Herbals for Insomnia? Now You Can Test Them at Home

Herbal remedies for insomnia are abundant online—valerian, hops, and chamomile, among the most common. Tested against placebo, none has been found to be definitively effective for insomnia. Yet some medicinal herbs have a long history as traditional calming, sleep-promoting agents. Might one work for you?

Researchers at Massachusetts General Hospital and Harvard Medical School have proposed a method you can use yourself to test herbal remedies via personalized therapeutic trials. Here’s more about herbals and how the trials work:

Insomnia may respond to treatment with herbal supplements and tincturesHerbal remedies for insomnia are abundant online—valerian, hops, and chamomile, among the most common. Tested against placebo, none has been found to be definitively effective for insomnia. Yet some medicinal herbs have a long history as traditional calming, sleep-promoting agents. Might one work for you?

Researchers at Massachusetts General Hospital and Harvard Medical School have proposed a method you can use yourself to test herbal remedies via personalized therapeutic trials. Here’s more about herbals and how the trials work:

Why Herbals for Sleep?

Interest in herbal and other alternative treatments for insomnia seems to be on the rise. About 5% of the participants in a national survey reported use of complementary and alternative medicine (CAM) for insomnia in 2002. A recent analysis of the same national survey conducted in 2007 found that almost 50% of participants with insomnia symptoms used some form of CAM therapy.

Some insomniacs see alternative medicines as less risky than prescription sleeping pills, with fewer potentially harmful side effects. Because they are “natural,” they’re viewed as more appropriate for long-term use than many sleeping pills, which, if used nightly, tend eventually to degrade sleep quality.

Scant Testing, Mixed Results

Most herbal remedies for sleep have not undergone as much testing as prescription sleeping pills (one reason may be that there’s relatively little money to be made on them). But as with sleeping pills, tests that have been conducted on herbals often show subjective sleep improvements that exceed objective measures.

The perception that herbal supplements improve sleep could be due to a placebo effect. Or, say the Massachusetts researchers, it could be attributable to basic differences among trial participants, including different insomnia symptoms. It could be that, just as a particular sleeping pill works for some insomniacs and not others, a particular herb may relieve insomnia in some people and not others.

Herbals That May Relieve Insomnia

Since the overall efficacy of herbal preparations for insomnia is still unknown and may differ from person to person, the researchers opted to consult six authoritative resources in their search for herbal and supplement remedies of potential relevance for insomnia, including reference books such as the Physician’s Desk Reference for Herbal Medicines (PDR) and online sources such as Medline Plus. In all, they came up with a list of over 70 herbal agents of possible benefit to sleep.

These 15 medicinal herbs were listed by 4 or more resources as a remedy for insomnia or another condition indirectly related to sleep, such as anxiety or nervousness:

  1. Ashwagandha
  2. Bitter Orange (Neroli)
  3. Catnip (Nepeta)
  4. Chamomile (German)
  5. Hops
  6. Kava
  7. Lavender (English)
  8. Lemon Balm
  9. Linden
  10. Nutmeg (and Mace)
  11. Oats (Avena sativa)
  12. Passion Flower
  13. Schisandra (Wu-Wei-Zi)
  14. St. John’s Wort
  15. Valerian

Safety of Herbal Supplements

Natural substances are not necessarily safe for unrestricted use. The PDR for Herbal Medicines cautions against using several during pregnancy. Some herbs may be harmful to the liver. And, as herbal supplements are unregulated in the United States, the contents of a supplement do not necessarily reflect what appears on the label. In fact, a majority of herbal remedies evaluated in a recent study had contamination, substitution, or use of fillers not listed on the label.

For safety concerns associated with herbs used for insomnia, see these sources:

Find Out If a Sedating Herb Works for You

Let’s say you’re a sleep maintenance insomniac, awakening at least twice a night to feelings of anxiety. You’ve heard that passion flower is good for sleep and anxiety, and you’d like to try it to see if it cuts down on your nighttime wake-ups. But how long should you try it? Two nights, three nights or more?

Many insomniacs experience quite a bit of night-to-night variability in their sleep. When you’re stressed out you might sleep poorly for 4 or 5 nights in a row before you get a decent night’s sleep. If you tried taking a passion flower supplement for just 2 or 3 nights during a time of stress, the results you obtained wouldn’t be reliable. You might obtain a different result if you tested the passion flower during a 3-day period when your life was moving along on an even keel.

