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Natural Sleep Aids
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Natural Sleep Aids

Maybe you've just crossed a few time zones, or you work the night shift, or you're just stressed out and it's interfering with your sleep. A natural remedy may help you get some restful sleep.

In some cases, insomnia may be a sign of an underlying illness. Talk with your doctor about this possibility. However, if there does not appear to be such a condition interfering with your ability to snooze, some of these natural options may help you get quality sleep.

Valerian

For centuries, people have turned to the herb valerian to help them sleep. The particular plant species that is used to counter insomnia is Valeriana officinalis. Like other orally administered sleep aids, valerian is recommended for occasional insomnia only. Though it is unclear exactly how valerian works, some research suggests that, like sleeping pills, valerian affects the neurotransmitter GABA. This is still under debate. While not all clinical trials have shown valerian to be effective for sleep, there have been a number of positive studies.

The best study to date of valerian's effectiveness in treating insomnia involved 121 people followed for 28 days. Half of the participants took 600 mg of an alcohol-based valerian extract 1 hour before bedtime, the other half took a placebo. At first, there appeared to be no benefits to taking the valerian, but by the end of the study the participants treated with valerian were sleeping significantly better.

In another large study, valerian was immediately more effective than placebo. This trial followed 128 subjects who had no sleeping problems. On three consecutive nights they took either valerian, a valerian-hops combination, or placebo. The results showed that on the nights they took valerian alone, participants fell asleep faster than when they were taking placebo or the combination.

Other studies have found valerian to be equally as effective as the sleep aids oxazepam and bromazepam. There has also been some preliminary evidence that the combination of valerian and lemon balm can improve sleep quality.

The FDA categorizes valerian as GRAS—generally recognized as safe. A few people experience mild gastrointestinal distress when taking valerian, and there have been rare reports of people developing a paradoxical mild stimulant effect from valerian. Valerian does not appear to impair driving ability or produce morning drowsiness when it is taken at night, though it is recommended that you do not drive immediately after taking valerian. There have been some reports, however, of dangerous side effects from products containing valerian in combination with other potentially toxic herbs or medications, like benzodiazepines.

How to Use It

For insomnia, the standard dosage of valerian is 2 g to 3 g of dried herb, 270 mg to 450 mg of an aqueous valerian extract, or 600 mg of an alcohol-based extract, taken 30 to 60 minutes before bedtime. According to the study mentioned previously that used this dosage, valerian may require weeks to reach its full effects. If you are interested in valerian, be sure to inform your doctor before taking it.

Note: There can be risks in abruptly discontinuing benzodiazepine drugs. Consult your physician for advice.

Melatonin

Our bodies use the hormone melatonin to help regulate our sleep-wake cycles. When exposure to light decreases, the pineal gland (located in the brain) makes serotonin and then converts it to melatonin. Taking supplemental melatonin seems to stimulate sleep when the natural cycle is disturbed. Although several studies have supported the use of supplemental melatonin to treat insomnia, there are also many studies that have found this supplement to have no effect.

Reasonably good evidence tells us that melatonin can help people with jet lag or other similar sleep disturbances adjust to a new schedule, although there have been negative studies as well. Melatonin may also be helpful for many other forms of insomnia, although the evidence isn't entirely consistent.

For instance, studies of melatonin for the treatment of insomnia related to shift work have yielded relatively unimpressive results, though generally positive results have been seen with the use of melatonin for improving sleep in the elderly. Often, results are inconsistent. For instance, while some subjects found most improvement in terms of falling asleep, others found it helpful in different parts of the sleep cycle (such as staying asleep in the middle of the night). Other small studies have found that taking melatonin can improve the quality of sleep.

Melatonin may also be beneficial for people who have difficulties falling asleep until early morning, a condition called delayed sleep phase syndrome (DSPS). In addition, individuals trying to quit using sleeping pills in the benzodiazepine family may find melatonin helpful.

How to Use It

Melatonin is usually taken 30-60 minutes before bedtime. The optimal dose has not yet been defined, but studies have found positive results with doses ranging from 2 mg to 10 mg. Ask your doctor what a safe dosage is for you.

Note: The long-term safety of melatonin usage has not been established. Do not give your child melatonin except under physician supervision.

