Secrets of Restful Sleep: Exploring the Role of Melatonin Use and Therapeutic Strategies

by | Apr 4, 2024 | Sleep Insomnia | 0 comments

Trouble with Sleeping?

Are you sleeping too much? Is it hard to fall asleep, or is it hard to stay asleep? A solid portion of the general population has difficulties with their sleep hygiene. Studies have found that anywhere between 14.5 to 30% of people have insomnia (Roth, 2007) and 4 to 6% of the population struggle with hypersomnia (Dauvilliers & Buguet, 2005). If you have a difficult relationship with sleep, let’s explore potential causes, sleep aids, and different techniques you can try to improve sleep! 

Insomnia vs. Hypersomnia

Insomnia is defined, in the medical and mental health fields, as disturbed sleep cycles – inability to fall asleep, or difficulties staying asleep (Roth, 2007). There are many different causes for insomnia, which should not be self-diagnosed and deserve medical attention.  

Roth (2007) describes probable causes for insomnia: 

  1. Sleep apnea or related breathing disorders may cause disturbed sleep cycles or the inability to wake up feeling well-rested. 
  2. Menopause or hormonal changes can impact a person’s ability to sleep.  
  3. Medical issues – people with gastrointestinal issues, gastroesophageal reflux (also known as acid reflux), chronic pain, and neurodegenerative disorders (dementia, Alzheimer’s, Parkinson’s, etc.) have been known to be simultaneously diagnosed with insomnia. 
  4. Psychiatric and mood disorders such as depression and anxiety can cause issues like sleeping too much or not sleeping enough. 

The four reasons listed here can cause significant issues in a person’s ability to fall asleep or stay asleep through the night, causing fatigue, irritability, and cognitive functioning impairments (i.e. brain fog, difficulties with motor function and memory, etc.). And after not getting a good night’s sleep, you’re tired and feel like you just need a nap. You may suddenly feel like you’re sleeping too much during the day. Research shows similar, if not the same reasons listed above, as causes for hypersomnia (Dauvilliers & Buguet, 2005). Insomnia at night may lead to hypersomnia during the day, which may feel like depression.  

Depression is a prevalent cause of both insomnia and hypersomnia, however, the vice versa can be true as well – insomnia or hypersomnia can cause depression (Roth, 2007). Please seek medical attention from a primary care physician, psychiatrist, or licensed therapist if you experience any of the symptoms listed above. 

Causes for insomnia or hypersomnia that can be self-diagnosable (to an extent) may include excessive blue-light use (phone, TV, kindle/tablet, or computer), overstimulating environments, weather changes, or lack of sunlight. Moreover, people who work overnight shifts or have rotating and inconsistent day/night shifts may suffer from insomnia or sleep difficulties (Suni & Suni, 2023). Now that we know some potential causes… what do we do about it?  

First and foremost, seek a medical professional to rule out serious medical conditions that may be impacting your ability to sleep. Also, have blood work done to explore hormone levels, specifically melatonin levels. Monitor sleep-wake times and engage in behavioral changes that promote a healthier circadian rhythm (as much as possible in your life). 

Circadian Rhythm & Melatonin – Hormones & Supplements

Okay, what is a circadian rhythm? It sounds like a rhythmic bug… at least that’s what I think of. But it is actually our biological clock that helps regulate our alertness, sleepiness, appetite, and body temperature (Suni & Suni, 2023). Our circadian rhythm is heavily influenced by environmental cues, like light and dark throughout our 24-hour day. Circadian rhythm dictates when certain hormones, like melatonin, are released, based on environment and brain chemistry (Suni & Suni, 2023).  

In the previous section, we talked about potential causes for insomnia and hypersomnia, those external and underlying causes, can throw our circadian rhythm off and impact our abilities to sleep properly or release the correct amount of melatonin at the right time. Taking a melatonin supplement or other types of sleep aids can be beneficial (with the correct and accurate dosage) to induce sleep or put our circadian rhythm into balance (Cipolla‐Neto & Amaral, 2018).  

In the last 6+ years, melatonin supplements have been marketed and pushed to help people with sleep hygiene. Many people, myself included, have used melatonin supplements incorrectly because we’ve been thinking, or have been told, it is a sedative. So, we should take it right before we go to bed, and it will induce sleep.  

