Long-term use of the melatonin, a widely used over-the-counter (OTC) sleep aid, has been linked to a higher risk of heart failure and early death in adults with insomnia, according to recently released research. This might prompt patients to raise questions. And, due to the surge of GLP-1 use in your practice, there could be an overlap of patients who are using weight-loss medications and taking melatonin. 

Although melatonin is a natural hormone that helps regulate the daily cycle of sleep and wakefulness, and supplemental doses are available OTC to help the body’s sleep-wake cycle, ongoing use should be monitored. 

“Although many people try using melatonin to help fall asleep, the data indicates that it isn’t a great sedative/hypnotic, especially for the long term,” Indira Gurubhagavatula, MD, MPH, professor of sleep medicine at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia, where she serves as program director for the sleep medicine fellowship. 

There is data that discourages reliance on melatonin. Proactive discussions with patients who share sleep challenges could be warranted.

Sharing Precautions With Patients

Some patients may not immediately consider melatonin worrisome because they can purchase the supplement readily, but chronic use can be problematic. “Melatonin is not recommended for individuals living with chronic insomnia,” said Gurubhagavatula. Instead, try to suggest alternative treatment options such as cognitive behavioral therapy for insomnia (CBT-I), she said. 

Another point to raise with patients is when they are taking the supplement. “Melatonin also must be carefully timed. If it is taken at the wrong hour, it can have unintended effects on the timing of the sleep-wake rhythm,” said Gurubhagavatula.

A gentle reminder to discuss any supplements that they are currently or considering using is also advised. 

The effectiveness of melatonin varies for individuals and — more importantly — supplement brands. 

Since it’s not regulated by the FDA, there’s no way to be sure how much melatonin is in a supplement unless the product label has the USP Verified mark, which indicates that the formulation meets the requirements of the US Pharmacopeial Convention, said Gurubhagavatula. One study found the most significant variability in melatonin content was chewable tablets, a form that children are most likely to take.

As with any supplement, melatonin may interact with other medications that an individual is taking, so speaking with your patients to discuss dose, frequency, timing, and potential side effects based on their health history, tolerance, allergies, etc, is advised.

Here are a few key interactions to be aware of:

• Anticoagulants and antiplatelet drugs, herbs and supplements: These types of drugs, herbs, and supplements reduce blood clotting. “Combining use of melatonin with them might increase the risk of bleeding,” said Gurubhagavatula.
• Blood pressure drugs: “Melatonin might worsen blood pressure in people taking blood pressure medications,” the sleep medicine doctor said.
• Diabetes medications: Melatonin might affect sugar levels, so a warning is important.

Melatonin and GLP-1s

More research is needed to understand whether melatonin impacts GLP-1’s, said Gurubhagavatula. But a holistic approach can give you an understanding whether other medications your patients could be prescribed can have interactions with melatonin use. “By knowing the risks, individuals can make informed decisions with a healthcare professional about whether taking melatonin supplements is safe while also taking a GLP-1,” said Gurubhagavatula.

GLP-1’s can be used successfully to treat obstructive sleep apnea (OSA) related to obesity, according to the FDA.

“If we are working to address OSA, we may see an inherent correlation with improved sleep quality, duration, and satisfaction. That alone may be enough to improve sleep quality and symptoms of insomnia,” said Gurubhagavatula. When treating an individual’s sleep apnea with GLP-1’s and sleep issues persist, you may want to recommend a formal sleep study or connect the individual with CBT-I treatment, she said.

Is There Anyone Who Shouldn’t Use Melatonin?

Melatonin should not be used as a long-term treatment for chronic insomnia (more than 2 weeks without speaking to a physician) or other persistent sleep issues, said Shalini Paruthi, MD, board-certified in sleep medicine and internal medicine, who is co-director of the Sleep Medicine and Research Center at St Luke’s Hospital in Chesterfield, Missouri. She’s also an adjunct associate professor of internal medicine and pediatrics at Saint Louis University School of Medicine. 

Remind your patients that sufficient sleep is one of the three pillars of a healthy lifestyle, along with good nutrition and regular exercise, said Paruthi. “Insufficient sleep contributes to the risk for several of today’s public health epidemics, including cardiovascular disease, diabetes and obesity,” she said.

Studies show that sleeping less than 7 hours in adults is associated with weight gain. “This is likely due to increased caloric intake, increased snacking, poorer diet quality, and preference for energy-dense foods,” Paruthi said. 

Sleeping less than 7 hours per night on a regular basis is also associated with adverse health outcomes, including weight gain and obesity, diabetes, hypertension, heart disease, stroke, and depression, she said

Gurubhagavatula and Paruthi have disclosed no relevant financial relationships.