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Insomnia is a symptom of a sleep disorder and is characterized by difficulty falling or staying asleep, waking too early in the morning, and not feeling refreshed upon waking. An estimated 64 million Americans suffer from insomnia each year. The chronic sleep deprivation experienced by people with insomnia can lead to a cumulative deterioration of cognitive alertness and ability to function in the daytime. Some of the more common conditions associated with insomnia include anxiety, depression, stress reaction, pain, sleep apnea, and hormonal changes including those occurring with premenstrual syndrome and menopause. In addition, caffeine and alcohol can contribute to insomnia, and some medications have sleep-disruptive side effects.

Behavioral therapies and relaxation techniques often help people with insomnia to improve the amount and quality of their sleep. In addition, some herbal and nutritional supplements have been found to promote relaxation of mind and body.

Passionflower
Passionflower (Passiflora incarnata) is a popular herbal remedy for anxiety and insomnia with a long history of use in North America. Two studies have demonstrated its efficacy in treating anxiety, and in one it was found to be as effective as benzodiazepine medications. [i] In a controlled trial, passionflower extract effectively alleviated anxiety in pre-surgical patients, a circumstance in which benzodiazepine medications are typically used. [ii] Animal studies have suggested that chrysin, an active constituent from passionflower, might act similarly to benzodiazepines by affecting GABA (gamma-aminobutyric acid) receptors. [iii] [iv] Unlike benzodiazepines, however, regular use of passionflower extract does not appear to lead to dependence, and in one animal study it was helpful in treating benzodiazepine dependence. [v]

Lemon Balm
Lemon balm (Melissa officinalis) is a medicinal plant in the mint family with mild sedative properties. Lemon balm has traditionally been used for its calming effects on both the central nervous system and the gastrointestinal tract. Extracts have been shown to bind to both nicotinic and muscarinic acetylcholine receptor sites in human brain tissue, enhancing parasympathetic activity. [vi] A combination of lemon balm and three other medicinal herbs (lavender oil, hops, and oat) was found to alter electrical activity in the brains of healthy adults, reflecting its ability to induce a relaxed state. [vii] In other research, lemon balm improved self-rated mood, increased calmness, and improved cognitive functioning in healthy people under ordinary circumstances [viii] [ix] and during performance of tasks designed to induce stress. [x]

Hops
Hop strobile, commonly known as hops, is the flower cone of the hop plant (Humulus lupulus) and is most familiar for its use in flavoring beer. Its most common medicinal use, as a treatment for insomnia and anxiety, as well as hops’ other traditional uses, as a digestive aid, antibacterial, and antifungal agent, have been supported by animal and in vitro studies. [xi] [xii] [xiii] Results from several studies suggest that hops extract quiets the central nervous system by increasing GABA activity [xiv] [xv] and by activating melatonin receptors. [xvi] Hops have also been used to treat symptoms of menopause, including sleep disturbance, and researchers have identified at least one strong phytoestrogenic constituent. [xvii] [xviii] Menopausal women in a controlled trial had a reduction in menopausal symptoms when treated with hops extract. [xix]

California Poppy
California poppy (Eschscholtzia californicum) is a flowering plant in the poppy family. Although milder than the opium poppy, it is known for its sedative effects and has been used historically for insomnia and nervous tension. Its ability to influence the metabolism of several neurotransmitters has been documented. [xx] [xxi] An extract of California poppy was found to inhibit monoamine oxidase,[xxii] an action that could raise acetylcholine levels and contribute to its sedating effect. Other research suggests that a California poppy extract affects serotonin activity. [xxiii] In a controlled trial, a combination of California poppy and hawthorn plus magnesium was found to reduce symptoms in people with mild to moderate anxiety. [xxiv]

