Jana Barber, a teacher in San Francisco, has had insomnia off and on for 20 years. She's learned to function on just a few hours a night, but sometimes, she says, lack of sleep catches up with her. "I get really ragged sometimes," she admits. "When you haven't slept, it's tough to keep your sense of humor -- and your patience -- and you need both when you work with kids."
What are the options for people like Barber, who don't want to take prescription sleep medications but crave a good night's sleep? WebMD consulted some sleep experts about "natural" sleep aids to learn more about how -- and how well -- they really work.
Natural Sleep Aids: Dietary Supplements
- Valerian is a dietary supplement that has been used since ancient times for insomnia and nervousness. Although many people use valerian as a sleep aid, its effectiveness has not been proven. Jawad Miran, DO, a sleep medicine specialist at Somerset Medical Center's Sleep For Life program in Hillsborough, N.J., cautions that that there is little consistency in the quality or ingredients of valerian preparations on the market today: "There is no one compound which is valerian, rather there are numerous compounds in varying amounts," says Miran. He says most doctors he knows don't recommend valerian to their patients with insomnia. People who take valerian should not combine it with other supplements or medications for sleep.
- Chamomile, like valerian, is a traditional herbal remedy that has been used since ancient times to fight insomnia and a wide range of other health complaints. Chamomile is sold in the form of tea, extract, and topical ointment. Chamomile is widely available in health food stores and supermarkets. Chamomile's effectiveness as a sleep aid has not been widely researched in humans, but in animal studies it has been shown to be a safe and mild sleep aid.
- Melatonin is a hormone that is produced by the pineal gland in the brain. Melatonin is believed to play a central role in regulating sleep and circadian rhythms. Synthetic melatonin is a popular dietary supplement that is sold as a sleeping aid and antioxidant. According to Miran, there is evidence that melatonin eases circadian rhythm disorders like jet lag and delayed sleep phase disorders, but it hasn't been proven effective in treating insomnia or improving sleep quality in the long term.
While scientific research has not proven the effectiveness of many natural sleep aids, that doesn’t mean they won’t help you sleep, says sleep specialist Lisa Shives, a spokesperson for the American Academy of Sleep Medicine. "The research has not been robust," she says, still, some of her patients find these dietary supplements effective. "People like to feel they are taking something," she points out.
It's important to remember that the FDA regulates dietary supplements under a different set of rules than conventional foods and drugs. Manufacturers aren't required to register or get FDA approval of their product before selling it. "People think, 'it's natural, that means it's safe,'" says Shives, who is medical director at North Shore Sleep Medicine in Evanston, Ill. "But strychnine is also natural. 'Natural' doesn't mean you shouldn't use caution."
In the case of melatonin, for example, Shives doesn't advise parents to give it to children, especially boys, since there is evidence that it can affect testosterone levels.
Be sure to consult your physician before you take any dietary supplement. Some supplements can interact with other medications or have unanticipated side effects.
Natural Sleep Aids: Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy, or CBT, describes a variety of therapies that modify thought and behavior patterns. CBT has been used to effectively treat other conditions, including depression, phobias, and eating disorders.
When used to treat insomnia, CBT helps patients alter thoughts and behaviors that disrupt sleep and trigger insomnia. A CBT program typically includes six to eight half-hour sessions with a sleep therapist.
CBT programs for insomnia can include the following techniques:
- Sleep hygiene helps patients improve their daily sleep habits by counseling them to go to bed and get up at the same time each day, avoid caffeine in the late afternoon and evening, monitor nighttime eating, and engage in relaxing activities before bed, for example.
- Stimulus control helps patients develop calming, sleep-inducing associations with their bed and bedroom. For example, patients are counseled to remove TVs and computers from the bedroom, and to use the bed only for sleep and sex.
- Sleep restriction limits the number of hours spent in bed, which helps increase sleep efficiency.
- Cognitive therapy helps patients understand and counter negative thoughts and misconceptions that keep them awake.
- Relaxation techniques help people relax with guided imagery, meditation, deep breathing, and muscle relaxation.
- Biofeedback helps patients identify and learn to control physiological factors that could impede sleep.
CBT has been shown to effectively treat insomnia, even for people with long-term sleep issues, according to sleep expert Miran.
Shives, who routinely refers patients to a psychologist who uses a variety of CBT techniques, agrees. "I'm a big believer in CBT," she says.
For patients with serious insomnia problems, Shives often begins treatment by combining a CBT program and a short course of prescription sleep medication. "Many of my patients have a desperate look in their eyes by the time they come in to see me," she says. "I know if they don't go away with a slip of paper in their hands it will be a dark day indeed."
Sleep experts Miran and Shives agree that there needs to be more research into CBT and how it compares to other treatments for insomnia, but so far the results are promising -- without any side effects.