Melatonin effective for some sleep disorders

Journal of Family Practice, June, 2005 by N. Buscemi, B. Vandermeer, P.R. Hooton

Buscemi N, Vandermeer B, Hooton PR, et al. Melatonin for treatment of sleep disorders. Evidence Report/Technology Assessment No. 108. AHRQ Publication No. 05-E002-1. Rockville MD: Agency for Healthcare Research and Quality. November 2004.

* Clinical Question

Is melatonin effective for insomnia and other sleep problems?

* Bottom Line

Melatonin in doses from 0.1 mg to 10 mg is effective in helping adults and children who have difficulty falling asleep. It is particularly helpful in patients whose circadian rhythm is permanently off-kilter (delayed sleep phase syndrome). It increases sleep length, but not sleep quality, in patients who perform shift work or who have jet lag. (LOE=1a)

Study Design

Meta-analysis (randomized controlled trials)

Setting

Outpatient (any)

Synopsis

The authors of this systematic review evaluated the role of melatonin in the treatment of different types of sleep problems in different types of patients. They performed a thorough search of the literature though they limited the research to English-language publications. Potential research was screened by 2 independent reviewers and the data were abstracted by 1 reviewer and then checked for accuracy by another. They included controlled clinical trials and reviewed all studies for quality using the established Jadad criteria.

In normal sleepers, melatonin had a clinically insignificant effect on the time to sleep onset (sleep onset latency) or the amount of time actually spent asleep (sleep efficiency). Melatonin in doses of I mg to 3 mg caused an average 12.7-minute delay in rapid eye movement onset (REM latency) as compared with placebo.

In patients with simple insomnia, melatonin helped adults to fall asleep an average 10.7 minutes faster (95% CI, 3.7-17.6 min). Children had a better response, falling asleep an average 17 minutes faster. It was particularly effective in patients with delayed sleep phase syndrome, a condition in which we might say that a person's circadian rhythm is misaligned without an external cause such as jet lag or shift work. In these patients, sleep onset was an average 38.8 minutes faster (95% CI, 27.3-50.3 min). Melatonin had no effect on sleep quality, wakefulness, total sleep time, or percent time spent in REM sleep.

In patients suffering from jet lag, melatonin did not decrease sleep onset latency or increase sleep efficiency, sleep quality, or the time spent in REM sleep, though it was effective in increasing the total sleep time. It had an effect similar to zolpidem (Ambien) in patients with jet lag in one study. Melatonin is not effective in patients with a secondary sleep disorder.