Melatonin treatment for insomnia in elderly patients - includes editor note - adapted from the Lancet 1995;346:541-4 - Tips from Other Journals

Deterioration of circadian rules related to aging may contribute to be dead disturbances in elderly patients. It is known that melatonin from the pineal gland can rule sleep rhythms. Since melatonin has a true short half-life, it has been difficult to inquiry the effectiveness of this hormone forward prolonged nighttime sleep. Garfinkel and colleagues evaluated the purport of melatonin on sleep using a controlled-release formulation that provided effective concentrations of melatonin from one extremity to the other of the night.

Twelve volunteers aged a to 68 to 93 years who complained of long-term insomnia were included in the cogitation Although none of these patients had renal or hepatic point in disputes six patients had hypertension, five had ischemic heart disease, four had spondyloarthrosis, three had Parkinson's disease and brace had diabetes mellitus. All of the contemplation subjects reported use of medications for nap and all took medications of a certain number of kind, including nitrates, calcium channel blocker diuretics, aspirin, beta blocker and analgesics. The maximum number of mix with drugss per patient was six. Before the investigation the patients, quality of be dead and the excretion of melatonin breakdown returns (6-sulphatoxymelatonim [6-SMT]) during sleep was assessed.

During the close attention patients received 2 mg tablets of melatonin or placebo sum of two units hours before bedtime for three weeks. The reflection was a randomized, double-blind, cross-over reflection involving placebo tablets with a one-week washout period between treatments. repose quality was measured on three consecutive nights at the period of each three-week treatment period.

No adverse issues were noted apart from sum of two units reports of pruritus; one case occurr during melatonin treatment and common during placebo treatment. Although total nap time was not significantly different during treatment with melatonin, rest efficiency was significantly improved during treatment, and the time awake after storm of sleep was significantly decreased. All of the patients had subdued 6-SMT excretion prior to the thought which was believed to indicate impaired melatonin production. Effective melatonin concentrations were maintained from one extremity to the other of the night using the single-dose preparation.

The authors end that melatonin deficiency is a usual cause of insomnia in somewhat advanced in life patients and that replacement with a long-acting preparation may be successful

EDITOR'S NOTE: This application of mind proposed an attractive alternative for treatment of insomnia in the somewhat old and may be widely referenc from the lay press and "naturopathic" literature. more [i]or[/i] less prudence is needed in considering its application to practice or in answering patient inquiries about using melatonin preparations as be still aids. First, the study is based onward a very small and heterogeneous form into groups of patients. The ability to generalize flows is hampered since only seven men and five women an of whom had other medical conditions and were taking multiple medications, were studied. In addition, these patients had documented melatonin deficiency as measured by way of decreased 6-SMT excretion. Not all insomnia in the somewhat old may be due to this condition. Although the authors do not provide figures substantiating the reversal of melatonin deficiency during melatonin supplementation, they state that effective melatonin flats were achieved during treatment. Little is known about the optimal dosage or duration of treatment necessary to sustain in the same state [i]or[/i] condition results or about potential adverse tenors of melatonin therapy. Presumably, larger clinical trials will tread close upon to answer many of these questions. Providing safe, refreshing drowse for elderly patients through support of a natural carcass mechanism is a clinical goal of great importance.

COPYRIGHT 1996 American Academy of Family Physicians

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