Sleep-Aid Prescriptions on Rise after September 11
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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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References:
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.
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extract in patients with anxiety syndrome: Double-blind
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6. Lindenberg D, Pitule-Schodel H. D,l-kavain in comparison with
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7. Speroni E, Minghetti A. Neuropharmacological Activity of
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hops-valarian preparation and a benzodiazepine drug . Wien Med
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9. Dressing H, Riesman D, et al. Are Valerian/Mellisa
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