How melatonin is proving to be jet-lagged frequent flyer's friend in need

A fifth-grader in Ohio in the US got his hands on ZzzQuil, a candy-like sleeping aid, and brought it to school. He shared it with his two friends and soon all three complained about “feeling woozy”. Paramedics rushed to the spot, reported Associated Press on Thursday. Anxious reporters gathered outside the school. But the medics informed them that they weren’t gummies laced with a sedative, as speculated earlier, and just over-the-counter melatonin. The children were examined and sent home. 

Melatonin is a sleep-inducing hormone that is produced naturally by the tiny pineal gland in the brain. Its synthetic version is sold over the counter in the US, but is tightly regulated in the UK and, like in Australia, is available in the form of a slow-release drug and is mostly prescribed to people over the age of 55 who suffer from sleep disorders.

In India, too, melatonin is a prescription drug. But is also easily available on websites like Healthkart and sold under the “supplements” category. Doctors do not seem disturbed by this. “It’s generally a safe drug which is prescribed even to children with certain disorders,” says Mohammed Shakeel Ahmed, head, emergency and trauma at Fortis Hospital in Kalyan, Mumbai. 

Unlike other sleeping pills such as Alprax or Xanax (Alprazolam), which are minor tranquilisers, melatonin drugs help secrete the eponymous hormone that regulates the body’s sleeping cycle.

Our internal body clock, also called the circadian rhythm, is sensitive to light, exposure to which awakens the senses and the absence of which induces sleep. Melatonin levels in the human body decrease with exposure to light. This is why doctors usually recommend staying away from bright-lit screens of televisions and smartphones close to bedtime. But the exposure to light is not just restricted to the eyes. Even visually impaired people have a sense of day and night because of their melatonin levels.

There are many reasons for a body’s melatonin levels to shift. People who suffer most commonly are those who work night shifts — the kind of patients doctors routinely encounter with complaints of trouble sleeping during daytime.

“Melatonin is not just responsible for inducing sleep, but also affects wakefulness,” says Priyanka Rohatgi, chief clinical nutritionist, Apollo Hospitals. It’s one of the reasons why a person feels lethargic even with moderate sleep.

‘It’s generally a safe drug that is prescribed even to children’

Mohammed Shakeel Ahmed Head, emergency and trauma, Fortis Hospital, Mumbai

Melatonin is prescribed over the long term to people with sleeping disorders such as Delayed Phase Sleep Syndrome (no, not all of us have it) and insomnia, as well as depression, hormonal imbalance and ADHD (Attention-Deficit Hyperactivity Disorder), as a standalone drug or in combination with other drugs. Melatonin is also increasingly being given to patients with abnormal blood pressure and even during cancer treatment, says Ahmed of Fortis. But he says that the long-term effects of the drug are under-researched and its use in India is also limited because of the lack of exposure about its effectiveness.

Melatonin is mostly consumed in tablet or capsule form and the dosage varies from person to person, depending on their medical condition, weight and response to medication. 

“We usually start with a 3mg dose, and gradually increase it depending on how a patient responds to it,” says neurologist Rajnish Kumar, unit head and senior consultant at Paras Hospital, Gurugram. It should be taken 45 minutes to two hours before hitting the bed for the sleep process to take its natural course, he says.

Kumar says that the tablets are closest to the naturally present hormone and are safer, and more effective in many cases, than sleep-inducing chemicals.

Especially in the case of jet lag. When people travel between different time zones, their body’s internal clock is disturbed. Long-haul fights are the worst offenders. The concept of day and night is completely lost to frequent travellers who hop from one continent to another. This may lead to chronic sleeping disorders or worse if the symptoms are left untreated.

Melatonin tablets may not have an immediate effect on all, but are largely effective if taken over a period of over two days for jet lags. They also help soothe the senses in neurological and stroke patients, says Kumar.

While Rohatgi of Fortis says that a person might “start feeling good” and get into the habit of taking melatonin every night, Kumar says that it is generally not addictive and is rarely abused.

But Rohatgi and Kumar agree that the side-effects are few. But they also say that adverse symptoms shouldn’t be ignored. Most of these are common warnings that come with most medication, such as headaches and nausea. Palpitations are rare. Kumar warns about the possibility of “weird dreams”.

People usually dream during REM (Rapid Eye Movement) sleep cycles and rarely in non-REM. Melatonin tends to induce REM sleep, and dreaming is natural. And sometimes, says Kumar, dream enactments — movement during sleep — and bad dreams can occur. “The good effects of melatonin far outweigh its side effects,” says Rohatgi.

But just as the doctors quoted in this report seem to agree on the safety of the drug, they also voice a united concern about dependency on melatonin tablets. Especially because the other remedies are also essential for a healthy lifestyle, such as physical activity, the effects of which can’t be substituted by medication. Sleeping and waking around the same time keeps the circadian rhythm in check. Sleep hygiene, which requires one to switch off from all kinds of screens and avoid other light sources, is central to maintaining stable melatonin levels in the body. And routine is king.

For further assistance in finding sleep, says Rohatgi, one can have a warm glass of milk, or even a banana. Both help restore melatonin levels. Other prime sources of naturally occurring melatonin include fish (salmon), meat (chicken), fruits including cherry and cranberry, and nuts including pistachio and walnut.

But patients with chronic sleeping disorders and others with erratic work routines, especially night-shifters, and frequent travellers, can still benefit from the support of medication. Never without a prescription, caution doctors. Dosage, frequency, its interaction with substances (especially caffeine and alcohol) and other drugs must always be carefully tailored by a doctor.