Can Melatonin Help with Multiple Sclerosis Symptoms?

People who have MS experience symptoms which are specific to melatonin levels in the bloodstream.

Melatonin is a naturally occurring neurotransmitter released by the brain to facilitate sleep. Melatonin release is regulated by circadian rhythms, which are informed by several time cues, the most important one being the availability of light in one's immediate landscape.

As a rule, healthy people have lower levels of melatonin in their bloodstream during the day because melatonin is meant to be released into the body by the brain only as the day ends and the night begins. In the morning, as the sun rises, melatonin levels are also meant to drop off after a night's rest.

The relationship between MS and melatonin

To understand the link between melatonin's potential protective relationship to the brain in people with MS, we need to consider what we already know about MS. Here are two features of MS disease process that seem to be connected to levels of naturally occurring melatonin levels in the brain:

• MS flareups tend to be seasonal, with more frequent attacks in the spring and summer
• MS typically occurs in people who live farthest from the equator, owing to a theory that vitamin D deficiency may be part of the root cause of MS

In both cases, available levels of melatonin in the bloodstream are shaped by time (seasonality) and location (climate).

Circadian biology has rendered some interesting research that shows melatonin has a neuroprotective role in processes that can lead to demyelination and inflammatory response typical in MS. Simply put, the less melatonin one produces can lead to a higher frequency of symptoms and even relapses.

It's been found in mouse models that melatonin can also halt the formation of destructive T cells and cytokines, leading to an opposite effect: the formation of protective versions of these very same cell structures.

People with MS are also shown to excrete more melatonin metabolite in the urine at night than people without MS, suggesting a relationship between melatonin metabolism and MS.

It appears that disrupted circadian rhythms (often experienced by people who work nights or have disrupted sleep-wake patterns for any reason) have been shown to amplify one's risk for developing MS, as well.

Finally, adequate levels of melatonin have been shown to have an antioxidant effect in people with MS, as discovered in a patient study in 2014 where people with MS received dosages of the supplement to gauge its effectiveness in a controlled environment.

Overall, MS and sleep disturbances share some common mechanisms related to circadian rhythms that seem to be related to compromises in one's natural melatonin availability.

Keeping one's circadian rhythms in sync has been shown to have multiple benefits for overall health: healthy circadian rhythms lead to healthy sleep, healthy digestion, and a healthy immune system, for instance. By sticking to a regular sleep-wake regimen, even someone with multiple sclerosis can enjoy a better overall prognosis.

Can someone with MS use melatonin to their benefit?

Maybe.

In mouse studies, treatment with melatonin resulted in decreased symptoms and reduced flareups. However, there hasn't been enough research in humans to determine whether treatment with melatonin would be useful for people with MS, and if so, what a potential dosage and frequency might look like.

In the case of someone encountering a relapse, the use of steroids (specifically, methylprednisolone corticosteroid treatment) to reduce symptoms and slow down disease progression has also been shown to reduce levels of available melatonin. On top of that, aside from reducing one's own ability to fight disease using one's own melatonin as a neuroprotective agent, steroid use is infamous for leading to insomnia, which further reduces available levels that could be helpful for mitigating a flareup.

Fortunately, melatonin as a supplement can help reset disrupted circadian rhythms. If you fall into some inconsistent sleep-wake patterns, using melatonin at night can help you to achieve a rhythm "reset." This could be useful for those who are finishing up a course of steroids or in the case of cross-continental travel when jet lag (a kind of temporary circadian disruption) might lead to messed up sleep-wake patterns.

Should you supplement with melatonin?

It's best to approach melatonin use under the guidance of a sleep physician. Why?

Neuroscientists and circadian biology researchers are still discovering the neurochemical basis of the human circadian system as well as the usefulness of melatonin as a prescribed treatment for any health concern.

Melatonin is not categorized as a drug by the FDA. The bottles of synthetic melatonin sold at pharmacies are not regulated; dosages may not be accurate. Some commercial products are offered at dosages that could cause your melatonin levels to elevate your blood melatonin levels to 1 to 20 times what is considered normal. While there are no reported cases of toxicity or overdose, so little is known about this supplement that it makes better sense to work with a healthcare professional if you want to go this route.

One thing researchers do know: melatonin can interact with other medications, so keep this in mind when considering its use.

Also, keep in mind, a correct dosage taken at the wrong time of day can lead to more circadian rhythm disruptions, which previous research shows can put people with MS at a neurochemical disadvantage.

Sleep, MS and melatonin

Problems with sleeping and daytime drowsiness are common for people with MS. However, if you struggle with sleep at night or have daytime fatigue, it might be just as useful to have a sleep study overseen by a board-certified sleep specialist first to rule out diagnosable sleep problems you might not be aware of.

These can include obstructive or central sleep apnea, nocturia (the frequent need to use the restroom at night), restless legs syndrome, or periodic limb movements of sleep.

During that conversation, melatonin as a treatment can be discussed for its appropriateness to your situation. Keep your MS neurologist enlightened about these concerns as well. Remember, every person with MS has a different physiology, so "one size does not fit all" when it comes to treatments for MS symptoms.