By Barry Keate
Barry Keate, has lived with tinnitus over 40 years and has published 150+ research articles on numerous aspects of tinnitus. He is an expert on the condition and a well-known advocate for those with tinnitus.
Melatonin is a common dietary supplement used by people who have difficulty sleeping. There is a substantial body of clinical evidence that melatonin use is associated with improvement in sleep and a reduction of tinnitus, especially in those who have difficulty sleeping.
Melatonin is a hormone made by the pineal gland inside the human brain. It is a serotonin derivative that affects the modulation of the circadian rhythm, or sleep-wake cycle. It has long been known that melatonin can help in recovery from jet lag and aid those who work rotating or night shifts, by helping them get to sleep easier.
Production of melatonin by the pineal gland is inhibited by light and supported by darkness and is often referred to as “the hormone of darkness.” Secretion of melatonin peaks in the middle of the night and gradually falls in the hours before dawn.
In the modern world, our eyes are flooded with light long after dark, contrary to our cave-dwelling ancestor’s experience. Recent studies have shown that blue light impedes melatonin production more than light with more red wavelengths.1 Blue light is becoming much more predominant with the use of energy-efficient light bulbs and LED monitors.
Human melatonin production decreases as a person ages.2 For some reason, melatonin levels are reduced in teenagers as compared to younger and older age groups, leading to later sleeping and waking times.3
There are many wonderful health benefits obtained with the use of melatonin, including reducing ototoxicity from prescription medications. I will discuss these first as background then discuss the topic of tinnitus, melatonin and sleep.
General Health Benefits of Melatonin
In 2007 the World Health Organization declared shift work a probable carcinogen. Melatonin is an anti-oxidant and suppressant of tumor development. When someone works at night, in artificial light, and sleeps during the day, they generally have lower melatonin and may be more likely to develop cancer.4
A systematic review of clinical trials involving a total of 643 cancer patients using melatonin found a reduced incidence of death.5
Melatonin levels at night are reduced 50% by exposure to a low-level incandescent bulb for only 39 minutes. It has been suspected that women with the brightest bedrooms have an increased risk for breast cancer.6
Melatonin has been found to be helpful in Alzheimer’s disease. It prevents neuronal death caused by exposure to amyloid beta protein, a neurotoxic substance that accumulates in the brains of patients with the disorder.7
Several clinical studies show that supplementation with melatonin is an effective preventive treatment for migraines and cluster headaches.8,9
Melatonin is involved in energy metabolism and body weight control in animals. Many studies show that melatonin supplementation in drinking water reduces body weight and abdominal fat in experimental animals, especially in middle aged rats. The weight loss effect of melatonin does not require the animals to eat less or to be more physically active.10
Other areas where melatonin shows promise include Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disord (ADHD), fertility, mood disorders and Seasonal Affective Disorder (SAD), Amyotropic lateral sclerosis (ALS or Lou Gehrig’s disease), protection from radiation, and Irritable Bowel Syndrome (IBS).
Ototoxicity
There was an important study conducted using melatonin to mediate ototoxicity in the cochlea.11 It was used to prevent damage caused by aminoglycoside antibiotics and the chemotherapy drug cisplatin. Both of these medications are known causes of ototoxicity and tinnitus.
Melatonin was compared to a mixture of antioxidants that included tocopherol, ascorbate, glutathione and N-acetyl cysteine. Melatonin, which is also an antioxidant, was estimated to be up to 150 times more effective than the other antioxidants in limiting cochlear damage from the antibiotics and chemotherapy medications.
Sleep and Tinnitus
A study conducted by Jay Piccarillo and associates at Washington University in St. Louis, MO determined melatonin use is associated with improvement in tinnitus and sleep.12
24 patients with tinnitus were given 3 mg of melatonin per day for 4 weeks followed by 4 weeks of observation. Tinnitus and sleep were evaluated through use of the Tinnitus Handicap Inventory (THI) and the Pittsburgh Sleep Quality Index (PSQI). The THI score decreased significantly during weeks 0 to 4 and during weeks 0 to 8. The PSQI score also decreased during this time.
The authors concluded, “Melatonin use is associated with improvement of tinnitus and sleep. . . The impact of melatonin on sleep was greatest among patients with the worst sleep quality, but its impact on tinnitus was not associated with the severity of the tinnitus.”
Another study on melatonin and sleep was conducted at the Ear Research Foundation in Sarasota, FL.13 Patients were given 3 mg of melatonin daily for 30 days, followed or preceded by a placebo for 30 days, with a 7-day washout period between medications.
The authors concluded here, “Melatonin has been shown to be useful in the treatment of subjective tinnitus. Patients with high THI scores and/or difficulty sleeping are the most likely to benefit from treatment with melatonin. In light of its minimal side effects, melatonin should be a part of the physician’s tool kit in the treatment of tinnitus.
The last study is also my favorite. Conducted in Italy, it studied the effects of melatonin on tinnitus compared with melatonin and sulodexide.14 Sulodexide is an enhancer of blood flow and helps improve blood flow in the inner ear microcirculation. In this way, it is similar to Gingko biloba, used in Arches Tinnitus Formula.
Researchers studied 102 patients; 34 were treated with melatonin, 34 with melatonin and sulodexide and 34 were treated with placebo. Both actively treated groups improved, however better results were found in the group who received melatonin and sulodexide than in the group that was treated with melatonin alone.
References
1 – Tan DX, Manchester LC, Fuentes-Broto L, Paredes SD, Reiter RJ (March 2011). Significance and application of melatonin in the regulation of brown adipose tissue metabolism: relation to human obesity. Obesity Reviews 12 (3): 167-88.
2 – Reiter RJ, Tan DX, Korkmaz A, Fuentes-Broto L. Drug mediated ototoxicity and tinnitus: alleviation with melatonin. J Physiol Pharmacol. 2011 Apr;62(2):151-7.
3 – Megwalu UC, Finnell JE, Picirillo JF. The effects of melatonin on tinnitus and sleep. Otolaryngol Head Neck Surg. 2006 Feb;134(2):210-3.
4 – Rosenberg S, Silverstein H, Rowan T, Olds M. Effect of melatonin on tinnitus. Laryngoscope. Volume 108 Issue 3, Pages 305-310.
5 – Neri G. De Stefano A, Baffa C, et al. Treatment of central and sensorineural tinnitus with orally administered Melatonin and Sulodexide: personal experience from a randomized controlled study. Acta Otorhinolaryngologica Italica 2009; 29: 86-91.