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As someone in the US who has DSPD [0] and uses melatonin daily, I personally wish it was a prescription medication. There are a few reasons for this:

1) The proper dose of melatonin for me is somewhere between 150ug and 400ug, but most melatonin sold comes in 3mg to 10mg pills. That's around 10x too much, taking that dosage of melatonin destroys my sleep schedule. It takes a lot of hunting to find the right dose. I tried once to crush up some melatonin and make my own pills with a precise dosage, but that ended up being a bit of a disaster.

2) Melatonin is regulated as a supplement in the US. Basically that means there is no regulation and even the active ingredient can vary wildly in a pill. When I visited a sleep specialist they mentioned to always buy the same brand, because "Each supplier has a different incorrect dosage, your best bet for dialing in on the correct dosage and timing is hoping that they're at least consistent among themselves".

But I do agree with you, regulating it as a prescription medication would do more harm than good for most people. I wish there were some middle ground that would both solve the above issues but still keep it easily available for people who rely on it.

[0]: https://en.wikipedia.org/wiki/Delayed_sleep_phase_disorder

Wow, I never knew that there was a medical diagnosis for being a night owl. Without external forces, my sleep schedule would naturally drift until I am going to bed ~4AM-6AM. Melatonin has been a great help in making sure I get enough sleep so I can work regular hours. Like you, I've found that a small dose is sufficient. I take a quarter of a 3mg pill.

In fact there's evidence of four chronotypes! I, myself, am a napper: :)

https://www.sciencedirect.com/science/article/abs/pii/S01918...

Same here. During lockdown, my sleep schedule actually drifted a full circle around the clock.

Without the daily commute the same thing happened to me except its become more like two cycles of eight hours of activity followed by four hours of rest. I used to do the same thing in college - maybe that is my natural rhythm.

I have a similar thing going since a few years. Go to work for 8 hours. Come home and sleep on the couch for 3 to 4 hours, followed by another 4 to 6 hour period of hacking. I feel like I totally understand the concept of fiesta since I started this routine. However, during lockdown, as you have already indicated, things started to drift because of the lack of commute, or in my case, because of the lack of the 5 minute walk to work.

TL;DR: Yeah, powernapping is a thing.

If you don't mind, at what time of day do you take it?

It's been tough nailing down the optimal time, but right now what works best is taking 300ug of melatonin at 10:20pm and falling asleep at 11:50.

In the past I tried various different times ranging from 6:30pm to 9:00pm. Even taking it at a suboptimal time is better than not taking it at all.

There are also a few other things I do to keep my sleep schedule on track:

1) I heavily use bluelight filters on my computers and phone in the evening. Redshift/gammastep on Linux gives me full control.

2) I have low blue light lights which I use in the evening [0], then I switch to fully red bulbs in the hour before going to sleep.

3) I have a super bright daylight LED lamp which turns on automatically at 8:30am, a few minutes before I wake up. This is my solution to automate light therapy [1].

All of this combined lets me function mostly like a normal person. Hope some of that helps.

[0]: https://www.amazon.com/s?k=2000k+bulb

[1]: https://en.wikipedia.org/wiki/Light_therapy

Great, thank you very much.

I can't find the link right now, but I recall reading from a credible source that melatonin works two ways (from memory so may not be completely accurate):

* Adjusting diurnal rhythm (e.g. adjust a skewed sleeping schedule, jet lag). This works in lower doses over longer periods of time. So if you want to be less of a night owl, you may take 0.1-0.3 mg in the afternoon.

* Hypnotic - immediately making you more prone to fall asleep. This one is less well understood and dosages vary per person but it seems like 0.3-3 mg shortly before bed time is optimal. It also won't work on it's own like stilnoct or whatnot, so limiting light exposure, and all the other usuals, still apply.

I also find it frustrating how much more expensive and less available lower dosages are. From someone who also does bits and nibbles of 3mg pills.

For me, when I take melatonin, I feel sleepy within about half an hour, and if I don't go to sleep then, the sleepiness will pass and the melatonin would be ineffective. So I take it about half an hour before bedtime so that I am in bed within the effectiveness window.

