Melatonin

  • May shorten the amount of time it takes to fall asleep by 12 minutes.
  • Does not appear to improve the percentage of time that a person actually spends sleeping.
  • Overall considered “safe”, side effects may include: headache, feelings of depression, daytime sleepiness, dizziness, stomach cramps, and irritability
  • Risks: bleeding disorders, depression, diabetes (effect on blood sugar), hypertension, seizure disorders, transplant recipients

Melatonin has been shown to demonstrate effectiveness as a sleep aid. In patients with traumatic brain injuries (TBI), randomized controlled trials have demonstrated promising results. Grima found melatonin supplementation among outpatients with mild to severe TBI reported improved sleep quality over a 4 week period. It also increased sleep efficiency on actigraphy measurements as well as vitality and mental health on SF-36 v1 questionnaire. Anxiety was decreased on the Hospital Anxiety Depression Scale.

So it appears that sleeping aids such as melatonin may be effective over a 4 week (1 month) period as a safe intervention. But what about long term effects? When considering supplements as an intervention, some patients may also be reluctant to taking supplements, especially if they already have a complicated medication list.

A recent study demonstrated melatonin tolerance effects in younger patients with chronic insomnia and a diagnosis of intellectual disability. Their sleep quality worsened a few weeks after a “good response” to melatonin treatment. According to the NIH, melatonin supplements appear to be safe when used short-term, but research inconclusive for long-term safety.

Alternative Interventions for Sleep Disturbances

  • Cognitive Behavioral Therapy for Insomnia (CBTI)
    • “Sleep diary data amongst patients with TBI and comorbid insomnia following CBT-I is consistent with the wider literature, which strongly supports the efficacy of CBT-I as the standard treatment for insomnia” (Bogdanov).
  • Blue Light Therapy

References:

Bogdanov, S., Naismith, S., & Lah, S. (2017). Sleep outcomes following sleep-hygiene-related interventions for individuals with traumatic brain injury: A systematic review. Brain injury31(4), 422-433.

Braam, W., Van Geijlswijk, I., Keijzer, H., Smits, M. G., Didden, R., & Curfs, L. M. (2010). Loss of response to melatonin treatment is associated with slow melatonin metabolism. Journal of Intellectual Disability Research54(6), 547-555.

Grima, N. A., Rajaratnam, S. M., Mansfield, D., Sletten, T. L., Spitz, G., & Ponsford, J. L. (2018). Efficacy of melatonin for sleep disturbance following traumatic brain injury: a randomised controlled trial. BMC medicine16(1), 8.