Integrative Health Psychology

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Complementary and Alternative Medicine Therapies for Insomnia, Part I: Herbal and Natural Supplements

(From the article originally posted on GoodTherapy.org)

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Insomnia is among the most common complaints that people bring to healthcare providers. Approximately 20% of adults will experience insomnia in a given year. Of these, a small percentage will use one or moreCAMtreatments in an effort to get some shuteye. Women are more likely to experience insomnia than men; however, men still represent about 40% of those who have significant sleep problems. Additionally, insomnia becomes more common as we age; over time, it is more likely to coincide with other health problems. People who suffer from depression, anxiety, and schizophrenia often have difficulty sleeping. Poor sleep is associated with resultant mood symptoms, daytime sleepiness, and difficulty concentrating in both those with and without preexisting mental health issues, however.

Very often, sleep problems are treated conventionally using drugs that specifically target insomnia, as well as medications to reduce anxiety. Many times, sleep quality remains poor even following treatment with medications, unfortunately.

CAM Therapies for Sleep

The most commonCAMtherapies used for sleep are herbal remedies/nutritional supplements, and relaxation techniques. With regard to herbs, the most commonly used are valerian and kava kava. Melatonin is a non-herbal supplement that is also frequently used to treat sleep problems.

Kava Kava

Kava kava has been shown in several studies to decrease feelings of mild anxiety and symptoms of insomnia, and there are anecdotal reports of kava’s ability to do so without alterations in consciousness. At the present time, kava is not recommended as a safeCAM treatment because of reports significant side effects, as well as liver toxicity associated with larger doses or long term use. Because of the above, kava should be avoided by those who have health problems, and especially by those who have liver problems. People who consume alcohol should avoid kava as well.

Valerian

A larger number of studies have examined whether the herb valerian is effective for treating insomnia. In many of these, valerian decreased the time it took for participants to fall asleep and in some studies, it lengthened total sleep time and/or improved sleep quality. Frequently, it took a few weeks before the benefits of using valerian were observed. In other studies, valerian has been considered ineffective for treating insomnia. As opposed to kava, valerian is considered to be generally well tolerated although some side effects, such as headaches and digestive upset, and some rare toxic effects have been reported. There is no long term data with regard to valerian’s safety; thus, caution should be used with regard to this herb. Doses of valerian have varied widely in the studies conducted to date. The generally recommended dose is 450-600 mg taken about 2 hours before bedtime.

Avoid taking valerian if you are drink alcohol or are taking medications with sedative effects, such as barbituates or benzodiazapenes, as it is unclear if valerian will increase sedation beyond that associated with these substances.  For more information about valerian, consult the link from the National Institutes of Health below.

Melatonin

Melatonin is a hormone that occurs naturally in the body. It is associated with regulating circadian rhythms (your 24-hour wake-sleep cycle). Reviews of the research to date are conflicting with regard to the possible benefits of melatonin supplementation. Some studies have found that melatonin improved sleep in patients with major depression as well as for those with schizophrenia. Other research has found that melatonin improved both mood and sleep in those with seasonal affective disorder. There is also some evidence that melatonin improved sleep in studies of children presenting with Asperger’s Syndrome, ADHD, and Angelman syndrome (a rare genetic disorder).

Other research suggests that melatonin will not increase either the amount or quality of sleep for those who already sleep well. In people who have delayed sleep onset syndrome, melatonin appears to help decrease the amount of time it takes to fall asleep, and this effect is more pronounced in children under age 17 than in adults or the elderly. Although melatonin has been shown to decrease the time it takes to fall asleep in those for whom insomnia is the primary problem, the benefits are thought to be minimal. For those whose insomnia is secondary to another medical condition, the benefits of melatonin seem to be similarly small. Finally, melatonin may help alleviate some of the daytime sleepiness associated with jetlag, however, the evidence regarding whether it will improve actual sleep quality in travelers or others who have sleep restrictions (such as those who perform shift work) has varied.

Melatonin appears to be safe with minimal side effects reported.  Because melatonin is a hormone, however, care should be taken with regard to its use, as it is unclear if taking too much could create additional problems. Furthermore, people taking certain medications should avoid using melatonin (see the NIH guidelines below for more information). More research is necessary to say definitively what the benefits or possible risks are related to taking melatonin, therefore, it is advisable to consult a physician with expertise in treating sleep disorders when considering using this or other herbal or supplements for insomnia.

The CAMtherapies that are considered to be the safest, and which have the most convincing evidence of benefit in improving sleep are mind-body therapies. These include relaxation training, cognitive-behavioral therapy, and biofeedback, among others. These will be covered in more detail in the next article, CAM for Insomnia, Part II: Mind-Body Therapies.

In the meanwhile, the following are some don’t’s  and do’s with regard to improving sleep:

Don’t:

  • …eat heavy meals within a few hours of bedtime. Doing so may make it difficult to fall or remain asleep.  Nor should you go to bed hungry, as this, too, can interfere with a good night’s sleep. If you find yourself hungry as bedtime approaches, have a small, carbohydrate-rich snack, such as a banana.
  • Avoid daytime napping, so you will feel appropriately sleepy at bedtime.
  • Decrease or avoid consuming alcohol and caffeine altogether, as these substances can interfere with sleep even hours later.

Do:

  • …engage in regular physical activty, and make sure to spend some time outside during daylight hours. Doing so may help normalize circadian rhythms.
  • Prior to bedtime, engage in some form of relaxation to prepare your body for sleep.
  • Use the bedroom only for sleeping and sex (e.g., avoid watching TV in bed). This will help strengthen your body’s association of the bedroom with sleep.
  • Be patient – it may take some time to see improvements in sleep after making the above changes.

References:

Buscemi N., Vandermeer B., Pandya R., et al. Melatonin for Treatment of Sleep Disorders. Summary, Evidence Report/Technology Assessment: Number 108. AHRQ Publication Number 05-E002-1, November 2004. Agency for Healthcare Research and Quality,Rockville,MD. http://www.ahrq.gov/clinic/epcsums/melatsum.htm

Mischoulon, d. (2008). Herbal remedies for anxiety and insomnia: Kava and Valerian. In D. Mischoulon and J. F. Rosenbaum (Eds.), Natural Medications for Psychiatry: Considering the Alternatives.Philadelphia: Lippincott  Williams & Wilkins.

National Institutes of Health/Medline Plus – Information on Melatonin

http://www.nlm.nih.gov/medlineplus/druginfo/natural/940.html

National Institutes of Health/Office of Dietary Supplements – Information on Valerian

http://ods.od.nih.gov/factsheets/Valerian

Zhdanova, I.V., & Friedman, L. (2008). Therapuetic Potential of Melatonin in Sleep and Circadian Disorders. In D. Mischoulon and J. F. Rosenbaum (Eds.), Natural Medications for Psychiatry: Considering the Alternatives.Philadelphia: Lippincott  Williams & Wilkins.

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