Kava for Anxiety and Insomnia: Effective? Safe?

Kava (Piper methysticum) holds promise as an alternative treatment for anxiety and insomnia. But I’ve refrained from blogging about kava and kava supplements due to concerns about liver toxicity.

Now a comprehensive review funded by the National Science Foundation and published in the journal Fitoterapia has eased those concerns. I can write about kava, native to Hawaii and other Pacific islands, as I would any other medicinal plant, summarizing benefits and risks.

Kava, an alternative treatment for anxiety, may also help insomnia sufferersKava (Piper methysticum) holds promise as an alternative treatment for anxiety and insomnia. But I’ve refrained from blogging about kava and kava supplements due to concerns about liver toxicity.

Now a comprehensive review funded by the National Science Foundation and published in the journal Fitoterapia has eased those concerns. I can write about kava, native to Hawaii and other Pacific islands, as I would any other medicinal plant, summarizing benefits and risks.

Kava in Traditional Pacific Cultures

Traditional Pacific island cultures viewed the beverage they prepared from the kava root as sacred. Kava “was the food of the gods,” Hawaiian scholar Mary Kawena Pukui said. “No religious ritual was complete without it.”

Librarian-scholar Margaret Titcomb wrote that the custom of drinking kava “is of interest in Hawaii because it was a sacred drink of importance in many phases of Hawaiian life. . . . Its effect is to relax mind and body. . . . Medical kahunas (learned men) had many uses for it. . . . It was essential on occasions of hospitality and feasting, and as the drink of pleasure of the chiefs.”

Pacific islanders continue drinking kava today. Traditionally it’s mixed with water, strained by hand, and served on social occasions, often in coconut shells. Kava drinkers may consume several coconut shells of the beverage on one occasion.

Western Interest in Kava

Pacific islanders used different parts of the kava plant to treat various ailments, suggesting to Europeans who arrived in the 18th century that kava might have important medicinal uses. First the Europeans used it to treat venereal disease. By the 1880s, it was being used to relieve stress and anxiety. British herbalists have used it since the early 1900s to treat disorders of the urinary tract.

Kava in the 1990s became a popular herbal remedy for anxiety—an alternative treatment to benzodiazepine drugs such as Valium and Xanax. Consumed as a tablet or a tincture, kava supplements contain specific concentrations of kavalactones, which are extracted from the kava plant with alcohol, acetone, or water. Kavalactones are believed to be the main active ingredients in kava.

Anti-Anxiety and Sedative Effects

Studies of kava’s effects on animals show that it acts on many of the same neurotransmitter systems as anti-anxiety drugs. It results in GABA channel modulation and downregulates or inhibits systems that are active during arousal. In humans, quite a few studies have shown that kava is significantly more effective than placebo at lowering anxiety.

So far, though, only one randomized controlled trial has been conducted to investigate kava’s effects on sleep. In this 4-week study of people with sleep disturbances associated with anxiety, the authors compared 34 participants taking a kava extract with 27 participants taking placebo. By the end of the study, the kava group experienced a significant improvement in the quality of their sleep—but so did the group taking a placebo, although to a lesser extent.

So would taking a kava supplement improve the sleep of insomnia sufferers? No one knows, and no one will know unless more and better controlled studies are done. What the existing data do suggest is that kava might be helpful for people whose insomnia is closely associated with anxiety.

Why So Little Research?

Kava sales in the West fell off sharply at the turn of the 21st century. No Pacific islander was ever known to suffer liver failure related to kava, but between 1999 and 2002, 10 kava users in Europe and the United States had to undergo liver transplants. The need for the transplants was attributed to patients’ having consumed moderate doses of kava for anywhere from 2 to 12 months. Subsequently the CDC issued advisories in the United States. Germany banned kava in 2002.

On further examination, though, investigators found that kava could be implicated as a causal agent in only 3 liver failure cases. Germany overturned its ban on kava in 2014. Sales of kava products in the West are expected to rise again.

How Likely Is Liver Failure?

Why kava might trigger liver failure in a few of the millions of users is still an open question. It might have to do with

  • genetic factors;
  • the method of extraction. While the traditional drink is prepared by water extraction, extraction using acetone, ethanol, or methanol is used in the manufacture of supplements to achieve higher concentrations of kavalactones (which, most research suggests, are not themselves a source of toxicity);
  • interactions with drugs such as alcohol, barbiturates, and benzodiazepines;
  • the use of leaves, stems, and other plant parts in the manufacture of supplements rather than just the root; or
  • the use of inappropriate kava cultivars.

