Something New in Melatonin?

You don't have to be a shift worker or jet setter to have awkward or non-existent sleeping habits, but both groups suffer quite a bit. Melatonin, one of the more popular over-the-counter supplements, may be headed toward a new delivery system, a patch placed on the body with small pulses of the hormone administered throughout the evening (or day), through your skin!

I've written about this sleep aid frequently because I get so many questions on it. Many supplement companies and health food stores will claim that melatonin is a natural sleeping aid or nightcap because it "naturally" helps regulate sleep-wake cycles. Given its wide spread availability today, you'd presume it's safe and effective.

Is it?

Well, that depends. Melatonin has been shown to help regulate sleep cycles in certain populations and really help out quite a few people, but like anything there are pros and cons:

• The precise mechanism of melatonin secretion in the body is not well understood. We do know, however, that melatonin isn't just about sleep-wake cycles. It's been shown to help regulate the female reproductive cycle and may also affect the onset of puberty. Children who take melatonin can suffer a delay in sexual development. (So never ever give a child a melatonin supplement.)


• This new patch study showed that men and women had different levels of melatonin in their system with the same dosage patch! So a gender difference may apply.


• Studies have pointed to melatonin's role in regulating blood flow, specifically in constricting coronary arteries.


• And it's been suggested that melatonin can increase depression in people prone to the illness.

For the record, melatonin is a hormone, and it's not a regulated drug under the FDA. No other hormone is available in the United States without a prescription. In some parts of Europe, melatonin is available by prescription only.

If this experimental patch version of melatonin reaches the market, it could have a much bigger effect on the body than just popping a pill. The half-life of a melatonin pill is short and it doesn't last long; a patch, on the other hand, can deliver small doses throughout its use to keep the levels in the body consistent for a longer, stronger effect. This might be great for shift workers who sleep during the day, when the body does not like to produce melatonin.

The patch has been tested on people who sleep during daylight hours and work at night.. For this reason, I can see why a melatonin patch could be helpful to those who maintain schedules opposite to the usual solar day (where the body prefers to be functional). And I have great respect for those who manage to live this life for the sake of their careers and my safety (e.g., emergency care, pilots, etc.). But, even though the patch would be sold as a prescription, it wouldn't surprise me to see people getting their hands on it without trying other sleep hygiene tactics first, which can be far more effective and healthier overall for the body, particularly for those of us that can really get our shut-eye at night.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor™

This article on sleep and melatonin is also available at Dr. Breus' official blog, The Insomnia Blog.

Related Topics:

• WebMD Video: Melatonin - How It Affects Sleep
• Sleep Disorders: Member Discussion
• Get the Sleep Well newsletter in your inbox weekly

Short Sleeper: Are You Fooling Yourself?

There are plenty of stories about famous short sleepers to go around. Among those who claim (or claimed, as some are no longer with us) that they do perfectly well on four hours of sleep are Jay Leno, Madonna, Michelangelo, Napoleon Bonaparte, Florence Nightingale, and Thomas Edison (whose invention - the light bulb - forever changed our sleep habits). Winston Churchill got by on six hours, and Leonardo DaVinci kept one of the most outrageously crazy sleep schedules, sleeping 15 minutes every four hours day and night.

If you're a short sleeper, which is technically defined as someone who gets fewer than 6 hours a night, are you living well off that brief sleep? Are you catching more Zs during the day in the form of a nap? (Which, by the way, is how some of the aforementioned geniuses got by. Churchill took a complete 1.5- to 2-hour nap in the afternoon-and he undressed and got into bed.)

Well, if you think you could use more sleep time, you're probably right. And science continues to reveal what sleep deprivation can do to us (other than make us tired and cranky). The National Sleep Foundation recently released an alert pointing to new evidence: people who average fewer than six hours a night could develop prediabetes. And you know what that leads to: full-fledged diabetes.

Granted, some people actually can do well with fewer than four hours of sleep, and those people are probably genetic anomalies - people programmed to avoid all the risks related to insufficient sleep. For them, four to six hours is sufficient.

