An Ayurvedic Herb for Better Sleep

Might Ayurvedic medicine—traditional medicine practiced in India for 3,000 years—offer an effective treatment for insomnia?

If you’re looking for an alternative treatment vetted by scientists in controlled clinical trials, the answer is no. But an Indian herb called ashwagandha is receiving attention as a substance that might help people with several health conditions, including chronic stress, anxiety, and memory loss. It’s also being studied as a possible sleep aid. Here’s more about it.

Insomnia may respond to treatment with ashwagandhaMight Ayurvedic medicine—traditional medicine practiced in India for 3,000 years—offer an effective treatment for insomnia?

If you’re looking for an alternative treatment vetted by scientists in controlled clinical trials, the answer is no. But an Indian herb called ashwagandha is receiving attention as a substance that might help people with several health conditions, including chronic stress, anxiety, and memory loss. It’s also being studied as a possible sleep aid. Here’s more about it.

Ashwagandha (Withania somnifera)

Ayurvedic medicine is a holistic healing system. Patients are generally prescribed a combination of herbs, special diets, and daily practices aimed at promoting overall health rather than eliminating a specific problem like insomnia.

But the Latin somnifera means sleep-inducing, and ashwagandha powder, prepared from the root, leaves, or whole plant and taken orally, has been prescribed to improve sleep for centuries. A handful of laboratory studies on rodents have provided evidence for ashwagandha’s sleep-inducing effects. Results of some studies suggest that ashwagandha leaf extract may also protect rats from the consequences of sleep deprivation.

Authors of a recently published paper in PLOS ONE have identified a specific component of the ashwagandha leaf that puts mice to sleep. Following is a summary of their findings.

An Active Component That Promotes Sleep

Biologically active components in ashwagandha include withanolides—naturally occurring steroids—and triethylene glycol, or TEG. TEG is currently used in various manufacturing processes, but how it impacts biological systems is largely unknown. In this study, investigators wanted to find out if one or the other of these substances had sleep-inducing effects.

Via a complicated extraction process, the researchers isolated each of these compounds, mixing them with alcohol and water so they could be administered orally to mice. Here are the results:

  • Compared with the alcoholic medium alone, the alcoholic extract containing a high amount of active withanolides had no effect on the sleep–wake system of the mice.
  • Compared with water alone, the extract containing lots of TEG induced a significantly greater amount of non-REM, or quiet, sleep—without affecting the amount or nature of REM sleep.
  • Commercially available TEG was also administered to the mice in 10, 20, and 30-mg doses. The larger the dose, the more non-REM sleep the mice got over a 12-hour period and the more quickly they fell asleep.

The authors conclude that while low to moderate levels of TEG clearly induce sleep in laboratory animals, possible “toxicological properties of TEG need to be studied in detail before its used is advised in humans.”

Meanwhile, Is Ashwagandha Safe for Humans?

It depends on where you ask the question. Indian practitioners of Ayurvedic medicine have been prescribing it for centuries. A handful of scientific studies also attest to the safety of this herb when used short term in therapeutic doses. (Long-term effects are unknown.)

But an article in Medline Plus lists a number of safety concerns. People who are pregnant and breast feeding, who have diabetes, or who have an auto-immune disorder should steer clear of ashwagandha. The herb can interact with various medications and supplements, too.

For a definitive reading on whether ashwagandha could work as a treatment for insomnia we’ll have to wait and see. But it’s widely available as a dietary supplement in powder, capsule, and tablet forms. Of course, dietary supplements are less well regulated by the FDA than prescription medications. Quality is not assured.

But if you’re looking for better sleep and tempted to try ashwagandha, consult a practitioner of Ayurvedic medicine or a naturopath about whether the herb might have something to offer you.

Sleeping Pills: New Prescribing Guidelines

Let’s say you go to the doctor hoping to get a prescription for sleeping pills to relieve your insomnia. You’ve been through cognitive behavioral therapy and it has helped. But there are nights when you’re wound up so tightly that nothing—push-ups, meditation, a hot bath—will calm you down enough so you can get a decent night’s sleep. What then?

