Nutrients that aid sleep Sleep-Aid Prescriptions on Rise after Major Events 

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In the wake of the September 11 attacks, reports have arisen that many Americans are suffering from insomnia. The threat of another attack, combined with adrenaline-arousing news reports of war and bioterrorism often viewed prior to bedtime, can result in nights of restless or non-existent sleep. The has reported that there has been an increase in prescriptions issued for pharmaceutical sleep aids, especially in New York City.

Research shows that a number of natural sleep aids may benefit anyone involved in the pursuit of a good nights rest. Valerian, kava kava, hops, lemon balm, passion flower have all been shown to improve sleep quality. The German government and European community sanction these herbs for the treatment of insomnia.

The active chemical constituents of valerian are primarily the valepotriates, which possess sedative activity. The valepotriates weakly bind GABA-A receptors, the same receptors in the brain as the drugs known as benzodiazepines (e.g. Valium, Xanax). Sedation in the central nervous system is primarily controlled through these receptors. Because valerian weakly binds benzodiazepine receptors, its sedative actions do not result in the dependence and potential addiction that may occur with pharmaceuticals like Valium. The valepotriates also do not produce the day after hangover of the diazepam tranquilizers.

Numerous human sleep studies have demonstrated that valerian produces a significant improvement in sleep quality, and an increase in deep REM sleep (dream phase) without producing the side effects of sleep drugs. One German study compared the sleep of subjects taking a combination of standardized extracts of valerian and lemon balm (Melissa officinalis), or the benzodiazepine drug Halcion for nine nights. Both groups showed a significant improvement in ability to get to sleep and their quality of sleep. However, the Halcion group demonstrated sleep hangovers and impairment of concentration the next day. In comparison, the valerian/lemon balm group showed no impairment in their daily activities the next day.

Kava kava is recognized for the ability to produce relaxation without the loss of mental sharpness. The active constituents of Kava consist of a group of lactones similar in structure to gamma-butyrolactone,(GBL) a precursor to gamma hydroxybutyrate (GHB). In high dosages, GHB produces sleepiness and depresses the dopaminergic pathway.

Numerous clinical and experimental studies have documented the relaxing, sleep-promoting and anti-anxiety actions of kava extracts that contain high levels of Kava lactones. In a 1991 double-blind, placebo-controlled four-week study of patients suffering from anxiety, a group receiving 210 mg of kava lactone extract three times daily showed reduction in anxiety after just one week and were significantly improved at the end of the study. The kava group experienced a significant reduction in menopausal symptoms, anxiety and depression compared to the control group.

A 1990 study compared the effects of a kava lactone to oxazepam (a benzodiazepine drug) on patients suffering from anxiety, for four weeks. Each substance reduced symptoms of anxiety equally. The kava lactone produced no side effects and oxazepam produced side effects such as drowsiness, dizziness, headaches and vertigo.

Passion flower was listed in the National Formulary from 1916 to 1936 and approved as a sedative and sleep OTC drug. Pharmacological studies by European research groups have shown that passion flower preparations produce antispasmodic, sedative, anti-anxiety and hypotensive activity. In one study, Italian researchers tested Passion flower alone and in combinations with other sedative herbs. They observed a synergistic effect of sedative activity from the herbal combinations. A study published in 1988 showed that oral administration and injections of passion flower into rats prolonged sleeping time, protected animals from convulsive chemicals and relaxed their muscles. In a double-blind, placebo-controlled study conducted on outpatients with anxiety disorders, an extract of passion flower in combination other herbs significantly lowered anxiety test scores compared to a placebo group.

Hops are extensively used in botanical formulas for the treatment of insomnia because they significantly relax the central nervous system. They are recommended by herbalists to ease tension and anxiety, and may be used where this tension leads to restlessness. A 1988 randomized, double-blind, controlled clinical trial demonstrated equivalent efficacy and tolerability of a hop-valerian preparation compared with a benzodiazepine preparation in patients suffering from sleep disorders. The researchers concluded that a hop-valerian preparation in the appropriate dose is a sensible alternative to benzodiazepine for the treatment of non-chronic and non-psychiatric sleep disorders.

Lemon balm relaxes the nervous system to promote sleep. The terpenes, part of the essential oil from lemon balm, are thought to relax the nervous system. Lemon balm, like hops, is seldom recommended by itself to treat insomnia, and is usually combined with other botanicals to enhance sedative activity. For example, the sedative effects of a Lemon Balm / Valerian combination was compared to triazelam (a benzodiazepine drug) and a placebo. In the insomniac group, the herbal combination was as effective as the benzodiazepine in producing deep sleep stages 3 and 4. The herbal preparation did not cause daytime sedation like the benzodiazepines.

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How did we qualify them ?

1. Brown D. Valerian: A possible substitute for benzodiazepines? Quart Rev Nat Med. Winter Quarter, pp. 17-18, 1993.

2. Leathwood PD, Chauffard F, Heck E, Munoz-Box R. Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man. Pharmacology, Biochemistry and Behavior. 1982;Jul, 17(1):65-71

3. Dressing H, Riesman D, et al. Are Valerian/Mellisa combinations of equal value to bezodiazeopine? Therapiewoch. 1992; 42:726-36.

4. Seitz U, Schule A, Gleitz J. [3H]-monoamine uptake inhibition properties of kava pyrones. Planta Med. 1997;63:548-549.

5. Kinzler E, Kromer J, & Lehmann E. Clinical efficacy of a kava extract in patients with anxiety syndrome: Double-blind placebo-controlled study over four weeks. Arzneimittel-Forsch. 1991; 41: 584-88.

6. Lindenberg D, Pitule-Schodel H. D,l-kavain in comparison with oxazepam in anxiety disorders. A double-blind study of clinical effectiveness. Forschr Med. 1990; 108: 49-50, 53-54.

7. Speroni E, Minghetti A. Neuropharmacological Activity of Extracts from Passiflora incarnata. Planta Medica. 1988; 54: 488-491.

8. Schmitz M, Jackel M. Comparative study for assessing quality of life of patients with exogenous sleep disorders (temporary sleep onset and sleep interruption disorders) treated with a hops-valarian preparation and a benzodiazepine drug . Wien Med Wochenschr. 1998;148(13):291-8.

9. Dressing H, Riesman D, et al. Are Valerian/Mellisa combinations of equal value to bezodiazeopine? Therapiewoch. 1992; 42:726-36.


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