The little melatonin pill that many people pop before bed is getting a lot more scrutiny, as new cardiology data raise questions about what nightly, long-term use might be doing to the heart. Early findings presented at a major heart meeting connect more than a year of melatonin use in adults with chronic insomnia to higher rates of heart failure, heart failure hospitalizations and overall deaths over five years, although the research is still preliminary and does not prove that melatonin is the direct cause.
What the AHA analysis found
Researchers dug through five years of electronic health records for more than 130,000 adults diagnosed with chronic insomnia, labeling people as long-term users if their charts showed at least 12 months of melatonin on record. According to the Charlotte Observer, people in the melatonin group had roughly a 90% higher five-year rate of a new heart-failure diagnosis (4.6% compared with 2.7%), were nearly 3.5 times more likely to be hospitalized for heart failure and also had a higher overall death rate during follow-up. The analysis was presented through an abstract at an American Heart Association meeting, and the American Heart Association notes that the work has not yet been peer-reviewed.
What experts are saying
“Melatonin supplements may not be as harmless as commonly assumed,” the study’s lead author said during the AHA presentation, a warning line highlighted in the association’s release. At the same time, sleep specialists are quick to remind people that this is observational research, so it can only show an association, not prove that melatonin itself causes heart problems. Their advice has not changed much: for chronic insomnia, behavior-based therapy should come first. The American Academy of Sleep Medicine still recommends cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment over nightly supplements and over-the-counter sleep aids.
Why the concern is not simple
Researchers and independent reviewers are also urging caution in how the results are interpreted. The AHA analysis only captured melatonin when it appeared in medical records, whether as prescriptions or documentation, so many over-the-counter users may have been misclassified. The dataset also included countries where melatonin is a prescription drug alongside those where it is sold freely, which complicates direct comparisons. On top of that, regulators point out that supplements in the United States do not go through the same premarket review as medicines, and independent tests have repeatedly shown big variability in melatonin products. In some lab work, the actual melatonin content in a bottle ranged from far below to many times higher than what the label claimed. For those product-quality findings, see the Journal of Clinical Sleep Medicine analysis of commercial supplements and the FDA’s guidance on how dietary supplements are regulated.
Safer paths to better sleep
Clinicians say this new AHA abstract is a good reason to think twice before treating melatonin as a forever, every-night habit, especially for people with other heart risks. Instead, they suggest tackling sleep problems more deliberately. CBT-I, a consistent sleep schedule and basic sleep-hygiene steps remain the recommended starting points. Some people also turn to lower-risk add-ons such as L-theanine for relaxation or tart-cherry products that may modestly affect sleep-related biomarkers. Small trials and reviews have pointed to magnesium for some older adults, and chamomile appears to have a mild calming effect through GABA-related pathways. Evidence for valerian root is mixed, and Mayo Clinic guidance notes that dosing is unclear and drug interactions are a concern. These options are described in clinical reviews and randomized trials published in peer-reviewed sources.
Bottom line for people in Charlotte
The new AHA abstract raises an important safety question about long-term melatonin, but it does not mean that everyone who uses the supplement will develop heart problems. If you take melatonin most nights, sleep experts recommend talking it over with your clinician, reviewing whether CBT-I or other nonpharmacologic steps might help and, if you continue with supplements, looking for products that undergo third-party testing and using the lowest effective dose. For treatment details and the reasoning behind behavioral first-line care, see the American Academy of Sleep Medicine’s clinical recommendations.
