Sleep
Melatonin and Aging
Melatonin helps sleep modestly, and whether it declines with healthy aging is disputed. US sleep experts advise against it for chronic insomnia.
Your body already makes melatonin every night, on schedule, free of charge. Stores sell it anyway, often with a neat story attached for older adults: you make less as you age, so topping it up should bring your sleep back. Humanic Blue examines each link in that story about melatonin and aging; they carry different weights of evidence.
Where it stands, link by link. Whether melatonin really drops with healthy aging is disputed; a careful Harvard study of healthy older adults found no drop. As a sleep aid, melatonin helps by minutes, not hours. The American Academy of Sleep Medicine suggests doctors not use it for chronic insomnia, while Europe approves one prescription form for short-term use from age 55. And no human study shows melatonin slows aging or helps anyone live longer.
In This Article
- A careful study found no melatonin drop in healthy older adults
- As a sleep aid, melatonin adds minutes, not hours
- Europe’s one age-specific approval, from 55
- Where melatonin has a clearer job: the body clock
- What’s actually in the bottle
- The heart-failure question
- The studies and numbers behind all of this
Key Takeaways
- Melatonin shortens the time it takes to fall asleep and lengthens sleep by minutes, not hours. This finding comes from a review combining trial results.
- Whether melatonin declines as part of healthy aging is disputed.
- The American Academy of Sleep Medicine (AASM) suggests against melatonin for chronic insomnia, and against it for older adults with dementia who have irregular sleep-wake rhythms. Both recommendations reflect limited certainty.
- Supplement doses often don’t match the label.
- A 2025 heart-failure signal comes from a conference abstract that hasn’t been peer reviewed; a 2026 survey analysis found no statistically clear link.
- Melatonin hasn’t been shown to extend human lifespan.
Does your melatonin really fall with age?
The whole replacement idea rests on this step. Earlier studies had reported that melatonin declines with age, and the Harvard team behind a 1999 study in the American Journal of Medicine noted that those reports had prompted suggestions to treat sleep problems in older patients with melatonin replacement therapy. Jamie Zeitzer was first author and Charles Czeisler senior author, at Brigham and Women’s Hospital and Harvard Medical School.
They measured melatonin around the clock, under tightly controlled lab conditions, in healthy, drug-free adults aged 65 to 81 and a younger comparison group of healthy men. The older and younger groups had almost exactly the same average levels, and the same size and length of nighttime peak. See the numbers
The authors concluded that their results did not support the idea that lower blood melatonin is a general feature of healthy aging. The study was small, and it chose healthy people on purpose, so it can’t speak for older adults who are ill or take medications. The paper drew a published letter in response the following year. The Harvard team’s advice: measure a patient’s own melatonin before treating an older person on the assumption that it’s low.
Why sleep changes with age is covered in Why Sleep Gets Worse With Age.
How much does a melatonin pill change sleep?
Eduardo Ferracioli-Oda of the University of São Paulo Medical School and colleagues, with Yale’s Michael Bloch as senior author, combined trials comparing melatonin with a placebo in adults and children with primary sleep disorders—sleep problems considered the main condition being treated—in a 2013 review. Melatonin helped people fall asleep about 7 minutes faster and sleep about 8 minutes longer. Sleep quality improved modestly. Part of the funding came from Eli Lilly-supported research awards. (Note 1)
The authors called the effects “modest but do not appear to dissipate with continued melatonin use.” They added that melatonin’s benefit is smaller than that of other insomnia medicines, though it “may have a role” because of its “relatively benign side-effect profile.”
The American Academy of Sleep Medicine (AASM) weighed the same kind of evidence in its 2017 guideline on insomnia medications. It suggests that clinicians not use melatonin to treat trouble falling asleep or staying asleep in adults. That’s a weak recommendation, and the AASM notes that a weak rating shouldn’t be read as a sign that a treatment doesn’t work.
A newer guideline lands in the same place. The 2025 insomnia guideline from the U.S. Departments of Veterans Affairs and Defense (VA/DoD) lists melatonin, with chamomile, passionflower, saffron and valerian, under “For treatment of chronic insomnia disorder, we suggest against the use of,” also a weak recommendation.
