I discuss melatonin’s effects on sleep & its safety with research up to 2015; I segue into the general benefits of sleep and the severely disrupted sleep of the modern Western world, the cost of melatonin use and the benefit (eg. enforcing regular bedtimes), followed by a basic cost-benefit analysis of melatonin concluding that the net profit is large enough to be worth giving it a try barring unusual conditions or very pessimistic safety estimates.

One of the problems with ‘productivity’ gimmicks is assessing their worth. Many of them claim immeasurable gains , dubious gains , or clear gains which mayn’t be worth the overhead . The benefits of others are perfectly measurable, like adding keybindings for repetitive tasks; just time the manual way versus the shortcut, and multiply it by the usage. But then the cost is hard to measure. How to assess the price of creating, learning, and rendering habitual a custom shortcut? There are scads of useful bindings in Emacs that I have tried to learn, only to forget them or remember them after I needed them. My favorite ‘productivity tool’ is one that suffers from none of these problems, and has refreshingly clear-cut costs and benefits. Even though it eats up a third to a half of your life, sleep is neglected because people assume it is too hard to quantify or is too mysterious; but since it takes such a large chunk of time, even doubtful or unreliable improvements are well worth your while.

Use Melatonin (Examine.com; FDA adverse events) is a hormone secreted by the pineal gland. Its primary purpose is regulating the sleep cycle; its abatement permits waking. Odds are your local greengrocer carries it. It’s often used by people suffering from insomnia or to combat conditions such as jet lag. It has other miscellaneous uses like combating other chronobiological issues and linked problems like depression (it’s been claimed melatonin use may cause or exacerbate depression, but the research doesn’t seem to bear this out). But it’s also useful for adults with perfectly normal sleep-cycles . I am unsure whether its effect is to put one to sleep faster, or to do that and also deepen sleep, but melatonin does it well. The 2005 meta-analysis Brzezinski et al concluded that, over all (mostly healthy) adult participants, melatonin improved on placebo to the extent that it [statistically-]significantly reduced sleep onset latency by 4.0 min (95% CI 2.5-5.4) [The normal limits for latency to sleep are considered to be 15-20 min.]; increased sleep efficiency by 2.2% (95% CI 0.2-4.2) [The normal sleep efficiency is about 90-95%.], and increased total sleep duration by 12.8 min (95% CI 2.9-22.8). Since 15 of the 17 studies enrolled healthy subjects or people with no relevant medical condition other than insomnia, the analysis was also done including only these 15 studies. The sleep onset results were changed to 3.9 min (95% CI 2.5-5.4); sleep efficiency increased to 3.1% (95% CI 0.7-5.5); sleep duration increased to 13.7 min (95% CI 3.1-24.3). The meta-analyses or reviews Buscemi et al 2006 & Braam et al 2009 & Keegan et al 2013 & Ferracioli-Oda et al 2013 turn up weaker or similar results in other populations, the last mentioning (importantly for dependency concerns) that the sleep quality benefits did not seem to be moderated by “trial duration and melatonin dose.” The effects may be stronger in the old or elderly ; perhaps due to their lowered secretion of melatonin, and Braam et al 2009 interestingly speculates that effects of melatonin are understated due to most data coming from subjects sleeping in an alien sleep laboratory environment: Visual inspection of the standard forest plots, as presented in the three meta-analyses in individuals without intellectual disability, suggests that the change in sleep latency in studies in which measurements were performed in a sleep laboratory using polysomnography is smaller compared with studies that were performed under home conditions. Re-analyzing the data presented in these studies shows that the mean change in sleep latency in the studies using polysomnography is 10.1 minutes, whereas change in sleep latency in studies performed under home conditions is 16.8 minutes. The inclusion of a substantial number of studies using polysomnography in the meta-analyses in individuals without intellectual disability may have contributed to the smaller decrease in sleep latency compared with our meta-analysis, in which all studies were performed under home conditions.

Safety Pro Melatonin is apparently safe ; from Wikipedia, a meta-analysis, and a review (respectively) of melatonin studies: Melatonin appears to cause very few side-effects in the short term, up to three months, when healthy people take it at low doses. A systematic review[63] in 2006 looked specifically at efficacy and safety in two categories of melatonin usage: first, for sleep disturbances that are secondary to other diagnoses and, second, for sleep disorders such as jet lag and shift work that accompany sleep restriction.[63] The study concluded that ‘There is no evidence that melatonin is effective in treating secondary sleep disorders or sleep disorders accompanying sleep restriction, such as jet lag and shift-work disorder. There is evidence that melatonin is safe with short term use.’[63] A similar analysis[64] by the same team a year earlier on the efficacy and safety of exogenous melatonin in the management of primary sleep disorders found that: ‘There is evidence to suggest that melatonin is safe with short-term use (3 months or less).’ The most commonly reported adverse effects of melatonin were nausea (incidence: ~1.5%), headache (incidence: ~7.8%), dizziness (incidence: 4.0%), and drowsiness (incidence: 20.33%); however, these effects were not [statistically-]significant compared to placebo. This result did not change by dose, the presence or absence of a sleep disorder, type of sleep disorder, duration of treatment, gender, age, formulation of melatonin, use of concurrent medication, study design, quality score, and allocation concealment score. A 2010 trial tested a delayed-release melatonin over 6 months and found minimal adverse effects and no tolerance or “addiction”, as well as benefits for both the young and old adults in the trial. A 2012 survey of 101 Australian doctors prescribing melatonin for children for as long as 4 years found little awareness of side-effects. Natural Standard 2011: Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses (5 milligrams daily) for up to two years. Available trials report that overall adverse effects are not [statistically-]significantly more common with melatonin than placebo. However, case reports raise concerns about risks of blood clotting abnormalities (particularly in patients taking warfarin), increased risk of seizure, and disorientation with overdose. Con The FDA does not regulate melatonin, as a supplement, but it has declined to give it GRAS-status - the highest level of safety which allows it to be added to regular food; its warning letters are good sources if we are looking for evidence against melatonin’s safety. One such letter, sent to the makers of the soda Drank which includes melatonin, cites 3 pieces of evidence: increased cancer in female lab mice (but an increased lifespan! And human studies have not found any increased cancer ) retinal damage in 2 lab mice variants (human clinical study found a protective effect ) a summary of a Natural Standard review monograph mentioning human research finding weak potential for decreased blood pressure , hyperglycemia , and increased atherosclerotic plaque, and its general concern about the use of a hormone

