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It is that time of life, midlife, menopause, and you aren't sleeping so well. Is melatonin the answer?

Menopause and midlife aging happen at about the same time for most women, but they aren't exactly the same. Menopause is when periods stop because there are not any more eggs to ovulate in the ovary. It's the last period, and it happens at about 50 years of age in most women. Midlife is a little harder to define, but it is that middle of your life from about 40 to 70, after you are young, but before you get old. Maybe it's really from 30 to 60. It depends on where you are as to what range you will embrace. I embrace the 40 to 70, but 30 to 60 is probably better.

We are about as strong and as smart, and I'm not saying wise, as we're ever going to be in normal biologic function at about 30. After that, we begin to age with decreasing muscle mass, bone density, and cognitive speed.

We are usually really great sleepers until midlife. Of course, there are some kids who are naturally short sleepers, and there are those people whose sleep rhythms don't let them really fit into their daily lives. They're night people, but they have to get to work at 7:30 in the morning, so their sleep is disrupted. There are the years of infants and young children that wake us up at night. There are years of jobs that shift hours. But left to our own devices, we are often pretty good sleepers until the middle of our lives.

It's a combination of anxiety, all things for which you're responsible, adolescents in their 20s, finances, juggling stuff keeps us awake. Aches and pains with aging and stiffness keep us awake. And then menopause with hot flushes keeps us awake.

Now, what is melatonin? Melatonin is a small molecule that was originally thought to be made just in the pineal gland in the brain. Its function originally was thought to help us set our circadian rhythm, our internal clock. Pineal melatonin is suppressed by bright light. And when lights get dim, melatonin rises because of its own natural daily rhythm and the lack of suppression by light and helps us signal sleep time. As we age, we make less and less melatonin and that's the midlife aging part.

Now, we know that melatonin isn't only made in the brain, and its function isn't only to help our clock give us daily rhythms. It's found in our gut and may help our gut bacteria have a rhythm, and it's found in the placenta and the ovary and it's an important antioxidant in the body. There is much more that can be said about it, but let's get back to menopause and melatonin.

So you're a midlife menopausal woman and you're having difficulty sleeping. You're having a hard time getting to sleep and your hot flushes wake you up. You're not so interested in taking estrogen hormones for your hot flushes, but you should be and you've read about melatonin. Does it work? Is it safe to take? Can you get addicted to it? Can you take it for a long time?

Does it work? An international group of researchers published a summary of what we know about this in the journal "Sleep Science." Several studies done around the world suggested that a three-milligram dose of melatonin before bed helped with sleep. Women were given melatonin or a placebo and asked about sleep, physical symptoms, hot flushes, and psychological symptoms, and these all got slightly better when people took melatonin over placebo.

Of course, getting better sleep can help with joint aches, psychological symptoms, and hot flushes, but melatonin does a lot of amazing stuff and maybe melatonin was helping.

It was safe with few side effects. Some women in both the placebo group and the melatonin group had side effects of sleepiness and nausea and vomiting and headache, but the incidence was not different in the two groups. People who took placebo and people who took melatonin had the same rate of side effects.

Is it safe to take for a long time? The answer is probably yes. It is not addictive in the traditional sense. There's no evidence that a low dose leads to higher dose usage. There's no evidence that higher doses over three milligrams is more effective. There's no evidence of withdrawal.

The main problem is that there's no control over what's actually in the bottle when you buy it at the grocery store or the health food store. You might be getting melatonin or you might not.

The NIH has a Center for Complementary and Alternative Medicine with a short page about melatonin. They note that a 2017 study tested 31 different melatonin supplements bought from the grocery store and pharmacies. For most of the pills in the melatonin bottle, the amount of melatonin didn't match what was on the label and there were other compounds in the bottle. The biggest concern was 25% of the bottles had serotonin in them, and serotonin is a regulated drug with side effects that can be harmful at low levels.

Melatonin is widely used in Europe as a sleep aid, and supplements are regulated in Germany. So they have to have what they say on the label in the bottle, and no other funny stuff. In the U.S., they could sweep up what's on the lab floor, stick it in a little capsule, and you'd be none the wiser, and no one's watching.

So what do you do if you want to take melatonin? It would be good to talk with your clinician and make sure you don't have any contraindications. They should know that you're planning to take it and it should be on your medication list.

