at night as it points to an alteration in the REM sleep state. Again, whether or not this is of any detrimental relevance to the quality of your sleep is in the hands of the practitioner, I can simply provide what information I am aware of.

[WillSucceed]

Sleep-inducing chemicals, however, do have the unfortunate inherent curse of worsening a person's apnea while the drug is in their system.

This is a pretty broad statement and, I think, a bit confusing.

Certainly older sleep-inducers that contained narcotic agents (Tuinal, Nembutal, etc.,) would, through action of the narcotic relaxing the muscles, make OSA worse. These older drugs don't seem to be used much anymore.

Benzodiazepines (Valium/diazepam, Ativan/lorazepam) are tranquilizers with muscle relaxant properties (especially Valium) which are often prescribed to help with sleep. These drugs were designed to relax the patient, but Doctors often prescribe them for sleep. People with OSA should not be using these as the muscle relaxant component can worsen OSA.

Newer "sleep-inducing" medications like Immovane, Ambien, don't, to my knowledge, "worsen apnea" through a relaxant action on the muscles (like the drugs mentioned above) BUT, and this is a big but, if you are VERY asleep (due to the effectiveness of the medication) and you cannot be easily wakened by your bodies' need for CO2 blow-off (when you are having an apnea) you could be in trouble. If, however, your PAP system is working well, especially if it is an APAP, and you are not having a leak that is imparing treatment, being VERY asleep should not be a problem.

So, to my knowledge, the newer sleep-inducing drugs don't actually worsen the apnea, they just make it harder for your brain to cause a micro-arousal so as to counter the negative effects of the apnea. I've taken a look at the monographs and although there is caution/contraindication for those patients with OSA, I did not find specific info regarding use of a sleep-inducer by an OSA patient who IS using xPAP.

This same thinking would apply to melatonin. If you have taken a drug (Melatonin) that makes it harder for your body to wake you (a micro-arousal) when you are having a hypop or apnea, then melatonin is unsafe. If however, your xPAP is hooked up and working fine, then I'd think you might be OK. I've looked at my overnight data (Silverlining) after a night's sleep with melatonin on board (or Immovane) and have seen where my 420e dealt with hypop's and apneas just the same as it did when there was no sleep-inducer on board. The most melatonin I've taken is 3 miligrams. All the data that I have read on melatonin has said that 3 mg. is enough.

So, now that I've said all this, let me state that I'm not a Dr. nor a Pharmacist. Any of us who want to use a sleep-inducer should be having a long talk with his/her Dr. before doing so.

My Dr. has given me Immovane and knows full well that I have OSA. He also knows that I'm totally compliant with treatment and, that my APAP seems to be working well. He has cautioned me against using anything with a muscle-relaxant property, whether prescribed or over-the-counter, because of the OSA. I guess that one could argue that an APAP, working properly, with no unusual leak, could handle the extra muscle relaxation that occurs when a tranquilizer or muscle-relaxant is taken before sleep.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): APAP

[Snoredog]

Suggest going here to read more about it:


From the Mayo Clinic:
http://www.mayoclinic.com/health/melato ... -melatonin

http://www.nlm.nih.gov/medlineplus/drug ... tonin.html

The question I have for the Mayo Clinic is WHY don't they rate other drugs like Ambien and Lunesta on this same grading scale? I'd be willing to bet they wouldn't fare any better.

for those with RBD (sharon65), think you had a question about this just yesterday:
http://www.mayoclinic.org/news2003-rst/1937.html

http://www.melatonin.com/

I've read a lot about it over the years, from what I've read you can safely take up to 6mg. without problem.

I think if you follow the Mayo's suggestion you will probably find it totally ineffective at those minute doses.

I personally take 3mg before bed. But I found there is a difference in quality from mfg. to mfg. Schiff brand sold at Costco used to be pretty good at 1.5mg dose, it only had additional vitamin B6. Then they came out with Melatonin Plus in 3mg that had Vitamin B6 and green tea extract, I found that version totally ineffective for me in only the first few nights of use.

I then ordered some from WonderLabs.com in 3mg dose and it was much better quality melatonin. 30-45 minutes after I take it I can't keep my eyes open. I only came across Wonder because my ex's homeopathic doctor was prescribing her some of those supplements. So I tried them and found them to be pretty good, I buy all my supplements from them now.

I've had good luck with GNC brand melatonin, but it is more expensive. You can buy a year's supply from Wonderlabs.com for under $10 bucks.

[socknitster]

About 10 years ago I took melatonin on a regular basis to help with sleep onset problems. I did tons of research and found that university studies on college students showed 300 micrograms (mcg about 1/10 of a 3mg pill) was the optimal dose for simple sleep onset problems. I always found it worked like a charm. There was some controversy about it back then so I only took it when I needed it. Back then i was able to find the 300 mcg dose.