Self-discipline Speaking from personal experience, I know that one of the obstacles to sleeping well is going to sleep at all. Even though one knows that one ought to go to bed on time, and that not doing so will cause problems, it’s hard to actually do it. One wants to finish the book, chat with friends, play a game, etc. It is even more difficult when one doesn’t feel tired. For me, I had a chronic akrasia problem with going to sleep; in college, it was bad enough that I would on occasion stay up to 4 AM for no reason at all! This dilemma is far from unique. It is called hyperbolic discounting; humans can make the rational decision when at a great distance from a choice, but the closer they come, the more warped their decisions are. Procrastination is often thanks to hyperbolic discounting - ‘hard work pays off tomorrow but procrastination pays off now’, and never mind that tomorrow always comes. Similarly, addicts want to be free of their addiction, but their want for a drink right now overwhelms their lifetime desire to not have drinks. (For more on the topic, see “Akrasia, hyperbolic discounting, and picoeconomics” and “Applied Picoeconomics”.) How do we deal with this? The classic mechanism is avoiding the choice entirely. An addict can avoid bars or liquor stores, but no one can avoid sleep. Failing to avoid the choice entirely, one raises the cost of ‘procrastination’ - make the addict pay $100 for every drink they take. Even apparently trivial cost increases like someone watching our computer desktop through VNC, or working at a coffee shop can make a real difference with procrastination. We need to raise the cost, then, and somehow change the incentives to make us want to sleep. We can do this simply by waiting until the need to sleep is so strong we can no longer resist; and in practice, many (especially college students) do just this. But few of us have the luxury of the bizarre schedule this entails. We could try some sort of monetary fine for not going to bed by midnight, but enforcement is difficult and if you’re a college student, you may not be able to afford a vow painful enough to deter you. Melatonin allows us a different way of raising the cost, a physiological & self-enforcing way. Half an hour before we plan to go to sleep, we take a pill. The procrastinating effect will not work - half an hour is so far away that our decision-making process & willpower are undistorted and can make the right decision (viz. following the schedule). When the half-hour is up, the melatonin has begun to make us sleepy. Staying awake ceases to be free, to be the default option; now it is costly to fight the melatonin and remain awake. The choice of sleep may now prevail over the hyperbolically-distorted choice of video games. The long time-lag and the extreme ease of taking the melatonin makes it harder to succumb to a kind of ‘meta-akrasia’ where you come up with a good trick or solution to make yourself do whatever it is you need to do - and then you start procrastinating/suffering from akrasia about the trick! And going to sleep when you need to go to sleep is, in the long-run, a very valuable thing in its own right.

Excuses, excuses… Melatonin is a clear-cut Good Thing. The gains I have laid out are large enough I consider it irrational for someone not to use it, unless: You’ve never heard of it, or seen an analysis of the possible benefits. You, dear reader, are no longer allowed this excuse. You are so poor that 6 dollars every 150 or 300 days is a crippling expense. But then how come you have the free time to read this? Melatonin supplements just doesn’t work on you, period. Possible (I have read multiple anecdotes that melatonin did nothing to help), but it’s not that common. Melatonin isn’t some mental trick - it’s a fundamental fact of mammalian biology. I’ve run into more people who have tried melatonin and had it help than found it completely ineffective, and I wonder if some of the non-responders varied their doses to test the lower ranges like 0.1mg. They work, but not well enough. This implies that melatonin saves you only a few minutes or seconds, else the gain would be smaller but still be positive. (This too strikes me as unlikely.) You value a simpler, less complicated life that much. Taking a pill at night, and buying some pills once every year or two stresses you out? You value an hour at less than 11¢, so melatonin is not profitable. Please contact me. I would like to hire you at the princely rate of a quarter an hour to do drudge-work on Wikipedia. You are a child or adolescent (see the footnote previously) Legitimate; at the very least, the cost-benefit analysis becomes uncertain enough that there’s no obvious right answer. Melatonin is prescription-only or banned. You have my sympathies.

Competition A parting thought: millions of Americans (estimated at around a third or more of adults) regularly take multivitamin supplements. These supplements are unlikely to help a balanced diet, there is little evidence they do, and there are studies which have indicated actual harm from the consumption of multivitamins . Multivitamins are noticeably more expensive than melatonin pills, and are certainly harder to swallow. And this is to say nothing of supplements which are actually dangerous, like ephedra. Do you take a multivitamin, but not melatonin? If so, how can you justify this?