The use of melatonin preparations in sleep disorders

Abstract

The role in the body and the biological significance of the pineal hormone melatonin is discussed. Data are presented on the effect on biological rhythms in humans and animals, as well as on the sleep in general. In diurnal humans and animals, melatonin acts on the suprachiasmatic nuclei of the hypothalamus to dampen the wake-stimulating signal of the internal clock, thereby promoting sleep. Data are presented on the clinical use of melatonin in sleep disorders: Circadian Rhythm Sleep-Wake Disorders (jet lag syndrome, delayed sleep phase syndrome, irregular cycle), parasomnias (Rapid-Eye Movements Sleep Behavior Disorder) and insomnia. A significant effect of melatonin preparations with a high level of evidence was confirmed in Circadian Rhythm Sleep-Wake Disorders, less pronounced in Parasomnias. The effects of melatonin, used as a drug for jet lag, have the greatest degree of evidence. The melatonin preparation is recommended to be taken both before the flight and at the new place of stay in accordance with the time of its evening secretion in this time zone. In delayed sleep phase syndrome, the onset of melatonin secretion is delayed, reflecting a general lag in the body’s internal clock. Taking melatonin preparations leads to a shift in the sleep-wake cycle to an earlier time. In REM sleep behavior disorder, melatonin preparations to reduce excessive motor activity are preferred over benzodiazepines, since this disorder manifests itself in people of older age groups, and an undesirable effect on cognitive functions should be avoided. In chronic insomnia, the effect of melatonin significantly exceeds the placebo effect and is most pronounced in people of older age groups.