The American Academy of Sleep Medicine recently released a clinical practice guideline for the medical treatment of chronic insomnia in adults. Here’s what the academy now recommends.

New guideline for sleeping pills may change doctors' prescribing habitsLet’s say you go to the doctor hoping to get a prescription for sleeping pills to relieve your insomnia. You’ve been through cognitive behavioral therapy and it has helped. But there are nights when you’re wound up so tightly that nothing—push-ups, meditation, a hot bath—will calm you down enough so you can get a decent night’s sleep. What then?

The American Academy of Sleep Medicine recently released a clinical practice guideline for the medical treatment of chronic insomnia in adults. Here’s what the academy now recommends.

Why the Need for a Clinical Practice Guideline?

Most experts in sleep medicine are well acquainted with the literature on sleeping pills and know how to diagnose and treat insomnia. When medication for insomnia is warranted, they know the best drug to prescribe based on your symptoms and medical history.

But most people with sleep complaints take them first to primary care providers. And when it comes to prescribing sleeping pills, not all doctors are on the same page. In fact, a new study from Harvard Medical School shows that, rather than prescribing based on individual patients’ symptoms and history, many doctors find one or two sleep medications they’re comfortable with and prescribe the same drug or drugs again and again.

The new clinical practice guideline contains recommendations that are evidence based. It has the potential to change physicians’ prescribing habits and thus to affect people with insomnia who use sleeping pills, now and in the future.

The Guidelines Are Based on Weak Evidence

The four sleep experts who created the guideline first conducted a literature review. They concluded that no sleeping pill or sleep aid on the market today has been tested in multiple clinical trials and found to be extremely effective and carry very few risks. So the evidence base for their recommendations is, they note, “weak.”

This doesn’t mean that a given medication would not be appropriate and effective for a particular individual with insomnia. It just means as a general treatment for everyone with chronic insomnia, no sleeping pill is backed up strongly by the evidence.

These Sleeping Pills Got a Thumbs-Up

Perhaps predictably, the medications judged to be appropriate—based on the quality of evidence, the balance of benefits and harms, and patient values and preferences—are medications approved by the FDA for the treatment of insomnia. The guideline does not suggest that one drug is better than another since so few studies comparing the efficacy of two or more sleeping pills have been conducted. So the medications listed here are in no particular order:

MEDICATION

SLEEP ONSET INSOMNIA

SLEEP MAINTENANCE INSOMNIA

suvorexant (Belsomra)  X
eszopiclone (Lunesta) X  X
zaleplon (Sonata) X
zolpidem (Ambien) X
triazolam (Halcion) X
temazepam (Restoril) X X
ramelteon (Rozerem) X
doxepin (Silenor) X

These Sleep Aids Were Not Recommended

The following medications and supplements are sometimes prescribed and used for chronic insomnia. Depending on an individual’s symptoms and history, they may help. But the published data on these substances is insufficient in quantity and/or quality to warrant a recommendation for general use as a treatment for chronic insomnia.

  • trazodone (a sedating antidepressant)
  • tiagabine (an anticonvulsant approved for the treatment of epilepsy and used off-label to treat anxiety and panic disorders)
  • diphenhydramine (the antihistamine found in most over-the-counter sleep aids, including ZzzQuil, Sominex, and Tylenol PM)
  • tryptophan (a supplement containing an amino acid found in milk and other sources of dietary protein)
  • melatonin (a supplement which is bio-identical to a hormone produced in the body, useful for jet lag and delayed sleep phase disorder)
  • valerian (a plant-based supplement)

If you’ve used any of these medications or supplements, how effective were they, and did you experience any side effects?

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.

Magnesium May Ease Insomnia and Anxiety

Last week a new friend was telling me about her sons. She has quite a bit of anxiety about their situation and, since reaching menopause, she’s had trouble sleeping. She tried sleeping pills and didn’t like the way they made her feel. But magnesium supplements seem to do the trick.