Valerian
Valerian (Valeriana officinalis) is a flowering perennial plant that is well known for its ability to ease nervousness and promote sleep. Findings from several studies suggest that a variety of valerian constituents, including terpenoids and flavonoids, might be involved in its anxiolytic and sedative properties and might work by affecting GABA and GABA receptors. [xxv] [xxvi] [xxvii] [xxviii] [xxix] Some studies comparing valerian extract to benzodiazepines have found them similarly effective, [xxx] [xxxi] and one study found valerian extract to be helpful in people withdrawing from benzodiazepine therapy for insomnia. [xxxii] The long-used combination of valerian and hops has also been studied and results suggest its effectiveness in relieving insomnia, [xxxiii] [xxxiv] [xxxv] [xxxvi] and its similarity in effect to a benzodiazepine drug. [xxxvii] Despite a broad range of studies that appear to support valerian’s mild sedating effect, researchers have reached conflicting conclusions: in three recent reviews of clinical trials using valerian in the treatment of sleep disorders, one meta-analysis concluded that it was effective, [xxxviii] one concluded that it was not, [xxxix] and the third found the evidence inconclusive. [xl]

L-theanine
L-theanine (N-ethyl-L-glutamine) is an amino acid present in green tea. In animal research, L-theanine was found to increase the release of serotonin and the inhibitory neurotransmitters GABA, dopamine, and glycine, and block the binding of the stimulatory neurotransmitter L-glutamate. [xli] [xlii] In humans, L-theanine supplementation increased alpha brainwave activity, indicating movement toward a calmer mind. [xliii] It also reduced physiologic signs of stress in people given stress-inducing tasks in the laboratory. [xliv] These findings suggest that L-theanine might help promote sleep by reducing symptoms of stress and anxiety.

Lavender Essential Oil
Lavender (Lavendula angustafolia) is a perennial flowering shrub with a distinctive fragrance. The aroma is widely believed to ease tension and enhance relaxation, and the essential oil responsible for its smell is often used as a topical agent and in aromatherapy modalities. Aromatherapy with lavender oil has had relaxing to sedating effects in a number of studies, [xlv] [xlvi] [xlvii] [xlviii] [xlix] but in a few it has not. [l] [li] Inhaling lavender oil during sleep increased deep, slow-wave sleep, decreased rapid-eye movement (REM) sleep, and increased reported sense of vigor upon morning waking in one study, [lii] and a preliminary study found that aromatherapy with lavender oil improved sleep in people with insomnia. [liii] Lavender oil has been shown to help relieve anxiety and improve mood when combined with massage, [liv] [lv] [lvi] and it has demonstrated pain-relieving effects when combined with acupressure. [lvii] One study found that a lozenge containing lavender oil and extracts from hops, lemon balm, and oat altered brain activity in healthy people in a way that indicated they experienced a relaxing effect. [lviii] The effect of ingesting lavender essential oil needs further research.

Melatonin
Melatonin is a hormone that participates in regulating the sleep/wake biorhythm. It is secreted by the pituitary gland and its release is strongly affected by ambient light, with levels normally dropping during daylight hours and rising at night. Melatonin levels are low in people with insomnia, [lix] and supplemental melatonin has been found to be an effective treatment for insomnia in controlled trials. [lx] [lxi] [lxii] It has also demonstrated effectiveness in treating insomnia associated with medical illness in general [lxiii] and specific chronic conditions including schizophrenia, [lxiv] [lxv] chronic fatigue syndrome, [lxvi] mental retardation, [lxvii] and bipolar disorder. [lxviii] Melatonin appears to help shift the sleep phase in some circumstances, and studies have suggested that it can improve sleep in shift workers [lxix] [lxx] [lxxi] and people with jet lag. [lxxii] [lxxiii] People using benzodiazepine medicines for sleep disorders have found melatonin helpful during medication reduction and discontinuation. [lxxiv] [lxxv]

Recommended Dosage Before Bed:

