117Many older people purchase the hormone melatonin and consume it orally, each evening, to promote the onset of sleep at bedtime and, particularly, the resumption of sleep after premature nocturnal awakenings. This need for exogenous melatonin to supplement that secreted from the aging pineal arises from the gland's progressive, agerelated calcification, which decreases the number of active pineal cells, causing parallel reductions in melatonin's synthesis and secretion.1-3 In younger people, plasma melatonin levels generally are about 8-10 pcg/ml during the daytime hours when little melatonin is secreted, quickly rise to 100-200 pcg/ml with the onset of darkness, and remain at around that level until daybreak. With aging, plasma melatonin levels may be slightly lower during the daylight hours, however, nighttime levels are markedly reduced, usually rising only to 20-50 pcg/ml. 4 A single bedtime dose of 0.2-0.5 mg of melatonin will restore nighttime levels to those of younger people for several hours; 4,5 however, this dosage is not stocked in most pharmacies, so patients usually have little choice but to take the much higher doses (e.g. 3-10 mg) that are available. As discussed below, the very high doses may actually exacerbate insomnia in some people, by desensitizing the melatonin receptors on the brain neurons that mediate the hormone's sleep-promoting effects. Moreover such doses may also produce side effects (hypothermia, 4 hyperprolactinemia, 6 morning grogginess 5 ), which rarely, if ever, occur with endogenous melatonin secretion. Even with access to low melatonin dosages, it is still difficult, using melatonin supplements, for older people to reproduce the normal 'square-wave' pattern of plasma melatonin levels observed in younger people, i.e. the sudden, 10-fold-or-greater rise around 9-11 PM and the similar fall around daybreak. Doses that are high enough to produce satisfactory elevations in nocturnal plasma levels throughout the night usually cause plasma levels initially to peak well beyond their normal range, thus risking desensitization of the melatonin receptors. Some possible strategies for obviating this problem were described previously (Richard J Wurtman, Use of melatonin to promote sleep in older people, US Neurology, 2012;8(1):10-1) and additional ones are discussed below.
Regulatory Considerations in the Availability of Oral MelatoninAlthough large numbers of older Americans purchase the hormone melatonin and take it nightly to promote and sustain sleep, the US Food and Drug Administration (FDA) does not require that consumers be provided with guidelines concerning its proper dosage, nor information
AbstractPlasma melatonin levels in young adults are about 10-fold higher during the night than during daylight hours, and these high levels promote both the onset of sleep at bedtime and the speedy resumption of sleep after premature nocturnal awakenings. With aging, melatonin's nocturnal secretion from the pineal gland declines, as do plasma melatonin levels, total sleep time, and sleep ef...