I’ll skip the authors’ discussion of statistical power and cut to the chase: you need to test a substance for 10 nights in a row to have reasonable certainty that the result you obtain is repeatable and you’ve got enough data to answer the question of whether passion flower improves your sleep.

Self-Testing Flow Chart

Follow these 5 steps to determine whether an herbal insomnia remedy works for you:

  1. Simplify sleep. For you, does “good sleep” mean falling asleep sooner, sleeping longer, waking up feeling more rested, or waking up less at night? Choose the one thing that for you would most improve your sleep.
  2. Set a goal. Choose your target “good night” value and a percentage of nights for which this target value must occur. Let’s say you decide that a good night is a night when you awaken just 1 time or less (and on a bad night you awaken 2 times or more). Let’s say you set your goal at awakening 1 time or less on at least 70% (7 out of 10) of the nights.
  3. Choose a therapy. Try one intervention at a time. Starting a passion flower supplement and a yoga class at the same time will muddle the results.
  4. Do the 10-day test. Every day, record good nights and bad nights in a diary.
  5. Calculate the outcome. Did you achieve your goal? If so, you can conclude that passion flower improves your sleep. If you didn’t achieve your goal, clearly the passion flower did not work. Choose another therapy, starting the process at #3. If your results are borderline, continue testing for another 10 days. Then recalculate to ascertain whether you’ve met your goal of awakening 1 time or less on 70% of all 20 nights.

Insomniacs are big experimenters, I learned as I was conducting research for my book, The Savvy Insomniac. Several expressed interest in herbal and other alternative treatments. If you’re going to experiment, you need a systematic way to assess whether the remedy you’re trying improves your sleep or not. These Massachusetts researchers have given us a goal-oriented algorithm for doing exactly that.

Could Pumpkin Seeds + Carbs = Better Sleep?

Let’s begin with a caveat: no organic sleep aid on the market has been shown to cure insomnia.

But if you like warm, nonalcoholic, caffeine-free liquids, and if drinking a beverage is part of your evening routine, you might be interested in trying Zenbev Drink Mix. Here’s more information about it.

Insomnia sufferers may want to try a sleep aid called Zenbev Drink Mix, made from pumpkin seedsLet’s begin with a caveat: no organic sleep aid on the market has been shown to cure insomnia.

But if you like warm, nonalcoholic, caffeine-free liquids, and if drinking a beverage is part of your evening routine, you might be interested in trying Zenbev Drink Mix. Its claim as a sleep aid and alternative treatment for insomnia is based on a study showing that food bars made from the same ingredients significantly reduced insomnia subjects’ time awake at night.

Here’s more information about it.

What Is Zenbev Drink Mix?

It’s made from pumpkin seeds that are cold-pressed to remove the oil and made into pumpkin seed flour. The flour is then combined with dextrose (the sugar found in plants), rice starch (a carbohydrate), and guar gum (a binder–thickener); flavored with chocolate or lemon; and sold as a powder, to be mixed with warm milk or warm water. It’s touted as promoting “a natural and healthy sleep.”

A Tryptophan–Carbohydrate Combination

Research suggests there may be grounds for this claim. Like other protein sources—turkey, fish, milk—pumpkin seeds are high in tryptophan, an essential amino acid. Tryptophan is a precursor to melatonin, a hormone secreted at night. Your melatonin levels start to rise a few hours before bedtime, which helps you fall and stay asleep. Tryptophan is also a precursor to serotonin, a neurotransmitter the body eventually converts into melatonin.

But tryptophan has to cross the blood–brain barrier to exert its sleep-inducing effects. It competes with other amino acids to cross that barrier, so a drink high in tryptophan alone would not have much effect on sleep.

Adding a carbohydrate to the mix might help. It would promote the release of insulin, inhibiting production of competing amino acids or diverting them into muscle. With less competition at the gate, more tryptophan would be expected to cross the blood–brain barrier and begin its conversion into serotonin and melatonin, in turn promoting sleep.

Effects on Sleep

To test the effects of the pumpkin seed–carbohydrate combination on sleep, Biosential, the company that makes Zenbev Drink Mix, set out to conduct a randomized controlled trial, enrolling 57 people with insomnia.

