Vanessa Blumer, MD, FACC, FHFSA, is an advanced heart failure and transplant cardiologist who serves as Associate Director of Heart Failure Research at Inova Schar Heart and Vascular.
If you experience insomnia or other sleep issues, chances are you have tried melatonin to help fall asleep. Melatonin, which is a naturally occurring hormone, is commonly available over the counter as a sleep aid. But if you’ve read the medical headlines lately, chances are you’ve seen or heard a mention of a recent study linking melatonin use to heart problems.
This study followed over 130,000 adults who had chronic insomnia. Half of them had been taking melatonin for at least 12 months, while the other half did not take melatonin. The study’s results caused shockwaves.
Over a five-year period, long-term melatonin use (defined as at least a year of use) was associated with:
- 90 percent higher rate of heart failure
- More than three times higher rate of heart failure hospitalization
- A mortality rate twice as high as the no-melatonin group (7.8 percent versus 4.3 percent)
People who had been previously diagnosed with heart failure were not included in the study results.
A More Complicated Picture Than It First Appears
Before you throw out all your melatonin or get worried about your chances of developing heart failure, take a moment to put these results in the proper context.
These findings are early and should be interpreted with caution. The research has not yet gone through the peer-review process. During peer review, other independent medical experts carefully examine the study. This step helps catch errors, bias or overinterpretation before results are considered reliable. Because that review has not yet happened, we do not know whether these findings will hold up. More research is needed to understand whether this link is real and meaningful.
The study demonstrates an association, not causation. So, it did not establish that melatonin use leads to heart failure. The results suggest that more research may be helpful.
Because melatonin in the U.S. is predominantly obtained over the counter, many people who are categorized as “nonusers” may actually be using melatonin but not reporting it.
All the study’s participants had chronic insomnia, which is a population that already has a higher heart disease risk. The study design did not fully capture other factors that could help explain the association such as severity of insomnia, other contributing mental health issues, or the social drivers of health that might contribute to the results.
At present, there is no well-established biological explanation for why melatonin would increase the risk of heart failure to the extent suggested in this abstract.
Researchers did not group the study’s participants by how old they are, whether they had existing arrythmias, whether they were on heart medicines or what kind of heart failure they developed. It’s possible that this additional information would help to explain the results or identify a particular group who is at risk.
Overall, the findings are a noteworthy safety signal that researchers should look into more closely. Researchers should conduct more studies to evaluate chronic melatonin use carefully. Additional research should include a focus on people who have, or are at risk of developing, cardiovascular disease. However, this study’s results are not definitive evidence of harm.
Advice for Patients Currently Taking Melatonin for Sleep
First, the study identifies an association between long-term melatonin use and adverse cardiovascular outcomes in patients with insomnia, but it does not prove causation such that patients should necessarily make a change in their treatment.
For relief of chronic insomnia, I talk with my patients about evidence-based lifestyle changes rather than medication. My recommendations include:
- Cognitive behavioral therapy for insomnia (CBT-I)
- Good sleep hygiene (check out some tips below)
- Screening for sleep apnea, restless legs syndrome, mood disorders and circadian misalignment
Melatonin is a hormone, and you should approach long-term use cautiously, just as with any other hormone. Melatonin use should be:
- Short term
- Purpose specific (used to treat jet lag or shift work, for example)
- Reassessed periodically, rather than continued indefinitely
If a patient has been using melatonin nightly for months or years, I discuss tapering or stopping it, while using lifestyle changes to treat insomnia.
10 Tips for Better Sleep
If your sleep routine leaves something to be desired, there are a lot of things you can do to make it easier to get the recommended seven to nine hours each night. Here are a few ideas:
- Give yourself a regular bedtime – having a consistent schedule helps your body prepare for sleep.
- When it comes to your bedroom, keep it dark, quiet and cool (65 to 68 degrees Fahrenheit).
- Scrolling on your phone before bed is one of the worst things to do right before sleep – although it’s tempting, putting your phone across the room before bed can be a game changer.
- Skip caffeine in the afternoon and evening.
- Exercise, ideally early in the day, to boost the body’s natural melatonin hormone levels.
- If possible, reserve the bedroom for sleep and relaxation – don’t work or watch TV in bed.
- If you don’t fall asleep after 20 minutes of trying, get up and do a calming activity in another room, like reading a book.
- At least an hour before your bedtime, turn off the screens – although research on blue light’s effect is inconclusive, phones and TVs stimulate the brain.
- Avoid alcohol – although it can make people feel sleepy, it increases the chances of sleep disruptions during the night.
- Start a wind-down routine – doing the same things before bed can signal the body that it’s time to sleep.
Feature image, stock.adobe.com
