Insomnia is a symptom due to which the patients have difficulty in initiating or maintaining sleep or they have poor quality of sleep in spite of the opportunity and time to sleep. At present, treatment of insomnia mainly includes the conventional drugs like benzodiazepines (e.g. Diazepam) and some older drugs which are infrequently used now. Along with these, many other treatments are available from the complimentary or alternative medicine like herbal medicines, acupuncture and homeopathy.
Many patients prefer these alternatives to avoid the known or unknown side effects of the conventional drugs, although the available scientific data does not prove the same. Currently, the knowledge of the herbal drugs is limited as till now, these have been studied mainly in clinical trials of poor quality. Some of the herbal drugs which are available without prescription are:
St. John’s wort
It is one of the most well studied drugs for psychiatric disorders, but its effect as hypnotic (drug inducing sleep) has not been well studied. Some of its actions resemble those of Benzodiazepines. The main active ingredients are hypericin and psuedohypericin. Generally it is considered to be a safe treatment with some side-effects like sedation, dry mouth, dizziness and restlessness. Monotherapy of St.John’s wort should not be advised in patients suffering from anxiety. It may interact with drugs used for treating depression.
Valerian (Valeriana officinalis) has been shown to be a hypnotic in many well-controlled studies. The active ingredients are: valepotriates, sesquiterpenes (volatile oil components which account for valerian’s unpleasant odor), and amino acids.
Valerian also acts on GABA (gamma aminobutyric acid) receptors which are also the site of action of Benzodiazepines. The onset of action is slow (2-3 weeks). It augments the deep sleep. It is useful for long term use in elderly persons. Various doses of Valerian have been studied ranging from 400-900 mg. The highest dose leads to morning sleepiness. Valerian is associated with some rare side effects like gastrointestinal upset, contact allergies, headache and restless sleep.
Hops (Humulus lupulus) was earlier used for brewing of beer, but now it is used in combination with Valerian for insomnia. The side-effects with Hops can be menstrual disturbances and allergy.
Kava-kava is a drink prepared from the plant Piper methysticum. The mechanism of Kava-kava has been well studied and it also acts on the GABA receptors. In 2002, its use was banned in some countries because of the risk of development of liver toxicity with its use. Later, some questions were about this restriction as doubts were raised about the quality of kava-kava used in those trials.
Some other plants known to have sedative actions are Melissa and Passionflower. Aromatherapy (lavender, chamomile, Ylang-Ylang) is also known to improve sleep.
All these herbal remedies should be used with caution as there is limited knowledge about their side-effects and their interactions with other drugs. As insomnia is common in elderly and they are also on many other drugs, so cautious use is recommended. The patients should always inform his doctor about the intake of these herbs if he has taken them without prescription.