By Laura Norkin
Is anyone sleeping well right now? Based upon the amount of sleep supplements that have entered the market recently, the answer is no. The demand is understandable: Sleep heals us, restores us, and when it’s not happening, we’ll reach for just about anything that could help. Identifying the cause of your sleeplessness can feel like worry whack-a-mole. The problem is, supplements can be more of a Band-aid than a cure.
“A lot of people may drink, eat, or have caffeine late, then take melatonin to sleep, but that is not solving a root cause,” says Jordan Glenn, PhD, Head of Science at SuppCo, which compares supplements on an objective scale to snake-oil proof the shopping process. “But first,” he says, “we should be asking ‘what should we fix?’”
Sleep disturbances aren’t one-size-fits-all. You may have trouble falling asleep or staying asleep — not always helped by the same ingredients — or wake up exhausted due to an underlying medical issue. Did you know that in the U.S., 25% of women are at high risk for sleep apnea, regardless of weight, and that number increases to 32% at age 50? Lindsay Scola, a speaker and advocate for sleep-disorder education, explains that sleep apnea becomes more prevalent in perimenopause when estrogen and progesterone stop supporting our airways as well as they once did. (What the hell?)
“Sleep supplements can help somebody’s sleep improve, help it be a little bit better, but it’s not going to fix your sleep,” she says. Okay, well: If you’re here to sleep a bit better, here’s what to know.
Melatonin is the cheeseburger of sleep support, a blunt instrument that’ll get the job done but should not be a daily habit. The substance is a hormone that signals it’s time to sleep, but in supplement form it’s best used on occasion, not nightly.
Not only that, but, “Melatonin’s reputation as a harmless, natural sleep aid doesn’t hold up well under scrutiny,” says Jamie Schwartz RD, LDN, a nutritionist at Health Loft. Two separate analyses found a majority of melatonin products don’t match their labeling, containing anywhere from 0% to nearly seven times the stated dose. This poses a risk for people taking SSRIs, for whom melatonin is not recommended; neither is tryptophan (aka 5-HTP), which the body converts into melatonin for sleep. Blood thinners, oral birth control, and anything that causes drowsiness can also cause melatonin overload, so proceed with care.
The current It-Girl sleep supplement is magnesium, a mineral that helps the nervous system relax, supporting an overall calmness that allows for deeper sleep. Glenn says it’s “incredibly popular” because “most people are insufficient” (not deficient, which signals a health issue). It’s involved in too many physiological processes to get into, including supporting your cortisol cycle and lowering stress in general. As magnesium-glycinate, it can ease muscle tension (helpful for restless leg and other nighttime discomforts) to sustain sleep. You might see GABA on these labels, too; that’s a calming chemical messenger that increases with magnesium. Manage your expectations: Schwartz says the oft-cited research on magnesium’s benefits might be oversold to women in midlife. “It’s a real, peer-reviewed, placebo-controlled trial, but applying it to perimenopausal sleep is an extrapolation, not a direct finding.” She calls magnesium “a reasonable, low-risk option to try,” saying the biological mechanism behind it (GABA activity and body-temperature regulation) is “plausible.” As for which one, she likes glycinate for minimal risk and L-theanine for racing thoughts.
It’s ashwagandha that has the most direct research behind it for perimenopausal women, she notes, with the caveat that it’s not safe for everyone. A dose of 300mg of ashwagandha root extract twice daily was linked to improved sleep and energy, specifically reducing the psychological and urogenital symptoms that can impact sleep. It’s not recommended for anyone with thyroid or autoimmune disorders, is unsafe while pregnant or breastfeeding, and can interact with many types of medications.
