One systematic review that included studies examining adults with dementia and comorbid insomnia showed there was no significant difference between melatonin and placebo for change from baseline in carer-rated sleep quality.

While the systematic reviews showed a significant reduction in time to fall asleep for patients in the melatonin group compared with the placebo group, 5, 9 the RCT of 31 participants showed no difference between groups. Two systematic reviews 5, 9 and one RCT 10 assessed self-reported sleep onset latency. 10Īdverse effects/events were assessed in one study. This included subjective fatigue, which was assessed using the Fatigue Severity Scale, 10 anxiety and depression, which were assessed by self-report with the Hospital Anxiety and Depression Scale, 10 and health related quality of life (subscales: physical functioning, role-physical, role-emotional, vitality, mental health, social functioning, bodily pain, and general health) assessed by selfreport with the 36-item Short Form Health Survey (SF-36). 10įunctioning, mood, and quality of life were assessed in one study. 13 Daytime sleepiness in the previous four weeks was assessed in one study using the Epworth Sleepiness Scale. 13 Instrumental activities of daily living were assessed in one study using an unspecified measure. 5 Sleep quality was carer-rated using an unspecified measure. 12 Sleep onset latency was assessed in three studies by sleep diary, 9 Actigraphy 10 and an unspecified method. 10, 12 Quality and depth of nighttime sleep were assed in one review by an unspecified method of self-report. Sleep-efficiency was objectively assessed in two studies using Actigraphy. Specific sleep outcomes were assessed in five studies. Global sleep outcomes were assessed three studies using the Pittsburg Sleep Quality Index (PSQI) 9, 10 and the Athens Insomnia Scale. The objective of this report is to summarize the evidence regarding the clinical effectiveness, cost-effectiveness, and guidelines pertaining to the use of melatonin for the treatment of insomnia in adults.

5 However, the effectiveness of melatonin for the treatment of insomnia in adults is not clear. It appears not to have the potential for development of tolerance, dependence, or hang-over effect it has minimal side-effects at low doses, and has a short half-life. Exogenous melatonin has several apparent benefits. Melatonin has been examined as a potential treatment for various sleep disorders in adults. 5 Drawbacks of many pharmaceutical treatments include hang-over effects and the potential for dependence and tolerance, while drawbacks of psychological treatments include adherence issues. Management of insomnia normally includes complex therapies that often involve conventional drugs and psychological interventions. 4 Symptoms should be present several times a week for a minimum of three months, despite having adequate opportunities for sleep. 4 To be considered as insomnia, the sleep disturbance cannot be the result of another sleep disorder or the physiological effects of a substance. Insomnia disorder involves dissatisfaction with the quality or quantity of sleep, characterized by difficulty falling asleep, staying asleep, or falling back asleep after waking early, which is associated with distress and impairment in daily functioning. The main diagnostic classifications for insomnia disorder are: the International Classification of Sleep Disorders (ICSD), the World Health Organization’s (WHO) International Classification of Diseases (ICD-10) and the American Psychiatric Association’s Diagnostic and Statistical Manual. 2 Insomnia disorder has been described as the most prevalent of the sleep disorders, which include restless legs syndrome, periodic limb movement disorder, sleep apnea, and delayed phase sleep. 1 While not of those who do not get enough sleep have a sleep disorder, 13.4% of Canadian adults meet the criteria for an insomnia disorder.

Between 20 64.8% of Canadian adults aged 18 to 64 reported accumulating the recommended seven to nine hours of sleep per night.

Apparent persistent insomnia definition