Forty-nine participants completed the 3-week study. Each week they were randomly administered 3 different food bars. One week, the food bars contained deoiled pumpkin seed flour mixed with carbohydrate. Another week, the food bars contained pharmaceutical-grade tryptophan mixed with carbohydrate. In another week, the food bars contained carbohydrate only.

The bars containing deoiled pumpkin seed and those containing pharmaceutical-grade tryptophan led to significant improvements in sleep, as reported by study participants. The bars made of carbohydrate alone led to some improvement, too.

Measured objectively, the pharmaceutical-grade tryptophan outperformed the deoiled pumpkin seed when it came to increasing sleep duration. But the bar containing the deoiled pumpkin seed-carbohydrate preparation was the only treatment to significantly cut down on wake time after sleep onset.

The Take-Away

Offering the results of a single trial as proof that a treatment works is better than offering no results at all. Yet the study would have to be repeated—with Zenbev Drink Mix instead of food bars—to substantiate the claim that this beverage can actually improve insomniacs’ sleep.

Still, enough evidence points to tryptophan’s helpful effect on sleep that Zenbev Drink Mix may be worth trying, especially if you’re looking for alternative treatments for insomnia and interested in exploring the idea that dietary changes might help. The product is sold in the United States, Canada, and Europe.

Anxiety? Cranial Electrotherapy Stimulation May Help

If you have chronic insomnia, you may have developed anxiety about sleep. I had lots of sleep-related anxiety until I went through sleep restriction. Once my sleep stabilized, the anxiety disappeared.

Studies have shown that cranial electrotherapy stimulation (CES) is modestly effective at controlling anxiety. It’s FDA approved and widely used in the armed forces for anxiety, PTSD, insomnia, and depression.

Anxiety, PTSD, insomnia, & depression respond to treatment with CESIf you have chronic insomnia, you may have developed anxiety about sleep. I had lots of sleep-related anxiety until I went through sleep restriction. Once my sleep stabilized, the anxiety disappeared.

If you go through cognitive behavioral therapy for insomnia (CBT-I), your therapist may address sleep-related anxiety by challenging some of your ideas and beliefs about sleep. This approach works for some insomniacs, research shows. But others remain anxious at the approach of bedtime and look for alternative treatments.

Studies have shown that cranial electrotherapy stimulation (CES) is modestly effective at controlling anxiety. It’s not endorsed as an insomnia treatment by the American Academy of Sleep Medicine. But it’s FDA approved and widely used in the armed forces for anxiety, PTSD, insomnia, and depression. Here’s more about it.

What CES Is and Does

CES is a treatment you administer on your own with a device that sends mild, pulsed, alternating electrical current to the brain via electrodes placed on the earlobes. When the device is turned on, most people feel nothing at all (a few report feeling a slight pulsing at contact points on the earlobes).

The electrical pulses trigger changes in the brain. When UCLA researchers used a functional MRI scanner to look inside the brains of people undergoing CES, they found evidence of two things:

  1. Decreased neural activity in three areas of the brain: the frontal, parietal, and posterior midline regions.
  2. Altered connectivity in the default mode network (DMN). The DMN is a network comprising several areas of the brain that are active during restful alertness, daydreaming, thinking about self or others, remembering the past, and planning for the future. It’s activated by default, when your attention is not focused on performing a task or on some aspect of the outside world.

Why CES Might Help

A device that decreases neural activity might be useful for people with insomnia, which is associated with hyperarousal. Or, by introducing high- or low-frequency cortical “noise,” CES may change activity in the cerebral cortex in helpful ways. It might produce an increase in alpha activity (associated with relaxation), as other studies have shown.

CES may also achieve its effects by altering communication between the nodes of the DMN. Studies of people with depression and anxiety have detected abnormalities in these connectivity networks—abnormalities whose effects may be lessened with CES. Changes in the DMN may help people disengage from worry and rumination and/or focus on things outside themselves.

Safety and Effectiveness of CES

Studies of CES suggest that devices such as Alpha-Stim, the Fisher Wallace Stimulator, and CES Ultra are quite safe. The FDA reclassified the devices two years ago. Now they’re in the same risk category as acupuncture needles and power wheelchairs. Adverse effects from CES—such as headaches and skin irritation under the electrodes—are rare.

As for effectiveness, while several controlled trials of CES have been conducted, the only consistent result obtained is that compared with sham treatment, CES was effective in reducing anxiety.

