Overview 

Nearly everyone experiences occasional bouts of insomnia. However, approximately 30% of the American population suffers from chronic insomnia. At best, regularly tossing and turning at night can be frustrating, but long-term insomnia can lead to many problems. For instance, lack of sleep can interfere with concentration, performance at work or school, and even personal relationships. 

Not everyone experiences insomnia the same way. In fact, the National Institutes of Health have defined three classifications of insomnia: transient, intermittent and chronic.  Transient insomnia is short-term, occurring for a single night or up to a period of a few weeks. Intermittent insomnia refers to occasional bouts of transient insomnia. Chronic insomnia amounts to sleeplessness nearly every night, enduring for a month or longer. 

Transient and intermittent insomnia is usually related to stress or a life-changing event, such as the loss of a job or spouse. While both men and women of all ages have occasional insomnia, women witness a 40% higher rate incidence, especially those over 40 years of age.  People of advanced years also statistically evidence a greater rate of occurrence, but this is usually due to difficulty achieving or maintaining sleep due to a medical condition, rather than a decreased need for sleep dictated by popular myth.

Contrary to another common misconception, insomnia is not necessarily defined by a reduction in the quantity of sleep, but rather sleep quality.  In fact, regardless of how long it takes you to fall asleep or the number of awakenings that you endure, you may actually be getting enough sleep after all.  To fully appreciate this point, it is important to understand your own sleep “architecture,” the term used to illustrate the pattern of alternating between REM (rapid-eye-movement), or dream sleep, and non-REM sleep. 

There are five basic stages of sleep, ranging from relaxed wakefulness to a dream state. The entire sleep cycle takes up to three hours to complete and is repeated several times each night, regardless of what time one retires to bed.  As the night progresses, the duration of REM (rapid eye movement) phases increase and deep sleep periods grow shorter. This means that sleep becomes lighter in the second half of the night when more frequent awakenings are likely to occur. Adults spend about 50% of their total time asleep engaged in deep sleep early in the evening. This fact is significant since it means that it is possible to maintain daytime performance and alertness based on achieving an adequate amount of what sleep researchers refer to as “core sleep."

Risk Factors

Aside from stress-related factors, insomnia can be caused by several other variables, including:

Substance abuse

Medications

Excessive intake of caffeine

Advanced age

Hormonal imbalances

Disease

The Connection Between Disease and Insomnia

Various studies have been conducted to examine the correlation between sleep disturbances and disease by measuring secretion levels of certain chemicals, namely pro-inflammatory mediators categorized as cytokines. For instance, interleukin-6 is involved in regulating sleep and is associated with cardiovascular disease. Elevated levels of another cytokine called tumor necrosis factor has also been linked to chronic insomnia, coupled with increased fatigue during the day.

Another substance that plays a role in regulating sleep is melatonin, a hormone manufactured by the pineal gland. Well known as one of the ‘feel good’ hormones, melatonin release is triggered when there is little or no light in the environment. This hormone then stimulates gamma-aminobutyric acid (GABA) neurotransmission, which induces sleep by promoting a state of relaxation. Melatonin also sends signals the body to prepare for sleep by lowering body temperature. Unfortunately, production levels of melatonin diminishes with age, as well as in the presence of certain medical conditions, such as Alzheimer’s Disease.

The Natural Approach to Coping with Insomnia

Researchers and therapists use the term ‘sleep hygiene’ to refer to habits and behaviors that are conducive to sleep. The following represent some ways in which to improve sleep hygiene.

Use the bed exclusively for sleep and sex. Habitual reading or late night television watching can contribute to bouts of sleeplessness.

Don’t ‘try harder’ to sleep. If you can’t fall asleep after 30 minutes, leave the bedroom to engage in another activity that may encourage relaxation.

Get regular exercise. However, refrain from physical activity just prior to going to bed.

Limit alcohol consumption. Alcohol can interfere with sleep patterns, resulting in decreased deep sleep and increased periods of wakefulness.

Establish a regular routine before retiring for the night. In addition, try to go to bed and get up in the morning at the same time each day.

Recommended Supplements in the Treatment of Insomnia 

Several nutrients and botanicals can help to stimulate and increase the production of certain neurotransmitters to help promote sleep. This type of approach to treating insomnia is known as monoamine precursor therapy. 

L-tryptophan 

L-tryptophan is the metabolic precursor of serotonin and melatonin, neurotransmitters with sedative qualities. Studies have shown that a deficiency of L-tryptophan is common to insomniacs, and supplementation with this substance has been shown to help induce quality sleep. However, L-tryptophan is not easily synthesized into serotonin without the aid of vitamin B-6 (50 mg.) and niacin (100 mg.) being taken at the same time. 