So I looked for research on magnesium, anxiety and insomnia and here’s what I found.

Magnesium supplements may ease anxiety and improve sleepLast week a new friend was telling me about her sons. She has quite a bit of anxiety about their situation and, since reaching menopause, she’s had trouble sleeping. She tried sleeping pills and didn’t like the way they made her feel. But magnesium supplements seem to do the trick.

So I looked for research evaluating magnesium’s effects on anxiety and insomnia. Not much is out there, and most of what exists are investigations of magnesium in combination with other vitamins and supplements. But some readers of this blog want information about alternative treatments for insomnia, so here’s the gist of what I found.

Magnesium’s Effects on Anxiety Symptoms

Magnesium has several important molecular functions in the body. Both animal and human studies suggest that magnesium deficiency may be linked to anxiety and anxiety-related disorders. In the early 2000s, three randomized controlled trials were conducted to assess the effects of magnesium supplements on anxiety symptoms in humans:

  1. In 80 healthy male subjects, a 4-week treatment of a multivitamin containing large amounts of magnesium, zinc, and calcium significantly decreased anxiety symptoms and perceived stress compared with placebo. The effects got stronger the longer treatment progressed.
  2. In 44 women with premenstrual anxiety (but otherwise healthy), over 4 monthly cycles each, participants were alternately given 200 mg of magnesium, 50 mg of vitamin B6, both the magnesium and the B6, or a placebo pill. The combination treatment provided a small but significant reduction in premenstrual symptoms such as nervous tension, mood swings, irritability, anxiety. By itself, however, the magnesium was no more effective than placebo.
  3. The third study was conducted on 264 people with a diagnosis of generalized anxiety disorder (GAD) for 3 months. The anti-anxiety effects of a compound containing magnesium and two plant extracts was compared with placebo. Both the active treatment and the placebo greatly decreased participants’ anxiety symptoms—the supplement a little more than the placebo.

These results are certainly mixed. First, it’s hard to make claims about the anxiety-reducing effects of magnesium when it’s studied in combination with other substances. It’s also important to realize that the effects of magnesium on the subjects in these studies—healthy men, women with premenstrual anxiety, and people with a diagnosis of GAD—may not generalize to everyone with anxiety or anxiety-related trouble sleeping. So we’ll have to look to future research to confirm or disconfirm magnesium’s calming effects.

Effects of Magnesium on Insomnia

Magnesium affects systems that promote both wakefulness and sleep, so it might have a relationship to insomnia. Two randomized controlled trials suggest that it may improve the sleep and daytime functioning of older adults. (The rationale for exploring the question with older study participants is that as we age, we’re prone to experience changes in the way our bodies absorb, retain, and utilize nutrients, and changes in circadian rhythms. A magnesium deficiency would more likely show up in older adults.)

  1. The 46 participants in this 8-week study (ages 60–75) were divided into two groups: one taking 500 mg of magnesium a day and the other taking a placebo. Compared with the placebo takers, the magnesium takers experienced significant increases in total sleep time and sleep efficiency, and significant decreases in the time it took to fall asleep and insomnia severity. Moreover, their levels of melatonin (a sleep-friendly hormone) were up while their levels of cortisol (a stress hormone) were down.
  2. The 43 participants in this 8-week study (ages 74–82) were also divided into two groups, one taking a food supplement containing magnesium, melatonin, and zinc, and the other, a placebo. Again, compared with participants on the placebo, participants taking the supplement experienced significant increases in total sleep time, sleep quality, and ease of getting to sleep. Their early morning alertness and stamina was also improved.

The results of both studies suggest that magnesium may be an effective sleep aid for older adults. Whether young and middle-aged insomnia sufferers would experience the same benefits remains to be seen.

But if you’re comfortable experimenting with alternative treatments for insomnia, as long as you avoid taking too much, magnesium might be worth trying, especially if you’re older. It has none of the drawbacks associated with other sleep aids. Like other supplements, though, it may need to be taken a few weeks before producing effects.