In a recent survey of veterans and service members using CES devices, 67% of the 145 who answered all the questions reported improvement in anxiety; 63%, improvement in PTSD; 65%, improvement in insomnia; and 54%, improvement in depression. But many of the respondents were also using medication for symptom mitigation, so it’s hard to know how much of the benefit was due to the CES device and how much, to medication.

If you try using a CES device (or if you tried one in the past), please comment on whether it helps.

Relief for Hot Flashes and Menopausal Insomnia

About 40 to 50 percent of women experience insomnia before and after menopause. Add hot flashes, mood swings, and fatigue into the mix, and riding out “the change” can be tough.

Recent reviews suggest that acupuncture and isoflavones (plant-derived compounds that function like estrogen) may be effective as alternative treatments for menopausal insomnia and hot flashes.

menopausal symptoms respond to acupuncture & isoflavonesAbout 40 to 50 percent of women experience insomnia before and after menopause. Add hot flashes, mood swings, and fatigue into the mix, and riding out “the change” can be tough.

Fluctuating or declining levels of estrogen and other reproductive hormones often get the blame, and until recently hormone replacement therapy (HRT) was the No. 1 treatment for women with menopausal symptoms. But the risks that come with HRT have many women now looking elsewhere for relief.

Recent reviews suggest that acupuncture and isoflavones (plant-derived compounds that function like estrogen) may be effective as alternative treatments for menopausal insomnia and hot flashes.

Does Acupuncture Help with Insomnia or Not?

Apparently it depends on your situation. Scientists studying acupuncture as a treatment for insomnia in the general population have come up with mixed results. Researchers who surveyed medical literature through 2011 concluded there wasn’t enough high-quality evidence to answer the question one way or the other.

But a team of Taiwanese investigators recently did a literature review of acupuncture’s effects on sleep disturbances and hormonal irregularities occurring in women before and after menopause. Altogether they looked at 31 randomized controlled trials with 2,433 participants.

The results, published this month in the journal Obstetrics and Gynecology, showed that acupuncture treatments in peri- and postmenopausal women were “associated with a significant reduction in the likelihood of sleep disturbances.” They also found that treatment with acupuncture produced

  • an increase in the secretion of estradiol (a form of estrogen associated with stable sleep in younger women), and
  • a decrease in the secretion of follicle stimulating hormone, which is associated with sleep disturbance.

Acupuncture Sweet Spot Identified

The researchers also identified a particular spot where stimulation was found to be especially helpful in improving the sleep of menopausal women: the sanyinjiao acupoint.

The sanyinjiao acupoint—known as “Spleen 6” in English—is the junction point of the spleen, liver, and kidney meridians. It’s on the inside of the leg a few inches above the ankle. The reviewers strongly endorse acupuncture as helpful for the sleep of menopausal women, especially at the sanyinjiao acupoint.

Isoflavone Therapies for Hot Flashes and Insomnia

Would you rather take supplements to cut down on hot flashes and improve your sleep? Several options have been proposed but none are well studied, say authors of a systematic review of isoflavone therapies for hot flashes and other menopausal symptoms.

Isoflavones—plant-derived compounds that exert estrogen-like effects—might be able to serve as hormonal substitutes in women with menopausal symptoms. But so far, only one high-quality study identified by the reviewers has shown that isoflavones (combined with other substances) are effective at decreasing both hot flashes and menopause-related insomnia.

That study was a randomized controlled trial conducted on 89 middle-aged women for 24 weeks. By the fourth week, participants taking the active form of treatment reported significantly more relief from hot flashes and insomnia than did the control group. They also reported less irritability, anxiety, and depression. The treatment they received contained six ingredients:

  1. magnolia bark extract (60 mg)
  2. magnesium (50 mg)
  3. soy isoflavones (60 mg)
  4. lactobacillus (500 million spores)
  5. calcium (141 mg)
  6. Vitamin D3 (5 international units)

Other isoflavone-containing substances found to be helpful in reducing hot flashes (but not necessarily improving sleep) are these:

  • red clover, 80 mg daily, and
  • unsalted soy nuts (roasted soybeans), 1/2 cup daily.

If you’ve tried acupuncture or isoflavone therapies to relieve hot flashes and insomnia, please let us know if they helped.

