Should You Take Melatonin Supplements if You Have Sleep Apnea?

If you’re using a CPAP machine to treat Obstructive Sleep Apnea (OSA), it’s probably crossed your mind a time or two to take a melatonin supplement to help you ease into sleep a bit more smoothly. Especially when you’re first adjusting to CPAP, it can feel very difficult at times to fall asleep and get quality rest with the continuous airflow, so considering a sleep aid is a natural response to that pre-bedtime anxiety.

Prescription sleep aids generally aren’t recommended for those with sleep apnea, as many of them tend to relax the muscles in the neck and throat, exacerbating the core obstruction of sleep apnea. Melatonin, however, is a natural hormone produced by the body and, with proper and mindful usage, can be utilized by those with sleep apnea for an easier time drifting off to sleep each night.

Starting with a small dose of one milligram from a trustworthy brand, melatonin can provide that extra push to wind down for bed, though it does still need to be supported with a healthy bedtime routine. That means no screens within one to two hours of bedtime, no bright lights, no caffeinated beverages, and no sugar.

In this article, we’ll discuss melatonin and how it interacts with the body, so keep reading if you’ve ever wondered about taking melatonin with sleep apnea.

Melatonin is a hormone in the brain released by the pineal gland that plays a role in the regulation of the natural circadian rhythm of the body. The body, historically, produces this hormone when the sun goes down to prepare us for sleep. With our modern lifestyles, however, and tendencies to extend screen time into the late hours of the night, our bodies don’t always start producing melatonin at a ‘normal’ hour, leading to later and later sleep onset.

Melatonin is not a heavy sleep aid or sedative, however, and will not have a strong or instantaneous effect for most people that take it. Rather, it is one part of a healthy bedtime routine that also involves ending screen time an hour or two before bed. By taking in sources of bright or blue light before bed, the body won’t be producing its own melatonin. If you provide the right setting for melatonin production to happen naturally, however, a supplement will simply boost the natural production from your body, helping you wind down and become more tired.

Associate Medical Director of the Weill Cornell Center for Sleep Medicine and author of Let’s Talk About Sleep, Dr. Daniel Barone, recommends avoiding melatonin as a general treatment for unknown sleep issues and disorders, but notes that those who are being treated for sleep apnea can safely use melatonin to help their sleep.

“Assuming that a person has known sleep apnea, is properly treated, and is taking melatonin at a reasonable dose and with a trusted brand, typically, it is thought of as safe,” says Barone. “Melatonin is generally considered safe and completely non-addictive and, as a result, I have many of my patients use it regularly.”

Some other specific circumstances in which you can take melatonin to help regulate your sleep-wake cycle include:

• Insomnia: If you have consistent trouble sleeping and don’t know why, you should get tested for a sleep disorder. If you occasionally find yourself unable to fall asleep and think it could be stress or anxiety-related, melatonin may help you find your way to sleep a bit more easily.
• Jet Lag: Recovering from a flight through one or more time zone changes can be a shock to the body, but supplementing with melatonin and controlling your exposure to light may help you return to a more normal sleep schedule.
• Delayed Sleep-Wake Phase Disorder: Limited evidence suggests that those who experience DSWPD might be able to create a more natural sleep cycle by sticking to a set bedtime and taking melatonin an hour beforehand to stimulate sleep onset.

The intended use of melatonin supplements is to relieve you from short-term sleeping disorders, such as if you work night shifts or have an inconsistent work schedule. Melatonin may also help lower preoperative anxiety associated with surgical procedures. Many different studies highlight the anxiolytic and antidepressant effects of melatonin supplements.

When it comes to taking melatonin with sleep apnea, the story becomes a bit complicated. Melatonin relaxes muscles, which, if you have undiagnosed or untreated OSA, is a recipe for disaster.

Unlike insomnia, OSA does not develop because of difficulties in falling or staying asleep, but because of the narrowing of the airway due to excess tissue or the tongue collapsing into the airway and blocking it. So by introducing melatonin to your sleep routine when you may have undiagnosed or untreated sleep apnea, you’re making it more likely for your airway to collapse due to relaxed throat muscles.

To be clear: taking melatonin with sleep apnea is not recommended or a good idea if you aren’t actively treating your OSA with CPAP or an oral appliance prescribed for treated sleep apnea.

While it may sound like a good idea when you’re desperate for sleep, taking melatonin for undiagnosed sleep apnea is risky due to the following considerations:

Many people with sleep apnea also live with comorbidities such as obesity, hypertension, and diabetes. If living with any of these comorbidities, the first question when introducing a new supplement or medication is how it will interact or interfere with your existing medication.

Melatonin is known for its interaction with blood pressure and blood thinner medications, and you should always consult your healthcare provider before making a change to your medication.

