Melatonin for Day Sleep or Night Alertness?
Abstract & Commentary
Synopsis: These data do not show real improvement in day sleep or night alertness, and melatonin is not recommended for these uses.
Source: Jorgensen KM, Witting MD. Ann Emerg Med 1998;31:699-704.
To determine whether exogenous melatonin improves day sleep or night alertness in emergency physicians working night shifts, Jorgensen and Witting performed a double-blind, placebo-controlled crossover trial. They gave emergency physicians 10 mg sublingual melatonin or placebo each morning during two time-equivalent strings of night shifts. During day-sleep periods, subjective sleep data were recorded, and during night shifts, alertness was assessed using the Stanford Sleepiness Scale. Melatonin did not improve gestalt day sleep (P = 0.3) but did suggest a trend toward improved night alertness. Exogenous melatonin may be of modest benefit to night shift workers.
Comment by John La puma, md
I’ll bet that "ER" will feature melatonin, if it hasn’t already. As sure as perception is TV reality, their docs will soon be snoozing. But, if they were real docs, would they have a chance?
These two University of Maryland physicians decided to enroll their emergency medicine residents and attendings to find out. Residents worked two, three, four, or five 12-hour overnight shifts; attendings worked two or five eight-hour overnight shifts. A washout period of five days was created. Most subjects slept the time off through, instead of a few hours after work and a few hours before.
Though the sample size was small, Jorgensen and Witting claim that it had the power to show a dramatic benefit on day sleep or night alertness. There was no benefit. Jorgensen and Witting also claim that this is the largest study of melatonin in night shift workers. They imply that the large dosage would not be used again (0.3 mg is probably adequate to prevent jet lag). Trends toward initial sleep time, premature awakenings, and time to fall asleep favored melatonin, but slightly.
Though virtuous, this study suffers from many unanswered methodologic questions, from the level of activity in the ED on each night, to ways to make sense of subjects’ variable time periods worked, to the uncertainties about the constancy of subjects’ sleeping places and partners.
With nonstandardized, over-the-counter hormones now available on must-see-TV, go slowly. These data do not show real improvement in day sleep or night alertness, and melatonin is not recommended for these uses. If you recommend melatonin to patients for prevention of jet lag, suggest that it be taken in very low dose—1 mg or 2 mg—for no more than a few days at a time.
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