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even a relatively low dose of 0.3 mg per day may induce circadian levels of the
hormone in people over 50 years old well in excess of the normal level. Thus, before
deciding on a therapeutic dose to deal with insomnia, people should consult with a
physician to determine the precise amount of supplementation needed. Absent
testing, people should “work up” to a therapeutic level, beginning with 0.1 to 0.2 mg.
Note that these recommended dosages follow Fugh-Berman’s recommendation and
are less than those recommended by Brown et al and Weil.
Mischoulon and Rosenbaum advise that if melatonin is taken to improve nighttime
sleep, it should be taken about 30 minutes before bedtime to minimize the possibility
of an undesired circadian phase shift.
If melatonin is administered to contract the effect of eastward-travel jet lag,
Mischoulon and Rosenbaum recommend a dose of 0.1 to 0.3 mg at the local bedtime
following the flight. Such treatment will restore the deficit in melatonin that the
traveler will experience due to the advance of bedtime at the destination. Following a
westward flight, when the day is extended rather than shortened, it would be advisable
not to take melatonin at the local bedtime, when the endogenous level of the hormone
is already increased. However, it might be helpful to take a half dose (e.g., 0.1 mg)
immediately following a night or early morning awakening, as is typically experienced in
westward flights. In principle, this would facilitate resumption of sleep and its
maintenance, plus delaying the circadian phase and adjusting to the new location.
The Natural Standard differs from Mischoulon and Rosenbaum in recommending that
the melatonin be initiated before travel (at the destination bedtime) rather than on
arrival and recommending that supplementation continue for “several days.” Quick-
release is recommended as “more effective” than slow-release melatonin, but without
the elaboration given by Brown et al. and Mischoulon and Rosenbaum.
For jet lag, the Mayo Clinic recommends use of melatonin on the day of travel, and
continuing for several days. No timing or dosage is specified.