There are two herbs or supplements that have the best data supporting their effectiveness. Both appear to be safe but have modest effectiveness.
- Valerian (Alone or Combined with Hops or Melissa)
Melatonin: Rapid Effect on Sleep
The body uses melatonin as part of the way it regulates the sleep-wake cycle. Levels of melatonin increase as light decreases (at night), usually peaking around bedtime, and decrease as light increases.
Taking melatonin as a supplement seems to stimulate sleep when the natural cycle is disturbed. The most common uses are to aid with jet lag or help people who have to adjust their schedule from time to time because of work, although a recent review suggested that it may be helpful for children with mild to moderate insomnia.
A major review published in 2001 concluded that melatonin was useful for jet lag (Herxheimer A, Petrie KJ. Melatonin for preventing and treating jet lag. Cochrane Database Syst Rev. 2001;(1):CD001520).
In addition, melatonin may be helpful for delayed sleep phase disorder (naturally going to sleep later than you need to).
Mixed results have been seen in studies involving the use of melatonin for swing-shift workers and for elderly individuals with insomnia. (for the full discussion of the research and the only independent analysis of specific melatonin products I encourage you to subscribe to Consumer Lab and then go to their page on melatonin).
Dosing for melatonin is quite variable. Consumer Lab recommends beginning with a very low dose (some people respond to doses as low as 0.3 mg) taken an hour before bed time and then gradually increasing the dose (up to 3 mg). If you don’t respond to several nights at the 3 mg dose you are unlikely to get a benefit.
It is worth noting that while short term use appears safe, long term use can affect blood pressure, testosterone and estrogen levels, and may reduce bone strength.
There are many different formulations, but these ones are worth looking for –
Swanson Melatonin 1 mg – This is a useful form to take if you have tried melatonin in the past and know that 0.3 mg is unlikely to help. The usual dose is 1 mg an hour before bedtime for 2 – 3 nights and then increase, if necessary, up to a dose of 3 mg.
Life Extension Melatonin 300 mcg (0.3 mg) – Might be a good starting dose for those who are sensitive to supplements and want to minimize any morning hangover effect.
Source Naturals Timed Release Melatonin 3 mg – I you have trouble both with falling asleep and staying asleep this formulation may be useful, although melatonin is less useful for improving sleep continuity and there may be more of a hangover effect with timed release melatonin.
Valerian: Appears to Improve Sleep Gradually
Valerian has a long traditional use for insomnia, and today it is an accepted over-the-counter drug for insomnia in Germany, Belgium, France, Switzerland, and Italy.
Valerian is most commonly recommended as an aid for occasional insomnia. However, the results of the largest and best designed study suggest that it may be more useful for long-term improvement of sleep (Vorbach EU, Gortelmeyer R, Bruning J. Therapy for insomniacs: effectiveness and tolerance of valerian preparations [translated from German]. Psychopharmakotherapie. 1996;3:109-115.).
This 28-day, double-blind, placebo-controlled study followed 121 people with histories of significant sleep disturbance. This study looked at the effectiveness of 600 mg of an alcohol-based valerian extract taken 1 hour before bedtime.
Valerian didn’t work right away. For the first couple of weeks, valerian and placebo were running neck and neck. However by day 28, valerian had pulled far ahead. Effectiveness was rated as good or very good by participant evaluation in 66% of the valerian group and in 61% by doctor evaluation, whereas in the placebo group, only 29% were so rated by participants and doctors.
This study provides good evidence that valerian is effective for insomnia. However, it has one confusing aspect: the 4-week delay before effects were seen. In another study, valerian produced immediately noticeable effects on sleep (Leathwood PD, Chauffard F, Heck E, et al. Aqueous extract of valerian root ( Valeriana officinalisL.) improves sleep quality in men (Pharmacol Biochem Behav. 1982;17:65-71), which is what most practitioners believe to be typical. Why valerian took so long to work in this one study has not been explained.
Other studies of valerian alone, or in combination with hops or melissa, have produced mixed results.(for the full discussion of the research I encourage you to subscribe to Consumer Lab and then go to their page on valerian).
In addition several other treatments have some data to support their effectiveness, but the quality of that data is poorer and there may be safety issues as well: 5-HTP (5-Hydroxytryptophan); Acupuncture or Acupressure; Ashwagandha; Astragalus; Biofeedback; Chamomile; He Shou Wu; Hops; Kava; Lady’s Slipper Orchid; Passionflower; Relaxation Therapies; St. John’s Wort; and Skullcap.