Can we 'Melatonin' our sleep troubles away?

Kaishary Islam is now in her mid-20s and works in the IT industry. She remembers having trouble falling asleep. But it was Covid-19 which made a lasting – and detrimental –  impact on her sleep cycle. 

"My friend in Canada told me about melatonin in 2021," she said. The friend's suggestion came as a response to Kaishary's sleep troubles. It took a few months to fully incorporate melatonin into her daily routine.

She currently buys Square Pharmeceutical's FilFresh. 

Melatonin is a hormone produced by the pineal gland in the brain. It plays a critical role in regulating sleep-wake cycles. It is also available as an over-the-counter (OTC) dietary supplement at pharmacies around the world and also in Bangladesh. 

Although international studies and news reports on melatonin can be traced back to the 1990s, momentum, or popularity induced by its use, has been around for at least a decade.  

In fact, last year, there was massive media coverage of melatonin use in the Global North – including but not limited to its long-term effects (unknown for the most part, thus experts say to tread with caution) and use of these OTC by children and teenagers (particularly in the United States). 

So, is it prevalent in Bangladesh? Some of the biggest pharmaceutical companies (such as Square, Eskayef and Beximco) produce melatonin. However, their sales figures, at least for now, don't paint an excessively worrying picture. Of course, a range of other melatonin medicines are also available in the market here. 

Nonetheless, there is a growing consumer base, especially among the urban middle to upper-middle class, at least judging by anecdotal evidence. Which begs the question: How much do we really know about this supplement? And, perhaps, more importantly, why are people seeking it? 

We try to gauge melatonin's market presence and all these questions. 

Life with melatonin

Maqsud Kamal (not his real name) depends on melatonin for his sleep health. He is in his early 60s now and retired, but for more than three decades, he served in a very anxiety-inducing job in law enforcement.  

"From the very start [on the job], anxiety was high," said Maqsud, "[however] with age, sleep goes down." He was not new to sleep troubles and disruptions but over time, it became a problem, "for those who have to stay on the job [alert] for 24-7, sleep cycles tend to be disrupted by hypertension. Something that persists even after retirement."  

Maqsud recalls starting to use prescribed melatonin (Square's FilFresh) for about three years now. Earlier, he had imported melatonin. 

Melatonin is essentially a hormone which regulates our sleep cycle. It is the hormone produced by the brain when it gets dark (nighttime), particularly when the lights go out in the room — signalling the brain to go to sleep. It is generally prescribed by doctors to address insomnia, jet lag and even those who work odd shift hours, according to experts.  

Maqsud said he continues to lead a moderately active life – walks daily, plays badminton in winter – and melatonin helps with a 7-8 hour healthy sleep cycle daily. "Sleep is vital, without it, one has to deal with many consequences," he said. 

One observation he made was that life with melatonin generally means fewer dreams. "When I sleep, I dream less as opposed to if and when I do not take melatonin at night," he said. 

However, interestingly, when asked if there has been any striking difference with the use of melatonin, Kaishary mentioned the opposite: more vivid dreams.

But "No effect on dreams," said my colleague SM Abrar Aowsaf in his early 30s, who first used melatonin in 2017. It started from Googling solutions for sleeping problems, he said, "but it was hard to get hands on locally-made melatonin then." He managed to purchase imported melatonin, which was very expensive.  

In 2020, he was officially prescribed it, but at some point stopped its use because the doctor said, "Why take more medication into your body to fix something you have broken?" — and so, Abrar cut back on nicotine and caffeine to restore sleep health. 

Shortly after, "things got hectic again" and he fell back on his old habits. With it, Filfresh melatonin made a comeback. 

Squares's Filfresh was launched in 2009. But it was discontinued in 2018 because sales did so poorly, according to Square's Director of Sales and Marketing Atiquzzaman. In fact, the company relaunched it at the end of 2019 because doctors requested for it. 

However, "sales are insignificant," he said, "it's less than Tk1 crore annually." 

Although we did not get the sales figure, Beximco's representative (requesting anonymity) said their melatonin product, launched in July 2023, is not doing well at all. 

Meanwhile, Eskayef's Director of Marketing Dr Mizanur Rahman said, "There is potential for growth [for their product] and we have produced a product that does not need water. It dissolves once placed in the mouth, which is particularly good for elderly people."

In search of melatonin use, prevalence and effects in Dhaka – one thing became clear. This 'dietary supplement', even globally perhaps, has a niche consumer base. Not many people can afford the time and resources to effectively address sleep troubles. 

But where does sleep go?

Apart from age, what else causes sleep troubles? There is anxiety or a lingering effect from the pandemic, or habitual triggers (like nicotine and caffeine), which forces the body to stay awake and may cause long-term sleep disruptions. 

"Yes, you can say there is more awareness about sleep health now," said Dr Sarder A Baki (JPF Hospital), Family Medicine Specialist (Laparoscopic Surgery & Sleep Medicine), "and the common problems we treat are insomnia, sleep apnea [likely related to weight], snoring, etc."

"There is also anxiety, chronic disease or pain," he said, which can keep you up at night. 

When asked about use of melatonin, "it's safe," he replied. 

To be clear, melatonin is not the first in the pharmaceutical market to aid with sleep. There are scores of pharmaceutical drugs or sedatives such as Relaxen, Histacin, Cloron, etc. 

Screen time is one of the big factors, according to Dr Moniruzzaman Ahmed (Internal Medicine Specialist at BRB hospital), for our sleeplessness. This claim is backed by multiple studies. 

Dr Ahmed – who has a keen interest in sleep medicine – also said it is imperative to address long-term sleeping problems. Sometimes, sleeping disruptions are temporarily caused by an unprecedented life event, which can be solved with sleeping aids. "But for long-term use or dependency on melatonin, underlying causes must be addressed," he added. 

Misconceptions 

Kaishary remembers walking into the pharmacy close to her house [back in 2022] and asking for melatonin. The sellers at the pharmacy began questioning her with suspicion. "They asked why I need a sleeping pill etc. I was taken aback, really," recounted Kaishary, "I explained how this is OTC and a supplement. I have been going to the same pharmacy for FilFresh ever since." 

Kaishary believes there is still a lot of misconception surrounding the use of melatonin. "Elderly people do not understand. They think it is the same as a sleeping pill, which has a negative connotation of course. But it's like vitamins really. And so common abroad," she said. 

Melatonin is, however, not like vitamins. In fact, "A March 2024 report from the US Centers for Disease Control and Prevention discovered some 11,000 children had been seen in emergency rooms between 2019 and 2022 after ingesting melatonin while unsupervised. Melatonin gummies were involved in nearly 5,000 of those cases," according to CNN. 

Melatonin gummies are also available in Bangladesh via online pharmacies. "I remember hearing about it. But no, I have not purchased any. Not sure what effects they may have," said Kaishary.