Passionflower Herb Extract 150mg-450mg
Lemon Balm Leaf Extract 100mg-300mg
Hops Strobile Extract 100mg-300mg
California Poppy Herb Extract  75mg-225mg
Valerian officinalis Root Extract 75mg-225mg
L-Theanine 50mg-150mg
Lavender (Flowering Tops)
(Essential OilLavandula vera)		 20mg-60mg
Melatonin 0.25mg-0.75mg

 References:

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[xxvi] Fernández S, Wasowski C, Paladini AC, Marder M. Sedative and sleep-enhancing properties of linarin, a flavonoid-isolated from Valeriana officinalis. Pharmacol Biochem Behav 2004;77:399-404.

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[xxxi] Andreatini R, Sartori VA, Seabra ML, Leite JR. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study. Phytother Res 2002;16:650-4.

[xxxii] Poyares DR, Guilleminault C, Ohayon MM, Tufik S. Can valerian improve the sleep of insomniacs after benzodiazepine withdrawal? Prog Neuropsychopharmacol Biol Psychiatry 2002;26:539-45.

[xxxiii] Brattström A. Scientific evidence for a fixed extract combination (Ze 91019) from valerian and hops traditionally used as a sleep-inducing aid. Wien Med Wochenschr 2007;157:367-70.

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[xxxv] Morin CM, Koetter U, Bastien C, et al. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep 2005;28:1465-71.

[xxxvi] Vonderheid-Guth B, Todorova A, Brattström A, Dimpfel W. Pharmacodynamic effects of valerian and hops extract combination (Ze 91019) on the quantitative-topographical EEG in healthy volunteers. Eur J Med Res 2000;5:139-44.

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[xl] Miyasaka LS, Atallah AN, Soares BG. Valerian for anxiety disorders. Cochrane Database Syst Rev 2006;Oct 18:CD004515. Review.

[xli] Yamada T, Terashima T, Okubo T, et al. Effects of theanine, r-glutamylethylamide, on neurotransmitter release and its relationship with glutamic acid neurotransmission. Nutr Neurosci 2005;8:219-26.

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[xlv] Lehrner J, Marwinski G, Lehr S, et al. Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office. Physiol Behav 2005;86:92-5.

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well-being: two exploratory randomized controlled trials. Complement Ther Med 2002;10:223-8.

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[xlix] Saeki Y. The effect of foot-bath with or without the essential oil of lavender on the

autonomic nervous system: a randomized trial. Complement Ther Med 2000;8:2-7.

[l] Graham PH, Browne L, Cox H, Graham J. Inhalation aromatherapy during radiotherapy: results of a placebo-controlled double-blind randomized trial. J Clin Oncol 2003;21:2372-6.

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[lii] Goel N, Kim H, Lao RP. An olfactory stimulus modifies nighttime sleep in young men and women. Chronobiol Int 2005;22:889-904.

[liii] Lewith GT, Godfrey AD, Prescott P. A single-blinded, randomized pilot study evaluating the aroma of Lavandula angustifolia as a treatment for mild insomnia. J Altern Complement Med 2005;11:631-7.

[liv] Imura M, Misao H, Ushijima H. The psychological effects of aromatherapy-massage in healthy postpartum mothers. J Midwifery Womens Health 2006;51:e21-7

[lv] Lee SY. [The effect of lavender aromatherapy on cognitive function, emotion, and

aggressive behavior of elderly with dementia] Taehan Kanho Hakhoe Chi 2005;35:303-12. [Article in Korean]

[lvi] Soden K, Vincent K, Craske S, et al. A randomized controlled trial of aromatherapy massage in a hospice setting. Palliat Med 2004;18:87-92.

[lvii] Yip YB, Tse SH. An experimental study on the effectiveness of acupressure with aromatic lavender essential oil for sub-acute, non-specific neck pain in Hong Kong. Complement Ther Clin Pract 2006;12:18-26.