5-hydroxytryptamine (5-HTP) 

5-HTP elevates beta-endorphins and is readily bioavailable since it does not require a transport molecule or compete with other amino acids in the system. In addition, 5-HTP is biochemically closer to serotonin, chemically known as 5-hydroxy tryptamine. 

Herbs Used in the Treatment of Insomnia 

Valerian 

Valerian has been used as a mild tranquilizer and sleep aid for more than 1,000 years.  In terms of its efficacy, valerian extract, standardized to contain 0.8% valerenic acids, has been compared to diazepam (Valium). In one double-blind study involving 128 subjects, valerian root extract provided improved quality of sleep as measured by their brain wave patterns. In addition, studies have shown that valerenic acid enhances GABA receptor modulation. 

Gota Kola 

In Ayurvedic medicine, gota kola is considered a balancing herb that promotes relaxation and energizes the senses. For this reason, it is often included in the diets of yogis to help achieve meditative states and improve recall. Gota kola contains two agents with sedative qualities--saponin glycosides brahmoside and brahminoside.  The presence of pyridoxine (vitamin B-6) reportedly has the additional benefit of aiding dream recall.   

St. John’s Wort 

Since the mid-1980’s, studies have shown that this herb also contains monoamine oxidase inhibitors (MAOs) and can provide significant relief from anxiety and stress, thereby improving sleep quality. There are at least 10 pharmacologically active constituents found in the extract, but researchers are most interested in hypericin and pseudohypericin.  The exact mechanism of the herb’s ability to alleviate depression and anxiety remain largely unknown, but a fairly recent study may provide some clues. The action of hypericins at alpha receptor sites, known to be involved in the role of MAOs and 5-HTP reuptake inhibitors lends support to the herb’s reputation as a mood elevator and sedative.  Preparations of St. John’s Wort are standardized to contain 0.2% hypericin acid. 

Kava 

Kava, a member of the pepper family, has been used as a natural relaxant in the South Pacific for centuries.  The four active agents of this herb, known collectively as kavalactones, have received considerable attention for their ability to relieve stress and anxiety in recent years.  Several studies have shown that kava effects a GABA-receptor-binding capacity and an ability to block norepinephrine uptake.  In a 1997 German study, 101 subjects suffering from non-psychotic anxiety took part in a 25 week placebo-controlled, double-blind trial with an extract of kava.  The researchers concluded that kava is comparable to treatment with benzodiazepines but without unwanted side effects. 

Lemon Balm 

Researchers have recently studied the relaxation-promoting properties of lemon balm with positive results. One study involving children with sleep disturbances yielded improved sleep in 81% of the treatment group. Another recent study designed to deliberately trigger stress showed that a dose of lemon balm permitted the study subjects to remain anxiety-free, maintain accuracy in their responses, and even experience a significant improvement in mathematical processing.

Safety Precautions 

General 

Do not combine herbal sedatives with prescription antidepressant medications. 

L-tryptophan 

Be aware that the Federal Drug Administration has limited the importation of this substance in the US due to the entry of a contaminated supply from Japan in the late 1980s that resulted in the incidence of a serious disease known as eosinophilia-myalgia syndrome (EMS), in some cases with fatal results. Therefore, every effort should be made to find a reputable, domestic source of this substance. 

Consult with your doctor if you have fibromyalgia or a history of kidney or liver disease. 

Valerian 

Do not combine with barbiturates or benzodiazepines. 

Long-term use is not recommended. 

Gota Kola 

Do not take if you take insulin or hypoglycemic or cholesterol-reducing medications. 

St. John’s Wort 

Be aware that St. John’s Wort increases photosensitivity. 

Kava 

Do not take if you have a history of liver or kidney disease. 

Do not combine with benzodiazepines or barbiturates. 

Do not take if you are currently taking Xanax (there has been one report of this combination inducing coma). 

References

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Trauner G, Khom S, Baburin I, et al. Modulation of GABAA receptors by valerian extracts is related to the content of valerenic acid. Planta Med. 2008 Jan;74(1):19-24. 

Awad R, Levac D, Cybulska P, et al. Effects of traditionally used anxiolytic botanicals on enzymes of the gamma-aminobutyric acid (GABA) system. Can J Physiol Pharmacol. 2007 Sep;85(9):933-42. 

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Herb Research Foundation/BW Health Wire, April 6, 1998, Clinical Trial shows kava reduces stress. 

Muller SF, Klement S. A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children. Phytomedicine. 2006 15 Feb. 

Kennedy DO, Little W, et al. Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm). Psychosom Med. 2004 Jul-Aug;66(4):607–13.