Category: Sleep Health

Why melatonin doesn’t work

Melatonin doesn't work

We’ve all heard this from our patients:

“Melatonin doesn’t work for me.”

And to be honest, it often doesn’t work…at least not in the way most people are using it.

Melatonin isn’t a sedative. It’s a chronobiotic.

It’s a biological time cue that tells your body what time it is and helps regulate the sleep-wake cycle.

So when a patient says melatonin failed, the problem usually isn’t that melatonin doesn’t work.

It’s usually one of these 3 things:

  • Wrong timing
  • Wrong indication
  • Poor quality supplement

This week, I’m breaking down why melatonin doesn’t work and what to do about it.

In this 8-minute episode (Part 2 of my 3-part series on melatonin) I share two real clinical cases that illustrate how to make melatonin work for the right patient at the right time:

  • A 32-year-old who was misdiagnosed with insomnia and cycled through multiple hypnotics without relief
  • A man in his 60s with early-morning awakenings who tried melatonin without success, until he learned how to use it strategically

I’m also sharing:

  • How to time melatonin supplements relative to DLMO (dim light melatonin onset) instead of clock time
  • The optimal melatonin dose for circadian realignment
  • When to choose extended-release formulations
  • Why melatonin rarely works in isolation and how to use it most effectively

If you’ve ever wondered how to handle “melatonin doesn’t work” complaints in clinic, this episode will give you a roadmap.

Well worth the 8 minutes of your time.

Watch the full video here.

Then, stay tuned for Part 3, where we’ll explore melatonin use in perimenopause and menopause.

Did you learn something today? Click here to find out how Learner+ can help you meet your evolving educational goals.

In 8 minutes I’ll teach you to prescribe melatonin the right way

In this episode, Dr. Nishi Bhopal, a sleep physician and psychiatrist, dives deep into why melatonin often fails for patients and how to correct its use for optimal benefits. Learn the biological role of melatonin as a chronobiotic, not a sedative, and discover practical strategies for treating conditions like delayed sleep phase disorder and advanced sleep phase disorder. Dr. Nishi Bhopal walks through two compelling cases, highlighting the importance of timing, dosage, and formulation. Get insights on how to use melatonin effectively and explore other critical sleep-promoting behaviors. Join our masterclass for a deeper dive into evidence-based sleep supplements.

Is Melatonin Safe?

Is Melatonin Safe?

A 2023 research letter in JAMA (Journal of The American Medical Association) and 2017 study in JCSM (Journal of Clinical Sleep Medicine) highlighted serious issues with over-the-counter melatonin quality*.

One melatonin gummy was found to contain 347% more melatonin than what the label claimed.

That’s enough to make anyone pause.

It has definitely changed the way I recommend melatonin to patients.

But as I explain in this week’s video, the full story is more nuanced, and perhaps not quite as alarming, as the headlines suggest.

In this 10-minute episode (Part 1 of a 3-part series on melatonin), I unpack what every clinician needs to know about melatonin safety, including:

  • Why melatonin isn’t a sedative
  • What the JAMA and JCSM studies actually found
  • How to interpret dose variability and brand differences
  • What the research says about short, moderate, and long-term safety
  • My clinical take on when to use it…and when to rethink it

I also share a patient story that illustrates how melatonin, when used correctly, can retrain the circadian rhythm instead of becoming a nightly crutch.

If you’ve ever had a patient ask whether melatonin is “safe,” or wondered how to approach it in your own prescribing, invest 10 minutes of your time in this high yield video.

Click here to watch it.

Did you learn something today? Click here to find out how Learner+ can help you meet your evolving educational goals.

*References:
Cohen PA, Avula B, Wang YH, Katragunta K, Khan I. Quantity of Melatonin and CBD in Melatonin Gummies Sold in the US. JAMA. 2023 Apr 25;329(16):1401-1402. doi: 10.1001/jama.2023.2296. PMID: 37097362; PMCID: PMC10130950.

Erland LA, Saxena PK. Melatonin Natural Health Products and Supplements: Presence of Serotonin and Significant Variability of Melatonin Content. J Clin Sleep Med. 2017 Feb 15;13(2):275-281. doi: 10.5664/jcsm.6462. PMID: 27855744; PMCID: PMC5263083.

Melatonin Safety Guide: Should You Take It?

Melatonin Safety Guide: Should You Take It?

In this episode, Dr. Nishi Bhopal MD addresses recent headlines surrounding melatonin mislabeling and safety. She dives into the accurate use of melatonin, its role as a chronobiotic, and the importance of precise dosing, especially in clinical settings. Learn about melatonin’s applications for various conditions such as circadian rhythm disorders and pediatric neurological conditions, and explore the latest research on its long-term safety. Dr. Bhopal also shares insights from her clinical practice, discusses the variability in melatonin supplement labeling, and offers guidance on selecting high-quality, third-party tested brands. Subscribe for more practical clinical sleep medicine insights.

