A Natural Approach to Sweet Slumber

Sharon Palmer, R.D.

Environmental Nutrition Newsletter

Do you have trouble getting a good night's sleep? If you do, you're not alone. About one-third of Americans complain of sleep disorders--meaning any disorder that affects, disrupts or involves sleep.

Insomnia (from the Latin insomnis, meaning sleepless) is the most common kind of sleep disorder. If you're unlucky enough to suffer from a sleep disorder, you know how debilitating it can be; it can cause fatigue, moodiness, impaired function, higher risk of injury, and anxiety during your waking hours. In fact, inadequate sleep is even connected with a higher risk of health conditions like high blood pressure, heart attack, stroke and obesity.

Prescription sleep medications are a common, effective approach to treating sleep disorders, but many people experience unpleasant side effects from them, such as prolonged drowsiness or headaches. So, it's no big surprise that a growing number of people turn to alternative therapies like herbal supplements. In a scientific survey of more than 2,500 adults published in the Jan.16, 2002 issue of the Journal of the American Medication Association, it was reported that three percent of herbal supplement consumers use them as a sleep aid.

NATURAL APPROACHES FOR SLEEP

From acupuncture and Tai Chi to biofeedback and herbal supplements, a wide range of alternative therapies claim to help you sleep the "natural" way. Herbal supplements that claim sleep benefits include GABA (gamma-aminobutyric acid), St. John's wort, chamomile, and the sleep aid superstars melatonin and valerian.

Unfortunately, there is not a lot of science that proves they really work. In 2006, the American Academy of Sleep Medicine (AASM) issued a position statement on the treatment of insomnia with herbal supplements, concluding that there is only limited scientific evidence that they are effective sleep aids and they should be taken only if approved by a physician.

Let's take a closer look at the popular sleep aid supplements, valerian and melatonin.

-- Valerian (Valeriana officinalis) is not a newcomer to the natural sleep aid movement; it's been used as a sleep remedy for more than 1,000 years. A crowning bouquet of pink-white flowers is the signature for the valerian plant, which tends to grow in marshy areas throughout Europe and Asia. But the medicinal power of valerian hides below the ground in its roots, which produce a disagreeable odor that can only be compared to stinky feet.

Scientists don't completely understand how valerian works, although some evidence suggests that it may affect the neurotransmitter GABA in the central nervous system, which is the same way many prescribed sleep aids work.

Following its historical use in ancient medicine, valerian is still commonly used as an over-the-counter treatment for insomnia in Europe. Yet, the science does not yet definitively prove valerian's role in treating insomnia. In a June 2007 systematic review published in Sleep Medicine Reviews, researchers concluded that valerian is safe, but probably not effective for treating insomnia.

The field of valerian research is a complicated stew of conflicting results. In one well-designed study published in Psychopharmakotherapie in 1996, participants taking 600 milligrams of valerian one hour before bedtime did not report sleep improvements immediately, but by the 28th day, 66 percent of study subjects rated its effectiveness as good or very good.

Yet, other less well-designed studies found immediate sleep benefits for valerian, and four more recent studies found no sleep benefits at all. In a web-based, randomized 2007 trial of valerian in PLoS ONE, researchers found modest sleep benefits linked with valerian.

"AASM has done a thorough review on all of the literature, and their conclusion is that there is limited evidence that valerian may be effective in treating insomnia. The valerian research studies aren't strong, but there is some support that it seems to help some people," says Donna Arand, Ph.D., who is board certified in sleep medicine, a fellow of AASM, Clinical Director of Kettering & Sycamore Sleep Center, and Research Associate Professor at Wright State University Boonshoft School of Medicine in Ohio.

On the positive side, few adverse effects have ever been reported for valerian, though studies have not evaluated any potential long-term health risks.

-- Melatonin doesn't come from an herb or plant--it's a hormone that's naturally produced by the pineal gland in your brain. Your body uses melatonin as part of its normal control of the sleep-wake cycle, also known as circadian rhythm. The pineal gland makes serotonin and then turns it into melatonin when your exposure to light decreases. When you're in a completely dark room your body produces more melatonin, but when the light increases the melatonin levels drop.

The science on melatonin and sleep disorders is replete with conflicting research. In a 2004 USDA Agency for Health Care Research and Quality report on melatonin for treatment of sleep disorders, the scientists concluded that current evidence suggests it is not effective in treating most primary sleep disorders with short-term use.

"The studies on the effectiveness of melatonin in treating insomnia are contradictory at times. It appears that melatonin may be more helpful in treating circadian rhythm problems," summarizes Arand.

A 2001 Cochrane Database of Systematic Reviews found that melatonin supplements were helpful for those with insomnia related to jet lag. In addition, sleep improvements have been seen in specific conditions, such as sleep disorders in the blind, people withdrawing from sleeping medications, children with developmental disabilities or chronic sleep problems, and people with diabetes, schizophrenia, Alzheimer's or Parkinson's diseases, or who are hospitalized.

Arand reports that short-term melatonin appears to be safe, although long-term trials are needed to determine if there are any health risks for longer periods of use.

[Read 9 Safe Ways to Help Cure Insomnia]

AT THE END OF THE DAY

The science on herbs for sleep looks a little gloomy, but that doesn't mean it's a complete wash. Arand stresses that there is a dearth of good quality studies for sleep supplements. It could be that future research will paint a more positive picture for such natural remedies.

And what about the countless people who swear by herbal sleep remedies? Even though benefits could be attributed to the "placebo effect" (about 30 percent of people report benefits when they take a placebo (an inert medication), Arand suggests that people continue to use their supplements if they feel that they work for them.

Keep in mind, however, that the sale of herbal supplements is a multi-million-dollar industry and that the safety and accuracy of the information that appears on these products is not as tightly regulated as it is for drugs.

Supplements may be marketed and sold without prior approval from the U.S. Food and Drug Administration. Before you try herbal sleep remedies, check with your physician.

[Read Suffer From Insomnia -- Try Cognitive Behavioral Therapy]

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