It’s fair to say over the last fifteen years, I’ve used herbal and nutritional medicine to treat many people who have poor sleep, especially so in Hong Kong.
You only need to experience poor sleep to understand just how the quality of your day falls apart after just one or two bad nights.
In fact, nearly forty per cent of adults in the US with insomnia have either tried an over-the-counter medication or alcohol to induce sleep, and almost one in four have used prescription medicine at least once.[1]
Interestingly, although the prevalence of insomnia in Hong Kong is high, out of four thousand five hundred people surveyed, only forty per cent of adults and ten per cent of children and teenagers sought help to fix it.[2]
That’s sixty per cent of people, or six out of ten, experiencing less than optimal or poor sleep in Hong Kong.
This deficit highlights a need to help better because sleep plays a role in nearly every aspect of our daily function.
For example, metabolism, appetite control, and the functioning of our immune, hormonal, cardiovascular and digestive systems are all influenced by how we sleep.[3]
Whilst I try to take the opportunity in my articles to help you understand the origins of your digestive and mental health issues, let’s get straight to some of your herbal and supplemental options for poor sleep and the evidence behind them.
As the years go by, our understanding of herbal medicine becomes more precise.
And the way herbs influence our brain chemistry is an excellent example.
To get a sense of how some herbs work, let’s revisit one of the essential neurotransmitters in the brain, GABA.
Gamma-aminobutyric acid, or GABA, is the primary inhibitory neurotransmitter.
Its inhibitory action means its job is to somewhat calm things down after the day’s excitement.
If serotonin, dopamine and norepinephrine are the excited children, then I often say that GABA’s job is to shepherd them together when it’s time for bed.
GABA influences an extensive array of mental health issues, such as anxiety, stress regulation, circadian rhythm, memory enhancement, mood, perception of pain and, of course, sleep.[4]
It’s so important that over twenty per cent of all the neurons in your brain interact with GABA by design.
GABA exists in your diet via various foods such as white tea, tomato, soybeans, adzuki beans and some fermented foods.[5]
Probiotic strains such as Lactobacillus plantarum and Bifidobacterium adolescentis also help to create GABA naturally within the body.[6]
These types of probiotics are called “psychobiotics”, and you can find out more about them by downloading the e-book on probiotics and the brain to the right of this article.
Benzodiazepines, common prescription drugs for sleep, work on GABA receptors.
For most, however, these drugs almost work too well. Benzodiazepines can leave people drowsy and unrefreshed in the morning.
Reducing these side effects is where herbal and nutritional medicine can come in.
The herb Valerian (Valeriana officinalis L.) has the most research currently.
My experience with Valerian in the clinic somewhat reflects the evidence base. It works well for those experiencing mild sleep dysfunctions but not so well for those living with sleep issues for an extended period.
In saying that, you’ll almost always see Valerian added to over-the-counter sleep and anxiety formulas.
There are two types of poor sleep that Valerian helps.
And it does this by acting on one of the receptors to activate GABA production.
Valerian helps reduce the latency of sleep onset or, in English, helps you get to sleep quicker. It also increases sleep quality.[7]
As we touched on above, the drowsiness that can often accompany pharmaceutical prescriptions for sleep is absent with Valerian.
One systematic review that pulled together the results of sixteen studies suggested Valerian can improve sleep quality without producing side effects.[8]
From a research standpoint, some consistency still needs to appear regarding the dose and the part of the herb used to see just how effective it can be. From a clinical standpoint, however, I see Valerian work well for poor sleep, especially when combined with other herbs, which the research corroborates.[9]
One of the herbs we often see together with Valerian is Passionflower.
A study in 2010 confirmed that Passionflower (Passiflora incarnata L.) has GABA as one of its prominent ingredients![10]
Not only does Passionflower have a high amount of GABA it also works on the same GABA receptor that Valerian does.[11]
It’s easy, then, to see how Passionflower has garnered a good reputation for its use in stress[12] and anxiety.[13]
One review from 2017 found that Passionflower also positively affected restlessness and depressive states.[14]
Passionflower also has some fantastic research around its benefits in sleep. In a study with forty people using Passionflower in a tea, sleep quality had a significantly better rating than placebo with the Passionflower group.[15]
From my point of view, one of the critical parts of this study, although small in sample size, was the fact that these improvements occurred over just seven nights, suggesting a relatively short-term benefit for low-dose Passionflower in a tea!