Although the USP verified label on supplements is not a guarantee that you're getting what you think you're getting, it's a start. The USP label indicates that the product has been subject to voluntary testing and meets U.S. pharmacopeia convention standards, that's the USP part, meaning the product is accurately labeled and free of harmful substances. This does not mean that it's been tested by the FDA, but it's better than nothing.

Now, of course, melatonin is found throughout the plant kingdom, and a wonderful paper in the journal "Nutrients" from 2017 listed the melatonin contents of common foods. Some mushrooms have a lot of melatonin. Portobello mushrooms are the basic white and brown ones that you can get at the grocery store have a lot. Seeds and nuts have a lot of melatonin. And pistachios win the top melatonin prize in the nut family.

Sprouted seeds also have a lot of melatonin and sprouted lentils are at the top. I can see a dinner salad with sprouted lentils, mushrooms, and pistachios being perfect to help you sleep. Your gut will love it and you won't feel guilty. Both of those factors are important for a good night's sleep.

It turns out that roasted coffee beans have a lot of melatonin, and coffee has some, but coffee is defeating the purpose.

So there are a lot of reasons you may not be sleeping well in midlife. The American Academy of Sleep Medicine would suggest behavioral approaches, such as bright morning light and daily exercise, a bath before bedtime, and no coffee after noon, limit alcohol at night, and no screen time just before bed to suppress your melatonin.

Having said all that, international studies suggest that melatonin in low doses can be helpful for midlife women struggling to get to sleep. So sleep tight, and thanks for joining us on The Scope.

Dr. Kirtly Parker Jones: Love may be blind, but it's not deaf. This is Dr. Kirtly Parker Jones from the Department of Obstetrics and Gynecology at University of Utah Health. Snoring, the health problem woman wish their bed partners would fix, today on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Kirtly Parker Jones: It's called snoring spousal arousal syndrome, and it's not the kind of arousal we want in the marital bed.

According to the National Sleep Foundation survey, twice as many men report that they snore nearly every night, 32 percent, compared to women, 16 percent. Of course the majority of men don't know that they snore, they have to be told by their bed partner, hunting buddies, or kids. All snoring of any magnitude disrupts the sleep of a bed partner, but not all snoring is a health issue. What snoring is a problem for the guy, or the girl, and what to do about it?

Bed partners of snorers get on average one hour less per night of sleep, and they are frustrated and ticked off. It isn't good for their health or their relationship. According to Dr. Chris Jones, former director of the University of Utah Sleep Wake Center, and my wonderfully non-snoring bed partner, it takes an average of a year or two of fighting or negotiating, by the wife, before the husband is willing to seek medical attention.

So, snoring that is accompanied by breath holding, gasping and choking episodes is called sleep apnea. And women who have to listen to this know that it just isn't right and it worries them. Men with sleep apnea have more obesity, diabetes, hypertension, heart disease, and night time bathroom breaks, which also disrupts their sleep and the sleep of their bed partner. Woman complain that their husbands with untreated sleep apnea have excessive daytime sleepiness, falling asleep while waiting for dinner, watching TV, and very scary, while driving.

Woman who come with their bed partners that have sleep apnea will state that their husbands are irritable with the kids and with them, the way anyone that's sleep deprived can be irritable, and men with sleep apnea have decreased libido and lower testosterone. Enough said about that!

So men don't know that they snore or that they are sleep deprived. Often their bed partners have to convince them. I suggest you use the record button on your cell phone and prove it to them.

Woman can have sleep apnea too, but their hormones and where they store body fat, not in their belly or neck, works for them. After menopause more women snore and have sleep apnea. But snoring is not very feminine and it's a touchy topic and your bed partner may not tell you, or he's so unconscious and snoring too, he doesn't even hear you. So get your honey to talk to their primary care provider or see a sleep specialist before he isn't your honey anymore. And you need to go with him. Maybe simple things like weight loss, not drinking alcohol at night, and other approaches will help. But if it's serious, you need to get serious. Check out your local sleep center. This is Dr. Kirtly Parker Jones. Night, night, sleep tight, don't let the bed bugs bite.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: June 13, 2018
originally published: November 26, 2013