3 Natural Sleep aid treatments for insomniacs

Insomnia is a sleep disorder that involves difficulty in getting to sleep, or staying asleep for long enough to feel refreshed and function normally. At some point in life 50% of all adults with experience insomnia, often triggered by a stressful situation. Some individuals suffering from insomnia explore natural sleep aid as an alternative to pharmacological options in an attempt to find an aid that improves their sleep pattern whilst reducing side effects or reducing the chances of long term dependency. This article compares the natural treatments of valerian, hops and ziziphus, reviewing the evidence base and providing information on their efficacy and safety.

Valerian 

Valerian, or Valeriana officinalis, is a flowering plant that is indigenous to Europe and parts of Asia. In pharmacology and herbal medicine, supplements containing valerian are cultivated from the root of the plant and sold in capsule form. Given its sedative and anxiolytic (anxiety-inhibiting) properties, it is a popular choice of natural remedy for a range of anxiety and sleep related conditions. Its documented use stretches back for hundreds of years, with evidence of its use in both ancient Rome and medieval Sweden for sleep related ailments (1). As well as its most popular use for the temporary relief of disturbed sleep and anxiety, it is also used for mild digestive complaints such as bloating and excessive flatulence.

Hops 

Hops are the female flower of the hop plant Humulus lupulus. Commonly known for their role as a flavouring agent in beer, they are also frequently used in a range of herbal medicine preparations. Hops contain  natural phenols(2). It is thought that the relaxing effect of hops is in part due to the chemical component dimethylvinyl carbinol, yet this is an under-researched and under-tested hypothesis that requires further study.

Ziziphus 

The term ziziphus covers approximately 40 species of shrubs and small trees in the Rhamnaceae family and is commonly used in Traditional Chinese Medicine (TCM). The term ziziphus is usually used as shorthand for Ziziphus spinosa which is used to treat insomnia, as well as heart palpitations and irritability.

Comparisons of effectiveness and safety 

Overall, there is very limited evidence in general regarding natural insomnia treatments. Whilst herbal remedies are reported to have positive effects, there is no significant evidence base on which to test such reports. As they have not been thoroughly tested clinically, little is known regarding both their effectiveness and long-term safety, and more information is also required in regards to how such treatments might comply with conventional treatments, as well as possible positive and negative drug interactions and harmful side effects.

The majority of natural remedies, including valerian, hops and zizyphus, are registered globally with almost all regulatory agencies on the premise that evidence of their efficacy is as a traditional herbal medicine, with no data generated from clinical trials: there is no requirement or statutory responsibility in many countries that run a Traditional Herbal Registration scheme to prove that such products scientifically work and are beneficial for the ailments and symptoms they purport to treat (3).

A recent systematic review, undertaken in Australia in 2010, appraised all relevant studies concerned with the efficacy of both Valerian and Hops in the treatment of insomnia and found some improvements in both sleep latency and quality of sleep (4).

However, its authors also stressed the need to interpret its results cautiously due to poor study designs, a lack of randomised controlled trials, and significant differences between the studies in regards to their design, sample size and eligibility criteria. Another systematic review of the literature, conducted in 2007, concluded that valerian was a safe herbal aid, but it was not clinically efficacious for insomnia (5). Despite being safe, it does come with the possibility of dizziness and drowsiness as a result of its tranquilizing properties: as such, individuals are advised not to drive or operate heavy machinery when taking such remedies. Its other known side effects include allergic reactions, hives or minor breathing difficulties (6).

Dependence and/or tolerance

Again, there is little information available regarding the long-term impact of many herbal remedies for alleviation from insomnia. A small number of studies have expressed concern over potential complications associated with the long term use of valerian, reporting side effects similar to that of established benzodiazepines such as delirium and heart-related complaints (7).

Much of the formal literature on valerian is concerned with side effects and interactions with other medicines. There is very little formal literature on tolerance/dependence in hops, with the large majority of the limited evidence base focusing on the role of hops in providing relief for menstruation-related health problems (8). Overall, there remains little formal evidence that hops and valerian are either beneficial for sleep or have no known association with dependence and tolerance.

There is very little evidence regarding association with dependence in regards to ziziphus.

Of the limited studies that have taken place it is reported to have very little toxicity and minimal side effects (9), although none of these studies have addressed any long term use and any subsequent possible dependency. Much of the evidence that does exist regarding ziziphus is primarily concerned with its role in treating depression or a range of psychiatric disorders (10), and no studies have been conducted that examine tolerance to valerian, hops or ziziphus.

Further information around the effectiveness of herbal treatments requires a large number of new studies that have an appropriate timescale on which to judge their effectiveness and safety. Similarly, standardised doses, extracts and study conditions are required for the basis of any meaningful comparison as to which herbal extracts work best for a range of sleep disorders (11).

References

• 1. Thorpe B. Northern Mythology, Vol. 2, pp. 64–65. Available online at http://www.scribd.com/doc/53102432/Thorpe-Benjamin-Northern-Mythology-Vol-1#force_seo (last accessed 14th December 2014)
• 2. Nikolic D, Li Y, Chadwick LR, Grubjesic S, Schwab P, Metz P, Van Breemen RB. (2004). "Metabolism of 8-prenylnaringenin, a potent phytoestrogen from hops (Humulus lupulus), by human liver microsomes". Drug metabolism and disposition: the biological fate of chemicals 32 (2): 272–9
• 3. The Medicines and Healthcare Products Regulation Agency: Kalms Tablets THR 01074/0235. Available online at http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con263977.pdf (last accessed 14th December 2014)
• 4. Salter S, Brownie S. (2010). Treating Primary Insomnia: The Efficacy of Valerian and Hops. Aust Family Physician 39(6)433-437. Available online at http://search.informit.com.au/documentSummary;dn=146139375192083;res=IELHEA (last accessed 14th December 2014)
• 5. Taibi D, Landis C, Petry H, Vitiello M (2007). A systematic review of valerian as a sleep aid: Safe but not effective. Sleep Medicine Reviews 11 (3): 209–230
• 6. Miller LG. (1998). Herbal medicines: Selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 158 (220011): 2200–11
• 7. Garges HP, Varia I, Doraiswamy PM. (1998). Cardiac complications and delirium associated with valerian root withdrawal. JAMA 280 (15667): 1566–7
• 8. Bowe J, Li XF, Kinsey-Jones J et al. (2006). The hop phytoestrogen, 8-prenylnaringenin, reverses the ovariectomy-induced rise in skin temperature in an animal model of menopausal hot flushes. The Journal of Endocrinology 191(2): 399–405
• 9. Wu Zimou, Li Hongjian. (1984). Insomnia: Its symptom-sign complexes and treatments. Journal of the American College of Traditional Chinese Medicine (3): 51-54.
• 10. Frazer CJ, Christensen H, Griffiths KM. (1995). Effectiveness of treatments for depression in older people. Med J Aust 182(12):627-632.
• 11. Wheatley D. (2005). Medicinal plants for insomnia: a review of their pharmacology, efficacy and tolerability. J Psychopharmacol 19:414-421