Sunday, March 30, 2014

Melatonin for High Altitute Sleep.... What can we down here learn from it?

This was presented at the 27th annual meeting of the Associated Professional Sleep Societies LLC (June 4, 2013), as an abstract, also published as an online supplement in the journal SLEEP.

The official title of the abstract was
“Melatonin as a countermeasure to the effects of high altitude on sleep and cognition on North America’s highest peak,”

The study only involved 13 people (climbers). 2 were women.
Average age: 34
The were climbing at14,200 feet on North America's highest peak, Denali, in Alaska.
Keep in mind that 140 MILLION people live among 8,000 feet and many ski resorts in the contiguous United States have people skiing precariously on them greater than 10,000 feet.

They each were given melatonin or placebo on 2 consecutive nights. Neither they nor the person who gave them the pill at that time knew which night they were getting the melatonin versus the placebo, so they couldn't "predict" how well they should sleep or perform the next day on a test.
They took the medication 1.5 hours before bed.
They wore a wireless sleep monitoring device (polysomnogram) to help judge how much they slept.

The amount of time they slept was judged, as well as how they performed on the Stroop test the next day.... as a hopeful, indirect sign they actually got more sleep and would therefore have better cognitive acuity as a result.
-On average they fell asleep in 20 minutes (with melatonin) versus 44 minutes with placebo. They also had less wake after sleep onset time.
-The next day they also performed better on the Stroop test, which is a mark of reaction time, judging how fast one can correctly name a series of colors who's name (in word form) is different than the color you are to name. There are other variations on this test as well.


Things I believe you should take away from this study:
-Melatonin should be taken not just before bed (as many people are tempted to do) but at least 1.5 hours before bed.
-Melatonin helps with sleep solidarity and time to sleep onset, and does so without being a prescription, without as many side effects of the prescription sleep aids, and without the reliance & habituation which can come from regular prescription sleep aid use.

Things this study doesn't tell you:
-What dose will work for you personally
-Melatonin works best if you take it EVERY night at the SAME TIME before bed as part of regular pre-sleep ritual. Melatonin does not work like Ambien/Sonata/Lunesta, etc. Melatonin encourages the orchestra of sleep, but by itself cannot force sleep.You really need to use it regularly for some period of time to see a more robust positive & sustained effect.
-Whether other supplements could be just as effective or was it specific to melatonin's affect on a specific location within the brain or because of its affects on the circadian rhythm

Problems with the study: 
-It might lead someone to believe, erroneously, that the medication could or should work one night at a time, when melatonin is NOT designed to be a "rescue" medication.
-The wireless sleep study hardware/software could only offer a limited assessment. It was not as good as in-lab study, and it may be missing some key information.
-These were fit 34 year-olds... We don't know what type of implication the medication would have for older or younger people...
                       ...or people who snore or have apnea (Could melatonin make it worse by having them sleep more deeply and not protect their airway?)
-Small study: 13 people. How well can we extrapolate to a large population from that?
-We don't know what happens with longer use.