Case study: Melatonin

I discuss melatonin's effects on sleep & its safety; 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.

Full essay: http://www.gwern.net/Melatonin

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Your argument essentially amounts to the following:

  1. Melatonin significantly improves sleep quality.
  2. It has no side effects.
  3. It has low cost.

If all of these are true, then who wouldn't want to take it? However, you spend a lot of time on discussing point 3, but little on points 1 and 2, which are arguably the most important. How do you know that Melatonin really improves sleep quality so much? Is it just based on your personal experience (and perhaps that of other people you know)? If so, that is not convincing, as large scale randomized controlled studies are generally the only way to reliably tell if a medicine works. There are too many complicating factors like individual differences between people, the placebo effect, random fluctuation, reversion to the mean, difficulty in remembering how we felt in the past, etc. to rely on anecdotes.

Another point that your article does not address is the fact that there is a difference between a medicine having no known side effects, and a medicine ACTUALLY having no side effects. Any time that you take medicine you are taking a risk of a reaction that is unknown, or which failed to be uncovered in any studies that were done on it. For example, it is probably unknown whether a decade of Melatonin use (rather than just one or two years) causes problems of any kind. This sort of danger is unfortunately difficult to quantify, but I believe deserves at least some mention.

spend a lot of time on discussing point 3 This is by far the biggest failing of the post, it grates hugely. It's cheap, we get it.

Upvoted for truth. The original article basically amounts to saying, "There's this drug that will totally improve your life, guaranteed, with no side effects, trust me ! Now go ahead and ingest it." Ummm yeah that's great, but I think I'll wait for some long-term studies to tell me things like this:

  • What are the long-term side effects of the drug ?
  • How will this drug interact with any other drugs I might be taking ?
  • What is the correct dose for me personally ? What are the consequences of an accidental overdose ?
  • Overall, how likely is this drug to kill or cripple me ?

Until those questions are answered, I'm not taking this drug, regardless of how cheap it is.

It sounds interesting but I'm a little wary of your one line dismissal of any potential side effects without reference. To the best of my knowledge the function of sleep is still not completely understood and the long term effects of reduced sleep are not known. A suggestion to take any kind of supplement every day for the rest of your life places a fairly high bar on safety. Taking melatonin to overcome jet-lag seems very likely to be safe but I'm more wary of using it on an ongoing daily basis.

Do you have any references to support the claim that there are no long term side effects of daily use?

I did link to Wikipedia for a reason; see http://en.wikipedia.org/wiki/Melatonin#Availability_and_safety . But besides AngryParsley's link, there's

Given the unanimous results of safety in the short-term, positive results in long-term child use, the exploitation of a regular physiological process, the long track-record of melatonin use, and the lack of evidence for any long-term harm, I think I'd say the onus is on any doomsayers.

(No doubt there's a witty Eliezerism or post on the topics of negative results and burdens of proof, but offhand I can't think of it.)

It took large scale randomized studies to establish the negative health effects of vitamin supplements/antioxidants and HRT both of which appeared safe in the short term, exploited a regular physiological process and had a long track record of use. I'd want to see a large randomized study of the long term effects of melatonin use in adults to establish the long term effects of melatonin use in adults.

The Wikipedia link you give merely concludes that "evidence suggests that melatonin is safe with short-term use, three months or less". From your other links:

The findings of this review suggest that exogenous melatonin is a relatively safe substance when used in the short term, over a period of days or weeks, and is safe at relatively high doses and in various formulations. However, the safety of exogenous melatonin when used in the long-term, over months and years, remains unclear.

There are no published long-term safety data on the use of melatonin for whatever purpose, assuming long term to mean more than 6 months of daily medication. In the light of its physiological role in animals, the potential deleterious effects include inhibition of reproductive function, delayed timing of puberty, and influence (when taken during pregnancy and lactation) on the circadian status of the fetus and neonate and on future development. Its interactions with other medications are virtually unexplored. For most positive effects published, there also exist negative reports.

There is evidence to suggest that melatonin is not effective in treating most primary sleep disorders with short-term use (4 weeks or less); however, additional large-scale RCTs are needed before firm conclusions can be drawn. There is some evidence to suggest that melatonin is effective in treating delayed sleep phase syndrome with short-term use. There is evidence to suggest that melatonin is safe with short-term use (3 months or less).

The evidence you present for the benefits of melatonin is also weak and the Wikipedia article is fairly circumspect about the benefits of melatonin. The first review you link to states:

Melatonin decreased sleep onset latency (SOL) in normal sleepers (weighted mean difference (WMD): -3.9 min; 95- percent CI: -5.3 min., -2.6 min.). The magnitude of this effect appears to be clinically insignificant. There was evidence of possible publication bias in the selection of studies that were analyzed; we found a greater number of studies reporting positive results compared to negative results.

and

Melatonin increased sleep efficiency in normal sleepers (WMD: 2.3 percent; 95-percent CI: 0.7 percent, 3.9 percent), and this effect was dependent on the timing of sleep, such that the effect of melatonin was greater in daytime sleepers (daytime sleep: WMD: 8.0 percent; 95- percent CI: 1.0 percent, 15.0 percent; night-time sleep: WMD: 1.2 percent; 95-percent CI: 0 percent, 2.4 percent). The magnitude of this effect appears to be clinically insignificant. There was considerable evidence of possible publication bias in the selection of studies analyzed; we found a greater number of studies reporting positive results compared to negative results.

and

Generally, these studies were of low-to-moderate quality.