What the AASM does strongly recommend for chronic insomnia, in a 2021 guideline, is cognitive behavioral therapy for insomnia (CBT-I), a structured, talk-and-habits treatment. More on that in Improve Sleep After 50.
The one age-specific approval
Europe has approved one melatonin product with age written into the label. The European Medicines Agency authorized Circadin, a prescription tablet that releases melatonin gradually, in 2007 for “short-term treatment of primary insomnia characterised by poor quality of sleep in patients who are aged 55 or over.” It’s taken one to two hours before bedtime, for up to 13 weeks.
Even the regulator was measured about it. The EMA’s expert committee said Circadin “has only been shown to have a small effect in a relatively small number of patients,” but judged that its benefits outweighed its risks. How the approval trials worked
Here, primary insomnia means insomnia considered the main condition, rather than a sleep symptom attributed to another illness. That approval is narrow: prescription-only, time-limited and for one type of insomnia. It isn’t the same thing as the over-the-counter supplements sold in the US.
Where melatonin has a clearer role
Melatonin works as a timing signal for the body clock, and the evidence is stronger for clock problems than for general insomnia. According to the NIH’s National Center for Complementary and Integrative Health (NCCIH), melatonin supplements “appear to help with sleep” in people with delayed sleep-wake phase disorder, in which sleep drifts late into the night, “but it’s uncertain whether the benefits outweigh the possible harms.”
The AASM’s 2015 guideline on circadian rhythm disorders endorsed timed melatonin for that disorder, as a weak recommendation.
The same guideline advised against melatonin, and more firmly against sleeping pills, for older adults with dementia who have irregular sleep-wake rhythms. For that group it endorsed light therapy instead. The guidelines in detail
How does shifting sleep timing differ from treating chronic insomnia?
Does the bottle match the melatonin label?
In the US, melatonin isn’t an approved drug. It’s sold over the counter as a dietary supplement, and product testing on both sides of the border has found gaps between label and contents.
In Canada, University of Guelph researchers tested 31 products from 16 brands bought in local stores and pharmacies, in a 2017 study. Melatonin content ranged from 83% below to 478% above the label, and more than 71% of products weren’t within 10% of their label claim. Eight contained serotonin, a related brain chemical that’s tightly controlled as a drug. (Note 2)
In the US, a 2023 JAMA study led by Pieter Cohen of Cambridge Health Alliance found that 22 of 25 melatonin gummy products were inaccurately labeled. Among those that contained melatonin, the amount ranged from 74% to 347% of the stated dose; one had no detectable melatonin at all. (Note 3)
Use has grown in the meantime. A JAMA research letter drawing on adults in the national NHANES health survey found melatonin use among US adults rose from 0.4% in 1999–2000 to 2.1% in 2017–2018. Among adults 65 and older, it rose from 0.6% to 2.1%. The authors, including Mayo Clinic cardiovascular researchers, called for “robust evidence of long-term safety.” (Note 4)
The heart-failure signal
That long-term safety question got louder in November 2025. A study presented at the American Heart Association’s Scientific Sessions reported that adults with insomnia whose health records showed a year or more of melatonin use were diagnosed with heart failure more often over five years than matched non-users: 4.6% versus 2.7%. The analysis used the TriNetX health-records network. Lead author Ekenedilichukwu Nnadi, chief resident in internal medicine at SUNY Downstate, said: “If our study is confirmed, this could affect how doctors counsel patients about sleep aids.” (Note 5)
It was a conference abstract, not a peer-reviewed paper, and it couldn’t show cause and effect. As of September 26, 2026, we found no peer-reviewed version in PubMed. The researchers lacked data on insomnia severity and psychiatric conditions. Carlos Egea, president of the Spanish Federation of Sleep Medicine Societies, pointed out in comments shared by the Science Media Centre that because melatonin doesn’t need a prescription in the US, “the control group (without melatonin) included many patients who take melatonin without a prescription.”
Marie-Pierre St-Onge, a Columbia University sleep researcher who chaired the American Heart Association’s 2025 statement on sleep health and wasn’t involved in the study, told the AHA that people “should be aware that it should not be taken chronically without a proper indication.”
