BOSTON – Over-the-counter melatonin appears to provide a measure of sleep for older individuals who have insomnia, a meta-analysis showed.
Among individuals 55 and older, treatment with melatonin significantly improved sleep onset latency by 6.36 minutes (95% CI 11.37 to 1.34) and improved total sleep time 18.29 minutes (95% CI 3.65 to 32.94), according to Jennifer Brault, MD, a resident in psychiatry at the University of Ottawa.
Sleep efficiency was improved by 3.54% (95% CI 0.84 to 6.24), she reported in a poster presentation at the annual meeting of the Associated Professional Sleep Societies.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- Explain that a meta-analysis found that taking melatonin resulted in small, but measurable increases in total sleep time, sleep onset latency, and sleep efficiency in adults with insomnia over age 55.
- Note that the investigators reported considerable heterogeneity among the nine included studies which enrolled a total of about 300 patients.
"When I first saw these numbers, I thought, 'well, it is statistically significant, but is it clinically significant?' " Brault told 鶹ý. "But when I went and looked at the results for benzodiazepines – the numbers are similar. So now I think these results may be more significant than I originally thought."
Brault indicated that there were very few side effects reported but, she said, "at this point in our work we are not ready to make recommendations as to whether older individuals should take melatonin if they experience insomnia."
Sleep regulation changes with age, which can lead to increased daytime sleepiness, memory problems and mood changes. But, although melatonin is a key hormone involved in regulating circadian rhythms and has been reported to have soporific effects, previous studies in older adults have yielded mixed results, Brault said.
So, she and her colleagues began scouring medical literature on the subject. They found nine studies enrolling 297 patients.
In general, the people who used melatonin in the trials took the hormone supplements around dinner time.
Although dosing was all over the lot – from 0.1 mg to 10 mg -- Brault said they were unable to observe a difference in outcomes based on dose. The researchers also saw no impact of melatonin on waking after sleep onset.
"I don't think there is any problem with using melatonin in the short term for treatment of insomnia or to get over such things as jet lag, "Olivier Vanderveken, MD, a sleep medicine specialist at the University of Antwerp in Antwerp, Belgium, told 鶹ý. "However, I am not sure about long-term use of melatonin. I am not aware of any studies in long-term treatment."
Vanderveken said that with long-term treatment unexpected adverse events might emerge.
Brault said the next phase of their trial will look at subjective data such as sleep logs and whether participants felt they had a better night's sleep or if they had more energy the next day.
She cautioned that there was considerable heterogeneity in the studies included in the meta-analysis.
Disclosures
Neither Brault nor Vanderveken had any disclosures.
Primary Source
Associated Professional Sleep Societies
Source Reference: Brault J, et al "Treatment efficacy of exogenous melatonin for insomnia in older adults: A meta-analysis" APSS 2012; Abstract 0671.