Melatonin Applications in Sleep Disorder Management

Melatonin, an endogenous hormone synthesised by the pineal gland, has emerged as a versatile agent in the management of diverse sleep disorders. Its primary action involves the synchronisation of the endogenous circadian pacemaker, thereby promoting the onset and maintenance of sleep. Exogenous melatonin formulations range from immediate-release preparations, which mimic the physiological peak shortly after ingestion, to prolonged-release formulations designed to sustain therapeutic levels throughout the night. Clinical applications encompass the treatment of primary insomnia, the alleviation of circadian rhythm disturbances such as delayed sleep phase syndrome and jet-lag, and adjunctive use in neuropsychiatric conditions where sleep disruption is a prominent feature. The favourable safety profile of melatonin, characterised by minimal next-day residual effects and a low incidence of dependency or tolerance, underpins its global adoption as a first-line or adjunctive intervention. Dosages spanning 0.5–10 mg, administered 30–60 minutes before habitual bedtime, have been evaluated in adults, older populations and paediatric cohorts, with efficacy influenced by timing, formulation and patient chronotype. Beyond its chronobiotic properties, melatonin exhibits antioxidant and neuroprotective actions, suggesting additional benefits in comorbid medical conditions and age-related decline in endogenous production. Continued research aims to refine dosing strategies, clarify long-term safety and extend applications to vulnerable groups such as shift workers, neurodegenerative disease patients and those undergoing oncological therapies.

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Melatonin Applications in Sleep Disorder Management publication trend

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Technical terms

Circadian rhythm: The endogenous, approximately 24-hour cycle of physiological processes governing sleep–wake patterns, hormonal secretion and metabolic functions.

Sleep latency: The interval between lights off and the onset of sleep, used as a primary efficacy measure in insomnia trials.

Prolonged-release melatonin: A formulation designed to mimic the natural nocturnal secretion profile by releasing melatonin slowly over several hours.

Chronobiotic: A substance that can shift or entrain the timing of the endogenous circadian clock to a desired phase.

Sleep efficiency: The ratio of total sleep time to time spent in bed, expressed as a percentage and used to assess sleep quality.

References

1. Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders. PLOS ONE (2013).
2. Nightly treatment of primary insomnia with prolonged release melatonin for 6 months: a randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety. BMC Medicine (2010).
3. International Expert Opinions and Recommendations on the Use of Melatonin in the Treatment of Insomnia and Circadian Sleep Disturbances in Adult Neuropsychiatric Disorders. Frontiers in Psychiatry (2021).