On the other side, a 2026 analysis in Open Heart by Vanderbilt University Medical Center researchers, using the same national NHANES survey, found that recent melatonin use “was not significantly associated with prevalent composite cardiovascular disease or heart failure.” They concluded that the observational data “do not establish definitive cardiovascular harm or safety.” This survey compared recent melatonin use with illness people already had. It did not follow people taking melatonin for years, so it cannot settle the long-term question raised by the conference report. (Note 6) Both studies in detail
What would establish whether the reported heart-failure association reflects melatonin or other differences between users?
What’s Interesting
Melatonin may be the rare supplement whose sales pitch was checked, and questioned, before most people ever bought a bottle. The “you run low with age” idea was tested in 1999 in carefully screened older adults, who turned out to make about as much as young men. The idea kept selling anyway.
Meanwhile, the question that matters most for someone taking it nightly for years, long-term safety, is among the least studied. The pill is everywhere; the long-term trials aren’t.
What This Means in Practice
If the goal is living longer and better, the sleep experts cited here point toward finding out what’s disrupting sleep after 60, rather than simply supplementing.
- Look for the cause first. Sleep apnea, pain, medications, alcohol and depression can all disrupt sleep. See Sleep Apnea and Longevity.
- Ask about CBT-I for chronic insomnia. The AASM strongly recommends it.
- Contents and suitability are different questions. Third-party verification concerns what is in a product; it does not establish whether melatonin is appropriate or effective for an individual.
- Discuss long-term use with a clinician, especially if you have heart disease or take several medications.
- For older adults with dementia and irregular sleep-wake rhythm disorder, the AASM weakly recommends against melatonin. Its 2015 guideline also gives a weak recommendation for light therapy in this specific group. These are disorder-specific recommendations with limited certainty, rather than instructions for every sleep problem in dementia.
These findings come from averages across many people, so how melatonin works for one person can differ. A primary care clinician can review medications and screen for apnea. A sleep specialist can diagnose insomnia and body-clock disorders and provide CBT-I or refer you.
Bottom Line
The “replace what aging takes away” story rests on an assumption that a careful 1999 study didn’t confirm in healthy older adults. As a sleep aid melatonin adds minutes, and the AASM advises against it for chronic insomnia, although Europe approves a prescription prolonged-release form for short-term use from age 55. Its role is clearer for body-clock disorders. Supplement labels are often inaccurate, and long-term heart safety is unresolved. No study shows melatonin extends lifespan. A useful next step is finding out, with a clinician’s help, what’s disrupting your sleep.
A NOTE FROM LONGEVITY365
We read research, consult expert perspectives and work to make complicated health information easier to understand. What you’re reading here reflects how we’ve interpreted and organized that information. It is educational content—not personal medical advice, diagnosis or treatment guidance.
We’re not perfect, and neither is the available research. Evidence changes, new studies emerge and what’s appropriate for one person may not be appropriate for another.
Use this article as a starting point for your own research and conversations with qualified professionals. Always talk with your doctor or another trusted healthcare professional before making decisions that could affect your health, particularly if you take medications, are receiving treatment, have existing health conditions, are pregnant or have other circumstances that could affect what’s appropriate for you.
Reader Questions
A few questions to carry into the comments or your next conversation. Please leave out identifying or personal medical details.
- 01Which difference would you like explained further: changing sleep timing, treating insomnia, or testing long-term safety?
- 02Which distinction in the article would be most useful to carry into everyday life?
- 03What would you want Humanic Blue to unpack next from this topic?
Extra Insights & Sources
For readers who want the details behind each claim above.
Reading the numbers. Picomoles per liter (pmol/L) is a unit of melatonin concentration in blood. A 95% confidence interval (CI) describes uncertainty around an estimate. A hazard ratio (HR) compares how quickly an outcome occurs over time; an odds ratio (OR) compares the odds of having an outcome rather than not having it. For either ratio, 1 means no difference between the groups; below 1 means lower rates or odds and above 1 means higher rates or odds. A standardized mean difference expresses a score difference relative to how much scores vary; it is not a number of minutes of sleep. These group comparisons cannot predict an individual outcome.