Excessive melatonin supplementation (above 10mg) can cause unwanted side effects like waking up groggy, drowsy, dizzy, or with a headache. This sleep-inducing hormone can increase daytime drowsiness and interfere with your work performance.

Some melatonin users also report frequent nightmares and daytime tiredness with frequent usage.

Melatonin supplementation has the potential to exacerbate your sleep apnea. Supplements containing melatonin impart sufficient muscle-relaxing effects. That has a positive impact on people having a hard time falling asleep due to temporary sleeping issues.

However, relaxation of the oronasal musculature can negatively impact sleep apnea conditions. OSA is the result of the collapse of the structures of the mouth and nose. The collapse of the muscles narrows the air passage of the tongue, soft palate, and uvula.

Due to the narrow passage, those with sleep apnea experience oxygen deprivation and wake up after short intervals to catch their breath, typically gasping for air.

By taking melatonin, you relax the already relaxed muscles. As mentioned, this effect on the throat muscles further constricts the airway and worsens sleep apnea.

So, while the answer to “can melatonin cause sleep apnea” is a no, it can possibly make your sleep apnea worse in the long run.

It is generally safe to take melatonin for short-term insomnia. However, taking melatonin for untreated sleep apnea is not recommended as it will not treat the underlying problem causing your condition.

If you are undergoing sleep apnea treatment, taking small doses of melatonin (1-5 mg) up to a maximum of 10 mg with a trusted brand is typically safe.

Your sleep doctor is the best person to guide you regarding using melatonin for sleep apnea. If you have co-morbid insomnia and sleep apnea, your doctor might prefer managing insomnia first (with melatonin) and then recommend CPAP therapy for controlling sleep apnea.

Taking melatonin at a reasonable dose does not cause any significant harm to CPAP users. The safe dosage for melatonin is 1-10 mg max.

Due to the relaxation of the throat muscles with both OSA and melatonin, standard CPAP pressure may not be able to fully clear the obstruction of the airway if melatonin makes the blockage more significant.

People consuming melatonin with sleep apnea might need to increase the pressure setting to compensate for the (throat) muscle-relaxing effect of the supplement, though this should only be done with the supervision of your healthcare provider. If you sleep with an APAP machine, it will automatically adjust to this difference and you shouldn’t have any issues getting effective therapy with melatonin supplementation.

Studies found an abnormal melatonin secretion pattern in people suffering from OSA. Sleep apnea sufferers frequently have deviations in the amount of natural melatonin in the body. A 2013 study highlights melatonin’s role in the pathogenesis of OSA.

According to a 2017 study, CPAP treatment for three months effectively improves melatonin concentrations in the body and restores the physiological rhythm of the body’s natural melatonin production.

The takeaway here is that there is evidence that by sticking to a regular schedule with good CPAP compliance, your body will likely have more normal and natural melatonin production after as little as three months of therapy.

The following are some frequently asked questions regarding melatonin use for sleep apnea:

You should not take sleep aids if you have sleep apnea because they typically cause muscle relaxation, exacerbating the airway blockage associated with Obstructive Sleep Apnea.

There are certain drugs that you should avoid if suffering from OSA. Some beta-blockers (anti-hypertensive medicine) and testosterone supplements can worsen apnea conditions. Learn more about how sleep apnea can lower testosterone levels.

Muscle relaxers and OTC sleep aids can also exacerbate your sleep apnea by narrowing your airway.

Anti-anxiety medications like Xanax can also aggravate the condition, and opioids are notorious for inducing respiratory depression.

Erectile dysfunction drugs like sildenafil can also have a negative impact on OSA, so you should avoid it too.

If you’re treating your sleep apnea with a CPAP or APAP machine, small doses of melatonin can help support your sleep onset and help you get to bed more quickly. You may need a slight pressure increase to keep up with the effects of melatonin, and over time you may need less, as CPAP therapy has been found to naturally increase melatonin production.

Melatonin is a natural hormone released in response to darkness, which induces sleep. Melatonin supplementation is only intended to help manage limited, short-term sleep disorders such as circadian rhythm disorders, insomnia, and jet lag.

The collapse of soft throat tissues characterizes obstructive sleep apnea (OSA). Taking melatonin with sleep apnea can increase muscle relaxation of the oronasal structures, leading to the worsening of sleep apnea.

That said, small amounts of melatonin (one to five but no more than ten milligrams) for those who are actively treating their sleep apnea with CPAP therapy are generally regarded as safe, though CPAP pressure may need to be increased slightly with the guidance of your healthcare provider. Also be sure to consult your healthcare provider before making changes to your medication, especially if you’re taking medications for other conditions.