BU Today: What is melatonin and why is it useful?

Auerbach: Melatonin is produced inside the brain in the pineal gland. It’s involved in sleep regulation, and we use it in sleep medicine for three reasons. The first is that it does help promote sleep, but more for some people than others. The second is it is sometimes thought to be helpful in regulating sleep rhythms, especially in people who have a hard time falling asleep, for instance, if you work a night shift. The third is in a much less common disorder that can be seen in older patients, where people sort of act out their dreams [REM sleep behavior disorder]. 

In general, it is used in children to help them fall asleep.

BU Today: Is it considered safe and non-habit-forming?

Auerbach: It’s an interesting medication, although I don’t know if medication is the right word because it is not FDA-approved for anything. There’s always been a problem with it because it’s not under the same strict guidelines as an over-the-counter medication, like aspirin. 

The general feeling is that it should be safe. It can be dangerous in very high doses. I deal with adults in my clinic, and I’ve sometimes seen people come in with side effects. In theory, it’s supposed to have a short life in the body, but I’ve had people complain that they take it, they go to sleep, and the next morning they are still groggy.

BU Today: The CDC study reported the biggest increase in children’s melatonin overdoses happened in 2020 and 2021, during the COVID-19 pandemic. How did the pandemic affect sleep issues?

Auerbach: We saw patients who had issues sleeping because they reported feeling anxious, they weren’t getting as much exercise, they were gaining weight. We definitely saw an uptick in patients during the pandemic.

BU Today: Are there alternatives to melatonin that people can use to help them get a better night’s sleep?

Auerbach: You want to make sure you have a regular routine for going to sleep and waking up in the morning, because our clocks are geared for that. Factor in adequate amounts of time for relaxation at bedtime, time to wind down. Exercise is great for maintaining good quality sleep; however, you don’t want to do a lot of aerobic exercise and then pop into bed. The sleep environment has to be appropriate, a comfortable bed, not too much noise.

And then we get to this tricky part about the other stuff—reading and watching television. There’s something in that that makes many people relax and transition to sleep. Screens have a lot of blue light, and this light helps activate this circadian system and so you want to minimize or eliminate this. The biggest culprit we see are people who just can’t relax.

BU Today: What do you advise parents of young children about using melatonin?

Auerbach: The usual advice is to first address behavioral issues and sleep habits. Parents should talk to their pediatricians, since sleep problems are common issues in children. If they were to consider supplements, melatonin, in low doses, may be effective and is generally considered to be relatively safe. Obviously, they should keep it in a secure place with other medications, to avoid mishaps.
 
I am not a pediatric physician and I have not evaluated their child, so I take care to avoid prescribing. I give them the information to address with their pediatrician.