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Hey, I'm Christina Quinn, and welcome back to Try This from The Washington Post. Look at you. You've made it to the final class in our sleep course. Way to go. The goal with this audio course has been to explore a number of ways we can adjust our relationship with sleep. I hope by accepting sleep as a bodily function, you'll let yourself loosen up a bit and shift focus away from what you can't control and instead consider what you can do in your waking hours to help yourself out at night. But sometimes we need a little extra help. So in this fifth and final class of our sleep course, we're going to learn about melatonin.


How it works.


And if you decide to take it, how much you should take, and why.


Melatonin is a hormone produced and secreted in our pineal gland, which is right in between the brain's two hemispheres. Fun fact, the pineal gland is super tiny and shaped like a pine cone, hence the name. It produces and suppresses melatonin in response to its surroundings. So during the day, our melatonin levels are very low. And as it gets closer to bedtime, those levels increase and make us feel sleepy. That's why you often hear about the importance of getting light in the morning and dimming your lights before bed.


We talked.


About that in our third class. These are all important signals that make your body naturally produce melatonin. Melatonin is also widely available as an over-the-counter dietary supplement in the form of gummies, pills, sublingual melts, you name it. The US Food and Drug Administration treats it like a food. That means it is not approved for medical use, nor is it regulated like a medicine. But I'm sure you know someone who swears by it, or maybe you yourself do. It's blown up in recent years.


Our melatonin gummies are scientifically developed to help you fall asleep faster naturally. Instead of lying awake, worried about tomorrow. So you.


Can make your next day your best day. Here's something that floored me. Researchers found that melatonin use in the US more than quintupled between 1999 and 2018. For this session, I've been speaking with experts who devote their time to studying sleep, circadian rhythm, and supplements. Keep in mind that we're not giving you clinical advice. We just want to provide you with knowledge and tools to help you sleep better.


First, let's find out how melatonin works in our bodies.


There is a significant variation in the amount of melatonin that can be produced nightly in the human brain. It's really anywhere from, say, 20 pic molars up to over 100 or 150 picomolar. So it's really quite a broad range.


Picomolar are how we measure the amount of melatonin in our brains. And this is Jamie Zeyser. He's a professor in the psychiatry and Behavioral Sciences Department at Stanford University and co-director of Stanford Center for Sleep and Circadian Sciences. He says, if you happen to be cranking out a lot of picomolar, it doesn't necessarily make you a better sleeper. And the reason for this is unclear.


There doesn't seem to be a difference in people who make 25 or 50 or 100 or 150. That does not seem to change their sleep. We don't find any real significant correlations with how they sleep or if they've got insomnia, or anything like that.


What matters is that the on-off signal works. Ideally, you want to rely on your own body's melatonin to whisk you away to sleepy you down based on triggers that we've talked about throughout this course: scheduled worry time, calming playlists, and adjusting your lighting before bed. But sometimes you might want to turn to an over-the-counter supplement. Our second sleep expert in this lesson says taking melatonin can be a good option.


There is very good evidence that in very specific situations, melatonin can be helpful.


Peter Cohen is a primary care physician at Cambridge Health Alliance in Massachusetts and an associate professor at Harvard Medical School. He's done a lot of research on supplements and specifically melatonin.


So sometimes a person might be called Night Owl, someone who cannot go to bed until 3:00 or 4:00 in the morning and then sleeps soundly until 1:00 in the afternoon. In those situations, melatonin might have a role because it helps reset that day-night cycle, the timing of the day-night cycle.


A meta-analysis of 14 sleep studies showed that short-term use of melatonin can help you fall asleep 5-18 minutes faster than a placebo. So like Dr. Cohen said, if you're a night owl who wants to reset your rhythm, or if you're looking to fall asleep a few minutes faster, then melatonin might be the right fit. You can take it 30 minutes to two hours before you plan to sleep. It can also be useful when you're traveling across time zones and need help resetting. On the other hand, if you have severe chronic insomnia and often find yourself waking up in the middle of the night, melatonin might not be the right solution for you. That same meta-analysis shows that the supplement doesn't help you stay asleep anymore than a placebo. So overall, melatonin can help you fall asleep, but there's no evidence it's going to help you stay asleep. If you decide that melatonin is something you want to try or revisit, here comes another question to grapple with. Exactly how much is the right amount? When you set out to buy melatonin at the grocery store or health food store or wherever it is you get your supplements, you're likely to see doses of melatonin in amounts like.


1 milligram, 3 milligrams, 10 milligrams, or even higher.


But it turns out those levels aren't exactly a match for what our bodies produce on their own. In fact, they're not even close. This is Jamie Zeitzer again from Stanford Center for Sleep and Circadian Sciences.


And those levels are super high. They are something that you would never see in a human being naturally produce. Remarkably, if you can take around 0.3 or 0.5 milligrams, that's physiologic replacement. And that's in fact, even on the high side of physiologic replacement.


A physiologic replacement mirrors what your own body produces. And Jamie is saying, we should be taking doses much lower than what's lining the shelves in any pharmacy or supermarket. So what happens to our bodies when we take those 5 or 10-milligram doses amounts much higher than what our pineal glands would naturally produce.


