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Melatonin: Understanding Indications, Dosages and Timing

Melatonin: Understanding Indications, Dosages and Timing

Deepak-Shrivastava-photo

Deepak Shrivastava, MD

The demand for over the counter melatonin continues to increase while the scientific research findings and clinical evidence remains relatively less than optimal for most indications.  Little was known about the pineal gland in until 1958 where Lerner reported that it secreted melatonin. However, the Greeks described it as the Realm of Thought; Descartes called it the Seat of the Soul. In Eastern medicine it has long been associated with the ‘Third Eye’ and intuition, and it is linked to an important energy chakra. While on one hand there are claims associating melatonin with delayed ageing, cancer fighting properties, improved sexual vitality and cure for insomnia; on the other concerns regarding possible side effects like headache, depression, dizziness, daytime sleepiness, irritability and stomach cramps are well documented.1 Melatonin is considered possibly unsafe to use during pregnancy and breast-feeding. Since melatonin interacts with other hormones in the body and might be unsafe to use in people who have bleeding disorders, high blood pressure, diabetes, seizure disorder, depression and organ transplantation.

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Understanding the Report of a Sleep Study

Deepak-Shrivastava-photo

Deepak Shrivastava, MD, FAASM, RPSGT

(A Sleep Specialist)

A ‘Sleep Study’, also known as polysomnography or PSG, has been used for decades to diagnose and evaluate the severity of sleep apnea or reversible cessation of breathing during sleep.  Sleep apnea, sometimes called obstructive sleep apnea, is a common health problem that affects millions of men and women. It occurs in children as well. The potential life-threatening effects of sleep apnea include heart and blood pressure problems, anxiety, depression and other mental health problems and difficulty is controlling blood sugar and cholesterol levels.  An increasing number of sleep studies are being conducted as more people are becoming aware of the importance of good quality sleep and doctors are evaluating more people with sleep apnea symptoms. The presenting symptoms could be as subtle as daytime fatigue, tiredness, non-refreshing sleep or more intense like snoring, daytime sleepiness, and bed-partner noticing complete cessation of breathing until an awakening (can occur every few seconds to every couple of minutes).

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Why women sleep worse than men

Originally posted by SHELLEY WHITE, Special to The Globe and Mail

This is the third of a nine-part print and online series looking at the science of sleep and the vital role of sleep in maintaining overall health.

Like millions of Canadian mothers, Dawn Trudeau’s sleep troubles began when her daughter was born.

“You’re getting up at all hours for feedings and whatnot, and I had a hard time getting her to sleep through the night,” says the Ottawa-based, 46-year-old social media marketer and blogger at TheModernMomBlog.com. “My husband is great, and he would help in a minute but he just did not hear the baby crying,” she says.

Even after her daughter started sleeping through the night consistently at age 4, Ms. Trudeau says her sleeping problems persisted to the point of insomnia. “I kind of got used to it at that point.” And now that her daughter is 7, her sleep disturbances are also business-related.

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Fibromyalgia – Does Melatonin Help?

Originally posted in National Pain Report on August 24, 2015

Talk to a person who suffers from fibromyalgia and it doesn’t take long for the topic of sleep to come up.

“I’ve had major issues with sleeping,” said Jenny Schwarz who is from East Helena, Montana. “I have heard that a full night’s rest would greatly reduce my pain, but I don’t remember the last time I slept through the night.”

Is melatonin a possible answer?

Natural levels of melatonin in the blood are highest at night. According to the Mayo Clinic, Some research suggests that melatonin supplements taken at the right time might be helpful in treating jet lag or other sleep disorders that involve poor alignment of your natural biological clock with the night-day pattern around you. Melatonin might also reduce the time it takes to fall asleep — although this effect is typically mild

Now there’s world that several studies have shown that melatonin supplements can reduce pain in patients who have fibromyalgia.

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How important is CPAP compliance for individuals afflicted with Obstructive Sleep Apnea (OSA)?   

Below is a snippet of a study that was completed to try and predict who was going to become a compliant CPAP user based on information from their sleep study.

Extensive use of continuous positive airway pressure (CPAP) has positive clinical benefits for most patients with obstructive sleep apnea (OSA). However, patient adherence is a major limiting factor to the effectiveness of CPAP treatment. This study determined the potential factors affecting the willingness of patients with OSA to undertake CPAP treatment by comparing the polysomnographic parameters (Sleep Study) recorded during diagnosis (without CPAP) and titration (with CPAP).  A total of 312 patients who were diagnosed with moderate and severe OSA, were divided into persistent users and nonusers of CPAP according to their use of in-home CPAP during a 7-day CPAP trial.  Among the patients, 146 (46.8%) became persistent CPAP users. A 10% improvement of oxygen desaturation index (ODI) and a 10% increment in deep sleep percentage increased the chance of persistent CPAP use.  

