Melatonin improves sleep quality and reduces anxiety after a TBI (traumatic brain injury)

New research shows that melatonin improves sleep quality and reduces anxiety after a TBI (traumatic brain injury). The study, Efficacy of melatonin for sleep disturbance following traumatic brain injury: a randomised controlled trial was completed in Australia and used a prolonged-release (also called timed-release) melatonin product.

The study participants, 67% of whom were male, had mild to severe TBI and sleep disturbances as a result of their injuries (most of which were from car accidents). There were 2 study groups, with one group given 2mg of prolonged-release melatonin for 4 weeks and then switched to a placebo for 4 weeks (with a 48-hour window in between). The other group did the opposite.

The prolonged-release melatonin was made by Sigma Pharmaceuticals Australia and called Circadin. Each night 2 hours before bedtime, 2mg of Circadin was taken by study participants. They received a reminder text message each night.

These are the study results for sleep:

Melatonin was associated with a significant and moderate reduction in PSQI [Pittsburgh Sleep Quality Index] global scores, indicating improved sleep quality.

There was no significant reduction in sleep onset latency with melatonin compared to placebo.

What this means is that overall quality of sleep improved but there was no change in the time it takes to fall asleep (sleep onset latency). The latter is to be expected with prolonged-release or timed-release melatonin.

The study concluded that:

The present results, therefore, suggest that melatonin may be useful in treating sleep disturbances in patients with TBI.

With better sleep quality you would expect reduced fatigue and improved vitality – both were reported by study participants.

Melatonin associated with a small decrease in self-reported anxiety

What is interesting is that melatonin was also associated with a small decrease in self-reported anxiety (no differences in depression were reported.) The authors suggest that one possible mechanism of this may be that melatonin acts a muscle relaxant. In this commentary: Potential action of melatonin in insomnia, the authors equate the beneficial effects of melatonin to benzodiazepines:

many of the actions of melatonin on sleep propensity, anxiety, thermoregulation, and convulsions resemble those reported following administration of benzodiazepines. It is possible that some of these actions of melatonin may be mediated via peripheral benzodiazepine receptors

They are suggesting that with melatonin we get the sleep improvement (sleep propensity is the readiness to transit from wakefulness to sleep, or the ability to stay asleep if already sleeping), relaxation effects and antianxiety benefits of benzodiazepines.

But you get none of the side-effects, tolerance issues and withdrawal nightmares with a benzodiazepine which do more harm than good. On a side notes: this month World Benzodiazepine Day is celebrated to create awareness and offer support for benzo sufferers.

I would have picked something more inert for the placebo ingredients

I would have picked something more inert for the placebo ingredients: mannitol (106mg), acacia (11 mg) and pure icing sugar (106 mg). Mannitol, a sugar alcohol, can cause bloating and diarrhea in some individuals and although the amount is tiny (5g of sugar equals 1 teaspoon), sugar consumption is not ideal before bed. As I would expect adverse symptoms:

were more frequently reported during placebo treatment. The most commonly reported symptoms were neurological, followed by bodily pain, gastrointestinal and dermatologic.

In Australia, melatonin cannot be purchased over the counter (OTC) at health stores or via online retailers, unlike in the USA, and is only available by prescription. I’m all for melatonin being available OTC but the silver lining to this is that companies that make melatonin, such as Circadin, have a vested interest in the research. Research is expensive and time-consuming and we get to benefit too.

Keep in mind that this research is applicable to anyone with low melatonin, whether or not a prior TBI has occurred.

There are many root causes of insomnia – how I work with clients

In those with TBI, sleep disturbances are common, and the authors do report reduced evening and overnight melatonin production in this population. However, there are many root causes of insomnia, with low melatonin being one possible root cause – in TBI and in those who have not had a TBI.

One study limitation is that they didn’t measure melatonin levels or circadian rhythm (salivary cortisol) in all of the study participants so we can’t be sure everyone did have low melatonin.

And melatonin isn’t going to work in all instances of insomnia. It’s one root cause I look at.

This is how I work with clients who have insomnia:

• I start with low serotonin and address this with tryptophan observing improvements in sleep and easing of worry and anxiety (on a side note, low serotonin is common after a TBI so this makes total sense)
• Then I have my client use sublingual melatonin if they have issues falling asleep AND timed-release melatonin if they have issues staying asleep (you can see some of the melatonin products I recommend here)
• When saliva results come back, we address the adrenals as needed, often adding Seriphos when cortisol is high
• Other factors are addressed based on each person’s need: gluten issues, SIBO, parasites, candida, EMFs, sex hormone imbalances, medication side-effects, sleep habits

We’d love to hear if timed-release melatonin has helped you improve your sleep quality? And if it also helped with easing anxiety?

What about tryptophan or sublingual melatonin for helping you fall asleep? And the other root causes?

If you’re a practitioner, do you use tryptophan or sublingual or timed-release melatonin with your clients? And address the other root causes of insomnia?

Feel free to post your questions too.