Ayurvedic Routines for Sleep — Psychiatrist & Sleep Doctor Explains

Ayurvedic Routines for Sleep — Psychiatrist & Sleep Doctor Explains

Join us for a discussion with Drs. Judith Pentz MD and Nishi Bhopal MD on Ayurvedic rituals for better sleep. Dr. Pentz shares her unique perspective as an integrative psychiatrist and dives into Ayurvedic practices such as morning and evening routines, the importance of understanding your dosha, and the role of nutrition and herbs like ashwagandha. Learn about self-care routines, the significance of circadian rhythms, if Ayurveda is evidence-based, and how Ayurveda aligns with modern sleep science. Don’t miss out on valuable tips for managing anxiety and promoting overall wellbeing.

CBT-i Only Works If You Do This

CBT-i Only Works If You Do This

We all see patients struggling with insomnia, but implementing CBT-I (cognitive behavioral therapy for insomnia) in real-world practice can feel daunting, especially when you’re not a sleep specialist.
I remember my first time recommending “sleep restriction” to a patient.

The look of panic on her face made me question if I was helping or just adding to their anxiety.
In fact, sleep restriction is often the thing that scares people away from CBT-i or leads to non-adherence with treatment.

This is where the art of clinical practice comes in: meeting patients where they are.
This week, I sat down with Dr. Parky Lau PhD, a sleep psychologist at Stanford, to talk about how to make CBT-I practical, flexible, and patient-centered, even for clinicians who don’t do this every day.

In this episode, Dr. Lau shares:

  • How to build a case formulation for insomnia (and why it matters)
  • How to practically implement time in bed restriction (and why he prefers that term over “sleep restriction”)
  • Practical analogies (like pizza dough and finger trap) to help patients understand sleep
  • How to adapt CBT-I for menopause and bipolar disorder
  • Tips for supporting patients who are anxious, perfectionistic, or dependent on sleep aids
  • How to build flexibility and empathy into a successful treatment plan
  • And more…

When your next patient mentions insomnia, you’ll have practical tools from this video to guide your clinical thinking.

Did you learn something today? Click here to find out how Learner+ can help you meet your evolving educational goals.

References:
Walker J, Muench A, Perlis ML, Vargas I. Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer. Klin Spec Psihol. 2022;11(2):123-137. doi: 10.17759/cpse.2022110208. PMID: 36908717; PMCID: PMC10002474.

Why CBT-I Fails

In this insightful episode, Dr. Parky Lau delves into the practical implementation of Cognitive Behavioral Therapy for Insomnia (CBTI) in clinical settings. The discussion covers how to build a case formulation for insomnia patients, focusing on menopausal and bipolar disorder patients. Key concepts such as sleep drive, circadian rhythm, and hyperarousal are explained in detail, along with practical strategies like time in bed restriction and sleep compression. Dr. Lau also shares candid advice on navigating patient anxiety, using effective analogies, and avoiding common clinician mistakes. Moreover, the episode emphasizes the importance of empathy and patient-tailored approaches. For clinicians eager to expand their cognitive-behavioral therapy skills, this episode is a must-watch. Don’t miss the companion mini course offered by Dr. Lau for further learning!

3 Steps to End Sleep Anxiety

One of the most common misconceptions about insomnia is that it’s just a matter of bad sleep hygiene.

But many of your patients with chronic insomnia have better sleep hygiene than anyone you know…and they’re still lying awake.

Here’s why: insomnia isn’t all about bad habits.

It’s more like a phobia.

The brain has learned to fear the very experience of being awake at night.

So people end up cycling through one sleeping pill or supplement after another, or trying gadgets and all the “sleep hacks” they heard about on podcasts, but it doesn’t get any better.

The paradox is that the harder patients try to “fix” it, the worse it gets.

In my new video, I share how I explain sleep anxiety to patients, plus 3 strategies that work far better than piling on more rules about caffeine and blue light.

It’s less than 5 minutes, designed for both clinicians and patients, and part 2 of a short series I’m creating on insomnia.

Feel free to share it directly with anyone in your care who’s caught in the cycle of sleep anxiety.

And if you (or your patients) want to go deeper, I’m teaching a free masterclass on how to quiet racing thoughts and sleep through the night.

It’s a deeper dive with tools you can use right away. You (and your patients) are welcome.

Register here. 

Stop Waking Up in the Middle of the Night

Can't Fall Back Asleep

Do you find yourself waking up in the middle of the night and struggling to fall back asleep? In this video, Dr. Nishi Bhopal MD, sleep doctor and psychiatrist, explains why nighttime awakenings are normal and shares three science-backed strategies to help you return to restful sleep without panic or frustration.

How to quiet your mind at night

Stop Waking Up at Night

One of the most common things I hear from patients is this:

“My brain just won’t shut off at night.”

Do you hear that in your clinic too?

And most of them have already tried the usual fixes like meditation apps, relaxing harder, melatonin, sleep hygiene checklists, and so on.

The problem is: When you try to force the brain to relax, it’s like chasing a dog with the zoomies.

The more you try to contain it, the zoomier it gets.

In my new video, I explain why racing thoughts at night are so persistent, and three steps to redirect that energy so your patients can actually fall asleep and stay asleep. 

This video is part of a short series I’m creating for both clinicians and patients.

It’s less than 5 minutes but jam packed with the same info I share with my patients 1:1.

Feel free to share it directly with your patients and colleagues.
And if you (or your patients) want to go deeper, I’m teaching a free masterclass next week on how to quiet racing thoughts and sleep through the night.

You and your patients are welcome to attend that too.
Sign up here.