12 natural aids to help you nod off

For many people sleep is elusive. And that’s not good, considering it’s not only important to help you function day in and day out, but lack of sleep or insomnia is also tied to disease and poor health. Your body needs those precious nightly hours to rejuvenate and repair.

What can you do to sleep better? First of all, as I mentioned in my previous post, you need to examine what’s robbing you of your sleep. Hopefully it’s something easily under your control.

Still there are times when you need extra help getting to dreamland. In times like these, safe and effective nutrients, herbs and essential oils can help you sleep. Plant-derived compounds work with the natural metabolites in your body, which pose little if any health risk for long term use.

The following solutions work through various mechanisms, assisting you to feel calm and drift into sleep…

1. GABA (gamma-Aminobutyric Acid) is the main neurotransmitter in our brain that blocks nerve excitability, and therefore has anti-anxiety and nerve calming effects. At 750 mg twice daily this natural supplement helps lower anxiety and can also help block nerve pain. There are many natural and prescription medications that have “GABA-like effects.”
2. Kava kava (Piper methysticum) is relaxing and mildly sedating. It has GABA-like effects. It is used to treat both insomnia and anxiety. ¹
3. Valerian root (Valeriana officinalis) is also relaxing and sedating with GABA-like effects.
4. Passion flower (Passiflora incarnate) has similar GABA-like effects.
5. Lemon balm (Melissa officinalis) is another useful herb. At 600 mg per day subjects experienced improved mood and calmness in a 2004 study and also lower anxiety when combined with valerian root in another study. ^{2   3}
6. L-theanine is an amino acid derived from green tea (Camellia sinensis). While not directly sedating, it is known to reduce your emotional and physical response to stress. ⁴ The usual dose is 200 mg once or twice daily.
7. Tea from chamomile, peppermint, lemon balm, kava kava, passionflower, and valerian root will calm anxiety.
8. Essential oils are calming and are a safe and effective option. ⁵ Choose from these: lavender, sweet marjoram, chamomile, sandalwood, ylang ylang, neroli, bergamot, frankincense and vanilla bean extract. Aromatherapy with lavender is probably the most studied for sleep. In a small 2005 study just a sniff before bed brought more deep sleep, and a 2008 study found similar results. ^{6 7}
9. Melatonin is your natural sleep hormone, and less is produced naturally when your stress hormone cortisol is elevated. Begin at just 1 mg at bedtime, and you may find you need to increase up to 5 or even 10 mg doses. Be sure not to use it more than five nights per week to avoid becoming resistant to its effects.
10. Adrenal extract. Eventually worry and anxiety will lead to adrenal fatigue or exhaustion. In this case you will need adrenal extract (natural cortisol) in addition to the supportive herbs such as L-theanine and lemon balm to restore your ability to sleep soundly.
11. 5-HTP (5-hydroxy-tryptophan) which is a precursor to Serotonin, the known neurotransmitter that calms mood in the brain. Niacin helps this conversion.
12. Ashwagandha (Withania somnifera) is an antioxidant herb that can help reduce anxiety, panic attacks, phobia and depression. In one study, Ashwagandha for five days had anxiety-relieving effects similar to the benzodiazepine medication lorazepam and antidepressant effects similar to the TCA antidepressant medication imipramine. ⁸

All of these will potentially (and do) interact with other prescription medications, and they can decrease or increase prescription medication effects. For these reason it is best to disclose these to your doctor.

Prescription meds for insomnia

I always advice my patients to try a natural route before anything. It doesn’t always work for everyone. Sometimes I have to prescribe pharmaceuticals, but like any prescription drug, these are best used temporarily while you focus on reversing the underlying causes. In order of my preference these are:

• Trazodone: this older tricyclic antidepressant works extremely well. At its lowest dose of 50 mg it induces sleep for about 6 hours with no Benadryl-like hang-over. Minor and less common side effects are dry mouth, blurred vision, urinary retention, or constipation. Plus, it’s very inexpensive.
• Hydroxyzine (a.k.a. Atarax, Vistaril): this is very sedating. It may also cause dry mouth. It has antihistamine effects so it is also effective for itch relief.
• Ambien (and Lunesta, Sonata): These are short-acting hypnotic medications that potentiate GABA (see GABA under Nutrient Supplements below). They work usually within 15 minutes and last 4-6 hours. I sometimes hear patients complain of strange hallucinatory dreams or sleep-walking.
• Benzodiazepines (e.g. Xanax, Klonopin, Valium, Ativan): Besides making you sleepy, these anti-anxiety medications that make you tranquilized but care-free. However, these are quite common drugs of addiction and abuse. If combined with alcohol they are potentially lethal (you may stop breathing). If taken over months, you’ll surely have terrible withdrawal symptoms such as severe anxiety or even seizures.

To feeling good in health,
Michael Cutler, M.D.

[1] Wheatley D. Medicinal plants for insomnia: a review of their pharmacology, efficacy and tolerability. J Psychopharmacology. 2005 Jul;19(4):414-21.
[2] Kennedy DO, et al. Attenuation of laboratory induced stress in humans after acute administration of Melissa officinalis (lemon balm). 2004. Psychosomatic Medicine. 66:607-613.
[3] Kennedy DO, et al. Anxiolytic effects of a combination of Melissa officinalis and Valeriana officinalis during laboratory induced stress. Phytotherapy Research. 2006 (20):96-102.
[4] Kimura, Kenta; Ozeki, Makoto; Juneja, Lekh Raj; Ohira, Hideki (2007). “L-Theanine reduces psychological and physiological stress responses”. Biological Psychology 74 (1): 39–45.
[5] Mi-Yeon Cho, Eun Sil Min, Myung-Haeng Hur, Myeong Soo Lee.  Effects of Aromatherapy on the Anxiety, Vital Signs, and Sleep Quality of Percutaneous Coronary Intervention Patients in Intensive Care Units. Evid Based Complement Alternat Med. 2013; 2013: 381381. Published online 2013 February 17 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588400/
[6] Goel N, Kim H, Lao RP. An olfactory stimulus modifies nighttime sleep in young men and women. Chronobiol Int. 2005;22(5):889-904. Access online at http://www.ncbi.nlm.nih.gov/pubmed/16298774
[7] http://www.wsj.com/news/articles/SB10001424052748703846604575447591695802182?mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052748703846604575447591695802182.html
[8] Bhattacharya SK, Bhattacharya A, Sairam K, Ghosal S. Anxiolytic-antidepressant activity of Withania somnifera glycowithanolides: an experimental study. Phytomedicine. 2000 Dec;7(6):463-9.