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Volume 34, issue 4

Review article

Melatonin in the treatment of Circadian Rhythm Sleep-Wake Disorders – the principles of choosing the right time and dose of administration

Adam Wichniak1, Aleksandra Wierzbicka2, Katarzyna Gustavsson2, Joanna Szmyd1, Wojciech Jernajczyk2
1. III Klinika Psychiatryczna i Ośrodek Medycyny Snu, Instytut Psychiatrii i Neurologii w Warszawie
2. Ośrodek Medycyny Snu, Zakład Neurofizjologii Klinicznej, Instytut Psychiatrii i Neurologii w Warszawie
Farmakoterapia w Psychiatrii i Neurologii 2018, 34 (4), 263–283
Date of publication: 14-10-2018
DOI: https://doi.org/10.33450/fpn.2019.01.002
Keywords: melatonin, circadian rhythm sleep-wake disorders, treatment

Aim. Circadian Rhythm Sleep-Wake Disorders (CRSWD) are a common group of sleep disorders. The aim of this article is to present the principles for treatment of CRSWD with melatonin.

Methods. Review of data from randomised, placebo-controlled clinical trials.

Results. The main indication for the use of melatonin is a treatment of Delayed Sleep-Wake Phase Disorder (DSWPD). Melatonin is also recommended for the treatment of Irregular Sleep-Wake Rhythm Disorder and Non-24-Hour Sleep-Wake Rhythm Disorder. However, in the treatment of Advanced Sleep-Wake Phase Disorder melatonin plays a secondary role. The therapeutic effect of melatonin primarily depends on the appropriate time of its administration. In DSWPD it should be administered even 6–8 hours before the scheduled sleep time. The available data does not indicate that the melatonin’s therapeutic effect is strongly correlated with the used dose and the recommended doses fall within a wide range of 0.5 to 10 mg. However, usually higher doses, e.g. 5 mg, are beneficial in the first 3–6 weeks of treatment. In neuropsychiatric disorders in children, dosage even up to 10 mg is recommended. Melatonin is also an effective form for relieving symptoms of exogenous CRSWD: shift work disorder and jet lag disorder. Prolonged-release formulation of melatonin in a 2 mg dose is registered for the treatment of insomnia patients aged 55 years and older.

Conclusions. Treatment of CRSWD is based primarily on chronotherapeutic interventions. They include phototherapy, light avoidance, melatonin treatment and behavioural interventions that influence, among other things, the rhythm of meals, physical and social activity.

Address for correspondence:
Adam Wichniak
III Klinika Psychiatryczna, Instytut Psychiatrii i Neurologii
ul. Sobieskiego 9, 02-956 Warszawa, Poland
tel. +48 22 45 82 556
fax: +48 22 842 40 87
email: wichniak@ipin.edu.pl