All these possibilities notwithstanding, instances of kava toxicity are relatively rare. Say authors of the review, “The incident rate of liver toxicity due to kava is one in 60 to 125 million patients.”

So the risk is pretty slim.

Have you tried kava for sleep or anxiety? How did you fare?

Cut Down on Nighttime Wake-Ups: A Survey & Advice

Who would you guess wakes up more frequently at night because of stress and anxiety? Adults who are young, middle aged, or old?

What the Sleepless Nights survey tells us about middle-of-the-night awakeners, together with a dash of commentary and advice.

Sleep is less deep & restorative when disrupted by wake-ups in the middle of the nightWho would you guess wakes up more frequently at night because of stress and anxiety? Adults aged

(a) 18 to 24

(b) 25 to 34

(c) 35 to 44

(d) 45 to 54

(e) 55 and above

According to a recent survey of 1,000 adults in the United States, the youngest adults lead the pack, with 46% of the 18- to 24-year-olds reporting stress-related wake-ups at night.

Does this surprise you? Maybe so and maybe not. But data can sometimes contradict expectations. Following are a few more findings taken from the Sleepless Nights survey conducted October 19 by OnePoll,* an online market research firm, together with a dash of commentary and advice.

Waking Up in the Middle of the Night

It’s not unusual to wake up once or even a few times during the night. In fact, in the OnePoll survey, less than 1% of the respondents reported never waking up at night. But having lots of nighttime awakenings is a problem. It’s a symptom of sleep maintenance insomnia.

You might think the total amount of sleep you get is actually more important than the number of wake-ups you experience. But this isn’t true. Sleep interrupted by frequent wake-ups is not as restorative as the same amount of sleep gotten all at one time, according to a study published in the November issue of Sleep. People who sleep in fits and starts miss out on a significant amount of deep sleep, the study shows. They report feeling unrefreshed in the morning, and waking up in a bad mood.

In addition to waking up in the middle of the night, 39% of the respondents in the OnePoll survey reported feeling exhausted on awakening in the morning—and this complaint was more frequent among the young and middle-aged than in adults 55 and older. This suggests that quite a few Americans aren’t getting the amount or type of sleep we need.

Reason #1: Bathroom Calls

About 74% of the respondents reported that one reason for their middle-of-the-night wake-ups was the need to go to the bathroom. This is not surprising given the ages of the respondents (43% were 55 and older). But not only does having to void several times at night decrease sleep quality. It also puts you at greater risk for developing chronic insomnia.

So if your nighttime wake-ups are due to an overactive bladder, have a look at the blog I wrote last December on ways to cut down on the need for bathroom calls at night.

Also, a few preliminary studies I’ve seen in the past year suggest that supplements containing pumpkin seed extract, alone or in combination with soy isoflavones, may reduce symptoms of overactive bladder. If you’re game to try the pumpkin seed extract/soy isoflavone supplements, keep in mind that like most plant-based medicines, they may need to be taken a few weeks before you notice effects.

Reason #2: Temperature Changes at Night

About 36% of the respondents reported usually waking up in the middle of the night because they were too hot, and about 19% reported awakening because they were too cold.

Some of this may have to do with changes in core body temperature at night. From a high in the evening, your temperature falls by about 1.5 degrees Fahrenheit during the night, bottoming out a few hours before wake-up time and then rapidly rising again. No wonder that during the first part of the night you’re piling the covers on and in the last part, throwing them off.

Especially if you tend to sleep hot, my blog on tips for overheated sleepers may help.

Reason #3: Stress and Anxiety

Finally, 32% of all survey respondents blamed their nighttime wake-ups on stress and anxiety—which isn’t so surprising. But the suggestion that the youngest adults are the most prone to stress-related wake-ups gives pause.**

Pressure to get into a good college, find the right job, land securely among the “haves” rather than the “have-nots” at a time when in the United States the haves and have-nots are growing farther and farther apart . . . Is young adulthood more stressful now than in times past?

What do you think?

* Results of this poll, which I accessed on 12/4/2015, are no longer available online. Use the contact form on the menu bar if you’d like me to send you a copy.

** Only 37 adults aged 18 to 24 participated in the survey, so the findings on young adults may not be very reliable. Yet other research has shown at least that the number of young adults who experience insomnia is actually quite high.