Melatonin Randomized Trial in Insomnia in the Elderly

Summary

Principal Investigator: Nalaka S Gooneratne
Abstract: Chronic insomnia affects up to 35% of the elderly. It can significantly impair quality of life and daytime functioning. Currently, most medical therapy for insomnia involves sedative-hypnotic agents that may lead to dependence, withdrawal side effects and reduced efficacy after extended periods of use. A growing body of work has suggested that melatonin, a neurohormone produced by the pineal gland and regulated by the suprachiasmatic nucleus, the primary circadian pacemaker, may play a role in mediating insomnia. Ongoing research at the University of Pennsylvania in 180 elderly insomnia patients has found statistically significant evidence of a decreased sleep efficiency in low melatonin insomniacs. Thus, melatonin production is impaired in a subgroup of elderly insomnia patients and this may contribute to their insomnia. However, melatonin treatment trials in elderly insomniacs have been equivocal. These studies have had serious methodologic limitations including inadequate sample size (Type II error), lack of objective measures of sleep or daytime functioning, and no placebo control arm. This has raised many questions such as whether melatonin deficiency is a marker of insomnia or, instead, a contributing factor and whether increased doses are needed to recreate the higher levels seen in the cerebrospinal fluid compartment. In addition, melatonin is widely used as an over-the-counter sleeping aid with litre true insight into its effectiveness/safety, especially in older adults. To address the primary hypothesis that melatonin can treat insomnia in melatonin-deficient elderly, the principal investigator proposes conducting a large randomized, double-blind clinical trial comparing low dose melatonin (0.4 mg), high dose melatonin (4.0 mg) and placebo in a well-defined group of elderly insomniacs with low melatonin levels (189 total subjects). The specific aims are to 1) evaluate the effectiveness of melatonin and 2) assess the daytime consequences and safety of melatonin treatment in this population. Intention-to-treat analysis will compare low dose melatonin, high dose melatonin, and placebo on objective and subjective parameters of sleep and daytime function. This protocol will extend well beyond the research done to date by rigorously testing the role of targeted melatonin replacement therapy as an effective treatment for insomnia in the elderly and by evaluating the safety profile of melatonin with a particular focus on daytime functioning.
Funding Period: 2003-09-22 - 2008-05-31
more information: NIH RePORT

Top Publications

  1. pmc Case-control study of subjective and objective differences in sleep patterns in older adults with insomnia symptoms
    Nalaka S Gooneratne
    Division of Geriatric Medicine and Center for Sleep and Respiratory Neurobiology, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA
    J Sleep Res 20:434-44. 2011
  2. pmc Melatonin pharmacokinetics following two different oral surge-sustained release doses in older adults
    Nalaka S Gooneratne
    Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
    J Pineal Res 52:437-45. 2012
  3. ncbi Consequences of comorbid insomnia symptoms and sleep-related breathing disorder in elderly subjects
    Nalaka S Gooneratne
    Division of Geriatric Medicine, Center for Sleep and Respiratory Neurobiology, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
    Arch Intern Med 166:1732-8. 2006
  4. pmc Complementary and alternative medicine for sleep disturbances in older adults
    Nalaka S Gooneratne
    Division of Geriatric Medicine, Center for Sleep and Respiratory Neurobiology, University of Pennsylvania School of Medicine, 3615 Chestnut Street, Philadelphia, PA 19104, USA
    Clin Geriatr Med 24:121-38, viii. 2008

Scientific Experts

Detail Information

Publications4

  1. pmc Case-control study of subjective and objective differences in sleep patterns in older adults with insomnia symptoms
    Nalaka S Gooneratne
    Division of Geriatric Medicine and Center for Sleep and Respiratory Neurobiology, Department of Medicine, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA
    J Sleep Res 20:434-44. 2011
    ....
  2. pmc Melatonin pharmacokinetics following two different oral surge-sustained release doses in older adults
    Nalaka S Gooneratne
    Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
    J Pineal Res 52:437-45. 2012
    ....
  3. ncbi Consequences of comorbid insomnia symptoms and sleep-related breathing disorder in elderly subjects
    Nalaka S Gooneratne
    Division of Geriatric Medicine, Center for Sleep and Respiratory Neurobiology, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
    Arch Intern Med 166:1732-8. 2006
    ..The prevalence of sleep-related breathing disorder (SRBD) and insomnia symptoms increases considerably with advancing age, but little is known about their cooccurrence and their effects on daytime functioning when present together...
  4. pmc Complementary and alternative medicine for sleep disturbances in older adults
    Nalaka S Gooneratne
    Division of Geriatric Medicine, Center for Sleep and Respiratory Neurobiology, University of Pennsylvania School of Medicine, 3615 Chestnut Street, Philadelphia, PA 19104, USA
    Clin Geriatr Med 24:121-38, viii. 2008
    ..Future work examining CAM has the potential to significantly add to our treatment options for sleep disorders in older adults...