Functional Melatonin Replacement for Sleep Disruptions in Individuals With Tetraplegia

Inclusion Criteria: * Age 18 years or older, male or female veterans of any racial or ethnic group * Neurologically complete (Frankel A or B) damage to the lower (C4-C8) cervical spinal cord * Absence of melatonin production * Time since SCI is greater than 6 months \[no cases of acute spinal cord injury\] * Subjective complaint of sleep disruption Exclusion Criteria: * Current use of fluvoxamine (Luvox , antidepressant), rifampin (antimycobacterial), ketoconazole (Nizoral , antifungal), or fluconazole (Diflucan , antifungal) \[these interact with the same liver enzyme that is the primary metabolizer of ramelteon\]; use of sleep medications is okay * Hepatic dysfunction * Concomitant use of over-the-counter melatonin * Pregnancy or breast feeding * Currently or have within the past six months met DSM-IV (Diagnosis and Statistical Manual IV) criteria for drug or alcohol abuse or dependence or AUDIT score \>19 * Acute illness or unstable chronic illness. Use of continuous positive airway pressure (CPAP) for treatment of sleep apnea is acceptable. * No travel across three or more time zones within three weeks or during the protocol * Illiterate or unable to read or write English or are judged by the investigator to be unable or unlikely to follow the study protocol