Nowhere have in these links do I see any evidence supporting your key claim that melatonin allows for the benefits of 8 hours of sleep in 7 hours.

I think your post spent too much time discussing the relatively uninteresting topic of the cost of melatonin and not enough on the evidence for safety or efficacy. Based on the discussion and the further research you and others have linked I'm not persuaded enough by the evidence for safety or efficacy to adopt melatonin for long term use, but I may try it out for jet lag or other short term sleep difficulties.

I'd want to see a large randomized study of the long term effects of melatonin use in adults to establish the long term effects of melatonin use in adults.

How big a study do you need before you'll judge something as safe? You selected two examples of a class of therapies that "appeared safe in the short term, exploited a regular physiological process and had a long track record of use."

From the wikipedia article on the HRT study:

The risk in current users was increased about 1.2 fold; for every 1000 women using HRT, 2.6 developed ovarian cancer over 5 years, compared with 2.2 in those not taking HRT.

The reason huge studies were required to find issues with HRT is because HRT so rarely causes issues. The question you should be asking is: If it is known that a drug is safe in the short term, exploits a regular physiological process, and has a long track record of use, what is the chance that it is harmful in the long term (and to what degree)? The two examples you pointed out are not the entire data set. Your behavior is extremely risk-averse compared to other choices you make daily.

How big a study do you need before you'll judge something as safe?

I don't think it makes sense to ask that question in isolation. When judging whether some risk is worth taking I'd generally look at both the evidence for the potential risks and for the potential benefits. I focused on the potential risks in my original post but the reason I'm not convinced that taking melatonin on a long term basis is justified is that the evidence for the benefits is also weak. If there was extremely strong evidence for the claimed benefits of taking melatonin over the long term then I might consider the risks of long term side effects worth taking. My position at the moment is that the balance of evidence suggests that the risk/reward proposition is not compelling for long term use of melatonin, though as I have said I may well try it next time I have a transatlantic flight to counter jetlag.

The question you should be asking is: If it is known that a drug is safe in the short term, exploits a regular physiological process, and has a long track record of use, what is the chance that it is harmful in the long term (and to what degree)?

I don't think that's the right question. The right question is whether the evidence for benefits outweighs the evidence for harm. I used to take vitamin supplements because the risk/reward based on the available evidence seemed compelling. In light of more recent large scale studies that show no long term benefits and some evidence of long term harm I no longer take vitamin supplements.

Your behavior is extremely risk-averse compared to other choices you make daily.

I am not risk-averse in general, in fact I think I probably have a higher than average risk tolerance in general. I probably require a higher risk/reward payoff for any kind of long term use of supplements or drugs than the average North American however.

Here's the longest-term study I could find: http://www.ncbi.nlm.nih.gov/pubmed/19486273

Basically, children taking melatonin for several years didn't develop any problems. Melatonin is also used by blind people quite a bit, since without it their circadian rhythms are longer than 24 hours.

I believe it's not generally considered valid to apply results from medical studies on adults to children. I'm not sure if the reverse applies.

The fact that the study was on children certainly doesn't help the validity when applied to adults, but I think you're being overly risk-averse. Melatonin's mechanism of action is pretty well understood, and it occurs in the body already. The long-term effects would have to be very bad to outweigh the advantages of a regular sleep schedule and an extra hour of wakefulness every day. That's assuming melatonin works, of course.

Endorphins are chemicals that occur naturally in the body, with a mechanism that is pretty well understood. Yet taking opioids regularly is not good for you.

You cannot assume health-benefits simply because it already occurs in the body.

There may well be benefits, but they must be proved independently of simply understanding the natural mechanism.

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

What I'd really like to see is a study comparing unhealthy diets plus multivitamins to just the unhealthy diet.

Without having looked at the actual studies in detail, it seems that even several of the "no benefit" studies report multivitamins to be beneficial when one does have an otherwise unhealthy diet.

Wikipedia:

Similarly, a 2006 report for the United States Department of Health and Human Services concluded that "regular supplementation with a single nutrient or a mixture of nutrients for years has no significant benefits in the primary prevention of cancer, cardiovascular disease, cataract, age-related macular degeneration or cognitive decline."[16] However, the report noted that multivitamins have beneficial effects in people with poor nutritional status, vitamin D and calcium can help prevent fractures in older people, and that zinc and antioxidants can help prevent age-related macular degeneration in people at a high risk of developing this disease.

In 2007 the United Kingdom Food Standards Agency published an updated set of recommendations for eating a healthy diet.[17] The recommendations stated that pregnant women should take extra folic acid and iron and that older people might need extra vitamin D and iron. However, the report advised that "Vitamin and mineral supplements are not a replacement for good eating habits" and stated that supplements are unnecessary for healthy adults who eat a balanced diet.

From the cited New York Times article:

But a balanced diet typically provides an adequate level of these nutrients, and today many popular foods are fortified with extra vitamins and minerals. As a result, diseases caused by nutrient deficiency are rare in the United States.