But that, unfortunately, is not the case for the vast majority of the rest of us. Just as you don't hear about people who drink, smoke, and eat poorly living to the ripe old age of 100 very often, you don't hear about too many people who live like vampires and escape the ravages of that lifestyle. Those who claim they "get by" on little sleep are likely fooling themselves, but their bodies won't fool them.

So I ask you:

• How many hours of sleep are you getting on a regular basis?


• Do you feel refreshed when you wake up?


• Do you reach for caffeine, an energy drink, or a sugary snack in the afternoon?


• Are you having trouble losing weight or maintaining your ideal weight?


• Have you been diagnosed as prediabetic or diabetic but haven't changed your sleep habits?

May those answers inspire a lunch pad for making change. I'll give you wiggle room if you're about to change the world with an incredible invention you've been working on like mad, or if you're ruling the world as a great leader. But if you are... then it's highly unlikely - I'll make that impossible - that you're reading this blog.

Got ya. Now go get some more sleep!

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This sleep article is also available at Dr. Breus's official blog, The Insomnia Blog.

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• Late Bedtimes Linked to Heart Disease
• Sleep Disorders: Member Discussion
• Get the Sleep Well newsletter in your inbox weekly

Tips for Sleepless Mariah Carey

I'm not usually the sort to wade through celebrity gossip pages, but this one came across my desk because it is, well, directly related to my area of expertise... and I am compelled to reach out and offer some advice.

Word travels fast: no sooner did Mariah Carey Twitter about her sleep problems did her issues show up on various websites. Here's what she apparently wrote on her Twitter page:

"I just finished working out. Whooo! Quite naturally, 'its 5am and I still can't sleep' Who's up? Nick is too cute when he's sleep! I wish he didn't have to work tomorrow so he could help me sleep all day and I could sing all nite [sic]!"

How many red flags can you find in that tweet? Did she work out just before 5 AM and is only now trying to go to bed while the rest of the world (and the sun, let's not forget) is about to get up? And does she normally live like a vampire - going to bed in the morning and getting up in the evening to sing all night long?

There's nothing "quite naturally" about any of that. Her body is rebelling, thrown totally off key (pun intended) by the crazy break in its natural rhythm that wants to sleep at night and sing during the day. I help lots of jet setters and shift workers who struggle with weird working hours and blocks of time when they do, in fact, live during the night and sleep during the day due to their job.

Being a rock star (or singing sensation or pop queen or however you categorize Ms. Mariah is your choice) has its downsides. The music industry has to be one of the worst fields to work in if you love your sleep. I honestly don't know how some musicians do it when they travel constantly across continents and time zones-going from one late-night show to the next. And I have no idea how someone living on such a schedule can find time to exercise. It's hard enough for the rest of us.

The three simple things Mariah should heed:

• Exercise can be stimulating for some people, making it hard to fall asleep soon thereafter. She might want to try scheduling in her exercise earlier in the day (er, I mean night - maybe before her show?). Or exercise first thing after waking.


• Jumping right into bed and expecting to fall asleep quickly is unrealistic. It can take time for the body to unwind and prepare for sleep. This is when having good sleep hygiene is key.


• Consider re-calibrating the body clock for the short-term when there will be days when she expects her body to keep up with an unusual sleep-wake cycle

I wonder how her hubby fares once Mariah gets into bed. Does his sleep get disturbed? And when he rises, does it disturb Mariah? Ah, the joys of marriage. Hopefully they can sync up their schedules once in a while to enjoy one another.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article on sleep is also available at Dr. Breus's official blog, The Insomnia Blog.

Related Topics:

• WebMD Video: Insomnia - What to Do About It
• Sleep Disorders: Member Discussion
• Get the Sleep Well newsletter in your inbox weekly

Melatonin: Miracle or Mistake?

In this day and age, when sleep rhythms can go haywire at the drop of bad news, questions about sleep aids are a hot topic. They are no longer confined to those who are presumed to have oddball sleep cycles, such as jet setters and shift workers.

I get a lot of questions about melatonin in particular, since many supplement companies and health food stores will tout that melatonin is a "natural" sleeping aid. Given the availability of this supplement today, you'd presume it's safe and effective. But is it really?

What's better, taking a melatonin supplement to help you go to sleep on a crazed Monday night or going for a "PM" version of a pain reliever? Melatonin is a hormone your body produces to help it regulate your sleep-wake cycles, but taking additional melatonin in the form of a supplement isn't as good of an idea as you might think.

