Dr. Doni, author of The Stress Remedy, explains how melatonin works to control our sleep/wake cycle and gives advice on what to do if things go wrong.

Part 11 of Dr. Doni’s Series on Sleep Disruptors and Insomnia

Sleep. One of the most important things we can do for our health and yet research indicates that a huge number of people get less than seven hours of sleep each night.^1,2 At the same time, lack of sleep increases risk of cancer, heart disease, depression, diabetes, and simply not feeling well or functioning well during the day.³ If you are not sleeping well, this 12-part sleep series may be able to help you identify the root cause—and turn things around so that you can start to benefit from hours of slumber each night.

Melatonin and Sleep

Today we are going to discuss melatonin, the hormone we rely on to create our circadian rhythm (sleep-wake cycle) and give us the benefits of sleep.

It’s amazing how our bodies respond to light and darkness! As the day comes to an end, our eyes pick up the change from light to darkness and send a signal to the pineal gland in the brain to start producing a hormone called melatonin. Each hormone communicates different messages within our bodies; melatonin’s main message is sleep. As melatonin levels increase and start circulating through our bodies, we become sleepy. As you might guess, melatonin levels are highest in the evening (around 10 pm) and are lowest during the daytime.

In addition to telling our bodies when it’s time to sleep, melatonin is also an anti-oxidant—quenching the oxidative stress that damages our cells—and it influences our immune system and our mood. It’s a clever hormone with a raft of possible benefits including:

• Helping with depression and seasonal affective disorder (SAD)^{4, 5}
• Helping relieve pain (such as with fibromyalgia)⁶
• Preventing and even eliminating cancer cells⁷
• Decreasing the influence estrogen has on tumor growth⁸

This last point is why melatonin is so often recommended by practitioners who are supporting patients who have (or have had) cancer—especially breast cancer.

Understanding the benefits of melatonin overall helps us to see why lack of sleep is so damaging. The biggest concern is when melatonin levels are too low in the evening—when really, they should be high enough to be sending you to sleep for the night. When this happens, you are left vulnerable to both the effects of lack of sleep and the effects of a lack of melatonin. But it doesn’t have to stay that way. We can correct your melatonin levels by addressing the cause of low levels.

What causes melatonin to be low (when it should be high)?

There are a number of things that influence melatonin production including:

• Stress
• Lack of exposure to natural light during the day⁹
• Exposure to light at night (often from television, phones, computers, and clocks)¹⁰
• Working a night shift
• Travel and time zone changes (also known as jet lag)
• Lack of sleep (i.e. parents up through the night with an infant/child)
• Leaky gut and nutrient deficiencies

How will I feel if my melatonin is low (when it should be high)?

There are a number of possible symptoms—and everyone is different—but if you experience more than one of the following then your melatonin levels may be out and it might be worth considering getting tested:

• Feeling awake instead of sleepy after 10 pm
• Finding it hard to get to sleep
• Feeling tired during the day
• Forgetfulness
• Higher susceptibility to colds and flu (lower immunity)

How can I find out if my melatonin levels are too low?

As you will know if you follow my blog, I’m a big fan of testing. Why guess when you can find out for certain? The test for melatonin levels is very simple—you collect a saliva sample at about 10 pm to see what your melatonin level is at the time when it should be highest. It can also be helpful to measure your melatonin level right before you go to sleep (if that is different than 10 pm).

Unfortunately, this test is not commonly done in a standard medical office or in sleep clinics, so you’ll need to work with a naturopathic doctor (or functional medicine practitioner) who can do the test, interpret the results, and advise you on the support you need to get your melatonin levels back in balance again.

Support and Treatment for Low Melatonin

Here are four simple things you can do if you have low melatonin that will help you get a good night’s sleep:

1. Turn out the lights before 10 pm
   Some sources even recommend turning down the lights at sunset or by 7 pm. I recommend that you dim the lights at least one hour before going to bed and, as much as possible, turn off electronic devices and other lights in your bedroom (even the smallest little light can lower your melatonin).

2. Reduce exposure to blue light
   If you do need to be exposed to lights after 10 pm, you can buy glasses that block blue light, the type of light that turns off melatonin production. You can find these orange-colored glasses at Amazon from two companies: Uvex and Sun Shield. They allow you to see, but they stop the light from being noticed by your brain.There are also software programs, such as f.luxTM (which is free), that lowers the blue light exposure from your computer or other devices, while still allowing you to see the screen. It automatically adapts the light exposure based on the time zone in your location.

3. Take a melatonin supplement
   You can take melatonin as a supplement* to help increase your levels. It comes as capsules, sublingual lozenges (that dissolve under your tongue), and time-released—I usually recommend the capsule form. A common starting dose is 1 mg, taken within an hour of going to bed/sleep, optimally around 9 pm. If you don’t see enough of a difference with 1 mg, you could increase to 2 or 3 mg. In some cases the dose may be increased to 5 to 20 mg, though I wouldn’t advise doing this except on the advice of a qualified practitioner.You may also find that taking 1 to 5 mg of melatonin will help you adjust to a new time zone when traveling. I suggest taking the melatonin at bedtime (10 pm) in the new time zone.It is important to note that melatonin does not have addictive qualities or withdrawal symptoms, although it can cause your dreams to be more vivid.