In any event, most major vitamin studies in recent years have focused not on deficiencies but on whether high doses of vitamins can prevent or treat a host of chronic illnesses.

(I'll keep taking my multivitamins, as my diet certainly isn't balanced.)

I take multivitamins as a backup plan of sorts so that I don't have to worry too much about whether my diet is balanced.

I tried it for a few weeks and didn't notice any major difference. I think I'll try again on this recommendation. Perhaps my endogenous melatonin is already sufficient, or I was a lazy self-monitor.

I would summarize:

(1) In your personal experience, 1.5mg of melatonin 30 min before sleeping makes you feel 8-hours rested after 7-hours of sleep (but 9mg is harmful)

(2) that dosage has negligible cost

That's all you really needed to say.

It's jarring to me that you so meticulously analyze the cost of dosing with melatonin; once I know a cost is below some low threshold, I prefer not to think about it at all. I'd rather you took the same care into performing some objective tests of mental capability on varying amounts of sleep, so that it really means something when you say you gain an hour of wakefulness. Of course, I'd want this blinded as well, but I doubt you have convincing placebo pills available; besides, I don't mind taking something in hope of accruing some real and placebo benefits.

If your experience is typical, then the only reason people shouldn't be dosing melatonin is if there's some long-term health detriment (I don't have any mechanism in mind; it seems unlikely).

For me, the ability to force myself to go to bed is by far the most important claim made in this post.

I've long had trouble going to sleep, and it's not an issue of refusing to go to bed, but rather, that I can't seem to just fall asleep like everyone else. My mind just won't shut down. OTC sleeping pills don't work on me: all they do is make me really drowsy but just as unable to fall asleep, which is a sucky feeling.

Recently, I started going on a prescription medication that works like a charm, in that predictably makes me sleepy, and actually fall asleep, and, on occasion, lets me wake up refreshed in the morning. However, it's relatively expensive, even with insurance.

Based on this TL post, I'm going to try melatonin, and if it does the same thing in terms of making me fall asleep, that alone would be worth it.

If you don't mind, what's the prescription medication?

Seroquel aka Quetiapine (which unfortunately is prescribed for a lot of things other than insomnia, but only serves to knock me out in about an hour).

Based on this TL post, I'm going to try melatonin, and if it does the same thing in terms of making me fall asleep, that alone would be worth it.

And?

Unfortunately, it turns out it's never been able to make me go to sleep, anywhere near as well as the prescription. Though it does make me wake up earlier (restfully).

(Sorry for the delay, I guess I just haven't been logging in as much, lately!)

Though it does make me wake up earlier (restfully).

So you are still using it?

Yes, though I hope to one day not need it. I'm trying to use smaller amounts as time goes by.

Thanks! It's good to feel appreciated!

I've also moved to the SF Bay area, capital of LW.

It's jarring to me that you so meticulously analyze the cost of dosing with melatonin; once I know a cost is below some low threshold, I prefer not to think about it at all.

That's great for you - if you feel convinced, you save all the time I spent researching & writing this. But how do you know the cost is below that threshold? Because I did so meticulously analyze it.

More to the point, I don't analyze everything like this. Once I calculated the cost per night was below 10 cents and the benefit above half an hour, my mind was made up. Everything after that was for a hopefully educational 'case study' for readers, and to make the conclusion as strong as possible.

I'd rather you took the same care into performing some objective tests of mental capability on varying amounts of sleep, so that it really means something when you say you gain an hour of wakefulness. Of course, I'd want this blinded as well, but I doubt you have convincing placebo pills available; besides, I don't mind taking something in hope of accruing some real and placebo benefits.

I do have visually convincing placebos (some vitamin B supplements), but part of the problem is there's no way I can fool myself - I know what the onset feels like with and without melatonin.

Although it wouldn't be a bad idea to take some measurements on the Dual N-back test; I would like to know the saving more precisely than 'more than half and hour and less than 2'. :)

BTW, I did wind up measuring sleep over 6 months of on/off melatonin, so I now have more than intuition for the 1-hour claim (which turns out to be more like 50 minutes): http://www.gwern.net/Zeo#melatonin-analysis

Very impressive followup. I've skimmed that.

My less meticulous conclusion is that melatonin makes me wake earlier and easier with light (maybe in general, but I don't wake by alarm). I haven't bothered to check whether that means I actually slept better (in terms of improving my performance/mood going forward), but I consider it a good sign.

About 2 in every 7 days - when I feel like my past night's misadventures might make it hard for me to sleep and wake properly. So no, not really. If I lived alone, I'd probably be more regimented and go for 7/7 with some tiny dose (because stable habits that can be tweaked gradually are reassuring).

Based on my experience, I'd recommend it if you want to wake up "naturally" with the light but your recent sleep history (e.g. jet lag) wouldn't permit that. Otherwise, I've been too sloppy to know precisely what it does for me (I can feel a large dose, such that I'd guarantee it's not only placebo).

Pfff, 5959% is nothing. You can get a banana for 15 cents and it'll keep you from dying of starvation. So let's say you value the next 50 years of your life at $7.25 an hour... That's a return of 28419037481114.5%!

Seriously do you have a good link for where to buy melatonin?

