Oral magnesium supplementation for insomnia in older adults: a Systematic Review & Meta-Analysis

Abstract

Background: Magnesium supplementation is often purported to improve sleep; however, as both an over-the-counter sleep aid and a complementary and alternative medicine, there is limited evidence to support this assertion. The aim was to assess the effectiveness and safety of magnesium supplementation for older adults with insomnia.

Methods: A search was conducted in MEDLINE, EMBASE, Allied and Complementary Medicine, clinicaltrials.gov and two grey literature databases comparing magnesium supplementation to placebo or no treatment. Outcomes were sleep quality, quantity, and adverse events. Risk of bias and quality of evidence assessments were carried out using the RoB 2.0 and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approaches. Data was pooled and treatment effects were quantified using mean differences. For remaining outcomes, a modified effects direction plot was used for data synthesis.

Results: Three randomized control trials (RCT) were identified comparing oral magnesium to placebo in 151 older adults in three countries. Pooled analysis showed that post-intervention sleep onset latency time was 17.36 min less after magnesium supplementation compared to placebo (95% CI - 27.27 to - 7.44, p = 0.0006). Total sleep time improved by 16.06 min in the magnesium supplementation group but was statistically insignificant. All trials were at moderate-to-high risk of bias and outcomes were supported by low to very low quality of evidence.

Conclusion: This review confirms that the quality of literature is substandard for physicians to make well-informed recommendations on usage of oral magnesium for older adults with insomnia. However, given that oral magnesium is very cheap and widely available, RCT evidence may support oral magnesium supplements (less than 1 g quantities given up to three times a day) for insomnia symptoms.

Keywords: Geriatrics; Insomnia; Magnesium; Sleep; Supplementation.

Fig. 1

Possible biological mechanism & logic model underlying how magnesium supplementation influences older adult insomnia symptoms

Fig. 2

PRISMA flow diagram showing numbers of records identified at different phases of the systematic review

Fig. 3

Risk of bias summary. N.B.: Author’s assessment per risk of bias domain for each included study (above) and author’s assessment per risk of bias domain by percentage across all included studies (below)

Fig. 4

Evidence by vote count for change in insomnia outcomes after magnesium supplementation, a modified effect-direction plot

Fig. 5

Forest plot comparison of magnesium supplementation compared to placebo for sleep onset latency (SOL) outcome. N.B.: Inverse-variance weight method applied; Sleep onset latency converted to same unit (minutes); Statistical tests for heterogeneity (Chi² and I²) can be unreliable with small sample sizes – heterogeneity explored using other strategies

Fig. 6

Forest plot comparison of magnesium supplementation compared to placebo for total sleep time (TST) outcome N.B.: Inverse-variance weight method applied; Sleep onset latency converted to same unit (minutes); Statistical tests for heterogeneity (Chi² and I²) can be unreliable with small sample sizes – heterogeneity explored using other strategies