4. Check your serotonin levels
   Melatonin is made in the body from tryptophan and serotonin. So if your melatonin is low, then it is also important to consider whether your serotonin is low as well. Serotonin can be measured in a urine panel (read more here) and, if levels are low, can be supported by taking a tryptophan or 5HTP supplement. As your serotonin levels increase, so will your melatonin levels.You may also find products that contain both melatonin and 5HTP, as way to support your sleep now and into the future by optimizing the amount of both serotonin and melatonin. Find an example product here.

Digging Deeper

Melatonin, like other hormones, delivers important messages throughout our bodies. When it is low, often due to exposure to stress and light at night, we are likely to experience the negative effects of not enough melatonin. It is such a valuable hormone not only in terms of sleep, but also for healthy cells, immune function, and mood, that it is worth identifying whether it is an issue for you and addressing it if it is.

Now, if you follow these steps and find that you are still not sleeping, then it’s time to dig deeper and get a better understanding of what is keeping you awake. Quite often it is more than one thing. It could be that you have low melatonin and elevated cortisol, for example. Or perhaps it’s a combination of leaky gut, food sensitivities, low serotonin, and low melatonin, all of which are related to each other, but need to be addressed individually to completely address your sleep issue. Or it could be that you have inflammation (whether from an injury or a food) which has disrupted your sleep, causing you to gain weight and further disrupt your sleep patterns.

To break these vicious cycles, we need to first understand all the causes, and then address each of them in turn. Then, little by little, over time, the body will start to adjust and sleep will be restored. However, it’s worth noting that it is often a process that requires patience and diligence, and that can be challenging when you can’t sleep.

To make sure you have the support you need to get back to a healthy sleep pattern, I encourage you to work with a practitioner who can help guide you through the steps. I’ve created a Natural Sleep Solutions Package (now available!), which includes the testing that you’ll need to figure out what is disrupting your sleep and consultations with me to support you along the way in making changes that will break the pattern.

Please do share your thoughts and questions on sleep in the comment box below.

Next week is the last installment of this sleep series and we will be talking about how stress affects your sleep. If you want to be sure not to miss it, you can subscribe by using the subscription box on this page.

–Dr. Doni
19^th February 2015

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Dr. Doni’s Natural Sleep Solutions Package

I designed a special 4-month naturopathic treatment package to address the very issues outlined here in this post (and in this whole series on sleep).

This rigorous program will help you identify the underlying cause of your sleep issues, construct a natural remedy plan that will reduce or eliminate your symptoms, and design a long-term health regime to help you get restful sleep and restore your quality of life.

For more info, please see: https://doctordoni.com/sleep-solutions.

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References

1. Institute of Medicine. Sleep disorders and sleep deprivation: an unmet public health problem. Washington, DC: The National Academies Press; 2006.
2. Unhealthy sleep-related behaviors—12 states, 2009. MMWR 2011;60:233–238. Available http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a2.htm
3. Ram S, Seirawan H, Kumar SK, Clark GT. Prevalence and impact of sleep disorders and sleep habits in the United States. Sleep Breath 2010;14:63–70
4. Comai S1, Ochoa-Sanchez R1, Dominguez-Lopez S1, Bambico FR1, Gobbi G2. Melancholic-Like Behaviors and Circadian Neurobiological Abnormalities in Melatonin MT1 Receptor Knockout Mice. Int J Neuropsychopharmacol. 2015 Jan 31;18(3). pii: pyu075. doi: 10.1093/ijnp/pyu075.
5. Nagy AD1, Iwamoto A, Kawai M, Goda R, Matsuo H, Otsuka T, Nagasawa M, Furuse M, Yasuo S. Melatonin adjusts the expression pattern of clock genes in the suprachiasmatic nucleus and induces antidepressant-like effect in a mouse model of seasonal affective disorder. Chronobiol Int. 2014 Dec 17:1-11.
6. de Zanette SA, Vercelino R, Laste G, Rozisky JR, Schwertner A, Machado CB, Xavier F, de Souza IC, Deitos A, Torres IL, Caumo W1. Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: a phase II, randomized, double-dummy, controlled trial. BMC Pharmacol Toxicol. 2014 Jul 23;15:40. doi: 10.1186/2050-6511-15-40.
7. Plaimee P1, Weerapreeyakul N, Barusrux S, Johns NP. Melatonin potentiates cisplatin-induced apoptosis and cell cycle arrest in human lung adenocarcinoma cells. Cell Prolif. 2015 Feb;48(1):67-77.
8. Cos S1, Alvarez-García V1, González A1, Alonso-González C1, Martínez-Campa C1. Melatonin modulation of crosstalk among malignant epithelial, endothelial and adipose cells in breast cancer (Review). Oncol Lett. 2014 Aug;8(2):487-492.
9. Harb F1, Hidalgo MP, Martau B. Lack of exposure to natural light in the workspace is associated with physiological, sleep and depressive symptoms. Chronobiol Int. 2014 Nov 26:1-8. [Epub ahead of print]
10. Chang AM1, Aeschbach D2, Duffy JF3, Czeisler CA3. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proc Natl Acad Sci U S A. 2015 Jan 27; 112(4):1232-7. doi: 10.1073/pnas.1418490112. Epub 2014 Dec 22.

*Please keep in mind that any and all supplements—nutrients, herbs, enzymes, or other—should be used with caution. My recommendation is that you seek the care of a naturopathic doctor (with a doctorate degree from a federally-accredited program) and that you have a primary care physician or practitioner whom you can contact to help you with individual dosing and protocols. If you ever experience negative symptoms after taking a product, stop taking it immediately and contact your doctor right away.