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Doctors Debate Sleep Supplements

There’s nothing quite like a good night’s sleep. There’s also nothing like not getting enough sleep, which can wreak havoc on your mood, your focus and your body’s ability to function as it should.

Despite the essential role sleep plays in our health, Americans don’t (or can’t) always prioritize healthy sleep habits. Some 70 million Americans experience chronic sleep problems. The sleep aid market is booming as a result, with a seemingly endless array of products and supplements that purport to safely and naturally support a restorative night’s rest.

Natural sleep supplements can seem like a safer alternative to prescription sleep medications. But thanks to a nearly 30-year-old piece of federal legislation, dietary supplements like probiotics, multivitamins and natural sleep aids don’t require rigorous FDA testing and approval before hitting drug store shelves. That means the safety and efficacy of these products isn’t necessarily guaranteed across the board.

Are popular over-the-counter sleep supplements safe and effective? We asked doctors to weigh in. 


Melatonin

Our bodies produce the hormone melatonin in response to decreasing daylight. It makes us feel sleepy and relaxed, and plays a key role in regulating the body’s sleep-wake cycle. Melatonin supplements have become one of the most popular over-the-counter sleep aids in recent years. There’s evidence that it can be effective and safe to use in adults, if taken in limited doses over short periods of time.

“Rigorous human clinical trials on melatonin suggest it can reduce the time it takes to fall asleep and helps reset the body’s sleep-wake cycle in instances of circadian rhythm disruptions, like in jetlag or night shift work,” says Dr. Jeff Chen, CEO and founder of the clinical research company Radicle Science

Despite the potential upsides of moderate, short-term melatonin supplementation in adults, Dr. Po-Chang Hsu, a Boston-based medicine expert, says that high doses can cause headaches, nausea and dizziness. Some people also experience a “melatonin hangover,” or feelings of grogginess and irritability the morning after taking the supplement. “This usually happens when people take too much melatonin or consume it too late in the evening,” says Hsu. 

Melatonin supplements are also marketed as a sleep aid for children. That’s where the data gets fuzzier. While research into the pros and cons of pediatric melatonin use is limited, a recent report from the U.S. Centers for Disease Control and Prevention noted melatonin overdoses among children increased 530 percent from 2012 to 2021. In a small number of cases, overdoses led to hospitalization. Because of this, pediatricians are divided on the benefits of child melatonin use, particularly among very young children.


Magnesium

Magnesium is an essential micronutrient found in a variety of vegetables, nuts, grains and legumes. Some limited research suggests that magnesium supplementation can increase sleep quality and reduce anxiety. However, most people get enough magnesium through their daily diets, so supplementation can only do so much. 

Dr. Kelly Johnson-Arbor, a medical toxicologist at the National Capital Poison Center, adds a second caveat: Because dietary magnesium deficiency is often associated with older adults, studies to determine the sleep benefits of magnesium supplementation have focused on older adults. That doesn’t necessarily mean that magnesium isn’t safe or effective for younger people. But Johnson-Arbor points out that there’s “scant evidence” to support its effects on sleep quality in younger people.


5-HTP

Our bodies produce the amino acid 5-hydroxytryptophan to manufacture serotonin, an essential neurotransmitter involved in melatonin production. Because of this relationship, there’s some indication that 5-HTP could be used to improve sleep, though the existing research leaves some questions unanswered. 

Many major studies on 5-HTP have been conducted with people with disorders like schizophrenia or Parkinson’s disease, so the findings are not proven in the general population. 

“More long-term, high-quality human studies on 5-HTP in isolation are necessary before any conclusions can be drawn about its effects on sleep,” says Chen. 

The safety of 5-HTP is also an issue. “The main safety concern is that anything that increases serotonin, when combined with other medications that also do so” — like selective serotonin reuptake inhibitors (SSRIs)  — “could raise serotonin too high,” says Dr. Jacob Teitelbaum, an internist who specializes in chronic fatigue, sleep and fibromyalgia. Too much serotonin can cause serotonin syndrome, a serious and sometimes life-threatening drug reaction.


CBD

Cannabidiol is a nonintoxicating compound found in cannabis plants. Proponents tout its ability to reduce anxiety, which can also lead to a better night’s sleep.

Animal studies show potential in CBD’s antidepressant and antipsychotic properties. CBD may also provide neuroprotective benefits, potentially guarding nerve cells against degeneration and dysfunction.  Similarly, some clinical data supports the claim that CBD can reduce anxiety in humans. But large-scale, long-term CBD studies in humans have been limited, and the effects of CBD on sleep, apart from its potential to reduce sleep-interrupting anxiety, are not yet clear. 

Preliminary research is underway on the use of CBD as a sleep aid in insomnia patients. In the meantime, safety remains an important consideration. 

CBD can interact with some prescription and over-the-counter drugs, says Johnson-Arbor. These include some oral contraceptives, antihistamines and herbal supplements like kava, St. John’s wort and, notably, melatonin.  

Like grapefruit juice, which interacts adversely with a variety of medications, CBD contains compounds that neutralize certain digestive enzymes that help process and eliminate drugs in the body. As Chen puts it, anyone taking a medication that interacts with grapefruit should steer clear of CBD. The same goes for people who are pregnant, trying to become pregnant or nursing. 


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