Liquid melatonin is easier to get a ballpark dose in the 150-400ug range, since you can use single drops from the dropper.

if its water soluble, even better as you can put one drop in a glass of water and drink a quarter of that

FYI Nootripicsdepot standardises melatonin at 300ug if ur interested

Still a bit too much, at 500ug, but I’ve found the Trader Joe’s pills to work well, and are large and chewable, so should be relatively easy to divide.

I'm strongly anti-prescription and want every medicine to be over-the-counter but it's worth noting there usually are reasons behind the prescription status of a substance you should understand before taking it. Most of the people don't know how to take melatonin the right way. You should[1] take 0.3 mg 7 hours before you go to sleep, NOT 10mg right before that like many people do.

[1] https://www.lesswrong.com/posts/E4cKD9iTWHaE7f3AJ/melatonin-...

Also, unless you are really old or travel to different time zones all the time you shouldn't need long-term melatonin supplementation. It's supposed to adjust your inner rhythm so you will naturally fall asleep at the correct time after some days of taking it.

Interesting.... 3 doctors I’ve had and some sleep specialists didn’t know or recommend correct dosage

Not a particularly useful comment, but, wow: melatonin is a prescription in Australia?

I mean, there are potential complications to melatonin…but I think it’s hard to argue that it’s less safe than paracetamol or aspirin.

Paracetamol is a lot more dangerous than melatonin.

Take a big paracetamol overdose, get acute liver failure, significant chance of either death or urgent need for liver transplant–even if you are getting the best possible medical care.

Take a massive melatonin overdose, nothing anywhere near as serious happens. You may become unconscious for 12 hours. There are reports of other negative side effects – tachycardia, hypotension, hypothermia, etc [1][2] – medically risky, but still your odds of survival without serious long-term consequences are pretty high, especially if you get proper medical care. Animal studies have failed to determine an LD50 for melatonin, even giving massive overdoses to animals they survive–it isn't clear if it is even possible for a healthy human to die by massive melatonin overdose, I think if it were to ever happen it would require a complete lack of medical attention combined with a very big dose of bad luck. By contrast, fatal paracetamol overdoses (mostly intentional, sometimes accidental) occur with some regularity.

[1] https://journals.sagepub.com/doi/pdf/10.1177/102490790100800...

[2] https://pubmed.ncbi.nlm.nih.gov/31553200/

I think OP made that comparison because in Australia even a kid can get a pack of paracetamol for $1 over the counter at most grocery shops.

20 x 500mg tables $0.70 at Coles.

Two packs will end the average teen, formanent liver failure takes about 5 days though, quite uncomfortable I'm told.

The antidote is n-acytel-cysteine, available from most sport supplement type places, I always keep 100g or so around cos early / immediate oral treatment can make the difference until medical intervention arrives, where they give the n-acytel-cysteine intravenously.

Hi, It may be better not to publish exactly the dosage that is dangerous. For example, I tried not to read this part, because I know I’m tempted, and sometimes ignorance is bliss. I know you seek to share excellent knowledge, I’m myself passionate about air crashes and causes which is a topic a lot of people don’t like to hear about ;) It’s just, it’s very interesting to know for a public health perspective that lethal doses are possible to get at the local supermarket, perhaps the exact quantity is one detail too much. Cheers.

Don't do it!

This is a good point and something I consider every time I bring it up.

I don't have a perfect response though sorry.

I try to put people of this particular method by noting it's painful and takes a long time.

Do you have someone(s) you can talk to? Support people?

Yes, don’t worry too much for me, I have a psychologist and we got several things rolling recently, so I’ll be fine for a couple of months already. Thank you for your concern ;)

That's such a weird perspective to take. No information, including the exact dosage that will kill you, should be hidden "just in case". It's like security by obscurity of medical world. In fact I'd advocate that every paracetamol packet should say, in big letters in the back "TAKING X OF TABLETS WILL KILL YOU WITH NO KNOWN TREATMENT, AND IT WILL HURT ALL THE TIME AS YOU'RE DYING". There's so many people who don't realize how easily taking too much paracetamol can kill it's crazy.

