Miracles and Myths
The world of antiaging is full of hyped claims, breakthrough treatments, and wonder supplements. In this regular feature, we will look at some of the current fashions and evaluate whether they are supported by evidence:
Of all the anti-ageing strategies I recommend, none is more simple, yet elusive, than good sleep.
The amount of sleep we need is, surprisingly, culturally variable but a good guide would suggest that 7-8 hours represents the sweet spot for adult Australians. Of course that presumes a healthy balance between Core sleep, deep sleep, and rapid eye movement sleep (REM).
In theory, this should be straight-forward enough yet 39.8% of adults self-report that they experience inadequate sleep[1].
In fact, a clear majority of 59.4% experience one or more sleep symptoms including difficulty in falling or staying asleep at least 3–4 times per week.
At the serious end of the scale, 20% of Australians suffer from obstructive sleep apnoea (OSA), a condition that can result in serious health outcomes.
It’s hardly surprising therefore to find that 40% of the population resort to medications and supplements to correct their sleep deprivation.
For many (about 25%) this has meant prescription pharmaceuticals such as Benzodiazepines, anti-depressants, so-called “Z-drugs”, and sedating antihistamines, however GPs have become rightfully reluctant to dispense these as adverse outcomes including addiction have become more common.
In recent times, Australians have increasingly turned to so-called natural alternatives including Magnesium (supports muscle relaxation and nervous system function), Valerian root (reduces anxiety), Chamomile & Passionflower (traditional sleep inducer), Ashwagandha (an adaptogen) and L-theanine & GABA (amino acids that promote relaxation).
But the go-to supplement these days is Melatonin and its proponents swear by its effectiveness.
Melatonin is not just a “natural” product but it is actually a human hormone produced by the pineal gland in your brain. It plays a key role in regulating your sleep-wake cycle, (your circadian rhythm) and its levels rise in response to darkness. This acts as a signal to your body that it’s time to wind down and rest.
Melatonin doesn’t put you to sleep so much as it signals your body to prepare for sleep.
Somewhat surprisingly then it was only made available in Australia for OTC purchase in 2021 – and even then restricted to over 55s.
By contrast, in the US where it is freely available, [2] estimates suggest that roughly two-thirds of adults have used melatonin to help them drift off.
Melatonin is certainly appealing. Apart from being natural, it is cheap, non-addictive and promoted heavily by social media influencers.
But does it “wear off” with regular use as is commonly observed, and does increasing its dosage actually reboot its effectiveness?
As bedtime approaches, a small area of your brain, the suprachiasmatic, (memorise that and impress your friends) instructs your pineal gland to release melatonin into your blood stream, thus causing you to lose alertness. This indirectly encourages sleep by discouraging brain activity. This regulation continues until the early hours of the next morning and thereafter subsides.
So, unlike the earlier mentioned prescription medications, melatonin is NOT a sedative. It may help you fall asleep, but it won’t keep you there.
The best use of melatonin is in fact to help you readjust your circadian rhythm when its out of whack- for instance if you are a shift worker or dealing with jet lag.
In terms of treating insomnia, there are mixed research results including evidence that melatonin works no better than a placebo.
In addition, because of melatonin’s mechanism, varying its dosage makes no discernible difference whether 0.3mg (the body’s natural production level) or 3mg (the usual supplemental strength).
The alternative to taking melatonin is to help stimulate the body’s production of it. That’s easily achieved through the usual advice to avoid screen stimulation, keep night lighting dim and warm and take a daily dose of natural sunlight as soon as possible after waking.
If your sleep problem is due to an overactive mind, sleep anxiety or even just general anxiety, melatonin may help create the calm you need to be restful, although its probably less effective than practising the gold standard for insomnia, Cognitive Behaviour Therapy (CBT). On the other hand, if your underlying problem is undiagnosed sleep apnoea, you need some professional advice rather than an OTC quick fix.
[1] www.sleephealthfoundation.org.au
[2] American Academy of Sleep Medicine (AASM) survey
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