Sounds like now that it has been around for longer, it is getting more research on it and it is proving to be quite safe, except for the caveat of pregnancy and lactation.

Tater pie, if 6 mg is working for you, I'd keep at it but only for a while, then I'd try reducing the dose. Maybe with some good sleep under your belt for a week or two you won't need such a hi dose for the long term. Maybe you won't need it at all. Sleep begetts sleep and good sleep begetts better sleep. If I learned anything about sleep from raising a child, that is the take-home message.

I asked my sleep doc about melatonin, and he told me he liked it (melatonin) and to cut the 3 mg pills in 1/4 to and take that and see if that would do the trick. He confirmed that for most people, 300 mcg is the preferred dose, but manufacturers rarely formulate that dose, hence the instructings to quarter the pills. 1/4 pill would be roughly 750 mcg, give or take a bit.

Snoredog is right that quality varies from brand to brand of these types of supplements. The best thing to do is look on the label for indications that a third party checked to make sure the substance inside has been independently tested for potency. I wish I could remember what this is called--it isn't always easy to find this, however. Ugh. I hate it when my brain seizes up and i can't remember an important bit of info, just some vague general reference. Sorry. Maybe someone else will know what I'm talking about!

Great links, Snoredog. As usual, you come thru with some very important info. I always appreciate your input on matters like this.

Jen

[cwsanfor]

The research I did some while back agrees with Socknitster's. As best I recall, and I would have to google for those links, there was the idea that the usual 3 mg dose of melatonin was effective as an anti-oxidant, but that dosage quickly became ineffective as a sleep inducer. I think the recommendation for sleep was 3 mcg, rather than the the commonly available dose of 3 mg.

What I've been doing is getting the 3 mg dose at Costco, and cutting it into fourths with a pill cutter. That does not render 3 mcg doses, but I haven't noticed any harm in it. It's sort of like Coenzyme Q-10, which I take twice a day: I can't swear that I feel any effect, but I'm pretty sure it does no harm.

I'm more sure of the effect of Ambien CR, but I prefer to minimize the use of "harder" drugs like that, since there is a lesser track record with many of them, and they can be very expensive. My Ambien scrip costs about $US3 per pill, after insurance.

[Sparchitect]

Newer "sleep-inducing" medications like Immovane, Ambien, don't, to my knowledge, "worsen apnea" through a relaxant action on the muscles (like the drugs mentioned above) BUT, and this is a big but, if you are VERY asleep (due to the effectiveness of the medication) and you cannot be easily wakened by your bodies' need for CO2 blow-off (when you are having an apnea) you could be in trouble. If, however, your PAP system is working well, especially if it is an APAP, and you are not having a leak that is imparing treatment, being VERY asleep should not be a problem.

So, to my knowledge, the newer sleep-inducing drugs don't actually worsen the apnea, they just make it harder for your brain to cause a micro-arousal so as to counter the negative effects of the apnea. I've taken a look at the monographs and although there is caution/contraindication for those patients with OSA, I did not find specific info regarding use of a sleep-inducer by an OSA patient who IS using xPAP.

This same thinking would apply to melatonin.

Thanks. My knowledge is limited in these parts and I'm glad to see the answers. I'm going to draw the logical conclusion, then, from your post that the primary reason that sleep-inducers have been noted to be negligible is because of the many that have muscle-relaxing properties, and that other than that and the 'deep-sleep' issue you noted above, they are for the most part non-intrusive to the treatment of apnea. Relatedly, should I also assume that it is because of musclar relaxation that alcohol is a 'no-no' for OSA, or are their other major players inside of that concotion?

[WearyOne]

According to my sleep doctor (who has a background in neurology), and a naturopath/registered pharmacist, up to 6 milligrams of melatonin is fine.

Also, they have EXTENDED/PROLONGED RELEASE, melatonin, which is what you should take if you wake up during the night. This is what was recommended for me. Might have to go to a speciality store for this though, like Vitamin Shoppe or something, or order online

My son started taking 3 milligrams of regular melatonin for his delayed sleep phase syndrome/non-24 hour, and it's the first thing that's ever helped at all! (Plus high doses of sublingual methyl B12). So far after about 1-1/2 weeks, it's worked wonders--what a God-send.

Pam

[WillSucceed]

Relatedly, should I also assume that it is because of musclar relaxation that alcohol is a 'no-no' for OSA, or are their other major players inside of that concotion?

ABSOLUTELY! You have got it right. Alcohol does have a muscle-relaxant component which is exactly what you DON'T want if you have OSA. So, if you are inclined to a tipple in the evening, do your tippeling early enough that the booze is out of your system before you go to bed.

[frete50]

. Schiff brand sold at Costco used to be pretty good at 1.5mg dose, it only had additional vitamin B6. Then they came out with Melatonin Plus in 3mg that had Vitamin B6 and green tea extract, I found that version totally ineffective for me in only the first few nights of use.