Pfff, 5959% is nothing. You can get a banana for 15 cents and it'll keep you from dying of starvation. So let's say you value the next 50 years of your life at $7.25 an hour... That's a return of 28419037481114.5%!

Yes, but you have to keep buying them; leggo my bananos, you damn dirty ape!

Seriously do you have a good link for where to buy melatonin?

I'd rather not be perceived as advertising. I was concerned about mentioning Tommy Health at all, actually. As I said, it's very widely available. If you want an online link, Amazon is as good a place to buy through as any.

I was prescribed melatonin for a sleep complaint some years ago and noticed no detectable improvement: I didn't get to sleep more easily, wake up less during the night, or feel more refreshed in the morning. What might explain this?

I've been prescribed melatonin recently myself, and it's not helping me much. Here are my theories on the subject.

Melatonin is good for (at least) one thing: if you don't fall asleep naturally, either at all or at a convenient time, taking melatonin can help fix that. ("Naturally" here means you feel tired and sleepy and genuinely want to go to sleep, so you don't need to invest will to do so.)

A high level of melatonin tells your body to fall asleep. If you take melatonin at a time during the day when your body produces melatonin already, then the extra-high level may not make any difference. In other words, if the reason you had trouble falling asleep isn't low levels of melatonin but some unrelated physiological problem, then there's no point in raising levels.

The second possible scenario is what I appear to have. I have a natural sleep schedule that's at odds with the day cycle. Left alone (e.g. during summer break), I wil go to sleep at 2am and wake up at noon. If I take melatonin at 10pm, I can fall asleep at 11. But my body still produces its own melatonin until noon, so I don't wake up earlier - the net effect is that I sleep 14 hours and wake up tired.

The doctor said if I keep taking melatonin at a fixed time every day for half a year, my body may adjust its own melatonin-producing cycle to match. More likely it won't, but there's no alternative treatment that I know of. So far I've bee taking it for one month with only modest (possibly statistically-insignificant) improvement.

BTW, my prescribed dose is 5mg daily, higher than usual. The doctor said there are still no side effects ever reported, even with higher dosages. He's a sleep expert, not a GP, so that has some credibility.

I'm interested in hearing more ideas, stories, ...

I have a friend with this disorder, which sounds like what you describe. Pretty much what you have to do with that is be nocturnal.

I've been nocturnal since I've started attending university, but it makes for a lonely life. I'd rather fix it if possible.

The plus side I've found is there are radically less distractions around at 1am, so I can often get more work done between 11pm and 2am than I can in the whole afternoon. Last night I managed to complete an entire application form for an internship with BP, whereas in the day all I'd managed was half a page of geometry notes.

Possibly even more importantly, mindlessly hitting refresh on facebook is not an acceptable activity at 2am, whereas earlier in the day it is, so if I am awake then, it’s because I'm actually working.

That wouldn't help for the long term; circadian clocks, even wonky circadian clocks, are set by cycles of daylight and darkness.

Indeed. If I moved to the US, after a few weeks I would adjust.

One solution is to create an artificial light & dark cycle that's earlier than the actual daily cycle where I live. That would work - as long as I never left my room.

Surely you wouldn't have to stay in your room 24 hours a day? You could go outside when the light and dark of your artificial cycle and the natural cycle coincided, couldn't you? I don't know how sensitive human clocks are - maybe going out at nine a.m. right after you woke up when you're trying to fool yourself into "thinking" it's noon would create problems having to do with the exact location of the sun - but it seems like there would be a window there.

You're right, of course. I'll do the calculations.

Assume I want to shift my sleep cycle 4 hours ahead (i.e. wake up 4 hours earlier, 8am instead of noon).

We currently have sunrise and sunset roughly at 6:30 and 17:00 local time. I assume for simplicity that this remains constant and also ignore DST.

I'll want to simulate sunrise at 2:30 am and sunset at 13:00. So assuming the sun is "properly up" (high enough) starting at 7am, I can go outside from 7am-1200 and again after sunset at 1700. I have to stay at home during the night (for artificial lighting starting at 2:30) and during the artificial darkness period, 1300-1700.

This might actually be workable if there aren't too many interruptions. Hmm...

One thing I don't yet know is how exactly artificial lighting affects the body's sleep cycle; how the body reacts to it differently than darkness and also differently than sunlight.

I'll have to think about this some more.

I have exactly the same problem. I also tried Lunesta and Ambien, which didn't really work, and Rozarem, which is supposed to be quite similar to melatonin, and had similar but stronger effects. Nothing that worked. I also tried bright light therapy, which didn't seem to work at all, and was very inconvenient. At the moment I'm on a free sleep schedule, which seems to cycle completely every 2-3 weeks. (I'm not sure because I've never kept a sleep diary.) That's only currently possible because I'm unemployed.

Melatonin is best for sleep quality improvement with people who are above 40 as endogenous melatonin production usually starts to decrease from 30. You're much younger than that, so sleep disturbances are less likely to be caused by low night melatonin levels (so supplementary melatonin is less likely to be a significant remedy).

For at least some of us, the decrease in sleep is a boon. I'm only 36, and over the past 4-5 years I've had a very noticeable decrease in sleep, without any apparent side effects. It's not uncommon for me to sleep six hours and wake up refreshed before the alarm clock goes off, which is wonderful for someone who used to have to budget at least 8 hours a day for sleep.

