Herbal Recommendations for Deep Sleep Before Considering Medications
Herbal supplements are not recommended for the treatment of chronic insomnia due to the relative lack of efficacy and safety data. 1
Evidence on Herbal Options
Melatonin
- The American Academy of Sleep Medicine suggests that clinicians not use melatonin as a treatment for sleep onset or sleep maintenance insomnia in adults 1
- Despite its widespread availability and perception as a benign sleep aid, melatonin has shown only small effects on sleep latency with little effect on wake after sleep onset or total sleep time 1
- Melatonin is marketed as a "drug-free and non-habit forming" dietary supplement for occasional sleeplessness 2
Valerian
- The American Academy of Sleep Medicine suggests that clinicians not use valerian as a treatment for sleep onset or sleep maintenance insomnia in adults 1
- Studies of valerian (alone or in valerian-hops combination) show inconsistent results with only marginal improvements in polysomnographic sleep latency that fall below clinical significance thresholds 1
- A 2024 umbrella review found no evidence of efficacy for valerian in the treatment of insomnia, despite its widespread use 3
- While some research suggests valerian may improve subjective sleep quality, these effects have not been demonstrated with objective measurements 3, 4
- A systematic review concluded that valerian is safe but not effective as a sleep aid 5
L-tryptophan
- The American Academy of Sleep Medicine suggests that clinicians not use tryptophan as a treatment for sleep onset or sleep maintenance insomnia in adults 1
- Evidence shows a modest decline in total sleep time, slight decrease in wake after sleep onset, and mild increase in sleep quality, but none of these effects met thresholds for clinical significance 1
Recommended Approach Before Medications
Non-Pharmacological Interventions (First Line)
- Cognitive Behavioral Therapy for Insomnia (CBT-I) should be the initial treatment for chronic insomnia before considering medication 6, 7
- Sleep hygiene education, including maintaining a regular sleep-wake schedule, avoiding daytime napping, limiting caffeine and alcohol, and creating a comfortable sleep environment 6
- Stimulus control therapy to strengthen the association between the bedroom and sleep 6
- Relaxation techniques such as progressive muscle relaxation, guided imagery, or diaphragmatic breathing 6
If Medications Become Necessary
First-Line Pharmacological Options
- Low-dose doxepin (3-6mg) is most appropriate for sleep maintenance insomnia with a favorable efficacy and safety profile 7
- Ramelteon 8mg at bedtime may be considered for sleep onset insomnia 6, 7
- Short-acting benzodiazepine receptor agonists may be considered with caution, especially in elderly patients 6
Medications to Avoid
- Over-the-counter antihistamines (including diphenhydramine) are not recommended due to anticholinergic effects 1
- Trazodone is not recommended for sleep onset or maintenance insomnia 1, 6
- Alcohol should be avoided despite being a common self-treatment due to its short duration of action, adverse effects on sleep, and potential for abuse 1
Important Considerations
- Long-term use of over-the-counter treatments is not recommended as efficacy and safety data are limited to short-term studies 1
- When pharmacotherapy becomes necessary, the choice should be directed by symptom pattern, treatment goals, past responses, patient preferences, and potential side effects 1
- Starting with the lowest effective dose is particularly important for elderly patients 6, 7
Despite their popularity, herbal supplements lack sufficient evidence to support their use for insomnia, and established non-pharmacological approaches should be prioritized before considering any medication.