Snoredog,

Why would Schiff put a stimulant with a relaxant. No wonder you couldn't sleep.

Becky

[WearyOne]

. Schiff brand sold at Costco used to be pretty good at 1.5mg dose, it only had additional vitamin B6. Then they came out with Melatonin Plus in 3mg that had Vitamin B6 and green tea extract, I found that version totally ineffective for me in only the first few nights of use.

Snoredog,

Why would Schiff put a stimulant with a relaxant. No wonder you couldn't sleep.

Becky

This stuff really interests me!

Are you sure it was green tea or just the L-Theanine which is found in green tea? The reason I ask is because I looked up the ingredients for this and it lists Theanine, B6, and 3 mg melatonin as the ingredients.

It seems that as of April of this year, a lot of melatonin manufacturers have started including Theanine in their melatonin preparations. It seems to have an affect on alpha waves. (Wikipedia.)

I also found this, which I really don't understand fully (can someone help?) It mentions that the study showed that theanine decreases background alpha levels. Is that good for sleep or bad?

http://tinyurl.com/2aspur

B6 is needed to make hormones seratonin and melatonin, which may be why that's in there. Wikipedia says, “At least one preliminary study has found that this vitamin may increase dream vividness or the ability to recall dreams. It is thought that this effect may be due to the role this vitamin plays in the conversion of tryptophan to serotonin.

Just give me my melatonin straight! This is getting too complicated.

Pam

[oceanpearl]

Tried Melatonin 3.0 mg twice. Both time I had the wildest nightmares of my life.

[Snoredog]

According to my sleep doctor (who has a background in neurology), and a naturopath/registered pharmacist, up to 6 milligrams of melatonin is fine.

Also, they have EXTENDED/PROLONGED RELEASE, melatonin, which is what you should take if you wake up during the night. This is what was recommended for me. Might have to go to a speciality store for this though, like Vitamin Shoppe or something, or order online

My son started taking 3 milligrams of regular melatonin for his delayed sleep phase syndrome/non-24 hour, and it's the first thing that's ever helped at all! (Plus high doses of sublingual methyl B12). So far after about 1-1/2 weeks, it's worked wonders--what a God-send.

Pam

I think if you read some of those studies above, that they found the timed-release versions didn't work as well as the fast dissolving type.

If you do your research on it, think you will find our natural melatonin levels "peak" at about 2AM and taper off towards reaching morning when you wake up and remain low throughout the day and only start to climb again after dinner as darkness approaches. I have a graph somewhere which shows those levels.

So when you take supplemental melatonin you are only adding to those natural levels, levels shown to "decrease" as we age.

My experience: Different doses for addressing different symptoms

"mcg" or microgram doses may be taken for "sleep onset" problems, but that is NOT what I take it for, but it helps with insomnia or sleep latency also.

The main reason I take melatonin is to KEEP me asleep, if I don't take it, I will be wide awake by 2 or 3AM and/or wake up 3-4 times per night.

I have found NO benefit of the other advertised uses of melatonin other than insomnia and/or keeping you asleep. I have used it nearly every night since 1992 where before that I took TylenolPM to help me sleep. Then I learned taking tylenol every night is not good for your kidneys. I occasionally take TylenolPM and/or Kirkland's Sleep Aid (Unisom clone) instead of the melatonin. I have also had no problems going without melatonin for a week or more just to see if I could go off it, besides forgetting to take it with me, but my night time arousals returned shortly there after.

I suggest you read all the studies you can find. Do a google search on it, I always IGNORE search results sponsored by someone peddling the drug. I will always take a study done by a learning/teaching institution over a mfg or distributor sponsored one. Even the studies done by the Mayo are conflicting at times, if you read them all you come up with your own general "consensus" on melatonin.

I don't believe all the other claims and/or benefits of melatonin, especially as it pertains to cancer prevention, I've had malignant melanoma twice and BCC once, all cut off with surgery and/or scraping, so far it hasn't metastasized. I know that was from years and years of water skiing and being out in the sun over 30 years ago. I now have regular exams with my dermatologist/oncologist at least once a year looking for any new ones that pop up, he is a Professor at UCSF (actually I go to him because he has some successful treatments for aging skin and his office is always full of good lookin women ).

But this is an excerpt from one of the Mayo links above:

ROCHESTER, Minn. -- A Mayo Clinic study shows that melatonin successfully alleviates many patients’ symptoms of REM-sleep behavior disorder (RBD), a violent sleep condition that manifests during rapid eye movement (REM) sleep, a stage of deep sleep in which most dreaming occurs.

"Melatonin can be considered as one possible option for RBD," says Brad Boeve, M.D., Mayo Clinic neurologist and sleep specialist, and the study’s principal investigator.