It could be that you weren't taking enough. Another major factor is your bedtime routine. Exercise, bright lighting, and other stimulating activities (video games, emotionally-engaging movies) can discourage sleep.

Too low of a dosage for your body's tolerance level could explain it.

Too much is just as likely. Melatonin's response curve is weird.

Is it? It seemed like a normal enough U-curve as far as I knew.

Is it? It seemed like a normal enough U-curve as far as I knew.

It varies drastically from person to person. The effective dose has varied by a factor of 60 even among people I've designed cognitive/nutritional stacks for and varies even more so in the general case.

The inverted U is also different to the way it is usually used. Usually things have benefits to a certain level but then disadvantages start weighing them down if the dose gets too high. The cognitive enhancement from stimulants like caffeine for example reaches a peak then declines along that specific metric. But you certainly don't go back towards normal in the obvious effects. You're totally wired. With melatonin some will get a drastic alteration in their sleep behavior at 0.5 mg while a mega dose of 100 mg is not incredibly disruptive. For a hormone and especially a hormone with mind altering effects you can't usually get away with that.

I meant more in the way of clinical evidence, than anecdotes; I've never tried 100mg or heard of trying it before (my 1 9mg experience being sufficiently unpleasant to deter me from higher doses), so I guess I have to take your word for it on the claim of it not being incredibly disruptive.

so I guess I have to take your word for it on the claim of it not being incredibly disruptive.

You could take my word for it that large doses are not found to be incredibly disruptive (even in the long term) in clinical studies either.

Did you get a proper explanation for your sleep complaint?

Nope. A tentative hypothesis is sleep apnea, since my dad had that, but how well I sleep is extremely inconsistent (some nights I get excellent sleep, some nights I wake up a dozen times and am a zombie all the next day) and seems to correlate better with whether I've set an alarm than with any of the factors that are supposed to affect sleep apnea.

Do you have a study that confirms your 'melatonin subtracts an hour' theory you could link to? My husband uses melatonin and can still easily spend 12 hours in bed. I've avoided using it, since I don't have difficulty actually falling asleep and I didn't want to sleep longer as a result of using it. You should probably argue that everyone should try using melatonin for a week or so, since the potential gains are large, not that everyone who doesn't use it is being foolish. The whole argument falls apart if your base assertion is wrong, and you provide no evidence that the effect melatonin has on you generalizes to everyone. That being said, I am glad you shared this information.

Do you have a study that confirms your 'melatonin subtracts an hour' theory you could link to?

Not really, unfortunately, but I do have more than a subjective impression; see http://lesswrong.com/lw/1lt/case_study_melatonin/5w76

You should probably argue that everyone should try using melatonin for a week or so, since the potential gains are large, not that everyone who doesn't use it is being foolish.

Yes, this probably can be expressed nicely as a "value of information" problem. I've done that.

I looked up melatonin in FASS. The only melatonin based drug that's legal in Sweden is called Cirkadin. It has 2mg of melatonin per pill. It is a prescription drug, and only recommended for patients who are older than 55.

There are some side effects. Common ones are headaches, inflammation of the throat (lasting 1-2 days, they don't say if that's alltogether or after you quit melatonin), back pain and weakness (asteni). That's probably the real cost of using it.

Melatonin induces CYP3a in vitro. If it does that in the blood as well it will decrease the effects of several other drugs. It also increases the effects of some sedatives, and the effects of melatonin is influenced by several other drugs. So if you are on some important medication, talk to your doctor before taking melatonin.

Also, if you have liver problems melatonin will stay in your blood much longer than in gwern's, so you will be drowsy the day after you use it.

I don't care how long I spend asleep. I just hate going to bed, and I hate getting up.

I just hate going to bed, and I hate getting up.

Me too, and I'd love to know what that's about. It's a small, but puzzling form of irrationality.

Same here, and I agree it's puzzling. Especially not wanting to go to bed. With most of my behaviors that don't have an obvious motivation, I can think it through and figure out what's going on, but not with this one.

I wonder if it's a latent anti-bedtime reaction from childhood?

Speaking of which, why do all "good" American parents enforce bedtimes? I would think that if they enforced the getting-up time, the kids would take care of the getting-to-sleep part on their own.

This does not work with teenagers, in whom bedtimes are practically unenforceable, but whose need to get to school in a timely fashion does a reasonable job of imposing a getting-up time. They are chronically sleep deprived. Smaller children, I imagine, have even less of a chance of managing the feat.

...Woah. Thanks to your comment, I just remembered vividly how much my school years sucked.

Don't teenagers have brain-chemistry that makes them have trouble getting to sleep at a reasonable hour? I'm not finding a good reference, but I remember reading that, and that the effect doesn't apply to children.