We really don't know what it's doing because not only is it acting on melatonin receptors like the lower dose does, but at these higher concentrations, they're acting also on dopamine receptors, benzadazepine receptors, serotonin receptors. So all of these receptors aren't particularly sensitive to melatonin. But when you're using that much, well, that's enough to get a signal. And so at these higher doses, it might actually be that it's not just the activation of melatonin that's working. It's the activation of melatonin plus a little dopamine, plus a little serotonin, plus a little of the GABA system.


This could explain why some people feel groggy the morning after taking a higher dose of melatonin. We're essentially flooding our system with a hormone that's firing off all these other receptors in our brains. And as Dr. Cohen puts it, that's not how hormones typically function.


Almost every other hormone I can think of, if you give two, three times, 10 times as much, you're going to quickly run into problems. For reasons that are not really clear, it doesn't appear that if you just give two, three, four times more melatonin than the usual amount, it's dangerous. If 4-5 times the amount of melatonin is not dangerous, why not give 50 times, 100 times more melatonin than our pineal gland usually excretion-reactive treats.


It's worth noting that you can only get melatonin with a prescription in many other countries, like the UK and Australia. But again, here in the US, the FDA essentially treats melatonin like a food category and doesn't regulate it like it would a drug.


And just like manufacturers could put in as much garlic into a spaghetti sauce that they want to when they're making it, the ingredients, manufacturers of melatonin, remarkably, can put in as much melatonin into melatonin gummies or melatonin capsules as they want to. And that's what's happened with this thinking that sky is the limit.


Now, if you're wondering how many more Italian food references you're going to have to hear about in a course on sleep, I'm here to make it clear that's the last one. You know what's not always as clear? Melatonin product labels. Sometimes melatonin supplements are mislabeled and include other stuff. In 2022, Dr. Cohen conducted a study designed to figure out what exactly is an over-the-counter melatonin gummies.


We took a look at 25 different products, and these were mainstream products. What we found was that only a small minority of products, only 12 % were accurately labeled. In other words, they were the most high in the world. Most of the products did not contain the same amount of melatonin that was listed on the label. That didn't really surprise us because we've done a lot of research looking at the accuracy of labels for dietary softens and states. But what did surprise me was how often it was that the products had more melatonin, sometimes a lot more melatonin, than listed on the label.


Like in some cases, over 300 % more. And that might not change anytime soon.


Once something is widely available without a prescription at any corner, pharmacy, or supermarket, and widely available on the internet, it's really hard to encourage companies to pursue research into the product because people already have access to it. So how do you know.


If the melatonin you're taking isn't laden with extra stuff?


Look for the.


Usp seal from the United States Pharmacopia, or NSF, the National Sanitation Foundation. These are nonprofit organizations that independently test and certified products for safety and accuracy. Before we finish up this lesson on melatonin, there's one more thing to keep in mind. Sometimes it's not exactly what you take, but the habit and expectations of taking it at all that might do the trick. And Jamie Zeitzer, our Stanford sleep expert, says the mere act of taking melatonin can serve as a useful signal.


And that signal is basically they take this pill and they think, I've had my melatonin. I can sleep well now. They then close their eyes and they go to sleep because they're not worried about falling asleep. So this gets rid of one of the major barriers to sleep and one of the major causes of insomnia, which is worry about falling asleep. Because now you're not worried anymore because, Oh, you've taken this pill, and now you can fall asleep fine.


You're basically giving your brain confidence that you can fall asleep. So he's loath to call it a placebo effect.


When people tell me like, Oh, yeah, I take Malton and it's great. I would never say, Well, the double-blind placebo control trial says it's not doing anything because in them it is doing something. They've gotten into this pattern where now they take the pill, they fall asleep. They take the pill, they fall asleep. And so it's a great pattern to be in.


It really is a great pattern to be in. Now, ideally, you don't have to take a pill to fall asleep. Ultimately, the best option is to guide your body to use its existing melatonin system, that pineal gland, effectively.


The goal of this audio course is to help you sleep better. Over the last five classes, we've covered techniques to adjust some habits and expectations, and in doing so, reframe your relationship with sleep. But when it comes to sleep, it's not one size fits all. Some of the tips we suggest may work better than others. And if you're really.


Struggling, please speak with your doctor.


Remember, so much of getting restful sleep has to do with routine and habit, and you want to signal your brain that it's time to sleep. We hope you find a technique that works for you, but the key is not to be hard on yourself.


As our sleep therapist, Lisa Strauss, puts it.


Sleep is a bodily function. It will come when it's time. I've learned a lot, and I hope you have too. Thanks for listening to this audio course about.


How to sleep better.


If you have suggestions for what courses you love to hear, please send them our way at trythis@washpost. Com, or leave us a review. Otherwise, stay tuned for our next course coming soon. Try This is produced and hosted by me, Christina Quinn. The show's editors are Allison Michaels and Kanyakrit von Kitkajorn. Additional editing by Renita Geblonsky. Fact-checking by Nicole Pazulka. The music, sound design, and mixing is by Catherine Anderson. Show art is by Kathy Wurtys with design editing from Christian Font and Greg Manifold. Special thanks to Phoebe Connolly, Tara Parker-Pope, and Anjuman Ali.