In otherwise healthy adults with mild insomnia unresponsive to sleep hygiene, is valerian appropriate as a short‑term adjunct, and what dose, duration, and contraindications should be considered?

Valerian for Mild Insomnia: Not Recommended

The American Academy of Sleep Medicine explicitly recommends against using valerian for the treatment of sleep onset or sleep maintenance insomnia in adults, based on lack of demonstrated efficacy on critical sleep outcomes. 1

Guideline Position

The 2017 AASM clinical practice guideline provides a WEAK recommendation against valerian (versus no treatment) for insomnia, based on trials evaluating variable dosages of valerian and valerian-hops combinations. 1 This recommendation stems from:

• Absence of clinically meaningful improvements in objective sleep measures (polysomnography showed only marginal 9.29-minute reduction in sleep latency that barely approached clinical significance) 1
• No significant benefit on subjective sleep latency (actually increased by 3.77 minutes in one study) 1
• Minimal improvements in total sleep time (+10.96 minutes on PSG, +3.12 minutes subjectively—both below clinical significance thresholds) 1
• Limited evidence regarding potential harms, leading the task force to judge that harms potentially outweigh benefits 1

Evidence Quality and Dosing Studied

The guideline evaluated studies using:

• Valerian-hops combination: 374 mg valerian native extract + 83.8 mg hops native extract, administered nightly for 28 days 1
• Higher single-agent dosage: 3,600 mg valerian for two weeks (data not usable for meta-analysis) 1
• Overall quality of evidence: Low to very low, due to imprecision, potential publication bias, and heterogeneity 1

Contemporary Research Confirms Lack of Efficacy

Recent systematic reviews and umbrella reviews reinforce the guideline position:

• A 2024 umbrella review of systematic reviews concluded no evidence of efficacy for insomnia treatment, despite valerian's good safety profile 2
• A 2007 systematic review of 37 studies found no significant differences between valerian and placebo in healthy individuals or those with insomnia, with the most methodologically rigorous studies showing no effect 3
• A 2009 RCT in older women with insomnia found no improvement in sleep latency, wake after sleep onset, sleep efficiency, or self-rated sleep quality after either single-dose or 2 weeks of nightly valerian 300 mg 4

What Should Be Used Instead

For otherwise healthy adults with mild insomnia unresponsive to sleep hygiene:

First-Line Treatment

• Cognitive Behavioral Therapy for Insomnia (CBT-I) is the standard of care before any pharmacotherapy, demonstrating superior long-term efficacy with sustained benefits after discontinuation 1, 5

First-Line Pharmacotherapy (if CBT-I insufficient or unavailable)

• Benzodiazepine receptor agonists: Zolpidem, eszopiclone, or zaleplon for sleep onset and/or maintenance 1, 5
• Ramelteon 8 mg: Particularly for sleep-onset insomnia, with zero addiction potential 5, 6
• Low-dose doxepin 3-6 mg: Specifically for sleep maintenance insomnia, with minimal side effects and no abuse potential 5, 6

Agents to Explicitly Avoid

The AASM recommends against the following for primary insomnia:

• Valerian 1
• Melatonin supplements 1, 5
• Diphenhydramine and other antihistamines 1, 5
• Trazodone (insufficient efficacy data) 1, 6
• L-tryptophan 1

Safety Profile

While valerian is well-tolerated and safe with infrequent and benign side effects 7, 3, 8, safety alone does not justify its use when efficacy is not demonstrated. The 2010 valerian-hops combination study showed no serious adverse events and no rebound insomnia upon discontinuation, but efficacy remained modest at best. 8

Clinical Bottom Line

Do not recommend valerian as a short-term adjunct for mild insomnia. Instead, initiate CBT-I immediately and, if pharmacotherapy is necessary after 4-8 weeks, prescribe evidence-based first-line agents (ramelteon for sleep onset, low-dose doxepin for sleep maintenance, or short-acting BzRAs for either pattern). 1, 5, 6 The widespread use of valerian by patients and general practitioners is not supported by empirical evidence. 2