People who experience RBD appear to act out their dreams, in which screaming, yelling, hitting, kicking and jumping out of bed tend to occur. These behaviors can cause injury to these people or their bed partners.

It is only my opinion/theory that if you have PLMD and all other treatment options have failed, you should consider melatonin in strong enough doses to address the problem.

Is that .300mcg? or 3mg (3000mcg) or 6mg (6000mcg)?

I don't know, I ONLY use enough that works for me and I have cut a 1.5mg tablet in half before if I felt groggy the next day after using it. I know there is a big difference in "brand" quality, I try to buy the best quality USP grade of melatonin I can find (so far that is Wonderlabs.com). Even the best quality you can find is dirt cheap. I prefer straight melatonin over those with any additives. Many have B6 added, I don't see a problem with the B6.

When you COMPARE the side effects of melatonin from the studies and research, you should find even higher than recommended doses have fewer side effects than that prescription drug you may have already been taking which didn't work.

I also know that you need to take melatonin for at least 7-10 days to properly determine if it helps you or not, it does not respond at all in a single night's use in my opinion.

My understanding is:

Vitamin B6 is added to help with the absorption of melatonin and B6 itself has been shown to assist with sleep.

The Green tea extract added to Schiff's Plus version is aid in insomnia, just as drinking a cup of decaf green tea can settle you down or aid in turning off your thoughts. That cup of decaf green tea works for me, but not when added to melatonin. I have 2 jars of that destined for the trash.

[Snoredog]

Tried Melatonin 3.0 mg twice. Both time I had the wildest nightmares of my life.

yes it can promote that,

But did you have nightmares as a result of the melatonin's effect or was it you have them all the time and you awoke during REM state of sleep to notice them?

Because that is what melatonin does, it promotes deeper sleep and that may put you in REM longer than without. You may enter REM 1-5 times per night. That means you may have 1-5 dreams per night. You only remember the last dream not the 4 or so that may have been before it. Most likely you only recalled the nightmare because it was the last one you had.

Keep in mind that during REM you are in a near-wake state (as opposed to stage 3/4 or deep sleep). If you are in deep sleep you are much harder to be aroused as compared to REM.

Was it you had nightmares from being deprived from REM for so long or do you have them all the time and never wake up during REM to recall them?

From what I've read over the years while in REM you are in a near-wake state, so you can pop in/out of REM to wake state much more easily than from deep sleep to wake. Some people are light sleepers and yet others heavy sleepers. It is thought that the light sleepers are most likely in REM and the heavy sleepers spend more time in deep sleep.

I remember when I was a teenager, I'd have 3 alarms going off and my Mom would turn on the lights and yell at me to wake up and I'd sleep right through it.

Melatonin is NOT just a aid in insomnia, it helps promote deeper sleep which can put you in REM more so than without. Yes we can all probably get by fine without REM, but show me a study where you actually benefit from the lack of REM.

And that is the thought process behind trying higher doses of melatonin for PLMD.

My theory is your "neuro switch" that normally turns off muscle control as you enter REM sleep is dysfunctional. Let's say if that switch fails in one direction when you are waking or awake, you may find you are awaken to a conscious state and that muscle control hasn't been completely turned back On. When this happens, you wake up finding you are unable to move and have what they refer to as Sleep Paralysis. That is one direction for that "switch".

Now let's say that neuro switch fails in the opposite direction, instead of failing to turn "off" it fails to turn "On".

So now you enter REM sleep where we are thought to dream but without that neuro switch turning "off" muscle control. That may mean you now act out on your dreams, which may include talking, screaming, kicking, etc., etc., etc.

Why is that? what mechanism of our sleep controls that neuro switch?

Is it the time we spend in Stage2 or deep sleep what controls that neuro switch?

Because if that switch was truly "working" as you entered REM you shouldn't be talking, screaming, kicking or basically acting out on your dreams. It is thought that "neuro switch" is there to prevent us from harming ourselves during sleep.

But like all things neurological, there is more they don't know about the brain than what they know. My theory is you need deeper sleep to help turn that neuro switch off and stop the kicking and the Mayo research seems to suggest the same.

[Snoredog]

here is what Schiff says about their Melatonin Plus:

http://www.schiffvitamins.com/product_news.asp?id=166

Sorry, but I found it didn't work as well as their non-Plus version. I only bought the Plus formulation because I ran out of the prior.

Here are some of Dr. Luke's videos explaining how they work, keep in mind he is peddling the supplement, but he is a doctor and Ph.D, as least I haven't seen him link the beer belly to OSA yet.

For Vigor & Vitality (as it relates to daytime fatigue):
http://www.schiffvitamins.com/healthview.asp?id=9

For Sleep, explanation of their Melatonin Plus:
http://www.schiffvitamins.com/healthview.asp?id=5

I listened to them both, they are pretty good.