Holidays can be a time to lie in, take naps and generally try to catch up on sleep. Studies of sleep habits among NZers show up to 45% of participants reported experiencing insomnia symptoms at least once a week. Given a number of us struggle to fall – and stay – asleep, it’s perhaps not surprising we might use holidays to make up a sleep deficit. In 2021, Nicky Pellegrino looked at the reasons why sleeping well is hard to do, especially as we age, as well as some of the over-the-counter remedies available to help.
People tend not to sleep as well in later life, and one of the reasons is believed to be declining levels of the hormone melatonin. Produced by the brain’s pineal gland, melatonin helps control the body’s sleep/wake cycle. Levels increase naturally after darkness and it is suppressed by light in the morning.
For those whose brains aren’t making enough, melatonin is available as a supplement. In some countries, it can be bought easily online – it’s even supplied in “gummy” form – but in New Zealand, it is an unfunded prescription medicine, so it’s illegal to import without a prescription or letter from your doctor.
Many people who prefer not to take hypnotics, such as Zopiclone, turn to melatonin as a more natural alternative, so it’s highly likely some of them are unwittingly breaking the rules by buying it from overseas.
If you’re over 55 and suffering from insomnia, 2mg gradual-release melatonin tablets can be sourced without a prescription from a registered pharmacist for up to 13 weeks, but you’ll have to pay for it. Currently, it’s only subsidised for younger people with sleeplessness related to neurodevelopmental disorders such as ADHD, unlike Zopiclone, which is fully subsided and one of the country’s most-prescribed medications.
So, if you’re going to reach for something to help you sleep, which is better? Alex Bartle, director of the Sleep Well Clinic, says many people love Zopiclone because it’s so effective. You get a good night’s sleep when you take it. The trouble is, it’s easy to start feeling reliant.
“It becomes your confidence in being able to sleep,” he says.
Zopiclone isn’t intended as a long-term solution. Over time, the body starts to build up a tolerance, so you need something stronger. And if you stop taking it, the result can be rebound insomnia, so you’re back to square one. It also has risks, especially for the elderly, who metabolise drugs differently, making them more likely to have falls and impairing their thinking.
Bartle says melatonin is particularly useful as a reset when you’re travelling across time zones and struggling to adjust, but there’s also some evidence it can improve sleep in the over-55s. The idea is you take one to three milligrams 30 minutes or so before bedtime. It’s not a sleeping pill, but will calm you, making you feel drowsier and ready to sleep. Taking the modified-release form means if you wake in the night, you’re more likely to go back to sleep. And by morning, the effects will have worn off, so you will feel alert.
Melatonin also has a role in the ageing process and immune function; it’s known to be a potent free-radical scavenger with anti-inflammatory and antioxidant effects.
However, just because it’s a hormone we produce naturally doesn’t mean taking melatonin in supplement form is entirely free of side effects. It can cause headaches, nausea, dizziness, low mood and stomach cramps, and it’s not advisable to mix it with alcohol. Also, we don’t know if it’s okay for longer-term use.
Bartle reckons the effect of melatonin is mainly psychological: we take a sleep hormone, so feel as if we can go to sleep. “It’s a relatively safe drug, but we’re so hooked on pills,” he says. “There are other ways of boosting your brain melatonin rather than taking tablets.”
To encourage our ageing pineal glands to produce enough melatonin naturally, the key is to get outside in daylight. No sunglasses – we need the light to reach the retina to suppress melatonin and trigger the release of serotonin – but it doesn’t need to be the dazzling glare of full sunlight, either. Being in a garden with shade and scattered light is ideal. As darkness falls, the pineal gland converts the serotonin to melatonin, so we feel sleepy.
Screen use is an issue because the blue light screens emit suppresses melatonin. Even if you take steps, such as using dark mode or wearing blue-blocking lenses, the interactive nature of screens, and the fact we hold them so close to our face, is likely to contribute to sleeplessness as much as the light they emit.
“We’d rather you didn’t have any screen time for an hour before bed,” says Bartle, “although televisions aren’t quite as bad. They are backlit with blue, but are distant, on the other side of the room, and passive: you’re just watching a movie, not working with it.”
This story was originally published in the July 24, 2021, edition of the New Zealand Listener.