• And it's not a regulated drug under the FDA.


• No other hormone is available in the United States without a prescription.


• In Europe, melatonin is only available by prescription.

So here's the 411 on how natural melatonin-the kind produced by your body-works. When the sun sets and darkness sweeps over, a pea-sized structure located deep between the hemispheres of your brain called the pineal gland begins to secrete this hormone-preparing you for bed.

As melatonin levels in the blood rise, you begin to feel less alert and sleep becomes more inviting. Melatonin levels stay elevated for about 12 hours, falling back to low daytime levels by about 9 a.m. Daytime levels of melatonin are barely detectable.

The precise mechanism of melatonin secretion is not well-known. We do know, however, that melatonin isn't just about sleep-wake cycles. It's been shown to:

• Help regulate the female reproductive cycle and may also control the onset of puberty.


• Children who take melatonin can suffer a delay in sexual development. (So never ever give a child a melatonin supplement.)


• Studies have pointed to melatonin's role in regulating blood flow, specifically in constricting coronary arteries.


• It's been suggested that it can increase depression in people prone to the illness.

A hormone with all of these possible effects - even though it's "natural" - isn't something you should be taking without the specific recommendation of your doctor.

Most commercial products are offered at dosages that cause melatonin levels in the blood to rise to much higher levels than are naturally produced in the body. So taking a typical dose (1 to 3 mg) may elevate your blood melatonin levels to 1 to 20 times its normal state. If you take it at the wrong time of day, you may reset your biological clock in an undesirable direction.

How much to take, when to take it, and melatonin's effectiveness, if any, for particular sleep disorders is only beginning to be understood. Remember melatonin is a sleep regulator not a sleep inducer, so it really should not be used as a sleeping pill. In the future, we may find several useful applications of melatonin.

You're better off regulating your own sleep-wake cycles in a genuinely natural way by:

• exposing yourself to light during the day (preferably sunlight),


• engaging in physical activity regularly,


• practicing good sleep hygiene.

Remember: Your body will reset its own internal clock with the proper exposure to light at the right time. (And you shouldn't need a PM formula, either, unless you truly do need an occasional fix for quelling muscle aches or other pains that can prevent you from going to sleep easily. Just don't make this a habit every night.)

Bottom line: better sleep hygiene, better time going to sleep. And better moods the next day. Melatonin, on its own, is not a sleeping pill.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This sleep article is also available at Dr. Breus's official blog, The Insomnia Blog.

Related Topics:

• WebMD Video: Melatonin - How It Affects Sleep
• Sleep Disorders: Member Discussion
• Get the Sleep Well newsletter in your inbox weekly

Teens and Troubled Sleep

Photo Credit: Chuck Patch

Any parent of a teenager knows that teens don't keep regular bedtime hours, and it can be a chore to rouse them out of bed in the morning. Why is this the case? Does a preteen need as much sleep as a 15-year-old? Or more? What are the rules of disengagement from the world when it comes to adolescents?

First, let's get one thing straight: Despite the fact sleep is required for life - regardless of age - it's seen as a luxury among many today because it competes with our highly plugged-in society. We live in a virtual world now that steals our attention 24/7. We can, if we choose, work and communicate in the middle of the night through texting, emailing, and blogging to the universe (and that includes kids old enough to engage in such activities). Just a few years ago that wasn't possible. It has changed most everything, including bedtimes.

Shifts in Rhythms, Changes in Bedtimes
What hasn't changed, however, is a human's need to sleep based on a circadian rhythm. Everyone's body clock or circadian "pacemaker" ticks at a different rate, but as you age your pacemaker will speed up or slow down, thus altering how your body responds to that 24-hour cycle. Teenagers typically don't go to bed much before 11 at night (no matter how much you try) due to their rhythm. From the age of about 15 to 25, that pacemaker slows down so a 17-year-old's body usually won't want to go to sleep early or get up early. Sometime during our late 20s the body clock speeds back up again so it matches the 24-hour day.