Another famous tea is more potent than many thought initially.
Yep, Chamomile tea is one of the world’s most popular herbal teas, with around a million cups consumed daily![16]
Now, this is always a fun conversation with patients, but when using Chamomile tea, you are only really getting half of the potential of its active ingredients.
Why?
The active ingredients Bisabolol and Chamazulene in Chamomile are both unstable in water. This volatility means it’s best to preserve them in an alcoholic tincture[17] similar to the herbs we use in our clinic.
A randomised controlled trial for Chamomile, this time using a pharmaceutical grade extract, similar to what we employ in the clinic, found that long-term chamomile administration significantly reduced moderate to severe generalised anxiety, markedly lower than placebo.[18]
One feature of this study was that the anxiety returned after some time but was lower than previously, along with some bonus body weight and blood pressure benefits.
Sleep-wise, Chamomile’s calming effects are highly beneficial for sleep. One clinical trial in the elderly population found that Chamomile extract can significantly improve sleep quality over a twenty-eight-day period.[19]
These herbs are great for those looking to stay asleep; how help with getting to sleep?
We’ve covered some main herbs to get started with if you haven’t yet tried herbal medicine help, but what about supplementally?
You may remember earlier in the article; we looked at how Valerian seemed more effective when added to a formula with other herbs.[20]
As an insight, using combinations of herbs is how most herbal medicine is prescribed to patients. These combinations are now commonplace, of course, in supplements. We’re also finding that researchers are looking into these combinations in studies.
We’ve introduced GABA in the first part of the article and how herbs can help but did you know that you can take GABA supplementally?
And it’s often my go-to when herbal medicine doesn’t work. We’ve touched on GABA and how it works earlier. Evidence has shown some promise for helping people sleep when combined with an amino acid from green tea called L-Theanine.
If you’re new to L-Theanine, it rose to popularity when brain studies found that it significantly increases alpha frequency activity, indicating that it relaxes the mind without inducing drowsiness.[21]
Another study also demonstrated that L-theanine reduces the stress response and associated anxiety whilst under psychological or physical stress. An interesting side note to this study that reflects L-theanine’s real-world benefit is that it can reduce the increased heart rate associated with stress.[22]
And with so many of my patients experiencing heart palpitations, L-theanine is a perfect option.
Just on its own, L-theanine reduces sleep latency (the amount of time it takes to get to sleep), sleep disturbance, and the need for sleep medication post-administration.[23]
So far, in animal studies, the combination of GABA and L-theanine has been shown to be equally effective, so waiting for human studies to confirm dose and duration to see if the positive animal studies transfer over to humans for poor sleep.
So, what do you think?
There are multiple interventions to treat poor sleep, mainly because there are various reasons why your sleep can go out.
In this article, we have looked at the beginner’s guide.
A lot of the time, when I encounter patients in the clinic, they prefer to try a natural medicine option before trying a pharmaceutical drug. Hence, why I’ve chosen herbs that somewhat work with the same GABA receptor as pharmaceutical interventions or GABA itself.
Your options here are safe and largely effective without undesirable side effects.
Hope this helps xx
References
[1] Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I. Sleep. 1999;22 Suppl 2:S347-S353.
