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Melatonin in Patients with Reduced REM Sleep Duration: Two Randomized Controlled Trials

Department of Psychiatry and Psychotherapy (D.K., R.M., C.M., A.T.), Charité Campus Mitte-Universitätsmedizin Berlin, 10117 Berlin, Germany; and Medcare Automation (F.B.), Amsterdam, The Netherlands

Address all correspondence and requests for reprints to: Dr. D. Kunz, Psychiatrische Universitatsklinik der Charité im St. Hedwig Krankenhaus, Turmstr. 21, 10559 Berlin, Germany. E-mail: dieter.kunz{at}charite.de.

Recent data suggest that melatonin may influence human physiology, including the sleep-wake cycle, in a time-dependent manner via the body’s internal clock. Rapid-eye-movement (REM) sleep expression is strongly circadian modulated, and the impact of REM sleep on primary brain functions, metabolic processes, and immune system function has become increasingly clear over the past decade. In our study, we evaluated the effects of exogenous melatonin on disturbed REM sleep in humans. Fourteen consecutive outpatients (five women, nine men; mean age, 50 yr) with unselected neuropsychiatric sleep disorders and reduced REM sleep duration (25% or more below age norm according to diagnostic polysomnography) were included in two consecutive, randomized, double-blind, placebo-controlled, parallel design clinical trials. Patients received 3 mg melatonin daily, administered between 2200 and 2300 h for 4 wk. The results of the study show that melatonin was significantly more effective than placebo: patients on melatonin experienced significant increases in REM sleep percentage (baseline/melatonin, 14.7/17.8 vs. baseline/placebo, 14.3/12.0) and improvements in subjective measures of daytime dysfunction as well as clinical global impression score. Melatonin did not shift circadian phase or suppress temperature but did increase REM sleep continuity and promote decline in rectal temperature during sleep. These results were confirmed in patients who received melatonin in the second study (REM sleep percentage baseline/placebo/melatonin, 14.3/12.0/17.9). In patients who received melatonin in the first study and placebo in the second, the above mentioned effects outlasted the period of melatonin administration and diminished only slowly over time (REM sleep percentage baseline/melatonin/placebo, 14.7/17.8/16.2). Our findings show that exogenous melatonin, when administered at the appropriate time, seems to normalize circadian variation in human physiology. It may, therefore, have a strong impact on general health, especially in the elderly and in shift workers.

Abbreviations: aMT6s, 6-Sulfatoxymelatonin; CGI, clinical global impression; CTS, circadian timing system; EEG, electroencephalogram; NREM, non-REM sleep; PSG, polysomnography; PSQI, Pittsburgh sleep quality index; REM, rapid eye movement; SCN, suprachiasmatic nucleus.

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