L-Tryptophan May Help You Sleep

Interesting but dangerous: that’s what I heard about L-tryptophan supplements for several years. Research starting in the 1960s was showing that L-tryptophan might be an effective remedy for insomnia.

Then came the tryptophan-related outbreak of eosinophilia-myalgia syndrome (EMS) in 1989, killing 37 people and sickening thousands. The United States subsequently banned the supplements, and research on L-tryptophan and sleep came to a halt.

Now reviewers of alternative treatments for insomnia are again mentioning L-tryptophan as a substance of interest. Here are the pros and cons.

Mild Insomnia may respond to treatment with L-tryptophan supplementsInteresting but dangerous: that’s what I heard about L-tryptophan supplements for several years. Research starting in the 1960s was showing that L-tryptophan might be an effective remedy for insomnia.

Then came the tryptophan-related outbreak of eosinophilia-myalgia syndrome (EMS) in 1989, killing 37 people and sickening thousands. The epidemic was traced to contaminated L-tryptophan produced by a single Japanese company, but the United States banned L-tryptophan supplements from 1990 to 2001. Research on L-tryptophan and sleep came to a halt.

Now reviewers of alternative treatments for insomnia are again mentioning L-tryptophan as a substance of interest. Here are the pros and cons.

What It Is

L-tryptophan is an essential amino acid the body requires in order to synthesize proteins and other key molecules. It’s a precursor to serotonin, a neurotransmitter important to sleep, and melatonin, a hormone secreted at night.

Humans cannot produce L-tryptophan on their own. So it has to be gotten from food (or supplements). In one experiment, depriving insomniacs of L-tryptophan made their insomnia worse, as recorded by studies conducted in a sleep lab. Low levels of tryptophan resulted in sleep that was lighter and less continuous. This suggests that something about L-tryptophan facilitates sleep.

Laboratory tests show that tryptophan administered at night increases concentrations of both serotonin and melatonin in the brain. So its sedative effects are probably due to its enhancement of the melatonin or the serotonin system.

Randomized Controlled Trials

Taken at bedtime in amounts of 1 to 4 grams, L-tryptophan has been found to be at least somewhat effective for people with insomnia in several studies, including double-blind trials. But results from three randomized controlled trials, considered the highest standard of evidence, are mixed.

  1. In an early study of 96 “serious insomniacs,” weeklong treatment with tryptophan was compared with weeklong use of a placebo. No differences were noted during the tryptophan treatment—but participants taking tryptophan reported falling asleep more quickly than normal in the week following treatment.
  2. In a subsequent study, people with severe chronic insomnia were divided into two groups: one group took tryptophan nightly for 4 weeks, followed by 4 weeks of placebo; the other began with placebo and after 4 weeks swtiched to tryptophan. Group A reported improved sleep quality while taking the tryptophan; group B did not.
  3. In a more recent study, tryptophan from squash seeds and pharmaceutical-grade tryptophan, both in the form of food bars, significantly improved sleep duration and sleep quality in study participants compared with a food bar containing carbohydrate alone. The tryptophan from squash seeds outperformed the pharmaceutical-grade tryptophan in reducing time awake at night.

Well yes, these results are underwhelming.

Consider This, Too

Other research is more encouraging. L-tryptophan in some studies has reduced participants’ sleep latency and cut down on nighttime wake-ups. Reviewers make these comments:

  • The best results seem to occur in cases of mild insomnia with long sleep latency.
  • People with more severe forms of insomnia may need to take L-tryptophan for several nights before they notice improvement in their sleep.
  • In people with sleep maintenance insomnia, L-tryptophan may be more effective for those who wake up several times a night rather than for those who awaken less frequently.           

Foods High in Tryptophan

As alternative treatments for insomnia go, L-tryptophan supplements are now considered safe and relatively free of side effects. (For pregnant and breast-feeding women, however, L-tryptophan is listed as “likely unsafe.”)

But you may be able to get most of what you need in your daily diet. Meat, fish, and seafood contain lots of of L-tryptophan; eggs, cheese, and milk contain quite a bit, too. The following foods are also high in L-tryptophan:

  • soybeans and soy products
  • sesame seeds
  • seaweed
  • spinach
  • mushrooms, wild and garden variety
  • turnip and mustard greens
  • asparagus

One last caveat. By itself, L-tryptophan does not cross the blood-brain barrier. Combining an L-tryptophan-rich food with a carbohydrate greatly improves L-tryptophan uptake in the brain. So for your evening snack, have your cheese on a cracker and your tofu with rice.