What We Know
- Melatonin modestly shortens time to sleep and lengthens sleep. Supported.
- The AASM suggests against it for chronic insomnia and for older adults with dementia and irregular sleep-wake rhythms. Established (guideline positions, weak recommendations).
- It has a clearer role in body-clock disorders, such as delayed sleep phase. Supported.
- Supplement contents often differ from labels. Supported.
What We Don’t Know
- Whether melatonin declines as part of healthy aging. Contested. Earlier reports found declines; the 1999 Harvard study of healthy older adults did not.
- Whether long-term melatonin use affects heart health. Unknown. Observational findings conflict.
- Whether melatonin slows aging or extends human lifespan. Unknown. No human study has tested it.
- The right dose for older adults. Unknown; US supplement doses vary widely and often exceed labels.
Melatonin levels and age: the 1999 study
Zeitzer and colleagues compared 34 healthy, drug-free older adults (20 women and 14 men, aged 65 to 81) with 98 healthy, drug-free young men (aged 18 to 30), using a tightly controlled constant-routine lab protocol. The 24-hour average melatonin concentration was 70 pmol/L in the older group and 73 pmol/L in the young men (P = 0.97). The nighttime peak lasted 9.3 versus 9.1 hours (P = 0.43), and its mean was 162 versus 161 pmol/L (P = 0.63). The paper opens by noting that many reports of an age-related decline in melatonin, a hormone thought to promote sleep, had led to suggestions of melatonin replacement therapy for older patients’ sleep problems. The authors recommended measuring a patient’s own melatonin before using such treatment in older patients. A letter in response, from Germaine Cornélissen, Franz Halberg and colleagues, was published in the same journal in September 2000.
The 2013 meta-analysis
Ferracioli-Oda, Qawasmi and Bloch included 19 randomized, placebo-controlled trials with 1,683 participants. Melatonin reduced sleep latency by 7.06 minutes (95% CI 4.37 to 9.75) and increased total sleep time by 8.25 minutes (95% CI 1.74 to 14.75). Overall sleep quality improved (standardized mean difference 0.22). Trials that lasted longer and used higher doses showed larger effects on sleep latency and total sleep time. The authors concluded that “the absolute benefit of melatonin compared to placebo is smaller than other pharmacological treatments for insomnia,” while melatonin “may have a role in the treatment of insomnia given its relatively benign side-effect profile compared to these agents.” There weren’t enough trials in children to compare children with adults.
The guidelines in detail
AASM 2017, insomnia medications. The guideline made weak recommendations against melatonin, trazodone, tiagabine, diphenhydramine, tryptophan and valerian for chronic insomnia in adults. It explains that a weak recommendation reflects less certainty that the outcome and the approach are right for all patients. As of September 26, 2026, we found no newer AASM guideline on insomnia medications in PubMed; the AASM’s April 2026 guideline covers combining CBT-I with medication.
AASM 2021, behavioral treatments. The guideline recommends that clinicians use multicomponent cognitive behavioral therapy for insomnia to treat chronic insomnia disorder in adults, as a strong recommendation.
AASM 2015, circadian rhythm disorders. The guideline endorsed strategically timed melatonin, at a second-tier (weak) degree of confidence, for delayed sleep-wake phase disorder, blind adults with non-24-hour rhythm disorder, and children and adolescents with irregular rhythms and neurological disorders. For older adults with dementia and irregular sleep-wake rhythm disorder, it recommended against melatonin at a second-tier (weak) degree of confidence and against separate sleep-promoting medications at a first-tier (strong) degree. It weakly endorsed light therapy for this specific group.
VA/DoD 2025, insomnia. The VA/DoD Clinical Practice Guideline for the Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea (version 3.0) states: “For treatment of chronic insomnia disorder, we suggest against the use of” chamomile, melatonin, passionflower, saffron and valerian (Weak against). For melatonin it reviewed a 2022 systematic review of 16 trials; “In adult patients, there was no statistically significant improvement” in time to fall asleep (2.25 minutes shorter), total sleep time (1.23 minutes longer), sleep efficiency or sleep quality. It adds that, outside its evidence review, “melatonin has been associated with excessive daytime sleepiness, vivid dreams, and nightmares.” Work group members completed conflict-of-interest disclosure forms under VHA policy; the guideline says its recommendations “are not intended to represent VA or DOD policies.”