Roughly one-quarter of the kids fell into the borderline-acceptable category, meaning they reported eight hours of shuteye nightly. The overwhelming majority fell short — with 30.2 percent reporting seven hours, 22.8 percent slumbering closer to six hours, 10 percent catching a mere five hours of sleep, and 5.9 percent claiming to nod off for no more than four hours most weeknights. Just the thought makes me yawn. Certainly, schools don’t help the situation by starting classes earlier for teens than they do for younger kids — even though puberty and other developmental changes lead to adolescents needing more sleep than grade schoolers, not less.
But there could be other issues.
Like what share of teens don’t get enough sleep because they’re naturally night owls (like me) and find almost anything before 2 or 3 a.m. more interesting than slumber? http://www.sciencenews.org/view/generic/id/53220/title/Vast_majority_of_teens_are_sleep-deprived

The circadian link is to a gatewayed article; you can find a public copy at http://www.thefreelibrary.com/Sleepy+teens+haven%27t+got+circadian+rhythm.-a0134623686

In an attempt to reset the students' daily biological clocks Biological clocks, or circadian rhythms, so that they would be more alert in daytime and go to bed earlier, the researchers exposed some students in their classrooms to especially bright light between 8 a.m. and 10 a.m. Other students were exposed to muted red lighting. But the bright light neither changed students' sleep patterns nor improved their scores on tests of mood, vigor, and cognitive function cognitive function Neurology Any mental process that involves symbolic operations–eg, perception, memory, creation of imagery, and thinking; CFs encompasses awareness and capacity for judgment .

I remember. It was a very high-profile study that asserted a phase-delay in the teenage sleep cycle. The study was cited for a while in arguments to shift the school day later by a couple hours.

That makes sense - but let me add that the idea that it is a myth that bedtimes must be enforced fits another observation: parents also seem to believe that they have to persuade or force their children to eat; yet in big families where no one can make sure everyone eats, all the children learn quickly to eat on their own.

parents also seem to believe that they have to persuade or force their children to eat

They do? I would be very surprised at parents who believed this. Eating satisfies a natural desire and feels good. Sleeping means stopping the fun thing you're doing and lying down in a dark room; why would kids want to do that?

I have two kids. If left to their own devices, they would eat the tastiest things on their plate, then stop (then complain about being hungry an hour later). They would never eat anything remotely healthy, and subsist entirely on chocolate if given the choice.

Since we have evolved to value fat and sugar as being the tastiest substances, children do have to be taught/persuaded to eat healthy food.

They also do need to be told when to go to bed. The times at which we have tried to let them set their own bed times have resulted in them trying to stay awake as long as they possibly can, until they fall asleep in the middle of whatever they were doing. They almost never voluntarily go to bed, no matter how obviously tired they are.

Eat a meal with a family with a single child. In many cases, the parents will spend much of the meal ordering or pleading with the child to eat their food. Then eat a meal with a family with 6 or more children. That probably won't happen.

I do know one kid who really won't eat on his own; if you don't coax him into eating, he won't eat enough. But that's unusual.

They just want an hour or so to themselves before bed, if that.

It seems like it's a near/far problem, at least in part - it'd take a few weeks, perhaps even a month or two, for the kids to figure it out, and in the meantime the parents will be inconvenienced by having to deal with cranky kids, and also probably having to stay up later than they'd prefer to.

I suspect most parents don't give it enough thought to realize that the situation would be temporary (well, not counting the possibility that the kids could settle into an inconveniently late bedtime) and the lesson would be valuable, though, or they don't believe that their kids would figure it out at all.

Could you guys be more specific about what you hate about going to bed and about getting up? I don't even know whether you've all got the same problem.

Let's say it's midnight, I'm tired, and I'm home alone with nothing better to do. I know I have to get up early and I'll feel better / be more productive the next day in direct proportion to how much sleep I get. I still just don’t want to go to bed. It requires real force of will not to stay up and find something else to do, even if it just amounts to reading random stuff online or otherwise killing time.

I’ve gotten better at just making myself go to bed anyway in that situation, but I don’t know why it should take any effort in the first place. Going to sleep should – at least occasionally -- be my most attractive alternative, even from a short-term perspective. But for some reason it never feels that way.

I don’t have insomnia, nightmares, apnea or any other condition (that I know of) that would make sleep/bed unpleasant – so at least in my case the act of sleep itself doesn’t seem to be a factor.

This is my experience as well, for the most part.

The only times I recall "going to bed" feeling like a good idea is when I've been so far into exhausted sleep deprivation that base instincts took over and I found myself doing so almost involuntarily.

Even in those cases, my conscious mind was usually confabulating wildly about how I wasn't actually going to sleep, just lying down for a half a moment, not sleeping at all... right up until I pretty much passed out.

It's rather vexing.

Would you guys mind terribly if I picked your brains?

The kind of experience you're describing is described fairly often in autistic communities. There's a few variations, generally falling into the categories of sensory processing or executive dysfunction issues. The former category would include not experiencing, or noticing that you're experiencing, 'tiredness', even when your body is acting tired in a way that others would notice (e.g. yawning, stretching, body language). The second case involves not being able to stop whatever activity you're engaged in and go to bed, even though you recognize (perhaps briefly, before being drawn back into what you're doing) that you are tired and it would be a good idea. (This isn't quite the same as 'I'll do one more part, and then go to bed' in that it's less conscious and therefore harder to break out of - in many cases it takes a significant effort of will to stop your body from automatically taking the next step in what you're doing, even if you've actually decided not to take that next step.)