If you prefer to wait for science to confirm supplementary magnesium’s effects on sleep, you may be waiting a long time. There’s little money to be made on vitamins, minerals, and plant-based supplements—so the research lags. That doesn’t mean magnesium or any other supplement won’t help your sleep. It just means it hasn’t been studied yet.

Drinking to Get to Sleep

The story on alcohol and sleep is complicated. About 10 to 14 percent of adults in the United States use alcohol as a sleep aid. While it generally degrades the quality of sleep, the use of alcohol does not predict the development of persistent insomnia, say the authors of a large longitudinal study published in January 2012 in the journal Sleep. But—and here’s the troubling part—twice as many insomniacs become problem drinkers as people who sleep well.

Here is one woman’s story of how alcohol led to trouble sleeping and insomnia.

Insomnia more likely when relying on alcohol for sleepI mentioned to a gastroenterologist that I was writing a book about insomnia.

“Alcohol,” he said in response. “If you want to understand insomnia, look at alcohol and coffee.” His assumption that alcohol and coffee are causal factors in insomnia is widely held, and eventually I checked it out.

The story on alcohol and sleep is complicated. About 10 to 14 percent of adults in the United States use alcohol as a sleep aid. While it generally degrades the quality of sleep, the use of alcohol does not predict the development of persistent insomnia, say the authors of a large longitudinal study published in January 2012 in the journal Sleep. But—and here’s the troubling part—twice as many insomniacs become problem drinkers as people who sleep well.

Marilynn’s Story of Sleep and Alcohol

“Insomnia’s been a problem since I was very young,” Marilynn told me in an interview. “Unless the house was totally dark and quiet, I couldn’t sleep.” At her house those conditions were hard to come by. Her parents “always partied on the weekend, and very, very frequently during the week. It was just a noisy house.” The TV was always on, blasting away because her father was deaf in one ear. At parties the booze flowed freely. “In our house the bar was a shrine.”

“I remember my mom having bridge club and somebody letting me taste their creme de menthe,” she said. Marilynn was 9.  “So I just helped myself one night when the babysitter was upstairs and I was downstairs at the bar. I remember taking a glass …  and filling it with creme de menthe and thinking I was going to be sick to my stomach. But I also remember waking up the next morning and walking into this horrendous mess (from the party) downstairs. And I thought, ‘I slept through this. That stuff helped me sleep.’”

Marilynn dipped into the liquor cabinet occasionally for help in sleeping through the parties and her parents’ loud fights. Then in high school she learned about the dangers of drinking and stopped. But her problem with sleep continued unabated. Several years later she raised the sleep issue with her ob/gyn. “He suggested drinking a glass of red wine at night. He said two would be OK, too. And it worked for quite a while.”

Developing Tolerance

Then she found herself needing to increase the amount. To the wine she added a whiskey chaser. This, too, worked for a while. But by the mid-1990s, her drinking was out of control. She was hiding bottles from her husband and doing strange things at night.

“I wasn’t going to sleep,” Marilynn said. “I was passing out. I didn’t know then that I was also getting up.”

But her husband knew, and he was hiding the evidence. Then one morning Marilynn went down to the kitchen and found barley soup splattered all over the kitchen cupboards.

“’Who made this mess?’” she recalled shrieking at her husband. She had, he told her, and similar things had happened before.

“I had no recollection,” she said. “As far as I was concerned, I had slept through the night.” Around the same time, Marilynn lost her teaching job. She realized then that she had to get help, and she got it through AA. But while she’s given up drinking, her insomnia persists.

“I think it’s kept me very scattered, disorganized and unambitious. It’s been very, very limiting,” she said. “Definitely, absolutely, it’s what led to my problem with alcohol.”

Sleep problems are no trivial matter, as the link between insomnia and the higher rate of alcoholism suggests. If you’re going to imbibe, say the experts, do it early in the evening. But if you’re looking for a sleep aid, you’d be wise to choose something else.