That said, it helps to realize that problems with sleep actually can start long before a kid turns 13. School-aged children - kids between 5 and 12 years - need 10 to 11 hours of sleep, which doesn't happen in many families. Trouble can set in as school gets more demanding, and life gets busier with sports and other extracurricular and social activities. Kids at this age also become more interested in the very things that steal sleep from adults, such as the television, cell phones, computers (including the Internet), and yes...caffeine products. For example, playing on the computer or watching TV close to bedtime has been associated with bedtime resistance, difficulty falling asleep, anxiety around sleep, and sleeping fewer hours.

What's more, poor sleep can lead to mood swings, behavioral problems like hyperactivity, and cognitive problems that affect their ability to learn in school. This can then continue into a kid's teenage years, when school gets even more demanding and social activities entice an adolescent to choose wakefulness over sleep.

Even though a teenager's biological sleep patterns shift toward later times for both sleeping and waking, they still need about 9 1/4 hours of sleep each night to function best (for some, 8 1/2 hours is sufficient), which doesn't typically jibe with the morning school bell. For this reason, most teens frequently don't get enough sleep and they can struggle with staying awake during classes.

Cutting into a teenager's sleep hygiene is the irregular sleep pattern they keep throughout the week. Very few teens maintain the same exact schedule seven days a week. They prefer to stay up late and sleep in late on the weekends, which can affect their biological clocks and hurt the quality of their sleep during the school week. Teens can also suffer from treatable sleep disorders, such as restless legs syndrome or sleep apnea.

Multiple sleep studies have been done in recent years to look at teen sleep, some of which have revealed surprising findings. A recent study, for example, indicates that the prevalence of insomnia among adolescents is high - and is associated with future physical and psychological problems. That's not something any parent wants to hear. Getting through adolescence is tough enough. What's more, most people don't realize (or appreciate) the fact that its pervasiveness is comparable to that of other major psychiatric disorders such as mood, anxiety, disruptive, and substance use disorders.

A study like this is a call to action. A teen's bout with insomnia may have more serious consequences in the long term as they continue to mature and grow. The brain, for example, does not finish its complete development until one's early to mid twenties. So if a person has insomnia for years through those critical phases of one's physical and psychological development, what does that mean for one's future health?

A lot.

Sleep and health go hand in hand at every age, from young to old. With so many opportunities to engage in wakefulness today, my hope is that people pay more serious attention to their sleep patterns if they don't feel their absolute best day in and day out. This goes for adults and parents of kids who clearly aren't functioning at their best. Bedtimes are important- and not just for kids. As parents, we need to set examples and be open with our kids about the value of sleep. To that end, here are a few pointers:

• Make sufficient sleep a family priority. It's important for the health of all family members.


• Help your adolescent child try to establish regular bedtime routines, creating a quiet and comfortable bedroom. Televisions and computers need to be out of the bedroom and caffeine should not be part of a child's diet. Help your kids prepare for bed by making sure they disengage from stimulating activities at least 30 minutes prior to bedtime. Reading, for example, is much more relaxing and sleep-inducing than emailing or talking on the cell phone.


• Learn to recognize sleep problems. The most common sleep problems in children include difficulty falling asleep, nighttime awakenings, snoring, stalling and resisting going to bed, having trouble breathing, and loud or heavy breathing while sleeping. These sleep problems can be evident in daytime behavior such as being overtired, sleepy or cranky.


• Talk to your child's doctor about sleep - even if your doctor doesn't breach the topic.

The better we help growing, maturing kids learn to balance their disengagement from the world and their wakeful engagements with the world, the better we can, in fact, help them participate in life to the fullest.

Good Night.

Sweet Dreams,

Michael Breus, PhD
The Sleep Doctor

Related Topics:

• Common Sleep Disorders in Teens
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• WebMD Video: Teens and Caffeine
• Sleep Disorders: Member Discussion
• Get the Sleep Well newsletter in your inbox weekly

Headaches and Insomnia Going Hand in Hand

Headaches come with the territory these days. Any look at the news can give you one of the most common types around: the tension-type. But if you suffer from chronic tension headaches and resort to sleeping them off, you may want to listen up: a new study out of Rush University just emerged showing a behavioral link between these kinds of headaches and insomnia.

In other words, you could be worsening your headaches-and the quality of your sleep - by snoozing them off.

