Melatonin

Melatonin - considered by some to be a 'herbal myth' and others as a useful adjunct to help sleep in ICU patient and adults >55 years old. There is biological plausibility that melatonin could be a useful adjunct to aid restful and efficient sleep in those who could be deplete in melatonin. 

Overall - a meta-analysis here in 2013 showed that there was some evidence to say that it could work in some cohorts. Given its relatively safe profile, it could be useful to trial in patients with a sleep disorder. Particularly it could be of use in ICU, but, the evidence is currently out - awaiting a larger RCT. It's a cheap drug and even cheaper in the USA where it is available OTC. In patients who are restless or unable to sleep in a busy ICU, perhaps it has a role in being a first drug of choice before considering more 'heavy' sedative alternatives given it is a non-narcotic. 

The studies mentioned below are indeed rather small and a few are single-centre analyses, so we cannot say for certain whether there is true efficacy, but many practitioners would agree, it's certainly worth a go providing there are no obvious contraindications in your local formulary (primarily, not to use in patients with autoimmune conditions) and the person does not require heavy sedation for other reasons.

Outside ICU, the drug is quite popular with GP's and could even be used more frequently as a first line alternative to Z-drugs or benzodiazepines in a hospital cohort. Sleep deprivation, it will come as no surprise, is rife in hospitals - I think we can all agree, that any adjunct to promote restful sleep without being profoundly 'sedating' could be a useful drug. I look forward to seeing more definitive studies in the future.

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