Daytime melatonin and light independently affect human alertness and body temperature

Light significantly improves alertness during the night (Cajochen, Sleep Med Rev, 11, 2007 and 453; Ruger et al., AJP Regul Integr Comp Physiol, 290, 2005 and R1413), but results are less conclusive at daytime (Lok et al., J Biol Rhythms, 33, 2018 and 589). Melatonin and core body temperature levels at those times of day may contribute to differences in alerting effects of light. In this experiment, the combined effect of daytime exogenous melatonin administration and light intensity on alertness, body temperature, and skin temperature was studied. The goal was to assess whether (a) alerting effects of light are melatonin dependent, (b) soporific effects of melatonin are mediated via the thermoregulatory system, and (c) light can improve alertness after melatonin-induced sleepiness during daytime. 10 subjects (5 females, 5 males) received melatonin (5 mg) in dim (10 lux) and, on a separate occasion, in bright polychromatic white light (2000 lux). In addition, they received placebo both under dim and bright light conditions. Subjects participated in all four conditions in a balanced order, yielding a balanced within-subject design, lasting from noon to 04:00 pm. Alertness and performance were assessed half hourly, while body temperature and skin temperature were measured continuously. Saliva samples to detect melatonin concentrations were collected half hourly. Melatonin administration increased melatonin concentrations in all subjects. Subjective sleepiness and distal skin temperature increased after melatonin ingestion. Bright light exposure after melatonin administration did not change subjective alertness scores, but body temperature and proximal skin temperature increased, while distal skin temperature decreased. Light exposure did not significantly affect these parameters in the placebo condition. These results indicate that (a) exogenous melatonin administration during daytime increases subjective sleepiness, confirming a role for melatonin in sleepiness regulation, (b) bright light exposure after melatonin ingestion significantly affected thermoregulatory parameters without altering subjective sleepiness, therefore temperature changes seem nonessential for melatonin-induced sleepiness, (c) subjective sleepiness was increased by melatonin ingestion, but bright light administration was not able to improve melatonin-induced sleepiness feelings nor performance. Other (physiological) factors may therefore contribute to differences in alerting effects of light during daytime and nighttime

Nightly treatment of primary insomnia with prolonged release melatonin for 6 months: a randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety

<p>Background: Melatonin is extensively used in the USA in a non-regulated manner for sleep disorders. Prolonged release melatonin (PRM) is licensed in Europe and other countries for the short term treatment of primary insomnia in patients aged 55 years and over. However, a clear definition of the target patient population and well-controlled studies of long-term efficacy and safety are lacking. It is known that melatonin production declines with age. Some young insomnia patients also may have low melatonin levels. The study investigated whether older age or low melatonin excretion is a better predictor of response to PRM, whether the efficacy observed in short-term studies is sustained during continued treatment and the long term safety of such treatment.</p> <p>Methods: Adult outpatients (791, aged 18-80 years) with primary insomnia, were treated with placebo (2 weeks) and then randomized, double-blind to 3 weeks with PRM or placebo nightly. PRM patients continued whereas placebo completers were re-randomized 1:1 to PRM or placebo for 26 weeks with 2 weeks of single-blind placebo run-out. Main outcome measures were sleep latency derived from a sleep diary, Pittsburgh Sleep Quality Index (PSQI), Quality of Life (World Health Organzaton-5) Clinical Global Impression of Improvement (CGI-I) and adverse effects and vital signs recorded at each visit.</p> <p>Results: On the primary efficacy variable, sleep latency, the effects of PRM (3 weeks) in patients with low endogenous melatonin (6-sulphatoxymelatonin [6-SMT] ≤8 μg/night) regardless of age did not differ from the placebo, whereas PRM significantly reduced sleep latency compared to the placebo in elderly patients regardless of melatonin levels (-19.1 versus -1.7 min; P = 0.002). The effects on sleep latency and additional sleep and daytime parameters that improved with PRM were maintained or enhanced over the 6-month period with no signs of tolerance. Most adverse events were mild in severity with no clinically relevant differences between PRM and placebo for any safety outcome.</p> <p>Conclusions: The results demonstrate short- and long-term efficacy and safety of PRM in elderly insomnia patients. Low melatonin production regardless of age is not useful in predicting responses to melatonin therapy in insomnia. The age cut-off for response warrants further investigation.</p&gt