NCCIH. The NIH center’s “Melatonin: What You Need To Know” page (last updated May 2024) says melatonin supplements “may help with certain conditions, such as jet lag, delayed sleep-wake phase disorder, some sleep disorders in children, and anxiety before and after surgery.” On older people, it says: “Melatonin may stay active in older people longer than in younger people and cause daytime drowsiness.”
How the Circadin approval trials worked
According to the EMA’s public summary, Circadin was compared with placebo in three main studies involving 681 patients aged over 55 with primary insomnia. Looking at all three together, 32% of patients taking Circadin (86 of 265) reported a significant improvement in symptoms after three weeks, compared with 19% on placebo (51 of 272). An additional study showed an effect for at least 13 weeks. The European Commission granted the marketing authorisation on 29 June 2007; the product remained authorised on the EMA’s page as of September 26, 2026.
Label accuracy in detail
Erland and Saxena, 2017. Lot-to-lot variation within a single product reached 465%, and the variability didn’t track manufacturer or product type. Serotonin was found in eight supplements at 1 to 75 micrograms. The authors concluded that manufacturers need tighter controls.
Cohen and colleagues, 2023. The team identified 30 melatonin gummy brands entered into the NIH’s Dietary Supplement Label Database in 2021 and bought them online; 25 could be analyzed. Only 3 of 25 (12%) were within 10% of the declared amount. Five products declared cannabidiol (CBD), with measured amounts 104% to 118% of the label. The authors noted that the sample was small, only one sample of each brand was tested, and only gummies were analyzed.
Li and colleagues, 2022 (use trends). Reported use of more than 5 mg a day rose from 0.08% in 2005–2006 to 0.28% in 2017–2018. Use was self-reported, although interviewers checked supplement containers for 93.9% of users.
The heart studies in detail
Nnadi and colleagues, AHA Scientific Sessions 2025 (abstract). Researchers paired 65,414 long-term melatonin users with 65,414 non-users who had similar recorded characteristics, a method called propensity-score matching. Matching cannot account for differences the records did not capture. Over five years, incident heart failure occurred in 4.6% versus 2.7% (HR 1.89, 95% CI 1.78–2.00). Heart-failure hospitalization occurred in 19.0% versus 6.6% (HR 3.44), and death from any cause in 7.8% versus 4.3% (HR 2.09). Requiring at least two melatonin prescriptions 90 days apart gave a similar result (HR 1.82). Because the database mixes countries where melatonin needs a prescription with countries where it doesn’t, over-the-counter users would have been counted as non-users, the AHA noted. Nnadi also said: “Worse insomnia, depression/anxiety or the use of other sleep-enhancing medicines might be linked to both melatonin use and heart risk.”
Khan and Lima, Open Heart, 2026. In NHANES adults from 1999–2018, melatonin users were far more likely than non-users to report sleep disturbance (57.9% vs 20.5%) and depression (13.3% vs 5.5%). Recent melatonin use wasn’t significantly associated with cardiovascular disease (adjusted OR 0.90, 95% CI 0.58–1.40) or heart failure (OR 0.88, 95% CI 0.43–1.80). This was a cross-sectional analysis: it compared supplement use and existing illness in survey data, rather than following people over time. The authors described it as “hypothesis-generating.”