[lviii] Dimpfel W, Pischel I, Lehnfeld R. Effects of lozenge containing lavender oil, extracts from hops, lemon balm and oat on electrical brain activity of volunteers. Eur J Med Res 2004;9:423-31.

[lix] Attenburrow MEJ, Dowling BA, Sharpley AL, Cowen PJ. Case-control study of evening melatonin concentration in primary insomnia. BMJ 1996;312:1263–4.

[lx] Kayumov L, Brown G, Jindal R, et al. A randomized, double-blind, placebo-controlled crossover study of the effect of exogenous melatonin on delayed sleep phase syndrome. Psychosom Med 2001;63:40-8.

[lxi] Smits MG, Nagtegaal EE, van der Heijden J, et al. Melatonin for chronic sleep onset insomnia in children: a randomized placebo-controlled trial. J Child Neurol 2001;16:86-92.

[lxii] Peck JS, LeGoff DB, Ahmed I, Goebert D. Cognitive effects of exogenous melatonin administration in elderly persons: a pilot study. Am J Geriatr Psychiatry 2004;12:432-6.

[lxiii] Andrade C, Srihari BS, Reddy KP, Chandramma L. Melatonin in medically ill patients with insomnia: a double-blind, placebo-controlled study. J Clin Psychiatry 2001;62:41-5.

[lxiv] Suresh Kumar PN, Andrade C, Bhakta SG, Singh NM. Melatonin in schizophrenic outpatients with insomnia: a double-blind, placebo-controlled study. J Clin Psychiatry 2007;68:237-41.

[lxv] Shamir E, Laudon M, Barak Y, et al. Melatonin improves sleep quality of patients with chronic schizophrenia. J Clin Psychiatry 2000;61:373-7.

[lxvi] van Heukelom RO, Prins JB, Smits MG, Bleijenberg G. Influence of melatonin on fatigue severity in patients with chronic fatigue syndrome and late melatonin secretion. Eur J Neurol 2006;13:55-60.

[lxvii] Niederhofer H, Staffen W, Mair A, Pittschieler K. Brief report: melatonin facilitates sleep in individuals with mental retardation and insomnia. J Autism Dev Disord 2003;33:469-72.

[lxviii] Bersani G, Garavini A. Melatonin add-on in manic patients with treatment resistant insomnia. Prog Neuropsychopharmacol Biol Psychiatry 2000;24:185-91.

[lxix] Bjorvatn B, Stangenes K, Oyane N, et al. Randomized placebo-controlled field study of the effects of bright light and melatonin in adaptation to night work. Scand J Work Environ Health 2007;33:204-14.

[lxx] Smith MR, Lee C, Crowley SJ, et al. Morning melatonin has limited benefit as a soporific for daytime sleep after night work. Chronobiol Int 2005;22:873-88.

[lxxi] Yoon IY, Song BG. Role of morning melatonin administration and attenuation of sunlight exposure in improving adaptation of night-shift workers. Chronobiol Int 2002;19:903-13.

[lxxii] Srinivasan V, Spence DW, Pandi-Perumal SR, et al. Jet lag: therapeutic use of melatonin and possible application of melatonin analogs. Travel Med Infect Dis 2008;6:17-28.

[lxxiii] Suhner A, Schlagenhauf P, Höfer I, et al. Effectiveness and tolerability of melatonin and zolpidem for the alleviation of jet lag. Aviat Space Environ Med 2001;72:638-46.

[lxxiv] Siegrist C, Benedetti C, Orlando A, et al. Lack of changes in serum prolactin, FSH, TSH, and estradiol after melatonin treatment in doses that improve sleep and reduce benzodiazepine consumption in sleep-disturbed, middle-aged, and elderly patients. J Pineal Res 2001;30:34-42.

[lxxv] Garfinkel D, Zisapel N, Wainstein J, Laudon M. Facilitation of benzodiazepine discontinuation by melatonin: a new clinical approach. Arch Intern Med 1999;159:2456-60.
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