If you’ve tried L-tryptophan supplements, what effect did they have on your sleep?

An Insomnia Treatment from China

Sour date seed has been used as a sleep aid in China and other Asian countries for over 2,000 years. The seed of a small tree called Ziziphus jujuba Mill var. spinosa, sour date is used alone or in combination with other herbal medicines to relieve insomnia and anxiety.

Traditional Chinese herbs may relieve insomniaSour date seed has been used as a sleep aid in China and other Asian countries for over 2,000 years. The seed of a small tree called Ziziphus jujuba Mill var. spinosa, sour date is used alone or in combination with other herbal medicines to relieve insomnia and anxiety.

Despite its widespread use in Asia, no randomized controlled trials on sour date seed (also called sour jujuba seed) have been conducted on humans to determine its safety and efficacy. But preclinical tests on animals suggest that sour date seed (or one or more of its chemical constituents) acts on neurotransmitter systems that impact sleep and mood, and one observational study suggests that it may improve sleep in women with menopause-related insomnia. If you’re open to alternative treatments for insomnia, this one may interest you.

The GABA Connection

Exactly how sour date seed achieves its soporific effects is unknown. But laboratory tests have shown that it acts on the GABA system. In the brain, neurons that produce the neurotransmitter GABA are important for sleep. When the GABA neurons start firing, the lights in the brain go out.

Many sleeping pills prescribed today—zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata), and temazepam (Restoril)—enhance the ability of GABA to do its job. They bind to GABAA receptor complexes on the receiving ends of nerve cells and increase the flow of chloride ions moving into the cells. The cells are then inhibited from firing, which tranquilizes the brain. Anti-anxiety medications such as alprazolam (Xanax), clonazepam (Klonopin), and diazepam (Valium) also bind to GABAA receptors, inducing relaxation.

Research on lab animals has shown that sour date seed also binds to GABAA receptors and has sedating effects. In one such study, investigators administered jujubosides—active components in sour date seed—to rats during the day and at night. The jujubosides significantly increased the rats’ total sleep time both day and night.

Other Calming Activity

In another study, scientists used rats to observe the effects of jujuboside A on the hippocampus, an area of the brain associated with emotion, memory, and the autonomic nervous system. The main finding was that jujuboside A inhibited arousal in key pathways in the hippocampus.

Still other animal studies have been done using suan zao ren tang (SZRT), a traditional Chinese herbal medicine whose main ingredient is sour date seed. It was found to modulate the activity of several neurotransmitter systems associated with sleep and mood alteration.

An Observational Study

SZRT is commonly used to treat insomnia connected with menopause in Taiwan, but its use there is traditional and not the result of scientific evidence attesting to its efficacy and safety. So a group of Taiwanese researchers set out to measure its effects on 67 midlife women with insomnia.

The form of SZRT used was a powdered extract made into a granulated compound prepared by the Kaiser Pharmaceutical Co. in Taiwan. The women took 4 grams 3 times a day.

By the end of week 1, the women reported no changes in their sleep. But after 4 weeks, the women experienced these significant changes:

  • About 74 percent of the participants with mild to moderate menopausal symptoms reported improved sleep quality, and about 82 percent of those with moderate to severe symptoms reported improved sleep quality
  • The women fell asleep about 23 minutes faster, on average
  • The average total sleep time went from 4.7 hours to 5.5 hours a night

Three women withdrew from the study due to stomach ache, diarrhea, or dizziness—symptoms that disappeared once the SZRT was stopped.

Take These Results with a Grain of Salt

The main caveat here is that the study was neither randomized nor controlled. Without a control group taking a placebo, it’s impossible to know to what extent the results reflect the effects of SZRT and how much they reflect a placebo effect.

Also, as the authors of the study point out, the fact that by the end of the first week of the study the participants’ sleep remained unchanged suggests that SZRT—if it does improve sleep—works slowly. This is true of many herbal medicines, which must be taken for days or weeks before having an effect.

But the findings do suggest that sour date seed merits more study as a potential sleep aid. And as alternative treatments for insomnia go, this one—because of its history of use and current popularity in Asian countries—is likely fairly safe.

