Herbal supplements to help you sleep

Can an herbal supplement help me sleep?" Many of my patients ask me this question, and many others never ask but just take a supplement along with their other prescription medications.   The truth is that there aren't many good scientific studies on most herbal supplements. They are not regulated by the Food and Drug Administration in the way prescription medications are, so their benefits—and risks—don't have to be rigorously studied before they are sold, the way prescriptions drugs are.

That said, some people swear by various herbal supplements. If you want to try one, just be sure to talk to your doctor first. Even though supplements are not regulated like drugs, they can have dangerous side effects and alter the way other medications work in your body.  As I always say to my patients, "Why bother taking a prescription drug if you are going to also take a supplement that interacts by either increasing or decreasing the effect of the drug and thus rendering it ineffective or potentially toxic?"  Of course I am not suggesting that they stop their prescription medications, but rather that they talk to me or their other doctors first about everything they are taking—be it prescription or over the counter.

Here's some information—first published in the Harvard Medical School report called Improving Sleep: A guide to a good night's rest—on some dietary supplements used for sleep problems.

Many herbal products include a variety of active ingredients. Even a single herb is a complex chemical stew. Valerian root extract, for example, contains more than 100 specifically identified substances. Researchers don't know precisely which of these accounts for the herb's effect, nor can they say exactly how they might interact with other medications. Finally, the per-dose price of these remedies varies far more than that of standard sleeping pills.

Scientific understanding of these substances is limited, and what we know generally comes from small, short-term studies. Thus, most doctors discourage the use of herbal medicines as sleep aids. But the market for such products is booming. Readily available alternative sleep remedies include the following:

Valerian (Valeriana officinalis). A few studies suggest that valerian is mildly sedating and can help people fall asleep and improve their sleep quality. However, a 2005 review in the Journal of Clinical Sleep Medicine pointed out that most of the studies were small and flawed, and that even the positive studies showed only a mild effect. Also, the National Institutes of Health's 2005 State of the Science Conference statement on insomnia notes that "limited evidence [on valerian] shows no benefit compared with placebo." The most common reported side effects are headaches, dizziness, itching, and gastrointestinal disturbances.

As with other unregulated remedies, the quality of valerian-containing products varies widely. A report by ConsumerLab—a commercial laboratory that periodically tests the quality of herbal remedies—found that nearly a quarter of valerian-based products appeared to contain no valerian whatsoever, and an equal number had less than half the amount claimed on their labels.

Kava (Piper methysticum). Kava comes from a plant cultivated in the South Pacific islands. The German Commission E—which tests the quality and effectiveness of herbal remedies marketed in Germany—has found it effective in the treatment of anxiety. Some studies also report a benefit for treating insomnia. But scientists don't understand how kava works. High doses over prolonged periods can cause skin reactions and liver failure, and in 2002 the FDA warned users of the potential risk of liver damage after a previously healthy 45-year-old woman took kava, suddenly developed liver failure, and required a liver transplant.

Chamomile. Tea made from this flower, a member of the daisy family, is a traditional remedy long used to help people relax and become drowsy. Chamomile is both mild and safe—although rare allergic reactions, including bronchial constriction, can occur. If you're allergic to plants in the daisy family, which includes ragweed, you should probably avoid this herb. There are no scientific studies showing chamomile is effective in treating insomnia.

Synthetic melatonin. The brain's production of the hormone melatonin peaks in the late evening, in conjunction with the onset of sleep. Since the 1990s, a synthetic version has been widely available in the United States as a supplement at health food stores and pharmacies. In Great Britain and Canada, melatonin is classified as a medicine and available by prescription only.

Despite some initial enthusiasm for synthetic melatonin, most subsequent research has been disappointing, finding either minimal benefits or none at all. A 2004 review of the

melatonin research by the federal Agency for Healthcare Research and Quality (AHRQ) concluded that the supplement "is not effective in treating most sleep disorders." However, a subset of people do appear to benefit: those whose insomnia results from delayed sleep phase syndrome a circadian rhythm disorder in which people don't start to feel sleepy until hours after the traditional bedtime. The AHRQ review found that melatonin enables people with this disorder to fall asleep an average of nearly 40 minutes faster than they would with a placebo.

Melatonin does not appear to pose any major health risks when taken for a short time. The most commonly reported side effects are nausea, headache, and dizziness. Its long-term effects are unknown.

Have you tried any of these herbal supplements? Did they help you sleep better? Also, do you always talk to your doctor before you start taking an herbal supplement?

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

Herbs and Supplements
How do herbs and supplements work? Are they safe and effective? Do they do what the label promises? The Buyer's Guide to Herbs and Supplements is a special report from Harvard Medical School that takes an expert look at many popular herbal remedies and other supplements, and provides the answers to your questions.

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