Melatonin (saliva or urine)

ND-recommended test reviewed: melatonin (saliva or urine).
Indications reviewed: insomnia, fatigue, circadian or adrenal imbalance; no validated primary-care indication for this test identified.
Not ordered. Rationale discussed: melatonin level is not standardized for routine diagnosis and does not change management in primary care.
Patient informed test available privately via ND. Patient given info page: https://labs.ajaxharwoodclinic.com/melatonin/patient
Revisit if: symptoms suggest a specific sleep disorder warranting sleep-medicine referral.

Indicated when

None recorded.

Not indicated when

• —Routine testing of a melatonin level to investigate fatigue, insomnia, or 'adrenal'/circadian imbalance in primary care: no guideline reviewed for this record recommends measuring melatonin for these indications
• —Guiding melatonin supplement dosing from a single level

Why not

No guideline located in this batch sets a reference range or a primary-care diagnostic cutoff for a measured melatonin level, so an out-of-range result can't be reliably interpreted or acted on. Timing and light exposure strongly affect melatonin levels (standard physiology, not sourced in this batch; see evidence_notes).

Better first step

For suspected insomnia or disrupted sleep, assess with a sleep history and sleep diary, and refer to sleep medicine if a circadian rhythm or other sleep disorder is suspected, rather than ordering a melatonin level.

Typical ND rationale

An ND may order salivary or urinary melatonin to check whether a disrupted sleep-wake or circadian rhythm is contributing to fatigue or poor sleep, reasoning that a low or mistimed melatonin level explains the symptoms and can guide melatonin dosing.

Ontario coverage & CONO orderability

OHIP status

unverified

Melatonin is explicitly named as not found in the 2026 community Schedule of Benefits for Laboratory Services; absence from the Schedule is not proof it is never covered in any Ontario context, but no Ontario source establishing coverage was found this session. ND-ordered testing is patient-paid regardless [4, 5].

CONO orderable

Yes — CONO list #158, #180

CONO list items 158 (urine) and 180 (saliva), both 'Melatonin.'

Linked conditions

• "Adrenal fatigue" ↗

Counselling script

“A melatonin level isn't something I can reliably act on in this setting — the result depends heavily on light exposure and timing, and there's no standard cutoff that would change what we'd do. Let's focus on your sleep history instead, and I can refer you to sleep medicine if needed.”

Revisit if

• —Symptoms suggest a specific sleep or circadian rhythm disorder warranting sleep-medicine referral

References

1. [1]Endocrine Society (2008). The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. linkolder guidelineMelatonin does not appear among the recommended diagnostic tests for Cushing's syndrome in this guideline
2. [2]Endocrine Society (2016). Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. linkMelatonin does not appear among the recommended diagnostic tests for primary adrenal insufficiency in this guideline
3. [3]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkMelatonin is not a line item in the community lab Schedule of Benefits
4. [4]Government of Ontario (e-Laws) (2026). Health Insurance Act, R.R.O. 1990, Reg. 552: General, s. 22 (insured laboratory services). linkA lab test is insured only when ordered by a physician, midwife, or NP who has clinically assessed the patient
5. [5]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTests ordered by anyone other than an authorized provider, including NDs, are not insured services