When picking a sleep supplement, you may think you need to parse your melatonin from your magnesium; GABA from reishi; and so forth. The truth is, as the $209 billion supplement industry grows, more blended products emerge. And that’s fine! None of these ingredients work against each other, Glenn says. “The one thing that triggers my Spidey sense immediately is if I see a ‘proprietary blend’ that doesn’t tell me exactly the dosing involved.” That’s because each ingredient has a dosing threshold where research has proven its efficacy, beyond which it may be unsafe and beneath which it could be pointless. “We use the term ‘fairy dusting’ for that,” he says. “The ingredient may be usable but not [present] in a usable amount.”
So, read those labels. L-Theanine, an amino acid found in green tea that can quiet a racing mind and support relaxation without sedative qualities, will give you the desired effect in 200-250 mg, Glenn says, but some supplements dump in 400. Chamomile comes up a lot in sleep blends, and a useful extract should be in the range of 400 to 1,200 mg/day, but he thinks it’s more effective as a tea. Drinking a cup before bed is a helpful habit.
Scola says a lot of people take melatonin right before bed and in way too high a dose, which can cause vivid dreams and groggy mornings. The clinical recommendation here is 0.5 to 5 mg, taken 30 minutes to two hours before bed, with many sources putting 1-3 mg as the sweet spot for insomnia or jet lag. Beyond that, Glenn notes, benefits plateau. He adds that none of these recommendations are specific to women in midlife, primarily due to a lack of research. That’s unfortunate, as estrogen, which depletes in perimenopause, is directly linked to successful sleep.
Side effects are another sign you’re taking the wrong dose. You’ve probably heard of magnesium causing bloating, nausea, or diarrhea. That’s an excessive dose flooding the gut, not a supplement working as it should. The healthy standard range for magnesium is 310-320 mg/day for women, which can change depending on age and if pregnant or breastfeeding, and is often met through diet. Leafy greens, nuts, beans, bananas, and even dark chocolate are sources of magnesium. As always seems to be true, you can have too much of a good thing.
“The downside of sleep optimization is you try everything you’re seeing online and you’re not getting to the root of the problem, and so when it doesn’t work you keep blaming yourself,” says Scola. An Obama staffer who “wore exhaustion like a badge of honor,” she says she was later diagnosed with narcolepsy and “everything changed.”
In a recent TEDx Talk, she reveals that 80% of sleep disorders go undiagnosed, says that one in five people have one, and urges women who wake up multiple times in a night to find a doctor trained in sleep medicine specifically. “[Sleep apnea] symptoms don’t always look like a snoring, gasping, middle-aged man,” she says. “It might be waking up to go to the bathroom, waking up with a dry mouth, or waking up with general fatigue in the day. That doesn’t feel like a sleep issue so [women] grab supplements.”
If it’s not a body issue, there’s always therapy. Schwartz says CBT-I (cognitive behavioral therapy specifically targeting insomnia) “has stronger long-term evidence than any supplement and is worth knowing about.”
At 41, Shannon Estreller’s sleep fell apart, leading to all-day brain fog. Under the guidance of a primary care doctor who specializes in integrated medicine and women’s health, she increased her vitamin D intake, added an omega 3 supplement, and started taking a magnesium blend. Pretty instantly, she said, “sleep was much better.” The stack didn’t attack her PMS or anxiety, so her doctor prescribed HRT: a progesterone pill right before bed on days 14 to 28 of her cycle. This made the biggest difference. Schwartz, the nutritionist, seconds HRT, specifically if night sweats are part of your sleeplessness.
“I haven’t slept this much since before I had a baby,” Estreller says. “It’s made me a different person. The sleep debt is gone.” Because she has an Oura ring, she knows that with the supplements, she was getting six to seven hours of good sleep. (A dream for some.) Now, she’s asleep in five to 10 minutes when it used to take 30, and is getting eight to nine solid hours a night. She tried skipping the supplements to see if she’d sleep worse without them. It didn’t make a difference. A sample size of one, but herthe results say a lot.
Estreller still takes omegas for general health, vitamin D, and a magnesium blend. But, she says, “The primary player in determining if I have good sleep would be the hormones.