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Theravent and Talk About Sleep Partnership Expands the Discussion on Snoring

I am really excited to share with you that Theravent and Talk About Sleep are partnering to help build and expand the conversation around snoring including its causes, effects, and remedies. We are collaborating to expand and educate this robust community, while giving the average snorer more representation and resources online.

To facilitate educating and connecting those in the snoring community, Theravent will lend its expertise to offer snorers solutions as well as promote the importance of recognizing snoring as a sleep disorder. Theravent plans to use its knowledge-base to share the latest innovations and research and feature insights from respected sleep experts. Towards this end, Talk About Sleep has added multiple levels of exciting and insightful content including general information, diagnosis, treatment and disease management. In addition, a snoring forum has been added which I will moderate. I look forward to connecting with you via the forum and I hope you will participate.

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New Positional Obstructive Sleep Apnea Therapy

By Jerrold Kram, MD, FCCP

A recently published study found that over 70% of those diagnosed obstructive sleep apnea and having an apnea-hypopnea index less than 60 are at least twice as severe when sleeping on their back as compared to other (non-supine) position.

This condition is referred to as “positional obstructive sleep apnea” (POSA). The most commonly recommended approach for treating POSA is to sew tennis balls into a night shirt. Several manufacturers (REMatee and Zzoma) developed commercial adaptations of the tennis-ball approach using cushions held in place by a waist belt or shoulder harness to restrict back-sleeping.

I recently read very promising study results using a novel position therapy device called the Night Shift. Worn on the back of the neck, Night Shift begins to vibrate when users start to sleep on their back and slowly increases in intensity until a position change occurs. For patients with POSA, 90% responded to Night Shift therapy and had a median apnea-hypopnea severity reduction of 79%!  

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The Problem With Snoring

Snoring has long been considered a nuisance to bed partners and an issue of denial for millions of snorers.  Having spent time on both sides of the equation with a family full of snorers and as a snorer myself seeking a solution to provide relief for my wife, I completely understand the challenges for couples and family’s all over. 

In total, sleep related breathing disorders, ranging from simple snoring to obstructive sleep apnea, affects up to 90 million people in the US.  This is without counting the countless hours of sleep lost by those sharing the room with the snorer or apnea sufferer.

The numbers are astounding:

–          40 to 50 million snorers in the U.S. alone

–          35 to 50 million disrupted bed partners of snorer’s

The problem of snoring is nothing new; we’ve all seen snorers on sitcom’s and movies for years as its common place for us to normalize snoring as regular and untreatable. 

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Why So Sad?

Why so sad

I have always loved the rain! The first droplets heralded an immediate dash for wellies and umbrella followed by an immediate exit to the yard. Living in California, there were no worries about getting soaked to the skin or sick, we simply had a blast jumping into puddles and splashing around. As far as my mom was concerned, with six children under 12 years old cooped up, God had made us waterproof, “Everyone out! Go have fun, and don’t traipse water across the floors when you come in.” Every kid should have it so hard.

That was then, this is now.  Days and days of dark, wet or cold weather can affect adults and children negatively, and I realized how serious this could be when I visited a friend in Seattle over the Christmas holiday one year. Seattle is a beautiful city with great shopping, sightseeing, restaurants, and one of the most stunning Christmas trees in city center I had ever seen in my life.

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Sleep Apnea Is A Children’s Disease !!

There is a surprising incidence of obstructive sleep apnea in children with between 2% and 6% of all children having it. And, that number may be growing as the incidence of childhood obesity grows. Why is this a big deal? Because poor sleep impacts childhood growth and development. Some years ago Dr. David Gozal studied a population of elementary school children for sleep apnea. He identified about 5% with sleep apnea. Almost all were in the lower 10% in their class in terms of learning and behavior. About half had surgery to remove their adenoids and tonsils, a major factor in childhood sleep apnea. Of those who had surgery almost all improved school performance and had increased growth where those who declined to have surgery had no improvement.

More recently a 5 year study of children between 6 and 11 years old was completed. Some of the findings included:

  • 263 kids had overnight sleep studies
  • 43 either had or developed sleep apnea
  • Another 41 had apnea initially but it resolved spontaneously
  • The children with persistent apnea were 6 times more likely to have behavioral problems with parents reporting hyperactivity, attention disruptive behaviors, communication and social competency problems.
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