The ever-increasing awareness of the dangers of hypnotic use in the elderly leaves many patients, prescribers, and caregivers hesitant to initiate prescription medications to treat insomnia. Combined with the increased awareness and use of natural vitamins and supplements amongst hospice patients, many hospices are finding it desirable to utilize melatonin in certain patients having difficulty sleeping.
Melatonin is a hormone naturally produced by the pineal gland as part of the sleep-wake cycle, with its blood level being highest at night. Many proponents of its use believe that it provides benefit in sleep disorder or, more specifically, sleep disorder involving circadian rhythm. Melatonin is a body clock regulator and not a sleep initiator. It does not increase the body’s drive for sleep but, rather, tells the brain when it is time to sleep.
Though its adverse effects are typically mild, the most common side effects include daytime sleepiness, dizziness, and headaches, with abdominal discomfort, mild anxiety, irritability, confusion, and short-lasting feelings of depression possibly occurring. Mobile patients who take melatonin should be advised to not engage in activities requiring alertness for four to five hours after taking melatonin.
Melatonin can potentially interact with various medications. For instance, since it slows clotting, it should be used with caution with blood thinners. Melatonin stimulates the immune system, so its use should be avoided in patients on immunosuppressants. Due to its effect of increasing blood sugar levels, diabetic patients may need closer monitoring while on melatonin. Taking melatonin along with sedative medications can cause excessive sleepiness.
Though research is mostly inconclusive regarding the efficacy of melatonin, there also is no conclusive evidence of dangers of its use at reasonable doses for short periods of time.
Fall risk, psychiatric conditions, and concurrent drug therapy can make the use of traditional hypnotics undesirable. In such patients, it may be reasonable to consider a conservative dose of melatonin. Doses of 3 to 5 mg are commonly used, but research indicates that lower doses in the range of 0.3 to 1 mg are more effective and possibly safer. Regardless of the dose used, it is typically advised to administer melatonin about 90 minutes prior to the desired bedtime.