Sleep is a vital physiological process essential for maintaining overall health, supporting cellular repair, immune regulation, and cognitive functions. Sleep disruptions are associated with adverse health outcomes, including cardiovascular diseases, metabolic disorders, and impaired mental health. Sleep regulation is orchestrated by the circadian rhythm and homeostatic sleep drive, with melatonin-a neurohormone secreted by the pineal gland-playing a pivotal role in modulating these processes. Melatonin synthesis follows a biochemical pathway, converting serotonin to melatonin through key enzymes, AANAT and HIOMT, under circadian control. The suprachiasmatic nucleus (SCN) governs its secretion via light-responsive pathways, with light exposure inhibiting and darkness stimulating melatonin production. Acting through MT1 and MT2 receptors in the SCN and other brain regions, melatonin facilitates sleep onset, circadian rhythm alignment, and sleep maintenance while exerting antioxidant, anti-inflammatory, and chronobiotic effects. Exogenous melatonin has emerged as a therapeutic agent for managing sleep disorders, such as circadian rhythm sleep-wake disorders, jet lag, and insomnia. Its chronobiotic properties enable circadian phase-shifting, aligning sleep-wake cycles with environmental cues. Despite its growing use, questions remain regarding optimal dosing and long-term safety. This review delves into the physiology of melatonin, its synthesis, regulation, and mechanisms of action in sleep regulation. It also examines its therapeutic potential, highlighting gaps in research and paving the way for future studies on melatonin's broader implications in health and disease.

Hemolacria is a rare condition characterized by bloody tears. Its etiology is often multifactorial, but functional/psychosomatic mechanisms have been proposed when organic causes are excluded. A 48-year-old woman with a history of multiple traumatic brain injuries (coma in 2008, car accident in 2017) presented with refractory generalized anxiety disorder, major depressive disorder, insomnia disorder, and treatment-resistant hypertension. Since 2022, she developed bilateral hemolacria with a baseline frequency of 4-5 episodes daily despite extensive negative ophthalmological, neurological, hematological, and imaging workups. She had been on stable doses of sertraline 100 mg/day, amlodipine 10 mg/day, losartan 100 mg/day, and intermittent zolpidem for at least 6 months. Anodal transcranial direct current stimulation (tDCS) targeting the left dorsolateral prefrontal cortex (L-DLPFC; anode F3, cathode Fp2) was administered for 27 sessions over 61 days (1-2 mA, 20 min/session, 5 days/week). No concurrent medication changes were made during or after the intervention. Marked clinical improvement began around session 12. By session 27, standardized scores showed remission of symptoms (HAM-D-17 from 26 to 4, HAM-A from 34 to 6, PSQI from 16 to 5), office blood pressure normalized to 125-135/80-85 mmHg, and hemolacria frequency decreased to one minor episode every 43 days. All improvements were sustained at the 3-month follow-up without further tDCS. This single-case, open-label report describes concurrent reductions in psychiatric, cardiovascular, and hemolacria symptoms that occurred in temporal association with anodal tDCS over the L-DLPFC in a treatment-refractory patient after organic causes had been excluded. Given the uncontrolled design, causality cannot be established; alternative explanations including placebo response, non-specific effects of clinical attention, regression to the mean, or spontaneous remission cannot be excluded. Randomized controlled trials are warranted to investigate the potential efficacy and mechanisms of tDCS in functional hemolacria.

Objective: Breast cancer is the most commonly diagnosed cancer among women worldwide. Although survival rates have improved through advances in screening and treatment, many survivors continue to experience chronic sleep disturbances that impair quality of life. This review synthesizes evidence from randomized clinical trials evaluating non-pharmacological interventions for sleep management in breast cancer survivors. Methods: Following PRISMA guidelines, systematic searches were conducted in PubMed, EMBASE, Scopus, and Web of Science from inception to December 2024. Eighty-nine eligible studies were identified, and 73 met the predefined criteria for inclusion in the meta-analysis. Results: Psychosocial interventions lead to substantial improvements in sleep quality (SMD = -1.12; 95% CI: -1.57, -0.68), while physical therapies, such as acupuncture, demonstrate moderate benefits (SMD = -0.86; 95% CI: -1.32, -0.41). Physical activity interventions showed minimal effects (SMD = -0.20; 95% CI: -0.39, 0.00). Additionally, psychosocial interventions significantly reduced insomnia symptoms (SMD = -0.82; 95% CI: -1.09, -0.55). Conclusion: Nonpharmacological interventions, particularly psychosocial strategies, may effectively improve sleep quality and reduce insomnia among breast cancer survivors, supporting the integration of individualized supportive care plans within comprehensive survivorship and long-term follow-up programs.

