Herbal and Over the
Counter Sleep Remedies: Do They Work?
Lisa C. Routh, M.D.
Brainwaves Newsletter, 2007
Many
Americans use alternative and complementary medicine. In 1990, 33.8% of people surveyed stated they
had used at least one alternative treatment in the year prior to survey. This number increased to 42.1% by 1997. Additionally, 2.5% of people were using
herbal remedies in 1990 and up to 12.1% were by 1997. Those surveyed were using alternative
therapies most often for fatigue, insomnia, anxiety, depression and headaches.
Even
though these treatments and therapies are gaining in popularity there is very
little data to support their use. For
instance, an analysis of more than 500 studies of acupuncture found that
although it may have some benefits in a few special circumstances such as
controlling chemotherapy-induced nausea, results of the studies showed either
lack of benefit or contradictory data even for back pain and headaches.
The
use of alternative and complementary medicine can have significant health
consequences, some of which may be life-threatening. According to data from the World Health
Organization (WHO), the use of Kava Kava for anxiety,
insomnia and menopausal symptoms caused liver damage use of the
ephedrine-containing herb Ma-Huang has been associated with heart attacks and
strokes.
Because
the FDA does not regulate the herbal, vitamin and supplement industry, the
consistency, quality and purity of these products is variable. ConsumerLab.com reports that more than 40% of
herbal products fail their tests, usually because they contain far less of the
active ingredient than the label claims.
In other cases the products are contaminated or contain unlabeled
prescription drugs.
Over
the counter medications are used extensively as sleeping aids. According to the Consumer Healthcare Products
Association Americans spent a total of $124 million on over the counter
sleeping medications. Up to 27% of elderly
adults used an over the counter nonprescription medication in the year prior to
the survey. The most commonly used
products were Tylenol and Benadryl. Most
patients used the product weekly up almost one-third used them on a daily
basis.
Unfortunately,
between 10 and 15% of the general population uses alcohol in addition to over
the counter sleeping medications to help them sleep.
Alarmingly
for physicians, most patients do not disclose or report over the counter
medication use. Patients also rarely
list vitamins and supplements unless they are specifically and carefully questioned
about them.
Valerian
is the most commonly used herbal remedy for sleep and it has been around since
biblical times. It has been used
throughout the ages to treat conditions such as hysteria, hypochondriasis,
nervousness and insomnia. Theoretically,
Valerian might have some sedative properties since one of the chemicals it
contains (hydroxypinoresinol) binds the
(GABA)-benzodiazepine receptor complex.
However, clinical evidence is very limited. The best study involved giving patients 600
mg of a 70% ethanol extract of Valerian root one hour before bedtime for 28
days. For the first two weeks of the
study, Valerian was no better than placebo but by the end of the study 66% of
Valerian users thought they were sleeping better compared to 29% of the placebo
users.
Studies
using formal sleep recordings show that Valerian does not benefit the sleep
architecture or complaints after a single dose.
After two weeks of treatment, sleep improved in both the Valerian and
placebo groups.
A
small study of 14 elderly adults treated with Valerian showed that slow-wave
sleep was improved but that there was no improvement with sleep-onset time,
time awake or rapid eye movement (REM) sleep.
Other
studies have showed no effect on sleep.
There
are concerns about the use of Valerian.
There are reports of serious cardiac complications and delirium when the
use of Valerian is stopped. Valerian may
also change the effect of other drugs, either by increasing or decreasing their
effect.
Hops
are generally combined with other herbs in most products. There are virtually no data confirming the
use of hops.
Kava
Kava was previously used to help anxiety and to
promote sleep. However, this product was
withdrawn from most markets in the
Passion
flower, lavender and teas made from mimosa blossoms have no experimental data
to confirm their use or benefit.
Over
the counter sleeping medications are generally made up of antihistamines. These medications are sometimes recommended
by primary care doctors for sleep but most of the time patients are purchasing
them for the purpose of self-medicating sleep disturbance. These compounds (Benadryl, Nighttime Sleep
Aid, and so forth) cause daytime sedation but at night do not improve the
quality of sleep even though they sometimes increase the amount of time people
are asleep. Most studies involving these
compounds reveal that they increase nighttime restlessness and may cause
problems with mental performance that patient’s are sometimes unaware of. Benadryl, for instance, may cause memory
dysfunction. These drugs also interact
with other medications.
The
use of over the counter and alternative therapies is increasing in popularity
however the people who recommend them and use them are not necessarily informed
about the products. There is little data
to support the effectiveness of these compounds and serious complications may arise
from their use.
It
is important for anyone using alternative medicine or over the counter products
to be as educated as possible about the consequences of taking them. Some resources are listed below.