[2] Liu Y, Zhang J, Lam SP, et al. Help-seeking behaviors for insomnia in Hong Kong Chinese: a community-based study. Sleep Med. 2016;21:106-113. doi:10.1016/j.sleep.2016.01.006
[3] Medic G, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017;9:151-161. Published 2017 May 19. doi:10.2147/NSS.S134864
[4] Hepsomali P, Groeger JA, Nishihira J, Scholey A. Effects of Oral Gamma-Aminobutyric Acid (GABA) Administration on Stress and Sleep in Humans: A Systematic Review. Front Neurosci. 2020;14:923. Published 2020 Sep 17. doi:10.3389/fnins.2020.00923
[5] Hepsomali P, Groeger JA, Nishihira J, Scholey A. Effects of Oral Gamma-Aminobutyric Acid (GABA) Administration on Stress and Sleep in Humans: A Systematic Review. Front Neurosci. 2020;14:923. Published 2020 Sep 17. doi:10.3389/fnins.2020.00923
[6] Yunes RA, Poluektova EU, Vasileva EV, et al. A Multi-strain Potential Probiotic Formulation of GABA-Producing Lactobacillus plantarum 90sk and Bifidobacterium adolescentis 150 with Antidepressant Effects. Probiotics Antimicrob Proteins. 2020;12(3):973-979. doi:10.1007/s12602-019-09601-1
[7] Bruni O, Ferini-Strambi L, Giacomoni E, Pellegrino P. Herbal Remedies and Their Possible Effect on the GABAergic System and Sleep. Nutrients. 2021;13(2):530. Published 2021 Feb 6. doi:10.3390/nu13020530
[8] Bent S, Padula A, Moore D, Patterson M, Mehling W. Valerian for sleep: a systematic review and meta-analysis. Am J Med. 2006;119(12):1005-1012. doi:10.1016/j.amjmed.2006.02.026
[9] Shinjyo N, Waddell G, Green J. Valerian Root in Treating Sleep Problems and Associated Disorders-A Systematic Review and Meta-Analysis. J Evid Based Integr Med. 2020;25:2515690X20967323. doi:10.1177/2515690X20967323
[10] Carlini EA. Plants and the central nervous system. Pharmacol Biochem Behav. 2003;75(3):501-512. doi:10.1016/s0091-3057(03)00112-6
[11] Elsas SM, Rossi DJ, Raber J, et al. Passiflora incarnata L. (Passionflower) extracts elicit GABA currents in hippocampal neurons in vitro, and show anxiogenic and anticonvulsant effects in vivo, varying with extraction method. Phytomedicine. 2010;17(12):940-949. doi:10.1016/j.phymed.2010.03.002
[12] da Fonseca LR, Rodrigues RA, Ramos AS, et al. Herbal Medicinal Products from Passiflorafor Anxiety: An Unexploited Potential. ScientificWorldJournal. 2020;2020:6598434. Published 2020 Jul 20. doi:10.1155/2020/6598434
[13] Janda K, Wojtkowska K, Jakubczyk K, Antoniewicz J, Skonieczna-Żydecka K. Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review. Nutrients. 2020;12(12):3894. Published 2020 Dec 19. doi:10.3390/nu12123894
[14] Kim M, Lim HS, Lee HH, Kim TH. Role Identification of Passiflora Incarnata Linnaeus: A Mini Review. J Menopausal Med. 2017;23(3):156-159. doi:10.6118/jmm.2017.23.3.156
[15] Ngan A, Conduit R. A double-blind, placebo-controlled investigation of the effects of Passiflora incarnata (passionflower) herbal tea on subjective sleep quality. Phytother Res. 2011;25(8):1153-1159. doi:10.1002/ptr.3400
[16] Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Mol Med Rep. 2010;3(6):895-901. doi:10.3892/mmr.2010.377
[17] Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Mol Med Rep. 2010;3(6):895-901. doi:10.3892/mmr.2010.377
[18] Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. Phytomedicine. 2016;23(14):1735-1742. doi:10.1016/j.phymed.2016.10.012
[19] Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. Phytomedicine. 2016;23(14):1735-1742. doi:10.1016/j.phymed.2016.10.012
[20] Shinjyo N, Waddell G, Green J. Valerian Root in Treating Sleep Problems and Associated Disorders-A Systematic Review and Meta-Analysis. J Evid Based Integr Med. 2020;25:2515690X20967323. doi:10.1177/2515690X20967323
[21] Nobre AC, Rao A, Owen GN. L-theanine, a natural constituent in tea, and its effect on mental state. Asia Pac J Clin Nutr. 2008;17 Suppl 1:167-168.
[22] Yoto A, Motoki M, Murao S, Yokogoshi H. Effects of L-theanine or caffeine intake on changes in blood pressure under physical and psychological stresses. J Physiol Anthropol. 2012;31(1):28. Published 2012 Oct 29. doi:10.1186/1880-6805-31-28
[23] Hidese S, Ogawa S, Ota M, et al. Effects of L-Theanine Administration on Stress-Related Symptoms and Cognitive Functions in Healthy Adults: A Randomized Controlled Trial. Nutrients. 2019;11(10):2362. Published 2019 Oct 3. doi:10.3390/nu11102362