Insomniacs Weigh In on Mindful Stress Reduction

A lot of people with insomnia say the main barrier to sleep is an unquiet mind. The minute they lie down, the mind starts racing over the events of the day or sprints ahead to the next day, chewing over problems and unable to stop.

If you could put a lid on the chatter and improve your sleep by dedicating 20 minutes a day to meditation, focused breathing, and simple yoga poses, would you do it?

Here’s what you could expect to gain, in the words of those who are doing it.

Insomnia is less bothersome if you practice meditation, focused breathing and yogaA lot of people with insomnia say the main barrier to sleep is an unquiet mind. The minute they lie down, the mind starts racing over the events of the day or sprints ahead to the next day, chewing over problems and unable to stop.

If you could put a lid on the chatter and improve your sleep by dedicating 20 minutes a day to meditation, focused breathing, and simple yoga poses, would you do it?

This is the commitment a group of insomnia sufferers made after participating in an 8-week study comparing the effects of mindfulness-based stress reduction (MBSR) to treatment with the sleeping pill eszopiclone (Lunesta). The MBSR and the Lunesta groups experienced similar improvements in their sleep. But the MBSR group reported a lot more treatment satisfaction. Five months later, 9 participants gathered at the University of Minnesota in focus groups to discuss the effects of MBSR on their sleep and waking hours. Here are some of their comments.

Improved Sleep

Mine [my sleep] was almost immediately, positively impacted . . . I didn’t sleep longer, but I slept better. So I woke up more refreshed even though I wasn’t sleeping more, and that happened for me very quickly.

Sleep quality improved with MBSR practice. Specifically, people reported (1) getting to sleep more quickly, (2) having shorter nighttime awakenings and fewer early-morning wake-ups, and (3) waking up feeling more rested and refreshed.

Benefits of the Body Scan

The body scan is a guided meditation that several people in the group found was especially effective in halting mental chatter and helping them relax. (The body scan involves focusing your attention on body parts one by one, starting, for example, with the left big toe. With acceptance rather than judgment, you’re to notice any sensations you’re experiencing there, and continue doing the same thing through the rest of the body.)

The body scan helped keep my mind from racing, so that I could just decompress and fall asleep.

If I wake up in the middle of the night it [the body scan] seems to help me relax and get back to sleep. And a lot of times I’m back to sleep before I get past the left leg.

Better Sleep Habits

While undergoing the MBSR training, participants also learned the rules of good sleep hygiene: avoid caffeine late in the day, get up at the same time every morning, and so forth (you know the drill!).

MBSR helped in

making it a priority to do the things that we all know we are supposed to do, but we don’t necessarily do. Like not watching TV in bed, not eating chocolate at 7 o’clock at night.

Overall, MBSR training made it easier to shy away from behaviors that interfered with sleep and adopt habits that were helpful.

Benefits Beyond Sleep

Sleep wasn’t the only that improved with training in MBSR. People also reported feeling better emotionally and physically in the daytime.

I feel as though instead of getting worked up about things throughout the day and then having it be difficult to come down to relax and sleep, I feel that when I started doing the body scan [in the morning] I was at a stable emotional level throughout the day.

The yoga component of the training was helpful in increasing physical flexibility and reducing aches and pains.

It’s low impact and I don’t get stiff like I used to sitting working long hours.

Use It or Lose It

Like many techniques and skills, though, MBSR requires ongoing practice. One group member couldn’t do her customary meditation while on vacation and backslid as a result:

I noticed that the benefits left me. . . . I came back home and here was the chatter all back again. ‘I shouldn’t have said that. Shouldn’t have done that.’. . . It was all back. And . . . I couldn’t go to sleep. And when I do the meditation that chatter goes away. . . . I lay down at night and I’m not chattery.

The Take-Away

A maintenance routine of 20 minutes a day does not sound like a big investment if the potential gains are as great as these comments would suggest. As alternative treatments for insomnia go, this one is not so demanding.

But the initial 8-week training requires a bigger time commitment. To learn MBSR techniques, group members participated in a 2½-hour class every week and a daylong silent retreat. They were also asked to do 40 minutes of home practice 6 days a week. This is the standard MBSR training program recommended by Full Catastrophe Living author Jon Kabat-Zinn.

But a 20-minute maintenance regimen that can be done at home with no special equipment and no special clothes? Especially if mental chatter and/or conditioned arousal keep you from sleeping at night, MBSR is worth a serious look.