Yeah, exact dosage is irrelevant. If you're going to kill yourself, you just take a few packs. As you say and has been said elsewhere in here, the dosage difference between therapeutic and fatal is really small, so if you take multiple times the normal dosage, well... you don't need exact dosage for that.

France: buying paracetamol can be done freely here ,but it has to be asked for at pharmacies, and the dangerous dosage (4000mg/day) is heavily stressed.

Also, it is written on the instruction manual, in quite big letters.

Anything you consume to the point of unconsciousness is likely to kill you. Your world is full of intentional poisons (we use them to kill the things we don't like, germs and bugs) and dangerous things you aren't supposed to eat. The numbers don't matter.

Please don't end your life. Almost everyone who tries regrets it. Get help with your dark thoughts and keep on being a part to your communities.

I personally think paracetamol should be prescription only. The risk and consequences of overdose (whether suicidal or accidental) are too severe. A lot of far safer drugs are prescription only (or even completely illegal) yet deadly paracetamol is sold in the supermarket.

> I personally think paracetamol should be prescription only. The risk and consequences of overdose (whether suicidal or accidental) are too severe. A lot of far safer drugs are prescription only (or even completely illegal) yet deadly paracetamol is sold in the supermarket.

I can't tell if you're joking or not.

I'm being completely serious, why would I be joking?

I'm going on a stretch here but it was probably implied all NSAIDs have side effects which are all severe. Stomach bleeds, reduction of blood clotting or other problems related to thrombosis or kidney failure depending on the type. Highly unlikely when used by the book but deadly in overdosis or prolonged uses. Just like paracetamol.

Taking away people's pain medication is not a winning move I'm certain of.

At my local Coles supermarket, AUD 1.40 (USD 0.99) buys 2 packets of 20 tablet 500mg paracetamol. Swallow 40 tablets, take a 20 gram overdose. For a person who weighs 80kg, that's 250 mg/kg. That kind of overdose is likely to lead to acute liver injury; prompt treatment with NAC will avoid it, but without prompt treatment, acute liver failure is a likely outcome.

At the same supermarket, AUD 3.10 (USD 2.19) buys 2 packets of 24 tablet 200mg ibuprofen. Swallow 48 tablets, take a 9.6 gram overdose. For a person who weighs 80kg, that's 120 mg/kg. [1] reports that level of ibuprofen overdose is likely to produce mild CNS and GI symptoms. Fatalities have occurred with >300 mg/kg, so an 80 kg person would need to take over 24 grams, which is 120 tablets, 5 packets worth (cost AUD 7.75, USD 5.48). So you can immediately see how ibuprofen is safer than paracetamol, in that you have to swallow a lot more tablets to take a potentially fatal overdose. Given that, I think a case could be made for withdrawing over-the-counter paracetamol while continuing to allow over-the-counter ibuprofen.

Cannabinoids such as THC and CBD also provide pain relief, and certainly if we are just looking at overdose acute toxicity are far safer than either ibuprofen and paracetamol – indeed, there is no record of any fatal overdose ever happening from either. And yet, where I live they are only legally available on prescription, and prescribers face regulatory hurdles which do not apply to other drugs. If we are only thinking about safety in overdose, we'd make both ibuprofen and paracetamol prescription only, and allow THC and CBD over-the-counter instead.

[1] https://litfl.com/nsaids-toxicity/

Bleach will also kill you if you drink a bottle, but it's legal OTC.

Prescriptions are for things that are dangerous under casual misuse, not intentional suicide or ignorant children.

>withdrawing over-the-counter paracetamol while continuing to allow over-the-counter ibuprofen

Paracetamol is not an NSAID (unlike ibuprofen) and has a lot less negative effect on my gastritis. There are not many painkillers available OTC which are not also NSAIDs and so don't destroy your stomach lining. I'd rather not develop stomach ulcers to prevent some random lunatic from gorging himself on paracetamol into the grave.

As you've mentioned, you're only looking at overdose by healthy individuals, and in the case of both paracetamol and ibuprofen you'd be hard pressed to overdose accidentally. If you're making a concerted effort to overdose $10 vs $1 is likely irrelevant, particularly since they're both over the counter and trivial to steal.