However, melatonin is not a sedative, we should actually take it roughly 12 hours after we’ve woken up, but no less than an hour before bed (Cipolla‐Neto & Amaral, 2018). So, if you’ve been up for 9 hours, but you’re going to bed in 2 hours, you should still take the melatonin supplement as a hormonal indicator to our circadian rhythm that we need to start getting sleepy within the next few hours.  

According to Cipolla‐Neto & Amaral (2018), there are therapeutic uses and lack of toxic effects by taking a melatonin supplement, however, it should be used accurately, appropriately, and with the correct dosage. Please contact your doctor about proper use of melatonin if you struggle with sleep. 

Cognitive Behavioral Therapy for Insomnia

Let’s talk about therapeutic and behavioral techniques that don’t require sleep aids (medication) but can be taken if needed. 

Cognitive Behavioral Therapy for Insomnia, or CBT-I as it will be referred to, is an evidence-based therapeutic approach for people who have a difficult relationship with sleep (Sleep Foundation, 2024). CBT-I can be used digitally but is most effective with a therapist, whether in-person or telehealth (Sleep Foundation, 2024) because the foundation of CBT-I is improving the relationship between you and sleep through challenging and reframing beliefs, thoughts, and feelings regarding sleep.  

More technical rules and guides within CBT-I include: 

  1. No caffeine after 10 am or at least a reduced amount of caffeine 
  2. The bedroom should only be used for sleep and sex – you should avoid doing work or watching TV in your bedroom. Our brain tends to associate our bed and bedroom as a stimulus rather than a place for sleep if we’re using them for multiple stressful or stimulating activities. (Understandably, we may not be able to use areas other than our room to work or watch TV, depending on living situations, in that case, create an area in your room, other than your bed, to do those activities) 
  3. We should stop watching TV or using our phones or other electronics at least an hour before going to bed. Too much blue light can disrupt our circadian rhythm – simulating light or wake time.  
  4. We should pick a bedtime and a waketime – logging our ability to stick to those times, track how many times we wake up through the night, log how long it takes to fall back asleep; we should note when we wake up and when we actually get out of bed to start our day; lastly counting how many hours of sleep we successfully got. 
  5. Use the 30-30 rule: The 30-30 technique is a cycle – try to sleep for 30 minutes, doesn’t work, try a relaxation technique for 30 minutes, then try to go back to sleep. 
  6. if you’re struggling to fall asleep or go back to sleep after waking up, and it has been 30 minutes, you should leave your room or bed, and engage in a sleepy time activity or relaxation activity for 30 minutes before returning to your room or bed to try and sleep again.  

For more information about CBT-I explore the Sleep Foundation or find a therapist who is certified in CBT-I. Bridgeview Clinical Services offers CBT-I therapy and psychoeducation to the clients we serve. If you struggle with insomnia or hypersomnia, you are not alone, and there is support out there for you. 

References

Cipolla-Neto, J., & Amaral, F. G. D. (2018). Melatonin as a Hormone: New Physiological and Clinical Insights. Endocrine reviews, 39(6), 990–1028. https://doi.org/10.1210/er.2018-00084

Dauvilliers, Y., & Buguet, A. (2005). Hypersomnia. Dialogues in Clinical Neuroscience, 7(4), 347–356. https://doi.org/10.31887/dcns.2005.7.4/ydauvilliers

Ng, A., Adjaye-Gbewonyo, D., & Black, L. I. (2022). Regular bedtimes among children aged 5–17 years: United States, 2020. https://doi.org/10.15620/cdc:117490

Roth, T. (2007). Insomnia: Definition, Prevalence, etiology, and Consequences. Journal of Clinical Sleep Medicine, 3(5 suppl). https://doi.org/10.5664/jcsm.26929 

Sleep Foundation. (2024, January 16). Cognitive Behavioral Therapy for Insomnia (CBT-I): An Overview. https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia 

Suni, E., & Suni, E. (2023, November 16). Circadian rhythm. Sleep Foundation. https://www.sleepfoundation.org/circadian-rhythm

Suni, E., & Suni, E. (2023, November 22). What are the different types of insomnia? Sleep Foundation. https://www.sleepfoundation.org/insomnia/types-of-insomnia 


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