Insomnia: Could Cranial Electrotherapy Stimulation Help?

If you’re leery of sleeping pills and haven’t fared well with cognitive behavioral therapy, maybe it’s time to think outside the box. There are quite a few alternative treatments for insomnia. Among the least known is Cranial Electrotherapy Stimulation, or CES. CES has been cleared by the FDA for treatment of anxiety, depression and insomnia. Here’s a summary of information about it.

Insomnia may respond to treatment with cranial electrotherapy stimulationIf you’re leery of sleeping pills and haven’t fared well with cognitive behavioral therapy, maybe it’s time to think outside the box. There are quite a few alternative treatments for insomnia. Among the least known is Cranial Electrotherapy Stimulation, or CES.

The “electro” in CES might give pause, recalling cruel shock treatments that characters in movies like One Flew Over the Cuckoo’s Nest were forced to undergo. As practiced today, that form of treatment–Electroconvulsive Therapy–delivers 800 to 1,000 milliamperes (mA) of current to the brain, inducing seizures to relieve severe mental illness.

In contrast, CES is a treatment you administer on your own with a device that delivers 1 to 4 mA of current to the brain. The sensation it produces ranges from a slight pulsing at contact points on the earlobes or the head to nothing at all. But proponents claim this tiny amount of transdermal electricity has the power to relieve anxiety, depression and insomnia. In June the FDA announced it would soon grant approval of CES for the treatment of these disorders with fewer restrictions and reclassify CES devices as belonging in the same risk category as acupuncture needles and power wheelchairs.

What Does CES Do to the Brain?

The claim is that CES can relieve insomnia, but so far there are only theories about how it works. Studies suggest that CES alters electrical activity in the brain, deactivating neurons in the cerebral cortex and down-regulating activity in other parts of the brain. Alpha waves, associated with relaxation and focus, are slowed and become more prominent.

Other mechanisms of action have also been proposed. CES may 1) promote the release of endorphins and other neurotransmitters that inhibit arousal and agitation, or 2) stimulate peripheral nerves, triggering processes that calm the brain. The particulars are not known, but any or all of these actions could give relief to people with insomnia.

How Safe Are the Devices?

The FDA’s reclassification announcement suggests that the risks associated with CES devices such as the Fisher Wallace Stimulator and the CES Ultra are low. Of 57 service members recruited to participate in a randomized controlled trial of the effects of CES on insomnia, one subject in the active treatment group complained of a headache and another reported sleeping worse after a single session.

Fisher Wallace states that 1 in 500 users experiences a mild headache and 1 in 250 experiences an increase in wakefulness immediately following treatment sessions. I haven’t been able independently to confirm these figures. But Kirsch and Nichols, reviewing studies of CES in an article in The Psychiatric Clinics of North America, note that “adverse effects are rare (<1%), mild, and self-limiting, consisting mainly of skin irritation under the electrodes and headaches.”

How Well Does CES Work as an Insomnia Remedy?

Now we’re on shakier ground. Of 18 studies of the treatment’s effects on mood and level of arousal, only 2 were rigorous enough to be included in a meta-analysis conducted by Klawansky et al. in 1995. These researchers concluded that CES was better than sham treatment only for anxiety—and not for insomnia. (But . . . insomnia and anxiety are closely related, so you may be heartened by this result.)

Scientists who study sleep and insomnia remedies haven’t shown much interest in CES. In the study of service members cited above, subjects received 5 treatments or 5 sham treatments. Male subjects, more numerous than females, reported sleeping nearly an hour more after the first and fourth sessions of active treatment. Female subjects did not. Overall, the results were “encouraging but not decisive,” identifying a “nearly significant” increase in total sleep time among all subjects after the third treatment. “Nearly significant” is not a slam dunk.

The results of older studies are mixed, suggesting that CES may help people with insomnia fall asleep more quickly and sleep more efficiently. Clinicians offer mostly favorable reports of CES on the Internet, but nothing more decisive is known about its effects on insomnia.

Liz, a librarian I interviewed for my book, wrote to ask about the Fisher Wallace Stimulator and said she thought it might be worth a try, given the company’s 60-day money back guarantee. I can’t vouch for it personally. But for people with treatment-resistant insomnia, it’s worth consideration.

If you have tried a CES device or try one out in the future, please share your experience here.