Abstract
A systematic review was conducted using Samueli Institute’s Rapid Evidence Assessment of the Literature (REAL©) process to determine the evidence base for melatonin as an agent to optimize sleep or improve sleep quality, and generalize the results to a military, civilian, or other healthy, active, adult population. Multiple databases were searched yielding 35 randomized controlled trials (RCTs) meeting the review’s inclusion criteria, which were assessed for methodological quality as well as for melatonin effectiveness. The majority of included studies were high quality (83.0%). Overall, according to Grading Recommendations, Assessment Development and Evaluation (GRADE) methodology, weak recommendations were made for preventing phase shifts from jet lag, for improving insomnia in both healthy volunteers and individuals with a history of insomnia, and for initiating sleep and/or improving sleep efficacy. Based on the literature to date, no recommendations for use in shift workers or to improve hormonal phase shift changes in healthy people can be made at this time. Larger and longer-duration RCTs utilizing well characterized products are needed to warrant melatonin recommendations in young, healthy adults.
Highlights
Sleep quality is a problem in the civilian population, where 17.4% of respondents to the 2002 Alternative Health/ Complementary and Alternative Medicine supplement to the National Health Interview Survey (NHIS) reported insomnia or trouble sleeping in the past 12 months [1]
Previous research suggests that supplementation with melatonin may help increase total sleep time in individuals suffering from sleep restriction or altered sleep schedules; relieve daytime fatigue associated with jet lag; reset the body’s sleep-wake cycle; and reduce the time it takes to fall asleep in people with delayed sleep phase syndrome [64]
In contrast to earlier meta-analyses, the authors of this review investigated the use of melatonin in military and civilian populations across various sleep behaviors, and divided the included literature into four distinct user groups: shift workers, individuals experiencing jet lag, persons suffering from insomnia, and healthy individuals who want to improve their sleep; the review focused on healthy populations, the authors chose to include insomnia populations as many military personnel who have been deployed may experience some form of insomnia [67]
Summary
Sleep quality is a problem in the civilian population, where 17.4% of respondents to the 2002 Alternative Health/ Complementary and Alternative Medicine supplement to the National Health Interview Survey (NHIS) reported insomnia or trouble sleeping in the past 12 months [1]. Sleep quality is a concern within the military. A 2010 paper on the Millennium Cohort - 41,225 active duty and retired Service Members - demonstrated that. Exogenous melatonin, as both prescription and over the counter pills/tablets, has become one of the most frequently requested non-prescription sleep aids due to its regulator role in the internal timing of biological rhythms, including promotion/regulation of sleep [8]. Melatonin is marketed to help promote total sleep time, aid with fatigue from jet lag, or balance circadian rhythms from jet lag and rotating shift work. Melatonin has been shown to serve as a mediator between the thermoregulatory and arousal system in humans, such that exogenous administration of melatonin during the day can result in sleepiness in association with reduced core temperature [11,12]
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