Clinical Question: Is melatonin eff...

Clinical Question: Is melatonin effective for insomnia and other nap problems?

Setting: Outpatient (any)

consideration Design: Meta-analysis (randomized controlled trials)

Synopsis: The authors of this systematic review evaluated the part of melatonin in the treatment of various be dead problems in a variety of patients. The authors performed a thorough search of the literature, although they limited the research to English-language publications. Potential research was protectioned by two independent reviewers and data were abstracted at one reviewer and checked for accuracy according to another. Controlled clinical trials were included and all studies were reviewed for quality using the established Jadad criteria.

In patients with normal be dead patterns, melatonin had a clinically insignificant consequence on the time to repose onset (i.e., sleep onset latency) or forward the amount of time actually exhausted asleep (i.e., sleep efficiency). Melatonin in doses of 1 to 3 mg caused an average delay of 127 minutes in the storming of rapid eye movement (i.e., REM latency) compared with placebo.

In patients with simple insomnia, melatonin helped adults fall asleep an average of 107 minutes faster (95 percent confidence interval [CI], 37 to 176 minutes). Children had a better reply falling asleep an average of 17 minutes sooner Melatonin was particularly effective in patients with delayed nap phase syndrome, a condition in which a person's circadian periodical emphasis is misaligned without an external cause as it is as jet lag or shift work. In these patients, doze onset was an average of 388 minutes faster (95 percent CI, 273 to 503 minutes). Melatonin had no efficiency on sleep quality, wakefulness, total rest time, or percentage of time exhausted in REM sleep.

In patients with jet lag, melatonin did not decrease rest onset latency or increase rest efficiency, sleep quality, or the time wearied in REM sleep, although it was effective in increasing the total rest time. In one study, melatonin had an tenor similar to zolpidem (Ambien) in patients with jet lag. Melatonin was not effective in patients with a secondary nap disorder.

Bottom Line: Melatonin in doses from 01 to 10 mg is effective in helping adults and children who have difficulty falling asleep. It is particularly helpful in patients whose circadian metre is permanently disrupted (i.e., those who have delayed drowse phase syndrome). Melatonin increases lie in the grave length, but not sleep quality, in patients who per- form shift work or who have jet lag. (Level of Evidence: 1a)

consideration reference: Buscemi N. Melatonin for treatment of lie in the grave disorders. Evidence report/technology assessment. No. 108 AHRQ publication no. 05-E002-1 Rockville, Md: Agency for Healthcare Research and Quality, 2004 Used with permission from Shaughnessy AF. Melatonin effective for about sleep disorders. Accessed online April 27 2005 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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