What makes ibuprofen dangerous is that people tend to believe it can be taken safely to address arbitrary aches and pains. However, the kind of people experiencing aches and pains (beyond a common headache) tend to already be on some other form of medication. More often than not, these medications are either NSAIDs or steroids. Both of which interact poorly with ibuprofen, given that it is itself an NSAID. Paracetamol does not suffer from this issue.

I know little of how THC and CBD interact with other drugs people are likely to be consuming. However, drug interaction would need to be taken into consideration. As would subtle effects on mental state; focus, lethargy etc.

I mean, er, so is deadly drain cleaner?

Paracetamol is very safe if used correctly, and doesn't have many serious interactions or contraindications. If you have to have one OTC painkiller it's probably about the safest. There's maybe an argument that it should be prescription, but "poisonous things are available in supermarkets" probably isn't one.

It's been oft repeated that acetaminophen would not be OTC if it were discovered today. The difference between a therapeutic and a toxic dose are waaaaay too small.

It's setting the bar _really_ low to compare to acetaminophen. There's a good chance if it weren't basically the only safe painkiller for pregnant and breastfeeding women it would simply not exist anymore.

> basically the only safe painkiller for pregnant and breastfeeding women

Huh, is that why they keep it around? I thought it was mostly cruft/momentum. But it looks like NSAIDs are risky in the 3rd trimester.

https://www.aafp.org/afp/2003/0615/p2517.html

And doctors will tell you to pound paracetamol all day just to stop bothering them with a problem that is ‘just in your head’.

Why would we ever assume that another person, totally unrelated and unconnected, would ever prioritize our needs ahead of their benefit? This is the assumption of so many institutions where authority over ourselves is forcefully delegated to chosen others. This goes predictably wrong just about every time. We shouldn’t even be upset about it.

I suspect if paracetamol was newly brought to market today it would in fact be prescription.

On the other hand diclofenac is over-the-counter in Australia.

come on guys, really? You can even overdose with water https://en.wikipedia.org/wiki/Water_intoxication

Are you not familiar with paracetamol?

To post this and compare it to water overdose seem to be the only reason I can think of.

I've mentioned water because it is something that you wouldn't expect.

Probably alcohol would be another item that's easily available, and not many consider as dangerously lethal when overdosed.

On the other hand, I think there's still a lot of common sense left with paracetamol and other medicine.

Paracetamol has the nasty feature that the therapeutic dose is quite close to the lethal dose; water does not.

100%. With a drawn-out phase 3 and oodles of black-box warnings to boot.

And why is there so much credulity in this thread? In fact why isn't paracetamol's toxicity more well known? My mom is a nurse and I have an undergrad in chemistry and it wasn't till college senior year in a pharmacochem elective that I learned how narrow the therapeutic range is, and how alcohol shrinks it further to the point where accidentally nerfing your liver with booze and dayquil is plausible.

From what I recall it's illegal to buy without a prescription in the UK as well because it's a hormone and all hormones need prescriptions.

But it's not illegal to possess without a prescription, so you can just order it from abroad and essentially nobody cares, the same is true incidentally for steroids in the uk as well.

> and all hormones need prescriptions.

I don't think that's quite right; vitamin D is non-prescription in the UK AFAIK.

I thought I had insomnia but I fixed it by watching math lectures at night. Some people probably still need drugs and it doesn't work when you sleep with someone who doesn't like doing that, but it's one alternative to try.

I do something similar. I always have two audio books to listen to. An interesting book that I listen to recreationally and one that is somewhat boring or relaxing in some way. I use the relaxing material to get to sleep.

You can have it shipped from the US using iherb.com. There is no issue with customs for up to 5mg tablets.

You used to be able to buy melatonin online from the US where I am, but everywhere stopped shipping here, sadly. I guess customs got stricter... I did get a prescription for a month off my doctor recently, but its annoying that I have to pay just for a note to be able to buy it.

Taswegian here, I buy it from iHerb

https://au.iherb.com/pr/natrol-melatonin-3-mg-60-tablets/246...