It's no surprise that one of the ways to treat a headache is to lie down and take a nap (assuming, of course, you have the luxury of napping in the middle of your day). But napping can also conflict with your nighttime sleep if it's not planned carefully. It also appears to incite a vicious cycle: 59 percent of those in the study with tension-type headaches complained of sleep problems as a trigger of those headaches.

It's the classic catch-22. Sleep to dull headache. Sleep to trigger headache.

Not fair? Well, there are some solutions to consider.

The first is treating the headache with other means, such as drugs like aspirin or ibuprofen. A little bit of caffeine can help, too (which can be found in headache meds like Excedrin). But the secret is to be mindful of your nighttime sleep schedule and avoid things that can disrupt your normal bedtime.

I've always advocated avoiding naps after 3:00 pm, and the same goes for caffeine, including those caffeine-rich headache medicines.

So what do you do if your head begins to pound in the late afternoon?

The late-day headache can be a monster. Sometimes they are simply the result of:

• staring too long at the computer


• losing all sense of good posture and straining your neck, upper back, and shoulders


• forgetting to have a snack when your blood-sugar dives


• not realizing you haven't had anything to drink in hours


• letting the tensions of the day pile up in your head-literally.

For late-day headaches, why don't you try:

1. Take a 15 minute break from whatever you were doing. Go outside, breathe in some fresh air, and get your circulation going at a faster clip. You'd be amazed by what a little circulation can do.


2. Have a light snack and drink plenty of water.


3. Consider a brisk walk.

If you can work the headache out without resorting to pills, naps, or caffeine late in the day, you'll be able to sleep better at night and welcome a better-headache-free-day the next.

Nothing is more frustrating than a headache that won't go away... or chronic insomnia that has you perpetually on edge. The good news is acknowledging the link between the two can kill these two annoying beasts with one stone.

Sweet Dreams,

The Sleep Doctor
Michael Breus, PhD

This article by The Sleep Doctor is also available at Dr. Breus's official blog, The Insomnia Blog.

Related Topics:

• WebMD Video: Are Headaches Linked to Sleep?
• Sinus, Snoring, Sleep Apnea: Jordan S. Josephson, MD
• Get the Sleep Well newsletter in your inbox weekly

Good News for People with Insomnia

It's one o'clock in the morning and you're exhausted. The alarm will herald a new day in fewer than five hours and you're staring into the dark room (maybe listening to your spouse sleeping soundly). You can't fall sleep. You've done everything you're supposed to do in order to enter dreamland easily, such as relax before bedtime, cast away negative thoughts, and avoid work, caffeine, and stimulating activities like being on the computer. But now you're at your wit's end trying to figure out the problem. Why can't you fall asleep?

Well, insomnia just had a brighter light shined on it.

A new study in the journal Sleep reports that some people have abnormal brain activities that keep them hyperalert. The specific culprit is a neurochemical called GABA (for you science geeks, that's short for gamma-aminobutyric acid), which is reduced by nearly 30 percent in people who have been suffering from insomnia for more than six months.

Mind you, we're talking about primary insomnia, which, as opposed to secondary, means that you're having sleep problems that are not directly associated with any other health condition or problem such as asthma, depression, arthritis, pain, alcohol use, etc. Of the 10 percent of adults who suffer from insomnia, 25 percent of those are considered to have the "primary" variety.

Because this kind of insomnia is also a risk factor for mood and anxiety disorders, the study also raises the possibility that sleep habits could be a factor in people with these health issues and who have GABA deficiencies. It doesn't take a genius to link sleep habits to problems with chronic blue moods and feelings of intense anxiety. The current craziness going on between Wall Street and Main Street has me wondering how many more people are walking around with low GABA activity, and low quality sleep.

So where's the good news in all this? Insomnia may have real physiological reasons behind it, and because many of the hypnotic medications that are most effective in treating insomnia do, in fact, increase activity in the brain at the GABA neurons, there's hope for people who fall into this category.

If you're one of them, it still helps to follow the usual recommendations for getting a good night's rest. But when you have tried everything, this gives you one more thing to consider. It could be all in your head - literally.

This sleep article is also available at Dr. Breus' blog, The Insomnia Blog.

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