Melatonin will soon be available to order over-the-counter in New Zealand pharmacies, but could it create a reliance?
Insomnia robbed Andy Trainor of his enjoyment of life.
“You look at people and you’re jealous that they can smile, that’s kind of where you go when you can’t sleep for ages,” Trainor said.
“You’re so miserable and tired and you just want to sleep, everything makes you irritable and you fly off the handle – it’s really bad.”
He works as a software engineer which requires a lot of late nights and stressful hours, and he also competes in endurance sport.
“I’d go to bed and just lay there for the whole night, then I’d have to get up and function,” the Aucklander said.
“I tried every possible remedy I could find, every way to relax or turn off my brain.
“I suffered in silence for a long time.”
A long battle with insomnia led Trainor to try melatonin, something he said made him feel “amazing and revitalised” the first time he used it.
But then each night it began to wear off quicker and stopped having the same magical effect.
“It started to work less and less, and I just decided I didn’t want to get dependent on it.
“It wasn’t a silver bullet.”
Trainor began using a mixture of behavioural strategies and treatments, uncovering the fact that long-term injuries he had sustained from childhood were contributing to his insomnia.
“Within the last three months I haven’t really been taking sleeping pills, I’ve actually found a lot of the root cause of my problems were more pain-related and I didn’t realise,” he said.
For Trainor, the improvements to his insomnia have been “life-changing”.
In a recent appointment, his sleep specialist told Trainor he seen him smiling more in the past 10 minutes than his entire past year of treating him.
A recent Government decision to allow melatonin to be made available over the counter is being scrutinised by New Zealand sleep specialists who doubt its effectiveness.
Sleep problems, experts say, are increasing in an age of rising screentime and anxiety which means there are now countless solutions being marketed to the public.
The Government announced melatonin will be available in pharmacies as pills up to 5mg in packs with up to 10 days’ supply, remaining prescription-only for children and adolescents.
It now means people who use the drug can avoid carting large quantities of melatonin gummies in their suitcases from overseas, or ordering it online.
However, some New Zealand sleep experts don’t see it as being all positive for the health of the population.
Director of the Sleep Well Clinics Dr Alex Bartle, who has studied sleep for more than 25 years, said he was “not that pleased about it”.
“People are going to become reliant on something which isn’t that effective but has some possible placebo effect,” Bartle said.
“Placebos are really powerful ... then they get hooked on it.”
He said despite widespread availability of melatonin in the United States there were very few good long-term studies, and a lot remained unknown about the hormone.
“If you’re selling billions of dollars of melatonin over-the-counter why would you bother to investigate it? Because you might find it doesn’t work,” he said.
Auckland Sleep specialist Dr James Wethasinghe said melatonin would be sought out by patients looking for a quick and easy solution, but it may not help them.
“To have a sedating substance that’s potentially addictive, or at least you become tolerant or reliant on it, being made available without any real sort of monitoring or restriction – is that a good thing?” Wethasinghe said.
He said although melatonin may be beneficial in giving people a bit more sleep it wouldn’t provide better-quality sleep.
Long-term poor-quality sleep could increase the risk of disease, he said.
“Even though there’s no direct harm related to the chronic use of melatonin it’s probably overall not a good thing – it’s a net negative for people.”
Both Wethasinghe and Bartle said they were comforted by the fact melatonin was a relatively safe drug, meaning it was unlikely to cause negative side-effects.
A Ministry of Health spokesperson said the intent of the decision was to provide another option for people needing to manage their jet lag or insomnia in the short term.
“Consistent with Australia, there will be restrictions to the pack sizes available at pharmacies, and people wanting to use melatonin longer-term will need to consult a doctor,” the Ministry of Health spokesperson said.
Associate Minister of Health David Seymour said many Kiwis had asked him why people could buy melatonin overseas but they couldn’t buy it from their local pharmacy.
“Medsafe assessed this and concluded there’s no reason why it shouldn’t be available on pharmacy shelves right here at home,” Seymour told the Herald on Sunday.
“Melatonin mightn’t work for everyone, but for many people it can make a real difference, and they shouldn’t be forbidden from having that option.”
New Zealand Sleep CEO Barry Griffiths works in testing and solutions for sleep apnoea – a common sleep disorder where breathing repeatedly stops and starts, usually connected to loud snoring.
Griffiths said melatonin being made available “was a positive” as it was a relatively harmless substance, but it could be bad for people with sleep apnoea.
“The only thing from a sleep apnoea perspective is that melatonin or sleeping tablets can suppress the respiratory system ... and that means the number of waking events actually increases.”
Melatonin may help these people to sleep longer but their rest would still be disrupted by breathing problems, resulting in them still being fatigued.
Bartle said the most powerful timekeeper of the circadian cycle was light.
“The first thing you should do if you’re getting into a foreign country is get outside,” he said.
“Melatonin might help but light is more powerful.”
Bright, outside light produces lots of serotonin which then converts to melatonin naturally in the body at night-time causing sleepiness.
Shaded blue-green light in forests or a local park was more ideal than harsh light and exposure to this during the day would help people sleep better.
Bartle said the body often adjusted to sleeping pills quite quickly, meaning over time people needed stronger doses to get the same impact.
“They start becoming less and less effective and the person becomes more and more desperate,” he said.
“Writing a prescription for a pill is a temporary fix for GPs ... I don’t think it’s good, but I totally understand the position they’re in as they often only have 15 minutes.”
Wethasinghe said the long-term use of sleeping pills was unfavourable compared to using behavioural strategies to manage sleep.
That was because the quality of sleep you were getting was fundamental to the health of your body, he said.
However, Wethasinghe would still prescribe patients with chronic insomnia sleeping pills to help them reset their sleep cycle and avoid a dangerous lack of sleep.
“I don’t want patients to feel stigmatised when seeking help for these problems, and if this is a way patients can get some treatment and avoid that fear it’s a good thing,” he said.
A Ministry of Health spokesperson said it was too early to say how long it would take for melatonin products to become available in New Zealand.
“Pharmaceutical companies will need to start bringing in new products and getting them approved to sell them in pharmacies,” the Ministry of Health spokesperson said.
“Given there will be increased demand for the medicines, there is now likely more incentive for companies to introduce a wider range of melatonin products to the New Zealand market, but this is a commercial decision.”
Eva de Jong is a New Zealand Herald reporter covering general news for the daily newspaper, Weekend Herald and Herald on Sunday. She was previously a multimedia journalist for the Whanganui Chronicle, covering health stories and general news.
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