Targeted Natural Interventions
Amino Acids and Hormones
Melatonin. Melatonin, a hormone made in the pineal gland, is highly correlated with the body's sleep-wake cycle. In humans, elevated melatonin levels coincide with the body's normal time for sleeping. Low melatonin levels have been linked to insomnia, particularly in the elderly. In a clinical review, serum melatonin levels were reported to be significantly lower (and the time of peak melatonin values delayed) in elderly subjects with insomnia compared to age-matched normal controls (Cardinali 2012).
Several studies have found that melatonin supplementation is able to improve sleep. One study found melatonin helped reduce the amount of time needed to fall asleep (Geijlswijk 2010). Other studies have found it improves sleep quality and alertness after sleep (Lemoine 2012), as well as reduces the number of times subjects wake up during the night (Garfinkel 2011). Despite these successful studies, melatonin is not always an effective solution for those with severe chronic insomnia.
L-Tryptophan. L-tryptophan is an amino acid that serves as a precursor for serotonin and melatonin (Richard 2009; Peuhkuri 2012). L-tryptophan supplements may increase the amount of melatonin made by the pineal gland, thus facilitating sleep (Paredes 2009a). Early studies found 1 gram of L-tryptophan could reduce the amount of time needed to fall asleep (Hartmann 1974). Like melatonin, L-tryptophan levels decrease with age (Paredes 2009a). Therefore, L-tryptophan supplementation may aid in the treatment of elderly insomnia.
Animal studies have found that tryptophan supplementation reduced activity at night and lead to other biological changes that are conducive to sleep, such as a lower core body temperature and reduced levels of interleukin-6 (an inflammatory cytokine) (Paredes 2009b). In one small human clinical trial, intravenous infusion of L-tryptophan caused dramatic increases in plasma melatonin levels and had a sleep-inducing effect, regardless of whether it was administered during the day or night (Hajak 1991). In addition, L-tryptophan may help alleviate some forms of depression, which can exacerbate insomnia (Silber 2010).
Magnesium. Magnesium is a mineral that plays a role in cellular communication and regulation of circadian rhythms (Durlach 2002). As sleep restriction increases, intracellular magnesium concentrations decline (Omiya 2009). Magnesium supplementation combined with melatonin and zinc has been shown to improve sleep in the elderly (Rondanelli 2011). Another trial found that magnesium supplementation helped relieve insomnia related to restless legs in subjects mean age 57 years (Hornyak 1998). A form of magnesium known as magnesium threonate may be beneficial for sleep since it has been shown to penetrate the blood-brain barrier more efficiently than other forms of magnesium (Abumaria 2011; Slutsky 2010).
Zinc. Zinc may also play a role in facilitating sleep (Rondanelli 2011). Research found that women with the highest levels of zinc in their bodies slept for longer periods of time than women with the lowest levels (Song 2012). As mentioned above, when combined with melatonin and magnesium, zinc also supported quality of sleep in the elderly (Rondanelli 2011). Among children with attention-deficit/hyperactivity disorder, zinc (in combination with magnesium and omega-3 & omega-6 fatty acids) helped relieve problems falling asleep (Huss 2010).
Valerian. Valerian is a sedative herb that has been used since the 18th century for the treatment of insomnia (Fernandez-San-Martin 2010). The putative mechanism of valerian root is interaction with the GABA system in the brain, thus helping reduce brain activity and allowing users to fall asleep more easily. Valerian affects the transport and liberation of GABA, modulating GABAergic signaling. Valerian also improves quality of sleep; one study demonstrated that valerian increases the percentage of time participants spend in slow-wave sleep. This is significant because slow-wave sleep is considered the most refreshing sleep (Alt Med Review 2004). One study compared the effects of 600 mg of valerian to the commonly prescribed tranquilizer oxazepam. During 6 weeks of treatment, valerian showed comparable efficacy to 10 mg of oxazepam (Ziegler 2002). Evidence also suggests that the side effect profile of valerian is superior to commonly prescribed sleep aids. In one small study, subjects taking valerian reported none of the mood-altering or negative cognitive effects demonstrated by diazepam (Gutierrez 2004). The typical dose of valerian is about 300 to 600 mg, 30 to 120 minutes before going to bed sleep (Fernandez-San-Martin 2010). It may take up to two weeks of daily usage for the full sedative effect of valerian to manifest (Anderson 2010).
Chamomile. Chamomile is a popular herb often used as a tea to promote sleep and relaxation (Sanchez-Ortuno 2009; Zick 2011). It was noted in a study on rats that chamomile had a mild hypnotic effect (much like benzodiazepines) and improved sleep onset latency (Shinomiya 2005), though it is not clear how it has this effect. One clinical trial found that chamomile improved daytime functioning of humans with sleep problems (Zick 2011). More research needs to be done to determine the benefits and drawbacks of using chamomile for sleep.
Passionflower (Passiflora incarnata). Passiflora incarnate (P. incarnata), a member of the passiflower genus Passiflora, is best known for its sedative and anxiety-reducing effects(Dhawan 2004). The active compounds in P. incarnata appear to interact with the GABA and opioid systems (Nassiri-Asl 2007; Dhawan 2002; Appel 2011). In an animal model, P. incarnata was shown to reduce anxious behavior (Dhawan 2002). Additionally, another animal model found that passionflower-derived compounds were able to prevent diazepam dependence in mice when given along with the drug over a three week period (Dhawan 2003). More human studies are needed to evaluate the effectiveness and safety of passiflora products.
Ashwagandha. Withania somnifera, also known as Ashwagandha, is an Indian herb that may be beneficial for treating insomnia. This herb has been best characterized for its effects on stress, as several animal studies have found that it is able to improve the ability to handle stress and can significantly reduce anxiety (Archana 1999; Bhattacharya 2000; Kumar 2007). Because emotional stress can be a significant contributor to insomnia, using ashwagandha to reduce stress may help improve sleep. This herb has also been found to directly improve sleep in animal models; it appears to do so by increasing GABAergic activity (Kumar 2008).
Lemon Balm. Lemon balm is an herb traditionally used for its calming and anxiety-reducing effects (Raines 2009; Weeks 2009). One double-blind, placebo-controlled, randomized study showed that 600 mg of lemon balm improved mood and significantly increased self-ratings of calmness (Kennedy 2004). Lemon Balm has also been investigated in the treatment of sleep problems. A study found that a combination of valerian and lemon balm was able to treat sleeping disorders in children. About 81% of them experienced improvement of their symptoms after taking the study preparation (Muller 2006).
Lavender (as essential oil aromatherapy). Aromatherapy is an alternative medicine practice that utilizes plant oils to treat health problems. Lavender oils have been extensively studied for the treatment of insomnia. Studies have found that lavender oil improves sleep quality (Chien 2012; Lewith 2005) and reduces feelings of drowsiness after awakening (Hirokawa 2012).
Additional Natural Therapies Bioactive milk peptides. Select peptides, made by breaking down milk proteins with enzymes, may relieve stress related sleep disorders (Kim 2007). These bioactive peptides were able to increase the amount of time spent sleeping and reduce the amount of sleep needed after just two weeks of treatment (Saint-Hilaire 2009). Lactium, one of the trade names for this uniquely formulated product, is sometimes combined with melatonin to improve sleep by taking advantage of the sleep promoting effects of both bioactive milk peptides and melatonin.