Don't count on melatonin to cure long-term insomnia; it helps people fall asleep only about 7 minutes sooner on average; start with cognitive behavioral therapy for insomnia

Cost

Free, and you save the money spent buying melatonin long term. The hard part is that it is easy to buy, and taking a pill is much less trouble than going to a hospital for several weeks of treatment.

What you get

First, how big the effect is. A 2013 meta-analysis pooled 19 trials with 1683 people. Every trial was randomized and compared with placebo. In all the participants the sleep disorder was not caused by another illness, and 14 of the trials studied insomnia. People who took melatonin fell asleep an average of 7.06 minutes sooner (95% CI 4.37–9.75, the plausible range). Total sleep time was 8.25 minutes longer (1.74–14.75). The improvement in sleep quality was also very small (SMD 0.22, 0.12–0.32). The authors themselves state that this shortens the time to fall asleep less than other sleeping pills do. Now the guideline. The American Academy of Sleep Medicine issued a drug-treatment guideline for chronic insomnia in 2017. It advises doctors not to use melatonin for trouble falling asleep or staying asleep, with a recommendation strength of “weak.” The basis was 3 trials, all using 2 mg of extended-release melatonin, with all participants aged 55 and over. The quality of evidence was rated “very low.” Only sleep quality could be pooled (SMD 0.21, −0.36 to 0.77), which did not reach clinical significance. For health foods containing melatonin in China, the stated health function is “helps improve sleep.” The notes say “this product cannot replace medicine,” and the groups it is not suited to are children and teenagers, pregnant women and nursing mothers. The Beijing Municipal Administration for Market Regulation's 2026 public-education piece also says it is “by no means a ‘miracle drug.’” Jet lag is a separate matter. A Cochrane systematic review included 10 trials, and 9 of them had the same finding: after flying across 5 or more time zones, taking melatonin at local bedtime eases jet lag. Doses of 0.5 to 5 mg a day worked about equally. It looks like a good deal because it is a hormone the body makes itself, sounds mild, and needs no prescription

Notes

Dispute: the authors of that meta-analysis think melatonin has relatively few side effects and its effect does not weaken the longer it is taken, so it may have a place in insomnia treatment. The Beijing Municipal Administration for Market Regulation's piece says it suits easing trouble falling asleep in middle-aged and older people caused by insufficient melatonin secretion. But the participants in the American Academy of Sleep Medicine's 3 trials were all aged 55 and over, and the conclusion was still that the effect is not enough. There is a benefit, but it is too small to call a cure. For long-term insomnia, start with cognitive behavioral therapy; see §3.26 (cognitive behavioral therapy for insomnia). If you snore, stop breathing in your sleep or are very sleepy during the day, first check for sleep apnea; see §3.27 (sleep study to check for sleep apnea). The label also says that people who drive or operate machinery should not take it before or during work. Melatonin for children was not counted in this item, and the label in China says it is not suitable for children and teenagers. The benefit is rated small on judgment: no official figure was found for how much a year of melatonin costs. The beneficiary is you.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Ferracioli-Oda E, Qawasmi A, Bloch MH (2013). Meta-analysis: melatonin for the treatment of primary sleep disorders. PLoS One, 8(5):e63773. https://doi.org/10.1371/journal.pone.0063773
2. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL (2017). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, 13(2):307-349（Recommendation 12）. https://doi.org/10.5664/jcsm.6470
3. 陕西省市场监督管理局 (2025). 国产保健食品备案凭证-汉瑞宝®褪黑素片（产品说明书）. https://snamr.shaanxi.gov.cn/zfxxgk/zfxxgkzl/zc/tzgg/202505/t20250529_3526097.html
4. 北京市市场监督管理局 (2026). 你知道褪黑素有新吃法了吗？. https://scjgj.beijing.gov.cn/zwxx/scjgdt/202602/t20260202_4485364.html
5. Herxheimer A, Petrie KJ (2002). Melatonin for the prevention and treatment of jet lag. Cochrane Database of Systematic Reviews, CD001520. https://doi.org/10.1002/14651858.CD001520

Translated from the Chinese original. Original book, section 6, tip 34. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer