Onset of sleepiness occurs about 1–2 hours after taking Circadin®1, due to the sleep-promoting effect of melatonin. As Circadin® efficacy is measured as improvement in quality, rahter than quantity of sleep, this improvement has not been measured on a day-to-day basis, but a baseline, and again after 3 weeks and then up to 6 months11. This is similar to other disease areas, e.g., depression and hypertension, where full treatment effect is expected after days or weeks, as the body adjusts to the treatment. It is, therefore, recommended to take Circadin® at the same time every night, continuously for 21 days50. Benefit may be greater with continuous use of up to 3 months.
It is important to realise that, while historically, the treatment of insomnia has involved achieving a rapid CNS suppressant effect by using CNS depressants such as BZDs or ‘z’-drugs, Circadin® represents a new paradigm in the treatment of insomnia, in which treatment of insomnia with poor Quality of Sleep must be approached with the same expectations of gradual improvement as many other diseases, and not a quick ‘knock out’ effect.
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