Low-dose exogenous melatonin plus evening dim light and time in bed scheduling advances circadian phase irrespective of measured or estimated dim light melatonin onset time: preliminary findings

Mar 6, 2024Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

Low-dose melatonin with evening dim light and bedtime scheduling shifts the body clock regardless of melatonin timing

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Abstract

In a trial with 40 adults, low-dose melatonin treatment combined with behavioral interventions may improve several sleep parameters.

Scheduled low-dose melatonin treatment was administered either 3 hours before the measured dim light melatonin onset (DLMO) or 5 hours before the estimated sleep-onset time.
Significant improvements were observed in various circadian and sleep parameters, excluding total sleep time and sleep quality as measured by specific indices.
No differences were found in outcomes based on whether melatonin administration was timed according to measured or estimated DLMO.
The findings suggest that both administration strategies could be effective in managing delayed sleep-wake phase disorder.
Further research with a larger sample size is necessary to validate these preliminary results.

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STUDY OBJECTIVES: The purpose of the present study was to preliminarily evaluate whether knowing the dim light melatonin onset (DLMO) time is advantageous when treating delayed sleep-wake phase disorder with low-dose melatonin treatment plus behavioral interventions (ie, evening dim light and time in bed scheduling).

METHODS: In this randomized, controlled, double-blind trial, 40 adults with delayed sleep-wake phase disorder were randomly assigned to 4 weeks of 0.5 mg timed to be administered either 3 hours before the DLMO (measured DLMO group, n = 20) or 5 hours before sleep-onset time per actigraphy (estimated DLMO group, n = 20), in conjunction with behavioral interventions. The primary outcome was change in the DLMO (measured in-home). Secondary outcomes included sleep parameters per diary and actigraphy (sleep-onset and -offset times and total sleep time), Morningness-Eveningness Questionnaire, Multidimensional Fatigue Inventory, PROMIS-Sleep Disturbance, PROMIS-Sleep Related Impairment, and Pittsburgh Sleep Quality Index. Mixed-effects models tested for group differences in these outcome.

RESULTS: After applying the Bonferroni correction for multiple comparisons (significantvalue set at < .004), there were significant main effects for visit on all outcomes except for the Pittsburgh Sleep Quality Index and total sleep time per wrist actigraphy and diary. There were no group-by-visit interactions for any of the outcomes (> .004). P P

CONCLUSIONS: Scheduled low-dose melatonin plus behavioral interventions may improve many circadian and sleep parameters regardless of whether melatonin administration is scheduled based on estimated or measured DLMO. A larger-scale trial is needed to confirm these preliminary findings.

CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: The Clinical Utility of Measuring the Circadian Clock in Treatment of Delayed Sleep-Wake Phase Disorder; URL: https://clinicaltrials.gov/study/NCT03715465; Identifier: NCT03715465.

CITATION: Swanson LM, de Sibour T, DuBuc K, et al. Low-dose exogenous melatonin plus evening dim light and time in bed scheduling advances circadian phase irrespective of measured or estimated dim light melatonin onset time: preliminary findings.. 2024;20(7):1131-1140. J Clin Sleep Med

Low-dose exogenous melatonin plus evening dim light and time in bed scheduling advances circadian phase irrespective of measured or estimated dim light melatonin onset time: preliminary findings

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