Other Herbs and Supplements

Ginseng root has been used for a variety of health-promoting properties. Several studies indicate that some of the effects of ginseng on general well being may be related to its effects on maintaining normal sleep. In a study conducted for 12 weeks, a daily dose of 40 mg significantly improved quality of life, including sleep.

Several other herbs have been suggested to help promote sleep and reduce insomnia, such as kava , chamomile , and passionflower . However, there is very little scientific evidence for their efficacy. Again, talk these over with your doctor before trying them.

Acupuncture

Acupuncture involves the insertion of tiny needles into specific points on the body. According to Traditional Chinese Medicine (TCM), the balanced flow of a “vital force” called qi (pronounced "chee") maintains the health of body and mind. In TCM, insomnia is thought to result from an imbalance of this qi, and acupuncture is believed to restore this balance—thereby improving sleep.

One randomized, controlled study of 40 people with sleeping difficulties found that those given acupuncture for three to five sessions at weekly intervals showed significant improvements in an objective measure of sleep. People in the control group had needles inserted, but in non-acupuncture points, and therefore did not know which intervention they were receiving. The therapists, however, could not be blinded to which therapy they were giving, so it is possible that the effects of the therapist—which could not be measured—may have affected the results.

It is unclear exactly how this therapy could help induce sleep. One theory is that acupuncture causes the release of chemicals in the central nervous system that promote calmness and sleep.

Acupressure

Acupressure stimulates the same healing points used in acupuncture, but does so with manual pressure, rather than needles. Proponents of acupressure feel that it can help relieve tension and many common stress-related ailments, including insomnia.

A single-blind, placebo-controlled study, done on 84 nursing home residents, found that those who received five minutes of acupressure, five times weekly for three weeks fell asleep faster and slept more soundly than those who did not receive this therapy. This study has limitations, though. Again, the therapists could not be blinded to the therapy they were providing. Those in the control group could not be blinded either—they received only conversation.

Mind-Body Therapies

There is good evidence that mental and/or physiologic arousal causes insomnia. Therapies that aim to relax the body and the mind have shown some success in helping people get to sleep. These therapies include:

  • Progressive relaxation—the tensing and relaxing of various voluntary muscle groups throughout your body in an orderly sequence. The theory is that when you are emotionally tense, you unconsciously clench or tighten your muscles. Progressively relaxing your muscles releases both the physical and mental tension.
  • Meditation—the focusing of your mind continuously on one thought, word (mantra), object, or mental image for a period of time. It can also involve focusing on your breathing or on sensations in your body. The goal of meditation is to quiet your mind.
  • Hypnosis—a state of inner absorption, concentration, and focused attention. The unconscious mind is allowed to take over, and positive imagery and suggestions are used to help improve mental and physical health.
  • Yoga—a practice that includes physical exercises, postures, balancing, breathing techniques, and meditation

Lifestyle Habits

There are a few things you can change in your lifestyle to promote good sleep. For example:

  • Begin a safe exercise program with the advice of your doctor.
  • If you smoke, quit.
  • Cut down on alcohol and caffeine.
  • Establish a regular sleep cycle.

RESOURCES:

National Center for Complementary and Alternative Medicine
http://nccam.nih.gov/

National Sleep Foundation
http://www.sleepfoundation.org/

CANADIAN RESOURCES:

The Canadian Sleep Society
http://www.css.to/

Better Sleep Council Canada
http://www.bettersleep.ca/default_main.aspx/

References:

Attele AS, Xie JT, Yuan CS. Treatment of insomnia: an alternative approach. Altern Med Rev. 2000;5:249-59. Review.

Complementary Therapies. National Center for Complementary and Alternative Medicine website. Available at: http://nccam.nih.gov/.

Gooneratne NS.Complementary and alternative medicine for sleep disturbances in older adults. Clin Geriatr Med. 2008;24:121-138, viii. Review.

National Sleep Foundation website. Available at: http://www.sleepfoundation.org/ .

Marasco AC, Ruiz RV, Villagomex AS, Infante CB. Double-blind study of a multivitamin complex supplemented with ginseng extract. Drugs Under Exp Clin Res. 1996;22:323-329.

Melatonin. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114. Updated June 2008. Accessed July 29, 2008.

Valerian. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114. Updated May 2008. Accessed July 29, 2008.

Wing YK. Herbal treatment of insomnia. Hong Kong Med J. 2001;7:392-402. Review.



Last reviewed June 2008 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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