I'm curious to find out if those issues are also experienced by people who aren't autistic - perhaps to a lesser degree, or with different explanations than the ones that I mentioned. Do the issues I described sound like what you're experiencing? Are they close, or similar in some interesting way?

The former category would include not experiencing, or noticing that you're experiencing, 'tiredness', even when your body is acting tired in a way that others would notice (e.g. yawning, stretching, body language).

I'm not sure if this is what you're talking about, but I've long distinguished two aspects of "tiredness". One is the sensation of fatigue, exhaustion, muddled thinking, &c.--physical indicators of "I need sleep now".

The second is the sensation of actually being sleepy, in the sense of reduced energy, body relaxation, and a general feeling that going to bed sounds like a fine plan.

I almost always notice the former, but unless accompanied by the latter (often not the case), acting on it by going to bed requires a conscious decision. Usually, the sleepiness will appear after I'm lying down, but at times I've been unable to clear my mind of activity and will lie in bed for two or more hours, unable to sleep despite being extremely tired.

If I'm deeply involved in something and not feeling "sleepy" I can easily fail to notice the fatigue (along with hunger and various other non-urgent physical sensations).

The second case involves not being able to stop whatever activity you're engaged in and go to bed, even though you recognize (perhaps briefly, before being drawn back into what you're doing) that you are tired and it would be a good idea.

In my case it's more garden-variety procrastination; going to sleep is just one more thing that I know I should do but don't really want to, because it's boring.

I'm curious to find out if those issues are also experienced by people who aren't autistic - perhaps to a lesser degree, or with different explanations than the ones that I mentioned. Do the issues I described sound like what you're experiencing? Are they close, or similar in some interesting way?

My experience mostly reduces to a disconnect between a non-critical physical need and the desire to fulfill it, generally to an extent proportional to how much mental activity is bouncing around my conscious mind (the default state being "too much").

As a final note, besides the melatonin not making me sleepy, neither ethanol nor caffeine seems to have an appreciable effect on whether I can get to sleep (though both will reduce the quality of any sleep).

Thanks for the datapoint.

I'm not sure if this is what you're talking about...

I almost always notice the former...

If I'm deeply involved in something and not feeling "sleepy" I can easily fail to notice the fatigue (along with hunger and various other non-urgent physical sensations).

That doesn't sound like the experience I was trying to describe, which is of not noticing sleepiness or fatigue at all, even when not doing something engaging. The 'not noticing' caveat is there because some autistics won't automatically notice those sensations, but can consciously check to see if they're occurring, and get into the habit of doing so. (The issue can apply to hunger, too.)

If you're actually collecting datapoints, not just using the term semi-metaphorically, it may help to add that I've been diagnosed with (fairly moderate) ADHD; if my experience is representative of anything, it's probably that.

I'm curious to find out if those issues are also experienced by people who aren't autistic - perhaps to a lesser degree, or with different explanations than the ones that I mentioned. Do the issues I described sound like what you're experiencing? Are they close, or similar in some interesting way?

How will you distinguish between a non-autistic 'experiencing an autistic associated experience to a lesser degree' and, well, someone experiencing a lesser degree of autism? Considering the context I am not sure if a "I notice that too" from a LessWrong poster would inform me much at all about how much prevalence independent of the causal factors behind autistism.

My experience, for what it is worth:

The former category would include not experiencing, or noticing that you're experiencing, 'tiredness', even when your body is acting tired in a way that others would notice (e.g. yawning, stretching, body language).

My main experience of 'tiredness' is metacognitive awareness of impaired cognitive function. For example, I'll notice that my verbal expression and spelling becomes impaired and the names of things elude me and then conclude that I am tired. I don't feel 'sleepy'. Note that now that I have discovered melatonin I actually can feel tired (if I take ~6 mg). This was quite a novelty! I also seemed to have developed somewhat more awareness of other 'tiredness' indicators such as yawning over recent years (late 20s).

The above applies to hunger as well, for most part.

The second case involves not being able to stop whatever activity you're engaged in and go to bed, even though you recognize (perhaps briefly, before being drawn back into what you're doing) that you are tired and it would be a good idea.

Spot on.

How will you distinguish between a non-autistic 'experiencing an autistic associated experience to a lesser degree' and, well, someone experiencing a lesser degree of autism?

I'm not sure that those categories are naturally distinguishable, actually - there's a fair bit of controversy over whether there's a smooth spectrum between very autistic individuals and very NT individuals, and such datapoints could be taken as evidence for that theory. Whether the NT-leaning-toward-autistic portion of that spectrum (assuming it exists, which I believe it does) manifests in single examples of significant autistic-type experiences in otherwise NT people vs. multiple slightly autistic-leaning traits (or both) is also interesting.

I tend not to spell that kind of thing out unless asked, though - not everyone reacts well to overt suggestions that they might be autistic-leaning because of some trait. 'NT with a quirk' is much more palatable.

The second case involves not being able to stop whatever activity you're engaged in and go to bed, even though you recognize (perhaps briefly, before being drawn back into what you're doing) that you are tired and it would be a good idea. (This isn't quite the same as 'I'll do one more part, and then go to bed' in that it's less conscious and therefore harder to break out of - in many cases it takes a significant effort of will to stop your body from automatically taking the next step in what you're doing, even if you've actually decided not to take that next step.)