Clinical Use of Melatonin in the Treatment of Sleep Disorders

Sleep disorders are a group of conditions that affect the circadian rhythm of sleep-wake, leading to social and professional maladaptation. At the moment, there is a wide range of medications aimed at the treatment of sleep disorders, but the results from their use are not always satisfactory. Benzodiazepines, antidepressants, and antihistamines may cause dependence or withdrawal effects. Melatonin (N-acetyl-5-methoxytryptamine) is an endogenous hormone produced by the pineal gland that affects intraday, seasonal rhythm, and the sleep-wake cycle. Studies of the effects of melatonin have demonstrated its ability to synchronize circadian rhythms, reduce the latency of slow sleep, increase the duration of sleep, and improve its subjective quality. This review highlights the current therapeutic possibilities of using melatonin in various sleep disorders, taking into account the mechanisms of its action. Also, the prospects of using melatonin due to its chronobiological effect in other sleep disorders, such as parasomnia, sleep-dependent respiratory disorders, and hypersomnia, are emphasized. At the moment, melatonin is one of the methods for correcting intraday rhythms and some types of insomnia

Melatonergic Drugs for Therapeutic Use in Insomnia and Sleep Disturbances of Mood Disorders

Insomnia is common among elderly people and nearly 30 to 40% of the adult population also suffer from insomnia. Pharmacological treatment of insomnia include the use of benzodiazepine and non-benzodiazepine drugs like zolpidem, zaleplon,Zopiclone. Although these drugs improve sleep ,their usage is also associated with number of adverse effects, Melatonin ,the hormone secreted by the pineal gland of all animals and human beings has been used for treatment of insomnias,since the timing of its secretion in humans as well as in most of the animals coincides with the increase of nocturnal sleep propensity.Because of its short half life,melatonin slow release preparations were introduced for treatment of insomnia. Recently ramelteon ,a selective MT1,MT2 receptor agonist with greater efficacy of action in treating insomnia has been used clinically and has been found effective in improving sleep quality ,sleep efficacy and also in reducing the sleep onset time when compared to melatonin or slow melatonin preparations.The mechanism of action of ramelteon in improving sleep is discussed in the paper. Another melatonergic drug agomelatine besides acting on MT1/MT2 receptors also displays 5-HT2c antagonism and this drug has been found effective as a novel antidepressant for treating major depressive disorders.Agomelatine besides causing remission of depressive symptoms also improves sleep quality and efficiency. Other antidepressants depressants that are in clinical use today do not improve sleep. There are other melatonergic drugs like tasimelteon ,6-chloromelatonin.But ramelteon and agomelatine deserve special attention for treatment of insomnia and sleep disturbances associated with depressive disorders and have promising role for treatment of sleep disorders

Psicofarmácos inibidores da melatonina

Monografia apresentada ao Setor de Pós graduação da Universidade do Extremo Sul Catarinense - UNESC, para a obtenção do título de especialista em Saúde Mental.A presente pesquisa constitui-se de uma pesquisa de caráter exploratória e descritiva com o tema hipnótico sedativos do sono, cujo problema de pesquisa é: quais psicofármacos são utilizados como inibidores da melatonina. O objetivo geral foi descrever quais psicofármacos utilizados como inibidores da melatonina. É um trabalho de revisão bibliográfica, e como instrumento de coleta de dados, foi utilizada a leitura de artigos e pesquisas científicas