| Claim | Source | Date | Type | Limitation |
|---|---|---|---|---|
| No decline in healthy aging | Zeitzer et al., Am J Med | 1999 | Physiology study, 132 people | Small; healthy volunteers only |
| About 7 min faster to sleep, 8 min more sleep | Ferracioli-Oda et al., PLoS One | 2013 | Meta-analysis, 19 trials | Mixed ages and disorders |
| Suggest against for insomnia | AASM, JCSM | 2017 | Guideline | Weak recommendation |
| 55+ prolonged-release melatonin | EMA, Circadin | 2007 | Regulatory approval | EU approval; small effect |
| Label inaccuracy | Erland & Saxena; Cohen et al. | 2017; 2023 | Product testing | Canadian products; gummies only |
| Heart-failure signal | Nnadi et al., AHA abstract | 2025 | Observational abstract | Not peer reviewed |
| No statistically clear heart-failure link | Khan & Lima, Open Heart | 2026 | Survey, cross-sectional | Hypothesis-generating |
Sources
- Zeitzer JM, et al. Do plasma melatonin concentrations decline with age? American Journal of Medicine, 1999: PubMed 10569297
- Cornélissen G, et al. Letter, American Journal of Medicine, 2000: PubMed 11203147
- Ferracioli-Oda E, et al. Meta-analysis: melatonin for primary sleep disorders, PLoS One, 2013: PubMed 23691095
- Sateia MJ, et al. AASM guideline, pharmacologic treatment of chronic insomnia, Journal of Clinical Sleep Medicine, 2017: PubMed 27998379
- Edinger JD, et al. AASM guideline, behavioral and psychological treatments for chronic insomnia, Journal of Clinical Sleep Medicine, 2021: PubMed 33164742
- Auger RR, et al. AASM guideline, intrinsic circadian rhythm sleep-wake disorders, Journal of Clinical Sleep Medicine, 2015: PubMed 26414986
- U.S. Departments of Veterans Affairs and Defense: VA/DoD Clinical Practice Guideline for the Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea, 2025
- National Center for Complementary and Integrative Health: Melatonin: What You Need To Know
- European Medicines Agency: Circadin EPAR
- Erland LAE, Saxena PK. Melatonin natural health products and supplements, Journal of Clinical Sleep Medicine, 2017: PubMed 27855744
- Cohen PA, et al. Melatonin and CBD in melatonin gummies, JAMA, 2023: PubMed 37097362
- Li J, et al. Trends in melatonin supplement use among US adults, JAMA, 2022: PubMed 35103775
- American Heart Association newsroom, Nov. 3, 2025: Long-term use of melatonin supplements to support sleep may have negative health effects
- Nnadi E, et al. Abstract 4371606, Circulation, 2025: DOI 10.1161/circ.152.suppl_3.4371606
- Science Media Centre: Expert reaction to conference abstract on long-term melatonin and heart failure
- Khan B, Lima BB. Melatonin and cardiovascular risk, Open Heart, 2026: PubMed 42167796
Notes
Note 1: Funded by National Institute of Mental Health support of the Yale Child Study Center Research Training Program, the National Institutes of Health, the APIRE/Eli Lilly Psychiatric Research Fellowship, the AACAP/Eli Lilly Pilot Research Award, the Trichotillomania Learning Center, NARSAD and the National Center for Research Resources, among others, mostly awarded to senior author Michael Bloch. The authors declared no patents or products.
Note 2: Funded by a grant from Canada’s NSERC research council (grant 46741). The authors declared no financial conflicts of interest.
Note 3: The research letter lists no separate funding statement. Pieter Cohen reported research support from Consumers Union and the Pew Charitable Trusts and royalties from UpToDate; a supplement company, Hi-Tech Pharmaceuticals, had sued him, and the jury found in his favor. Co-author Ikhlas Khan reported grants from the FDA, NIH and USDA and coordinates a botanicals conference supported by supplement-related companies.
Note 4: Funded by the National Natural Science Foundation of China, the National Institutes of Health, grants from Sleep Number Corporation to Mayo Clinic, the Alice Sheets Marriott Professorship and a Mayo Clinic career development award. Co-author Virend Somers reported consulting for Respicardia, Baker Tilly, Bayer and Jazz Pharmaceuticals and serving on the Sleep Number Research Advisory Board.
Note 5: The published abstract does not list funding; it refers readers to the AHA Scientific Sessions website for author disclosures. Figures come from the AHA’s news release and the abstract published in Circulation.
Note 6: The authors declared no specific funding and no competing interests.
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The companion comparison explains the doses and release formats on named melatonin products, including the separate prescription context.
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