This sounds like me. Not just for going to bed, but for anything I need to do. Do you have links to descriptions or discussions of this experience? Have people found any way of dealing with it? I'm probably slightly on the autism spectrum.

ETA: I've also heard this described as ADD or OCD.

This is my go-to article on the subject. I can probably dig up some more things later, if you're interested. (I'm about to go to bed.) Mostly it's more worked-around than overcome, but there are resources out there on how to work around it, and I'll make a point of trying to find some of them if you want.

Executive dysfunction is part of ADD, too, so I wouldn't be surprised to hear of it being an element of that. My understanding of OCD is that the mechanism behind the issue isn't the same, but I could easily be wrong; I haven't done as much research on OCD.

Thanks! Yes, please dig up more on that! (Guess you didn't go to bed right away.) I'd love to see resources for how to work around it.

I definitely have those kinds of experiences. I don't believe that I'm autistic.

Use cron to make your browser open a new tab once a minute starting at midnight that says "GET TO BED!"

I have at times set cron to shut down the PC, with a 1 minute countdown. It worked wonders. It did cut down on productivity somewhat. Working 25 hours straight actually does get a lot of stuff done!

Going to bed is a little like dying. Someone slightly other wakes up in the morning.

Because I can't stop my compulsive quoting...

 "I lay me down and slumber
 And every morn revive.
 Whose is the night-long breathing
 That keeps a man alive?"

-- XIII, More Poems, A.E. Housman (1859 – 1936)

Going to bed is a little like dying. Someone slightly other wakes up in the morning.

Good point. For example, last night just before going to bed, I was totally absorbed in Eliezer's latest story. But when I woke up this morning, I forgot about wanting to finish the story, and started doing other things. (Eventually I came upon the open tab and finished it.)

BTW, if anyone hasn't read that story yet, you should keep this page handy as a reference, otherwise it's pretty hard to understand.

Since I wrote this post, the following comments have come in. If I missed any, please PM or reply with links. The following entries are compiled from LessWrong, #lesswrong, gwern.net, Reddit, or Google+, generally in relation to this melatonin essay; I classify as using/positive anyone who is using melatonin or will likely use melatonin in the future for any reason (eg. daily use counts, but so does using it for jetlag), and as negative/null anyone who is no longer using it for any reason (eg. found a better way to induce vivid dreams, or found it made them sleep better but this interfered with their diabetes-related medical devices).

Using/positive:

Not using/mixed/negative:

Unknown:

  • AdeleneDawner
  • CasioTheSane
  • Curiouskid
  • Cyan
  • Ralith
  • SoullessAutomaton
  • handoflixue
  • kevin
  • nazgulnarsil
  • shokwave
  • philh

I am microdosing, 300mcg plain + 300mcg time-release, both from LEF. Currently trying doubling the time-release dosage to see if that works better. More than 400mcg up-front did not work well. In general, people trying melatonin are advised to try microdoses.

In general, people trying melatonin are advised to try microdoses.

That's definitely something I noticed in the anecdotes: people with positive experiences seem to mention switching to 1mg doses and not experimenting.

I'm going to strengthen the language in my melatonin essay dealing with dosage, and add some reminders to myself to do more blind experiments with differing doses when I run out of my current melatonin pill mixes.

I'm going to strengthen the language in my melatonin essay dealing with dosage, and add some reminders to myself to do more blind experiments with differing doses when I run out of my current melatonin pill mixes.

Any updates on this?

Not yet. My five-fold sleep experiment was originally supposed to be long done by now, but I put the lithium part on hold to run another long experiment, and so it hasn't finished yet. Hopefully I'll be able to start by 2014.

I'm interested in knowing how you came up with the conclusion that it reduces your sleep need (or bed time) by one hour?

I can understand that taking melatonin would reduce bed time if it made you fall asleep faster, but personally I've had no trouble falling asleep quickly so there would basically be no difference. (In fact, I've experienced an opposite effect with the couple of times I've taken melatonin.)

It takes a lot more than just casual observations to conclude that there are other effects. Basically you'd need to measure your sleep debt some way and compare its development when taking the drug and when not. Unfortunately there is no direct way to measure sleep debt so it will require quite extensive tests to make any decisive conclusions about this hypothesis.

If you already have this data, please share it. If not, I'd be happy if you took a step back and really tried to measure and confirm this claim.

One final note is that current research has demonstrated that sleep has an important part in memory consolidation. If supplemental melatonin really does cut sleep need, it will necessary have effects on memory consolidation too. (For example, motor memory consolidation happens in REM and NREM-2 phases that most probably would be cut if daily sleep need was reduced.)

I've had no trouble falling asleep quickly so there would basically be no difference. (In fact, I've experienced an opposite effect with the couple of times I've taken melatonin.)

For people who actually have trouble falling asleep, or wanting to fall asleep, this is definitely a concern. When I was researching melatonin a few years ago, one of the problems I read was that if you fight off the effects of getting sleepy long enough, you'll actually find it more difficult to sleep afterwards (that night, I mean). This was the reason I chose to avoid it after a few tests at that time: I didn't feel I could afford the risk of accidentally pushing through the sleepiness and getting almost no sleep in a given night.