First-Night Effect of Melatonin Treatment in Patients With Chronic Schizophrenia

Abstract

The first-night effect (FNE) is the tendency for individuals to sleep worse than normal during their first night of polysomnographic sleep evaluation. FNE reflects the adaptive increase of alertness and perhaps the stress resulting from an unfamiliar sleeping environment. This effect is usually absent in patients with chronic schizophrenia. Melatonin (N-acetyl-5-methoxy-tryptamine), the hormone secreted by the pineal gland at night, has been found to improve sleep in elderly patients with insomnia and recently in patients with chronic schizophrenia. The authors used FNE as a marker to explore the neurobehavioral responses of patients with chronic schizophrenia to melatonin treatment. In a randomized, double-blind, crossover trial, 14 patients with chronic schizophrenia were administered melatonin (2 mg in a controlled-release formulation) or placebo for 3 weeks with a 1-week washout between treatment periods. Polysomnography was performed during the last two consecutive nights of each treatment period. The following significant FNEs were observed with melatonin treatment: (1) rapid eye movement sleep latency was longer; (2) sleep efficiency was lower; and (3) the duration of wakefulness during sleep was lower on the first night than on the second night. These effects were not found when the patients received a placebo. The FNE was manifested regardless of whether melatonin was administered before or after the placebo treatment period. For the first time, these results show that melatonin treatment exaggerates FNE in patients with chronic schizophrenia, thereby suggesting an improved ability of these patients to mobilize alertness in unfamiliar surroundings.

Efficacy and Safety of Exogenous Melatonin for Secondary Sleep Disorders and Sleep Disorders Accompanying Sleep Restriction: Meta-Analysis

“…Only five studies described a funding source; for all of these studies, funding was received from public sponsors. [18][19][20][21][22][23] Sleep onset latency Table 3 outlines the means and standard deviations for sleep onset latency for placebo and melatonin groups for the six trials providing data on this outcome. 15 18 19 21-23 The studies produced a combined estimate that favoured melatonin but was not significant (weighted mean difference − 13.2 (95% confidence interval − 27.3 to 0.9) min) (fig 2).…”

“…15 18 19 21-23 The studies produced a combined estimate that favoured melatonin but was not significant (weighted mean difference − 13.2 (95% confidence interval − 27.3 to 0.9) min) (fig 2). Heterogeneity among the studies was substantial (I 2 = 79.2%) due primarily to one study 23 that had a very small standard deviation and an estimate that favoured placebo, whereas the other studies had point estimates that favoured melatonin.…”

Efficacy and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: meta‐analysis

“…15 18 19 21-23 The studies produced a combined estimate that favoured melatonin but was not significant (weighted mean difference − 13.2 (95% confidence interval − 27.3 to 0.9) min) (fig 2). Heterogeneity among the studies was substantial (I 2 = 79.2%) due primarily to one study 23 that had a very small standard deviation and an estimate that favoured placebo, whereas the other studies had point estimates that favoured melatonin. The results for planned subgroup and sensitivity analyses are shown in table 4.…”

An Overview On Melatonin Hormone

“…Bu nedenle melatonin kullanımının sirkadiyen ritmi bozmadan ve yan etki oluşturmadan şizofreni hastalarının uyku sorunlarını çözebileceği düşü-nülmektedir. [118] Diürnal değişiklikler ve serum melatonin düzeyi ile ilgili narkolepsi hastalarında yapılan bir çalışmada, olguların sabah ölçülen tükürük melatonin düzeylerinin kontrol gurubuna göre daha düşük bulunmuştur. Ayrıca 18 hastanın 8'inde gün boyunca melatonin düzeyi ve çoğul uyku latansı testinde (multiple sleep latency test) ortalama uyku latansı yüksek bulunmuştur.…”