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Insomnia Insomnia is often associated with an underlying illness, often depression or an anxiety disorder. It is sometimes a feature of mania in bipolar disorder, and can also be associated with sleep apnea and the restless leg syndrome. Thus, as with other problems addressed on this website, medical attention should be sought out for proper diagnosis and treatment. For insomnia several prescription medications are effective, however they are often addictive and they are often poorly tolerated, especially in the elderly. Here are some possible alternatives for adults. Like conventional medications used in psychiatric practice to treat insomnia, it can be seen that supplements may similarly effect neurotransmitter systems including those for serotonin and GABA. Please read the warnings and precautions described on the "Disclaimers" webpage, included on this page are several but not all risks, interactions, contraindications, and side effects. Some dosing guidelines are given, but dosing should be guided by your health care provider. Additional resources concerning efficacy, dosing, contraindications and safety guidelines can be viewed on the "Science & Evidence" webpage.
L-tryptophan has been a popular supplement for insomnia. It was banned for a while in the U.S. as there was concern about a severe blood and muscle disease (eosinophilia-myalgia syndrome) , which turned out most likely to be isolated to a contaminated product from Japan. Also sometimes helpful as a supplement for the treatment of anxiety and depression, a similar supplement 5-Hydroxytryptophan is thought to be more beneficial as it is may not be as sedating and there is more supportive research. Like 5-HTP, tryptophan needs to be avoided with carcinoid syndrome and may adversely interact with antidepressants. Side effects may include nausea, dry mouth, gastrointestinal irritation, and sedation. A typical starting dose is 500 mg at bedtime.
Valerian has been popular for insomnia, though some of the research studies have been disappointing. The Natural Medicines Comprehensive Database at www.naturaldatabase.com rates this supplement as possibly effective for insomnia. The Natural Standard at www.naturalstandard.com gives Valerian a B rating (good scientific evidence for this use) for insomnia. Like some other supplements it may be of some help when tapering patients off of benzodiazepines. It may work by inhibiting the metabolism of of GABA. Valerian has a delayed onset of action and may need to be taken for several days or more. Valerian may cause day time sedation, cognitive and motor impairment, contact allergy, headache, restlessness, paradoxical insomnia, cardiac dysfunction, gastrointestinal upset and liver toxicity. Long term use followed by discontiuation may lead to a withdrawal syndrome. For sleep and sedation a typical dose is 200-400 mg at bedtime of a standardized extract containing 0.8 to 1% valerenic acids.
Melatonin may be helpful in sleep disorders that involve circadian rhythm incuding jet lag. The Natural Medicines Comprehensive Database at www.naturaldatabase.com rates this supplement as possibly effective for insomnia. The Natural Standard at www.naturalstandard.com gives Melatonin an A rating (strong scientific evidence) for jet lag, and a B rating (good scientific evidence) for insomnia in the elderly, delayed sleep phase syndrome, and sleep enhancement in healthy people. Melatonin gets a C ranking (unclear scientific evidence) for sleep disorders in Alzheimer's disease, depression, insomnia of unknown origin in the non-elderly, and REM sleep behavior disorder. A hormone derived from serotonin in the brain, melatonin may increase GABA binding and may also have antioxidant properties. It may help from the time it is first tried. There are a few potential side effects along with potential drug interactions and other risks. Included is the potential to inhibit ovulation, cause day time sedation, depression, anemia, headache, and seizures. Potential interactions occur with sedatives, anticoagulants, beta blockers, and corticosteroids among other drugs. Melatonin declines with age and may be especially helpful in the elderly. As with other sedatives fall precautions should be observed. It is usually best to start melatonin at its minimal effective dose which is typically 0.5 mg at night. Upward titration is often needed.
Kava is often helpful with insomnia as well as anxiety. While The Natural Medicines Comprehensive Database at www.naturaldatabase.com rates Kava as possibly effective for anxiety it rates it as having insufficient evidence for insomnia, and while the Natural Standard at www.naturalstandard.com gives it an A ranking (strong scientific evividence for this use) for anxiety, it does not rank Kava for insomnia. Kava seems to increase the effects of GABA by increasing GABA binding. While some people experience somewhat of an immediate sedating effect, the time of onset for treating anxiety disorders may take well over a week. It may have some risks for addiction and possible liver injury (rare-per an FDA warning, also see www.fda.gov/medwatch/safety/2001/kava.htm) and should not be used without careful monitoring (sometimes including liver function tests), or for extended periods. Kava is contraindicated in pregnancy, it can be lethal in an overdose, it may worsen Parkinson's disease (and should not be taken with levodopa) and has many other potential adverse side effects including gastrointestinal upset, allergic skin reactions, dry scaley rash, pupil dilitation, problems focusing, photosensitivity, movement disorders, hematological disorders, renal dysfunction, pulmonary hypertension, increased depression/suicide risk. Alcohol may somewhat increase the risk of sedation and liver toxicity. For insomnia Kava is often used in a standardized form with 30% Kavalactones at a dose of 250 mg at bedtime. Passion Flower seems to bind to the GABA receptor. It may have an effect like benzodiazepines with a relatively rapid onset of action, but it may interact with other sedatives and also cause cognitive impairment as well. It is rated by The Natural Medicines Comprehensive Database at www.naturaldatabase.com as possibly effective for anxiety but it is not rated for insomnia. It is given a C rating (unclear scientific evidence) for Sedation (agitation,anxiety,insomnia) by the Natural Standard at www.naturalstandard.com. There may be risks with bleeding disorders and with people on anticoagulants. For insomnia Passion Flower is often taken at a dose of 200 mg (standardized extract of 3.5% isovitexin) at bedtime. Hops tend to have a mildly sedating property. They are often combined with other supplements. Natural Medicines Comprehensive Database at www.naturaldatabase.com rate hops as having insufficient evidence. The mechanism of action is poorly understood. Hops may have some estrogen effects with related cancer risks and are contraindicated with estrogen-dependent tumors and may also effect endometriosis. Hops may increase the sedative and central nervous system depressant effects of other supplements and medications. Depression can be exacerbated. Hops have potential interactions with several medications including phenothiazines, and may like most supplements have other risks like allergic reactions, and unknown safety in pregnancy and lactation. A typical dose is 100 mg standardized to contain 5.2% bitter acids and 4% flavanoids at bedtime. |
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