According to recent reports, many people today have a serious problem getting a good night's sleep. Our lives are simply too busy for us to get the 8 hours we really need. To make matters worse, many of us suffer from insomnia. When we do get to bed, we may stay awake thinking for hours. Sleep itself may be restless instead of refreshing.
Most people who sleep substantially less than 8 hours a night experience a variety of unpleasant symptoms. The most common are headaches, mental confusion, irritability, malaise, immune deficiencies, depression, and fatigue. Complete sleep deprivation can lead to hallucinations and mental collapse.
The best way to improve sleep involves making lifestyle changes: eliminating caffeine and sugar from your diet, avoiding stimulating activities before bed, adopting a regular sleeping time, and gradually turning down the lights. More complex behavioral approaches to improving sleep habits can be adopted as well.
Many drugs can also help with sleep. Such medications as Sonata, Lunesta, Ambien, Restoril, Ativan, and Xanax are widely used for sleep problems. Of these, only Lunesta has been tested for long-term use. All of these medications are in essence tranquilizers, and therefore, have potential for dependence and abuse; the newer sleep-inducing drug Rozerem (ramelteon) acts like an enhanced version of the supplement melatonin (
Antidepressants can also be used to correct sleep problems. Low doses of certain antidepressants immediately bring on sleep because their side effects include drowsiness. However, this effect tends to wear off with repeated use. For chronic sleeping problems, full doses of antidepressants can sometimes be helpful. Antidepressants are believed to work by actually altering brain chemistry, which produces a beneficial effect on sleep. Trazadone and amitriptyline are two of the most commonly prescribed antidepressants when improved sleep is desired, but most other antidepressants can be helpful as well.
Principal Proposed Natural Treatments
Although the scientific evidence isn't yet definitive, the herb valerian and the hormone melatonin are widely accepted as treatments for certain forms of insomnia.
Valerian has a long traditional use for insomnia, and today it is an accepted over-the-counter treatment for insomnia in Germany, Belgium, France, Switzerland, and Italy. However, the evidence that it really works remains inconsistent and incomplete.
A systematic review published in 2007 concluded that valerian is safe but probably not effective for treating insomnia.
Valerian is most commonly recommended to be used as needed for occasional insomnia. Interestingly, however, the results of the largest and best designed positive study only found benefits regarding long-term improvement of sleep.
Although positive, these results are a bit confusing, because in another large study valerian was effective on an immediate basis, which is more in keeping with how the herb is typically used.
A study of 184 people that tested a standardized combination of valerian and hops, with mixed results.
Other studies have compared valerian (either alone or in combination with
Mixed results like these suggest that valerian is at most modestly helpful for improving sleep.
For more information, including dosage and safety issues, see the full
The body uses melatonin as part of its normal control of the sleep-wake cycle. The pineal gland makes serotonin and then turns it into melatonin when exposure to light decreases. Strong light (such as sunlight) slows melatonin production more than weak light does, and a completely dark room increases the amount of melatonin made more than a partially darkened room does. Taking melatonin as a supplement seems to stimulate sleep when the natural cycle is disturbed. It may also have a direct sedative effect.
Although not all studies were positive, reasonably good evidence indicates that melatonin is helpful for insomnia related to
, according to a major review published in 2001.
Mixed results have been seen in studies involving the use of melatonin for ordinary insomnia, insomnia in swing-shift workers, and insomnia in elderly people.
A 4-week, double-blind trial evaluated the benefits of melatonin for children with difficulty falling asleep.
Many individuals stay up late on Friday and Saturday nights, and then find it difficult to go to sleep at a reasonable hour on Sunday. A small double-blind, placebo-controlled study found evidence that use of melatonin 5.5 hours before the desired Sunday bedtime improved the ability of participants to fall asleep.
Benefits were seen in a small double-blind trial of patients in a pulmonary intensive care unit.
Blind people often have trouble sleeping on any particular schedule because there are no light cues available to help them get tired at night. A small double-blind, placebo-controlled crossover trial found that the use of melatonin at a dose of 10 mg per day was able to synchronize participants sleep schedules.
Some individuals find it impossible to fall asleep until early morning, a condition called delayed sleep phase syndrome (DSPS). Melatonin may be beneficial for this syndrome.
In addition, people trying to quit using sleeping pills in the benzodiazepine family may find melatonin helpful. A double-blind, placebo-controlled study of 34 individuals who regularly used such medications found that melatonin at a dose of 2 mg nightly (controlled-release formulation) could help them discontinue the use of the drugs.
Note: There can be risks in discontinuing benzodiazepine drugs. Consult your physician for advice.
For more information, including dosage and safety issues, see the full
Other Proposed Natural Treatments
In a trial involving 28 women, 6 weeks of auricular (outer ear) acupuncture, in which needles are placed in the outer ear, was more effective than sham acupuncture.
Preliminary evidence suggests that
Numerous controlled studies have evaluated
Herbs used for anxiety are commonly recommended for insomnia as well. As noted above, hops and lemon balm have been studied in combination with valerian. One double-blind study found that the anti-anxiety herb
Other herbs reputed to offer both anti-anxiety and anti-insomnia benefits include
A number of supplements might offer benefits for improving mental function during periods of sleep deprivation. See the
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Last reviewed April 2009 by EBSCO CAM Review Board
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