A cellular model for human daily behaviour

All the biochemical, physiological or behavioural processes whose period is about 24 hours possess a circadian rhythm. In mammals circadian rhythms control almost all aspects of human daily behaviour and physiology. Dysregulation of circadian rhythms leads to several pathologies, such as depression, cancer and metabolic syndromes. Mammalian circadian system is organized in a hierarchic fashion: suprachiasmatic nucleus (SCN) is master clock and governs the circadian rhythms of all peripheral oscillators, virtually all the other cells of the body. The study of human circadian rhythms in subjects in vivo is expensive, time consuming and invading. However, since SCN and peripheral oscillators share the same circadian molecular machinery, it is possible to use peripheral oscillator as model to study molecular mechanisms of circadian rhythms. To visualize in real-time cellular circadian rhythms, fibroblasts were infected with a lentivirus coding for the circadian reporter firefly luciferase under a clock gene promoter (Bmal1). After the synchronization of circadian rhythms, the measurement of the light emitted by the cells gave a representation of fibroblast circadian oscillations. The aim of the thesis was to establish the use of human primary skin fibroblasts as a valuable model to study different aspects of human circadian rhythms. To address these questions three projects were designed. A first set of experiments aimed at validating human skin fibroblast model, ascertaining that this in vitro model parallels in vivo human circadian parameters. We found a very good correlation between the in vivo and the in vitro period length in the three groups of subjects (two sighted and one blind) recruited for this study. Interestingly, although the in vivo period obtained from the blind group was longer than the in vivo period obtained from the sighted groups, the in vitro period length from the three groups of subjects was similar, revealing that human skin fibroblasts are insensitive to the after-effects caused by light. In summary, human circadian period can be approximated by measurement in fibroblasts. In a second project human age-related circadian impairments were studied in the cellular skin fibroblasts model. Indeed sleep-wake cycle alterations and phase advancing of gene expression and behaviour can be found in elder individuals. To better understand the rebound of ageing on the circadian rhythms we characterized the period length of skin fibroblasts from young and elder persons. No differences in amplitude, phase and period length were found between cells from the two groups. However, in the presence of sera from older donors human fibroblasts showed a reduced period length and a shorter phase of entrainment compared to the same cells measured in the presence of sera from young donors. These differences are likely due to one or more thermolabile substances, since heat-inactivation of sera from older donors almost undid the reduction of the circadian period length. Thus, these results suggest that during ageing the molecular machinery of peripheral circadian clocks does not change per se, but some age-related circadian changes observed in vivo might be caused by circulating molecules. Human fibroblasts were also used to investigate the role of melatonin as zeitgeber on peripheral oscillators. Melatonin is secreted in a circadian fashion and was demonstrated to regulate the SCN firing rate and to entrain the sleep-wake cycle of most mammals and humans. The circadian presence of melatonin is well conserved in all biological fluids, suggesting that melatonin may be one of the molecules that the master clock uses to synchronize peripheral oscillators. This hypothesis was tested in damped fibroblasts, using a wide range of concentrations of melatonin to restore the amplitude of the rhythms. However, no increase of amplitude or phase shift of the rhythms was observed after treating cells with melatonin. Moreover, the application of the hormone to newly synchronized oscillators decreased their bioluminescence. In summary, the experiments demonstrated that melatonin does not play a direct role as peripheral oscillator zeitgeber. In conclusion, the studies of the present thesis succeeded in revealing three primary findings: first, fibroblast circadian rhythms parallel human circadian physiology, such as circadian period length. Second, apparently, during ageing the molecular components of peripheral circadian clocks in skin fibroblasts do not change per se, but some age-related circadian changes observed in vivo might be caused by one or more heat-sensitive substances present in the blood of older subjects. Finally, melatonin does not possess direct synchronizing properties on peripheral oscillators like fibroblasts. In total, the present thesis revealed that primary human skin fibroblasts are an easily accessible, cheap and reliable model to enlighten our understanding of human circadian mechanisms

Avaliação dos efeitos da administração da Melatonina sobre parâmetros comportamentais e de metabolismo energético no modelo animal de esquizofrenia induzido por Cetamina

