What is the best herbal remedy for insomnia?

Best Herbal Remedy for Insomnia

Based on the highest quality evidence, no herbal remedy can be recommended for treating insomnia—valerian, chamomile, kava, and L-tryptophan all lack proven efficacy, and kava carries serious risks of fatal liver toxicity. 1

Evidence Against Common Herbal Remedies

Kava - Strongly Contraindicated

• The FDA explicitly warns against kava use due to risk of acute fatal liver toxicity and death. 1, 2
• Studies demonstrate no benefit over placebo for chronic insomnia disorder 1
• Must be discontinued at least 2 weeks before surgery due to CNS depression and cyclooxygenase inhibition 2
• Causes significant drug interactions through inhibition of multiple cytochrome P450 enzymes (CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4) 2

Valerian - Not Effective

• The American Academy of Sleep Medicine suggests clinicians NOT use valerian for sleep onset or maintenance insomnia (weak recommendation based on variable dosages) 1
• The most recent 2024 umbrella review found no evidence of efficacy for insomnia treatment despite widespread use 3
• While valerian shows small, inconsistent effects on sleep latency (approximately 9 minutes reduction), it fails to meet clinical significance thresholds for total sleep time, sleep efficiency, or wake after sleep onset 1
• A 2007 systematic review concluded valerian is "safe but not effective," with the most methodologically rigorous studies finding no significant differences from placebo 4
• The 2020 VA/DoD guidelines found no between-group differences in critical outcomes of daytime functioning, insomnia severity, or sleep efficiency 1

Chamomile - Insufficient Evidence

• No between-group differences versus placebo for daytime functioning, insomnia severity, sleep efficiency, sleep onset latency, total sleep time, wake after sleep onset, or sleep quality 1

L-Tryptophan - Not Recommended

• The American Academy of Sleep Medicine suggests clinicians NOT use tryptophan (weak recommendation based on 250mg doses) 1
• High-quality evidence shows modest decline in total sleep time (not clinically significant), with harms potentially outweighing benefits 1

Melatonin - Minimal Clinical Benefit

• Meta-analyses demonstrate only small effects: approximately 7-minute decrease in sleep latency and 8-minute increase in total sleep time 1
• Little to no effect on wake after sleep onset or total sleep time 1
• The clinical significance of these minimal improvements is unclear 1
• Many trials evaluated melatonin as a chronobiotic (phase-shifting agent) rather than as a hypnotic 1

Critical Clinical Pitfalls

Long-term use of any over-the-counter herbal treatments is not recommended due to:

• Limited efficacy and safety data restricted to short-term studies 1
• Unknown safety profile with chronic use 1
• Potential for drug interactions and anticholinergic side effects (particularly with antihistamines) 1

What Actually Works

The American Academy of Sleep Medicine strongly recommends Cognitive Behavioral Therapy for Insomnia (CBT-I) as first-line treatment 2, which is supported by a large evidence base showing superior outcomes compared to herbal remedies 1