Anxiety and insomnia can feel like two terrible friends going on a bender together in your brain. Anxiety about getting enough sleep often invites insomnia to the party. From there, sleep deprivation increases stress hormones like cortisol, which, in turn, produces more anxiety and makes it that much harder to relax and go to sleep. It’s a hellish cycle that can only be stopped by calming down (on the anxiety side of things — and obviously easier said than done) and/or forcing sleepiness the best you can (on the insomnia side of things).
On the latter count, doctors such as Alex Dimitriu, who specializes in psychiatry and sleep medicine, tend to recommend melatonin supplements even before something like Benadryl because the antihistamine “can disrupt sleep architecture by decreasing REM sleep,” he explains. By contrast, melatonin is a hormone produced in the brain that naturally increases about two hours before bedtime in order to relax us for sleep. Normally, the pineal gland produces enough melatonin, but there’s evidence that stress and anxiety inhibit this process, which short-term supplementation can balance out.
“Melatonin has various benefits, primarily to sleep, that may have downstream effects on mood and anxiety,” Dimitriu tells me. “Our brains grow new neurons and connections in our sleep, so it certainly helps.”
Cardiologist Sanul Corrielus agrees that taking melatonin for anxiety “can improve sleep quality, regulate circadian rhythm and ease negative feelings associated with anxiousness.” Corrielus also points to a study that found melatonin was potentially more effective at treating anxiety than sedatives. Other research shows that melatonin reduces anxiety related to sleep deprivation and might even alleviate post-operative anxiety for individuals after surgery.
Although melatonin doesn’t produce any feelings of intoxication or have the same potential for abuse as anxiety drugs like Xanax and other benzodiazepines, its use needs to be managed in a similarly delicate way. Otherwise, supplemental melatonin can cause the pineal gland to slow down making natural melatonin, or even worse, too much melatonin can make it harder to sleep or cause nightmares. Melatonin might also interact with other prescriptions, including blood thinners, blood-pressure medication and other sleep aids, so it’s important to consult with a doctor before trying it if you’re on any of the above.
For all these reasons, Corrielus recommends starting with a low 3-milligram dosage during times of heightened anxiety, especially if you’re stressed about getting enough sleep. Dimitriu suggests starting even lower, at 300 micrograms, and working your way up. Either way, both doctors concur that it’s important to take a break every few weeks and to only take melatonin before bedtime. “This allows the body to jump-start its own endogenous melatonin release,” Corrielus explains, adding that this regimen “works best in combination with exercise, yoga and meditation.” (It’s worth noting that melatonin isn’t a direct treatment for anxiety or a standard sleep aid, but something that, per Corrielus, “contributes to relief of anxiety symptoms through the restoration or maintenance of the sleep-wake cycle.”)
Since sleepiness can seemingly be a part of relaxation, I was curious if taking melatonin while awake might help during short bursts of high anxiety or a full-blown panic attack. Dimitriu, however, quickly shot down this idea: “Melatonin should be kept for the night-time only. Daytime use would probably make you groggy, but also confuse your body’s sleep-wake system.”
To that end, think of it as the responsible third wheel in the bender analogy above — its job is to help the two troublemakers in the group (in this case, insomnia and anxiety) safely pass the fuck out.