Tese de Doutorado apresentada ao Programa de Pós-Graduação em Ciências da Saúde da Universidade do Extremo Sul Catarinense para obtenção do título de Mestre em Ciências da Saúde.A pesar de várias décadas de esforços em pesquisa, a etiologia e fisiopatologia da esquizofrenia continuam sendo um desafio e os tratamentos existentes apresentam limitações consideráveis no manejo dos casos de esquizofrenia. Portanto, este estudo teve por objetivo avaliar o efeito da administração da melatonina sobre parâmetros comportamentais e de metabolismo energético no modelo animal de esquizofrenia induzido pela administração de cetamina. Para tal, duas doses de MLT (1mg/kg e 10mg/kg) foram usadas em dois protocolos diferentes, sendo um de prevenção e outro de reversão. Assim, no protocolo de prevenção os animais receberam MLT nas doses de 1mg/kg ou 10mg/kg ou salina por gavagem, uma vez ao dia durante 14 dias, entre os dias 8 e 14 receberam cetamina (25mg/kg) ou salina via intraperitoneal (i.p). Enquanto que no protocolo de reversão, os animais receberam cetamina (25mg/kg) ou salina (i.p), uma vez por dia, durante 14 dias, entre os dias 8 e 14 receberam MLT (1mg/kg ou 10mg/kg), uma vez ao dia. No 14º dia, os animais foram submetidos a avaliação da distância percorrida, estereotipia, tempo de permanência no centro e nas bordas além da avaliação da inibição da IPP. O córtex pré-frontal, hipocampo e estriado foram dissecadas para posteriores análises da atividade dos complexos I, II, II-III e IV da cadeia respiratória mitocondrial e atividade da Creatina Cinase (CK). Esses resultados demonstram que a administração repetida de cetamina, resulta em hiperatividade e comprometimento da IPP. Os resultados revelam que nos dois protocolos avaliados a cetamina induziu o aumento da distância percorrida, movimentos estereotipados e tempo de permanência no centro e nas bordas. A MLT, não teve influência sobre os efeitos da cetamina; no protocolo de prevenção a MLT na dose de 10mg/kg apresentou aumento dos movimentos de estereotipia e induziu os animais à um aumento do tempo de permanência no centro e diminuição do tempo de permanência nas bordas. Em relação a inibição do reflexo de sobressalto, a MLT nas duas doses testadas apresentou um efeito preventivo e de reversão das três intensidades avaliadas. Os resultados deste estudo também mostram que a MLT sozinha ou associada a cetamina induziu a alterações dos complexos da cadeia transportadora de elétrons (CTE). No protocolo de prevenção, o grupo MLT10+cetamina induziu o aumento da atividade do complexo IV no hipocampo; enquanto que no protocolo de reversão a MLT nas duas doses testadas sozinha ou em associação com a cetamina alterou a atividade dos complexos I, II-II e IV do córtex, estriado e hipocampo respetivamente. Com relação a atividade da enzima CK, resultados deste estudo mostram que a cetamina alterou a sua atividade no córtex e hipocampo no protocolo de prevenção, enquanto que a MLT nas duas doses preveniu o efeito deletério da cetamina nestas estruturas cerebrais. Diante destes resultados, assume-se que o modelo de esquizofrenia induzido por cetamina representa uma ferramenta útil para o estudo da esquizofrenia e que a MLT possui algum potencial protetor sobre a IPP no modelo animal de esquizofrenia induzido por cetamina. Portanto mais estudos são necessários para um melhor entendimento desta hipótese

Sleep-anticipating effects of melatonin in the human brain

Melatonin, the hormone produced nocturnally by the pineal gland, is an endogenous regulator of the sleep–wake cycle. The effects of melatonin on brain activities and their relation to induction of sleepiness were studied in a randomized, double-blind, placebo controlled functional magnetic resonance imaging (fMRI) study. Melatonin, but not placebo, reduced task-related activity in the rostro-medial aspect of the occipital cortex during a visual-search task and in the auditory cortex during a music task. These effects correlated with subjective measurements of fatigue. In addition, melatonin enhanced the activation in the left parahippocampus in an autobiographic memory task. Results demonstrate that melatonin modulates brain activity in a manner resembling actual sleep although subjects are fully awake. Furthermore, the fatigue inducing effect of melatonin on brain activity is essentially different from that of sleep deprivation thus revealing differences between fatigues related to the circadian sleep regulation as opposed to increased homeostatic sleep need. Our findings highlight the role of melatonin in priming sleep-associated brain activation patterns in anticipation of sleep