Insomnia is a disorder that involves dissatisfaction with sleep and difficulty falling or staying asleep. This study aims to explore the sedative activity of gallic acid (GA) on thiopental sodium (TS)-induced sleep in mice. Intraperitoneal (i.p.) injections of GA (50, 100, and 200 mg/kg) and diazepam (DZP) (2 mg/kg) were given to Swiss albino mice individually or in combination. After administering TS, the onset and sleep duration were recorded. Additionally, GA's binding affinity (BA) with the GABAA receptor (α1 and β2 subunits) was examined using molecular docking. Results revealed that GA significantly (p < 0.05) decreased onset and improved sleep duration in comparison to the control group in a dose-dependent manner. The highest dose of GA (GA-200) showed significant sedative activity with latency (1.77 ± 0.76 s) and sleep duration (182.28 ± 2.87 min). The combination of GA with DZP showed a synergistic sedative effect through decreasing latency and increasing sleep duration. In silico findings demonstrated that GA exhibited higher BA (-9.8 kcal/mol) against the GABAA receptor (α1 and β2 subunits) compared to DZP (-8.4 kcal/mol). It also exhibited good pharmacokinetic characteristics and was less toxic than the DZP. Overall, our in vivo and in silico studies suggest that GA showed promising sedative activity. However, further investigation, including clinical trials, is needed to discover its medicinal potential.

The postpartum period is marked by significant physiological and psychological changes, placing mothers at heightened risk for mental health disturbances such as anxiety, depression, and insomnia. While breastfeeding is widely recognized for its physical and emotional benefits, its association with maternal mental health outcomes in low- and middle-income countries, particularly Lebanon, remains underexplored. This study aimed to assess the relationship between breastfeeding practices (exclusive breastfeeding at 6 months and breastfeeding continuation at 12 and 24 months) and insomnia, anxiety, and depression among Lebanese mothers, adjusting for sociodemographic, pregnancy and delivery, dietary, and lifestyle variables. A cross-sectional online survey was administered in 2023-2024 to Lebanese mothers who had given birth between 2018 and 2023. Participants (n = 305) completed validated tools including the Patient Health Questionnaire (PHQ-4) for anxiety and depression, the Women's Health Initiative Insomnia Rating Scale (WHIIRS), and questionnaires on breastfeeding practices, sociodemographic status, dietary habits, and household food security. Statistical analyses examined associations between breastfeeding behaviors and mental health outcomes. Exclusive breastfeeding at 6 months was not associated with maternal insomnia, anxiety, or depression. In contrast, breastfeeding continuation at 12-24 months was positively associated with insomnia (aOR = 2.15). Beyond breastfeeding indicators, insomnia was also associated with anxiety (aOR = 2.42) and with lifestyle-related factors, including lower adherence to the Mediterranean diet (aOR = 0.80). Anxiety was associated with perinatal factors (shorter pregnancy duration: aOR = 0.89; absence of immediate skin-to-skin contact: aOR = 0.49), family characteristics (higher parity: aOR = 1.70), lifestyle factors (tobacco use: aOR = 2.69), and co-occurring mental health symptoms (depression: aOR = 19.79; insomnia: aOR = 2.36). Depression was primarily associated with food insecurity (aOR = 1.15) and anxiety (aOR = 20.00), and was inversely associated with alcohol consumption (aOR = 0.37). Overall, anxiety and depression were more consistently related to social, behavioral, and socioeconomic determinants than to breastfeeding practices. These results underscore the importance of routine perinatal mental health screening, in line with current recommendations, and of interventions targeting modifiable factors such as tobacco use and food insecurity, rather than framing breastfeeding itself as a risk factor for maternal mental health difficulties.