Caitlin Whyte (Host): Welcome to Flourish, the podcast by PRISMA Health, where we bring you valuable health tips and insights from trusted experts. I'm Caitlin Whyte. Today, we're excited to have Dr. Antoinette Rutherford, a Sleep Medicine Physician from PRISMA Health, on the show. 

We're diving deep into the world of melatonin and over the counter sleep aids. Whether you're battling sleepless nights, or simply curious about sleep health; this episode will provide you with informative and practical insights. Well, Doctor, we are so happy to have you on the show today.

I'm personally very excited to talk about this topic. What is melatonin to start us off and how is it used?

Antoinette Rutherford, MD: So, melatonin is a hormone that we normally secrete from our bodies, and we usually release it at nighttime when it starts getting dark. So that can depend on the time of the year as to when you secrete it. And so it's a medication that's sold over-the-counter in different formulations that should either help you to fall asleep or help you to stay asleep. It can be two different things that it's doing.

Host: Gotcha. And what is it about melatonin that makes us sleepy?  

Antoinette Rutherford, MD: So it's the fact that this is the hormone that tells your body that it's time to go to bed and to start transitioning to sleep and so by having, some people can be melatonin deficient, meaning that their body's not producing enough and telling them that they need to go to sleep. Or they could have where they've been sleeping during the daytime because they're nighttime workers and so they're not actually using the melatonin that they naturally produce and so they need some melatonin. And so and then there's some people who just have a delayed release of melatonin because they might, for instance we think about teenagers. They don't necessarily want to go to bed at 9 o'clock. They may prefer to go to bed as night owls and so their melatonin is being released later. So there's some people who we say have late release or a delayed release of melatonin, and so therefore they want to go to bed late.

So it's one of these things that you need a signal to your body to tell you to go to sleep. And it's part of that system to tell you to go to sleep.

Host: So, even though our body does make and secrete melatonin? Is it safe to take, and are there any situations where you should nottake melatonin?  

Antoinette Rutherford, MD: So, probably as I've said with other things in life, too much of anything is bad. So some people can overdose on melatonin just like you can on anything, even water. So, naturally your body secretes a little bit, and if you're not secreting it, then yes, it's safe and fine for you to take the melatonin.

It's when you get to these larger doses of melatonin, so anything more than 10mg I would be very concerned about. The average is probably 4 to 5mg that you need. Some people need less. So definitely I would monitor and make sure that you're not taking too much because once people start taking it, they may think, well, maybe more is better, but this is not a situation where more is better.

And then there's caution because it's not been very well studied in peds, um, not that I'm a pediatrician or do peds, but I would be cautious if you have a young child and using melatonin. This has been studied in adults a lot more than it has been in kids.

Host: Well let's focus on adults. Is it okay for them take melatonin every night if it seems to work?

Antoinette Rutherford, MD: It should be something that you think about short term. If you start needing to take melatonin every night, I probably would see a doctor or see a nurse practitioner, someone who specializes in sleep, or knows a little bit more about sleep. Cause it should be for short term insomnia. And then leave it to the doctor to help you decide whether you're actually melatonin deficient or not.

And whether you need it long term. But it shouldn't be a long term medicine. Not any of the over-the-counter medications that people think about for sleep should be long term. It should just be for short term.

Host: Alright, say we're using it the short term. Are there any negative side effects when taking melatonin that pop up?

Antoinette Rutherford, MD: Yeah, so some people can have nausea, be nauseated. Some people can get, on the other end be very sleepy because they took the medicine so they feel drowsy the next day and so they, that would be a bad side effect. Um, that's probably the more common side effects of it, but at the higher dosage you worry about whether there's other side effects that can happen with taking melatonin.

So, I would be cautious with the melatonin, but the biggest one you want to look out is for being too sleepy and feeling nausea and, even turning to vomiting because of it. But some people can also get bad dreams on it, so.

Host: Oh yeah, I've heard that too.

Antoinette Rutherford, MD: So that can be a bad side effect also.

Host: Well on that note, does melatonin interact with any regular medications?

Antoinette Rutherford, MD: For the most part at the lower doses it doesn't, but some of your blood thinning medicines I would be cautious with taking melatonin also.

Host: Gotcha. All right. Well, I'm sure we've all those other over-the-counter sleep aids out there at you know any drugstore or grocery store. How safe are those to take, especially for those of us with chronic insomia?

Antoinette Rutherford, MD: So, again I think of those as short term medications, not long term medications. The short term, they shouldn't have side effects, but they can. Some of those can be combined with other things. So, you have to look at the package and see if it's just purely one medicine. For instance, like Benadryl is used for some people to help fall asleep.

But, there are some over-the-counter medications that have Benadryl, but it also has Tylenol and some other additive things. And so do you really need the other additive things in these sleepy medicines? So just looking at the package and seeing exactly what you're getting, because I would be cautious, but using something short term to deal with insomnia, is fine.

However, if you're noticing it's six months and I'm still having trouble with falling asleep without medication; I would talk to a physician or nurse practitioner to make sure that there's not something else going on. And maybe there's a better medicine because you worry about side effects with some of these over-the-counter medicines too. Because it can cause you to get very dry mouth, affect on your blood pressure, and so you wouldn't want to have side effects from the medication.

Host: Well, my last question for you, Doctor, are there any natural ways you would recommend to overcome insomnia, or maybe some lifestyle changes that could help us get little sleepier?

Antoinette Rutherford, MD: Of course, there's always, lifestyle changes and there's also over-the-counter medications. Some things people already tried and may not consider it medicine, but like, some of the herbal things. So, some chamomile tea, some valerian root to maybe for short term, again, when you get to long term, I would talk to somebody, but I would also say that, you know, it's hard for people to focus and making bedtime a priority, but your bedtime should be a priority.

And that means making your bedroom like a spa. So having minimal TV turned on, having no exercise equipment, making sure your mattress is comfortable, making sure that your pillows are comfortable, making an environment that feels relaxing so that you're not doing work in there, not exercising, no kids toys, but just making it a priority.

So doing relaxing things in the bedroom, so reading, listening to music, to help put you in that environment of being sleepy. And even if in the middle of the night you wake up and you're like, I'm not sleeping, you shouldn't stay in the bedroom, on your phone or watching TV. You should get up and go somewhere else and relax. 

The other part of that is not doing things that are too stimulating during the day like some people might drink a Mountain Dew right before they go to bed and that's probably not a good idea or having a cup of coffee in the evening, because that can interfere with the quality of sleep that you're getting later. So just paying attention to some of your habits, which is hard at times and then maybe setting a bedtime. Because bedtimes are very important, so that you know that you need to go to bed as hard as we become adults. Because people as adults think they can go to sleep whenever they want, but you still need that routine as you did as a kid to make sure that your body knows when to go to sleep.

And it'd help because you're talking about melatonin and these signs for going to sleep at night. And so having a bedtime would help keep you on that regular schedule and wanting to go to sleep.  

Host: Thank you for joining us on today's episode of Flourish. We hope you found our discussion with Dr. Rutherford on melatonin and other over-the-counter sleep aids informative and helpful. Remember, better sleep leads to better health. For more health tips and advice, visit prismahealth.org/flourish.

And don't forget to share this episode with friends and family who are trying to get some better quality sleep. Until next time, take care and sleep well.