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The question: I've been struggling to get a good night's rest and despite my attempts to minimize stress and decrease caffeine, I still can't fall asleep regularly. I don't want to take a prescription strength medication and my friend recommended that I try melatonin instead. Is it safe and is it really effective?

The answer: Several sleepless nights can leave us feeling irritable, less energetic and unable to cope with the usual stressors that come our way.

Ideally, cleaning up your routine by practising good "sleep hygiene" should help you to naturally regulate your rest patterns. Sleep hygiene includes habits such as having a set time to go to bed and to wake up (even on weekends), avoiding stimulants such as caffeine or exercise, sleeping in a dark cool room and powering down electronics at least an hour before bedtime.

Despite these attempts, many still struggle to fall asleep and look for solutions such as melatonin so they can avoid prescription-strength medication.

Melatonin is a naturally occurring hormone that is produced in the brain by the pineal gland. It is often referred to as the "vampire hormone" because its production is triggered by darkness and suppressed by light. Its levels rise at nighttime, peaking around 9 p.m. and stay elevated for about 10 to 12 hours. Our natural melatonin levels drop in the morning to barely detectable levels throughout the day.

When you take melatonin in pill form, it is sold at doses that are 10 to 30 times the natural levels in your body. It acts quickly and rapidly leaves the body.

Since melatonin is triggered by darkness, even artificial light can reduce its power, which highlights the importance of powering down laptops, television and phones. It is most effective if taken about 90 minutes before you want to sleep and it's important to note that it should not be taken with other sleep aids or alcohol.

Despite its widespread use, there are some safety issues to consider. Melatonin is sold as a natural food supplement in Canada, therefore it does not undergo the same testing and mandated specifications by Health Canada that prescription medications do. As such, the dosage may not always be standardized.

Potential side effects include nausea, vivid dreams or nightmares, and grogginess the next day. Avoid using heavy machinery or driving for five hours after taking it due to potential drowsiness. Melatonin can affect your natural hormone levels so it is not recommended for men or women who are trying to conceive or for pregnant or breastfeeding mothers. Finally, your body can become dependent on melatonin so use it for a short duration of time.

More studies need to be done to definitively recommend melatonin for insomnia. While some studies show that it shortens the time it takes to fall asleep and helps to increase drowsiness, other research demonstrates no difference when compared to placebo. There are more promising studies that support melatonin's effectiveness when it comes to jetlag or shift workers who are trying to reset their clocks.

The bottom line: Taking a medication to assist with sleep can carry side effects and create dependency, so always look for natural ways to improve your sleep routine. Sleep disturbances can also be a sign of underlying medical conditions such as apnea or mood disorders, and your doctor may be able to support you in other ways that can help .

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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