Jet Lag? Sleepless Nights?

woman laying on bed awake
Courtesy of Wiros via Creative Commons

A while back I used melatonin supplements in order to help with jet lag, since I was traveling for work to Germany. A friend that travels a lot had recommend melatonin to me, and it did seem to help me re-establish a normal sleep cycle when dealing with a large time shift.

Occasionally I have trouble sleeping through the night at home also. I usually fall asleep right away, but I wake up in the middle of the night and sometimes have trouble falling back to sleep. I have allergies and regularly take antihistamines, so the popular over-the-counter sleep aids like Tylenol PM (which has the same active ingredient as Benadryl as the sleep aid) don’t really work for me. So I wondered if I should take melatonin instead. Although melatonin is an herbal supplement, I did a little research to determine if I think it is safe to take as a normal sleep aid. This is what I found.

Melatonin is a hormone naturally produced by your pineal gland, which is a small pea-sized structure located deep inside your brain between the two hemispheres. Melatonin regulates your circadian rhythm, or basically your 24-hour internal clock. When the sun sets and darkness falls, you begin to naturally secrete increased levels of melatonin.  As the melatonin levels rise in your blood, you start to feel sleepier. This hormone level is highest in your blood around bedtime and stays elevated for about 12 hours, then it falls back to the low daytime level around 9 am. Although nighttime melatonin levels remain at least an order of magnitude higher than at daytime throughout your life span, the concentration of melatonin continually decreases as you age. This helps explain why many older adults have problems with frequent insomnia.

Melatonin supplements have been shown to help “reset” the body’s internal clock in those suffering from jet lag, shift workers who work nights and sleep during the day, and blind people. There have been many studies on melatonin use, including studies on its effect to reduce insomnia for older adults. One such research study was performed by Richard Wurtman at the Department of Brain and Cognitive Sciences at MIT. He studied two groups of elderly subjects; one group had frequent insomnia and the other slept normally. Each subject received either a placebo or a melatonin dose about 30 minutes prior to bedtime, and those who received the melatonin were given a dose of either 0.1, 0.3, or 3.0 mg. Each subject was medicated for 7 days, followed by a “washout” period of 7 days. Wurton found that taking the hormone significantly improved the quality of sleep for the older adults. More importantly, he found that they were able to sleep through the night best when taking the 0.3 mg dose. Now perhaps this shouldn’t be surprising, because the body naturally produces melatonin at this “physiological” level. However, the typical over-the-counter melatonin dose is 3 mg and this was determined to be less effective in helping insomnia.

Despite the many studies that have demonstrated melatonin to be an effective sleep aid, there is still controversy about melatonin use though. Some doctors consider it harmless and others potentially harmful. This is true, in part, because the function of the melatonin hormone may not be fully understood. What is understood is that melatonin does more than just regulate the internal clock, such as affecting the onset of puberty. It is also clear that melatonin is only available as a prescription in many European countries and Canada (although this seems to be due more to ingredient regulatory issues than medical concerns), whereas in the US it is an herbal supplement that isn’t regulated by the FDA.

So what does this all mean? Mostly it means that the human body is a complicated system that we don’t entirely understand. But from what I’ve read, I’ve concluded that melatonin is probably a safe and effective sleep aid for adults (at least those over age 50). Of course, I’m a scientist and not a medical doctor. All in all, it is probably best to speak with your physician before taking it regularly as a sleep aid. If you consider taking melatonin, you do need to remember that it is a sleep regulator rather than a sleep inducer. It isn’t the same as taking something like Ambien or Tylenol PM. You also probably want to somehow chop up the over-the-counter pills into smaller pieces (doses) without getting a crumbled mess. For now, I’m just going to stick with daily exercise, relaxing before bedtime, Advil for sore muscles, and the World Finest Ear Plugs for peace and quiet. Sweet dreams.

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A Simple Blood Test Saved His Life

My brother-in-law was seemingly the healthiest person we knew. He hikes up and down steep hills as part of his daily work. He kayaks intense oceans as part of his weekend play. He never even gets a cold. So he rarely sees a doctor. Luckily he did finally go for a general checkup when he turned 50, and those simple blood tests saved his life. Turned out, he had aggressive prostate cancer. Standard screening, to find prostate cancer in people who do not have symptoms, allowed him to be treated in time.

Against a backdrop of uncertainty and controversy, the American Cancer Society recently updated their prostate screening guidelines for the first time in almost a decade. This was largely in response to the findings of a massive federal study that was published in the New England Journal of Medicine last year. This study evaluated the usefulness of a popular prostate screening test that measures the amount of prostate-specific antigen (PSA) in your blood. Basically, PSA is a protein produced by the prostate gland. PSA is present in small quantities for normal men, but it is generally elevated for men with prostate cancer or other prostate disorders.

Some recent news coverage sensationalized the results of this federal study, so here are the basics of the report. The research findings are based on 10 years of follow-up of nearly 77,000 men (ages 55-74). Half of the men received annual PSA tests for six years, and the other half received “usual care” from their own doctors (physicals that in some cases included PSA tests). After 10 years, the men that received annual screening were diagnosed with prostate cancer 17 percent more than those in the “usual care” group. However, the screening didn’t reduce the rate of death from the disease. (Various possible and plausible explanations are discussed in the report, but I’m not going to get into the gory details here.) This brings into question whether the PSA test should be used for general screening, because prostate cancer over-diagnosis leads to unnecessary treatment and potential lasting side effects such as impotence and incontinence.

So, what is a man to do? Since I work in the area of prostate cancer research, friends and family members have been asking my opinion on whether or not they should be regularly checked for prostate cancer.

To me, it seems like these new screening guidelines assume that ignorance is less stressful than having faith in your doctor. Namely, it is better to not even perform a simple PSA blood test, because patients with low PSA levels are often over-treated. I understand the issues that they are addressing, but I think the reasoning is somewhat flawed. Why not instead just change how you treat patients with low PSA levels? Such PSA test results would indicate that you probably have some non-aggressive cancer cells in your prostate but they are unlikely to harm you. Scary yes, but so are impotence and incontinence treatment side effects. So why not just repeat the blood test in 6 months or a year to see if PSA levels have risen? Is this common practice of “watchful waiting” by your doctor really more stressful than not having the blood test at all? Because, for some, that simple blood test could also indicate that you have aggressive prostate cancer that needs immediate treatment.

Based on my personal and professional experience, I recommend that men get at least one initial PSA test when they are in their early 40’s. Doctors can use this as an important baseline in the future. This agrees with the American Urological Association’s guidelines. However, I am not a medical physician and some men have higher risk for prostate cancer, so it is important to speak about your health and concerns with your physician