Is There a Problem Taking Melatonin to Sleep?

Chronic insomnia wears you down. It also contributes to a range of health problems, from high blood pressure to diabetes. But many of the medications people take to get to sleep are not intended for long-term use. Others are not safe for seniors. What about taking melatonin? Some readers wonder if it is better than prescription sleeping pills.

Does Melatonin Work as Well as Alprazolam?

Q. Is there any problem taking alprazolam to get to sleep? I’ve been doing this for years. Would melatonin work as well?

A. Alprazolam (Xanax) is a benzodiazepine approved for anxiety but not insomnia. Benzos are considered inappropriate for older people. Stopping alprazolam may make it much harder to get to sleep, though. Discontinuing the drug requires medical supervision.

Melatonin won’t substitute for alprazolam, but it may help you readjust your sleep-wake cycle (Neuropsychopharmacology, July, 2022). You can learn more about alprazolam, melatonin and many other strategies for overcoming insomnia in our eGuide to Getting a Good Night’s Sleep.

Taking Melatonin Doesn’t Work for Early Waking:

Q. I’ve always had trouble sleeping, so I’ve tried many sleep aids. Several things help put me to sleep, though none is perfect. Some lose their efficacy after I’ve used them a while — valerian, lemon balm, bedtime tea and melatonin among others.
Staying asleep is another story. The older I get, the more likely I am to wake at 2 or 3 am and not be able to go back to sleep.

The best remedy I’ve found for this is Sleep Answer, a timed-release low-dose melatonin pill. The company claims that the low dose works much better than a higher dose, and I’ve found that to be true. But it doesn’t always work to put me back to sleep, so I’m always looking for something else. I would appreciate any suggestions you might have.

A. If you have not tried listening to relaxing self-hypnosis audio, you might want to give that option a try. For example, Stanford psychiatrist Dr. David Spiegel offers an app called Reveri. One of the hypnotherapy sessions helps people with insomnia. Evidence suggests that self-hypnosis can help with early-morning reawakening (American Journal of Clinical Hypnosis, Sept. 2024).

Is Taking Melatonin a Safe Way to Get to Sleep?

Q. I have been taking melatonin for years to help me sleep. As I understand it, as your body ages it makes less of this natural sleep substance.

I try to avoid sleeping pills. The TV commercials for such medications scare me when they describe horrible side effects.

I recently read the fine print on my melatonin bottle. It said to take it for two months, then wait a week before taking it again. I can do this, but I don’t want to take sleeping pills while I am off melatonin.

I do not need anything that makes my memory worse, which is what I fear from the help-you-sleep stuff advertised on TV. At age 85, I’d like to stay safe. Is there a problem taking melatonin?

Risks of Sleeping Pills:

A. We appreciate your concerns about the dangers of OTC sleeping pills. Many contain DPH or other sedating antihistamines. A study in JAMA Internal Medicine (March 2015) linked the regular use of first-generation antihistamines like diphenhydramine (DPH) and other anticholinergic drugs to dementia.  Some prescription sleeping pills have also been associated with a higher risk of cognitive decline (Expert Opinion on Drug Safety, May 2015).

What About Melatonin?

Although melatonin is usually considered safe (Clinical Drug Investigations, March 2016), a British study recently found that older people taking melatonin are at a greater risk for fracture (Age and Ageing, Nov. 2016). That may be because of dizziness or a morning “hangover” effect.

You might consider a non-drug approach to overcoming insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is effective and does not provoke unwanted side effects (Journal of Cancer Survivorship, online Jan. 19, 2017). Not everyone can consult a therapist trained in cognitive behavioral therapy, but anyone with internet access could benefit from a computerized version of this therapy (PLOS One, Feb. 11, 2016).

Watch Out for Unexpected Stimulants:

Taking melatonin is not the only approach insomniacs may try. Some adopt the habit of drinking a non-caffeinated beverage in the evening. One reader discovered, to her surprise, that this tactic backfired.

Q. For years I had the same sleep problem: I’d fall asleep fine and then wake up three hours later. My mind would be racing and I’d be sweating, stressed and unable to fall back asleep for hours.

I tried everything I could think of: switched to decaf coffee, gave up all alcohol, started meditating, even found a lullaby playlist to condition my body into sleep-mode. (My husband hated it!)

Nighttime wakings turned into panic attacks; I was fighting with my husband, cranky with my kid and bad at my job. I tried to drug myself with over-the-counter stuff like Nyquil and Benadryl to sleep, but that was no good.

In the end, the culprit was so mundane I missed it for years: ginger tea. I love the strong flavor, and drank at least one cup every night, even on vacation or work trips. Because it’s not caffeinated, I overlooked its potential as a stimulant.

Once I stopped drinking ginger tea, all those problems disappeared, literally overnight. Now I can drink good coffee, have wine with dinner, ditch the lullabies and sleep fantastically. No more anxiety, night sweats, stress, sleep loss or fights. I offer this as a reminder that–for better or worse–herbs have powerful effects!

A. Thank you for sharing your fascinating story. Something as seemingly innocuous as an herbal tea could have unexpected consequences.

We could find no human studies demonstrating that ginger affects sleep. However, scientists studying mice found that ginger extract made the animals take longer to fall asleep and sleep less (Indian Journal of Experimental Biology, Oct. 2016).

Learn More:

You will find more information about sleeping pills and alternative ways to overcome insomnia in our online resource Guide to Getting a Good Night’s Sleep. It also offers many other suggestions for people suffering from insomnia. In addition, you may wish to listen to our interview with sleep expert Rafael Pelayo. It is Show 1268: Learning How to Sleep.