BMJ  2006;332:550 (4 March), doi:10.1136/bmj.332.7540.550-a

Letter

Does melatonin improve sleep?

Muddles with melatonin

The first 150 words of the full text of this article appear below.

EDITOR—Buscemi et al assert that there is no evidence base for exogenous melatonin for secondary sleep disorder.¹

Lewy et al have shown that low doses of melatonin (0.5 mg) reset circadian rhythm but not high doses (2 mg).² The prolonged half life of melatonin and the sensitivity of the circadian rhythm to its presence mean that in trying to achieve phase advancement or phase delay melatonin has a limited window of opportunity. Too low a dose and no effect, too high and the chronobiological effects are lost and only the direct somnolent action is experienced.

Until very recently there have been no commercially available preparations of the correct dose, substantially hindering research. As melatonin is of most use where there is circadian rhythm dysregulation the correct dose must be used at the right time. It would be a shame if a potentially useful treatment for a limited range . . . [Full text of this article]

London NW6 6BX jan.wise@nhs.net

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