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A natural sedative that may be helpful for insomnia
Valerian is commonly used as a sleep aid in traditional medicine. Over the years, researchers have tried to determine whether it is effective in the treatment of insomnia. The results have been mixed but promising. Recent efforts have produced a better picture of what makes valerian effective and which of its constituent phytochemicals are responsible for its sedative effects. Read on to find out what researchers think the evidence says about the sedative effect of valerian and also find out how well this herb compares against prescription sleep medications.
Valerian is a flowering plant native to Europe and Asia where it has been used as a sedative herb for centuries.
Although valerian is known for its scented white or pink flowers which were once used to make perfume, the medicinal part of the plant is the root (and sometimes, the rhizomes and running stems too).
Valerian root extract is commonly presented as a dietary supplement in capsule, tablet, tea and liquid extract forms. In some countries, it is classified as a drug.
As a traditional remedy, valerian is used to treat insomnia and anxiety disorders. Its effectiveness for these conditions is supported by solid evidence from multiple clinical trials. Other indications for which valerian has been prescribed in traditional medicine include stress, tension headaches, heart palpitation, nervousness and trembling.
In recent times, it has also been recommended in the treatment of muscle spasms, gastrointestinal spasms, epilepsy and ADHD (attention deficit hyperactivity disorder).
It is unclear which of these active ingredients is responsible for the sedative and hypnotic effects of valerian. However, scientists believe that the medicinal effects of this herb are most likely due to combinations of its phytochemicals rather than only one of them.
Even though the major phytochemical of valerian is unknown, valerian supplements are standardized to contain 0.3 – 0.8% of valerenic acid.
There is also no recommended dose for this herb although most studies use 400 - 900 mg of the herb given 2 hours before bedtime.
In these studies, valerian was found to be safe and well-tolerated. Recorded side effects of valerian are usually mild and include dizziness, headache, gastrointestinal complaints, dry mouth, vivid dreams and daytime drowsiness.
The last two side effects are commonly experienced when valerian is combined with other sedative drugs and herbs.
Scientists believe that more than one phytochemical in valerian is responsible for the herb’s sedative effects. In fact, studies seem to suggest that a number of phytochemicals act synergistically to produce the herb’s overall sedative effect.
On one hand, phytochemicals such as valeric acid and valepotriates have been shown to have direct sedative effects. On the other hand, some other phytochemicals in the herb act on the GABA system in the central nervous system to induce sleep.
The later mechanism of action is more extensively studied and regarded as the primary cause of the sedative property of valerian.
While valerian contains the amino acid, GABA, it is unlikely that it can increase GABA levels in the brain simply by supplying the amino acid to the central nervous system. This is because GABA does not cross the blood-brain barrier in appreciable concentration.
However, other phytochemicals in valerian can increase the amount of GABA produced in the brain and also increase its activity in certain parts of the brain.
Specifically, multiple studies confirm that valerian extracts have a high affinity for GABA-A receptor.
GABA-A receptor is the major GABA receptor responsible for controlling the daily sleep-wake rhythm.
Once bound to this receptor, valerian increases the amount of GABA released in the brain. Since GABA is the chief inhibitory neurotransmitter in the central nervous system, the increased production of this brain chemical reduces neuronal activity in certain brain cells.
This reduced activity is responsible for the calming effect of valerian as well as its ability to induce sedation.
Although studies show that valerian is less effective than prescription sedative drugs, they also confirm that the drug is safer.
Valerian is regularly recommended as an alternative sleep aid especially for those with mild to moderate insomnia.
However, this herb has some advantages over prescription sedatives. First, it is much less likely to cause a “hangover effect”. This means that it does not affect mental and physical activities the next morning as much as prescription sleep medications.
Secondly, valerian does not cause a “rebound effect” like prescription sedatives. When taken off sleeping pills, patients often experience a few days of worsening insomnia. This temporary rebound insomnia has not been reported for valerian.
While valerian is actively marketed as an herbal sleep aid, and even approved as a prescription sedative drug in some countries, not all studies investigating its sedative effects is positive.
The two studies discussed below highlight the body of research that found valerian ineffective as a sleep aid.
In a 2003 study published in the journal, Complementary Therapies in Medicine, the authors investigated the effectiveness of valerian in the treatment of insomnia. The study population was 42 patients in Queensland, Australia.
The results of this study showed that the effectiveness of valerian for improving sleep quality was poor to modest and comparable to placebo treatments.
While the researchers concluded that valerian was ineffective in the treatment of insomnia, this study is far from being definitive. One of its criticism involves its poorly design. Secondly, even though 42 patients were recruited, complete outcome data were taken from only 24 of them.
To find studies with better designs, reviewers often sift through medical journal databases in order to conduct meta-analyses on an area of study. One such meta-analysis on the effectiveness of valerian as a sleep aid was published in 2007 in the journal, Sleep Medicine Reviews.
For this analysis, the authors selected 37 qualifying studies from a pool of 592 past studies evaluating the efficacy and safety of valerian in the treatment of different forms of insomnia.
In their analysis, the authors found that most studies did not find valerian better than placebo as a sleep aid. In addition, they found that all recent studies did not find that valerian significantly improved insomnia or the quality of sleep.
However, the authors concluded that the consensus was that valerian was a safe herb.
To highlight the mixed results produced by clinical studies on valerian as an herbal sleep aid, we should consider this 2000 review published in the journal, Sleep Medicine.
After searching through scientific literature on the topic, the reviewers found 9 randomized, placebo-controlled, double blind clinical trials that met their inclusion criteria. Even then the reviewers noted the inconsistencies in the methodologies of these studies as well as their results.
Therefore, they concluded that the clinical evidence to support or disclaim the sedative effect of valerian was inconclusive and further studies were needed to determine the herb’s efficacy.
On the other hand, there are studies and meta-analyses that have found valerian quite effective in the treatment of insomnia.
One of such studies was published in the journal, Pharmacopsychiatry, in 2000. In a rather critical evaluation, the researchers investigated the effect of single dose as well as long-term use of valerian on both objective and subjective measurements of sleep quality.
In this placebo-controlled, randomized and crossover study, 16 adult insomnia patients were given valerian as a single dose and then over the course of 14 days.
Objective sleep parameters measured include polysomnogram recordings, arousal index and sleep stage analysis. Subjective parameters include sleep quality, morning-after feeling, performance in daytime activities, perceived length of sleep and onset of sleep.
The results of the study showed that the single-dose treatment with valerian did not improve sleep quality or sleep structure.
However, the long-term use of valerian did. Specifically, the 14-day course of valerian improved slow-wave or “deep” sleep over placebo. In addition, the patients experienced shorter onset of sleep when given valerian.
Lastly, there was a high correlation between objective and subjective sleep parameters during long-term valerian treatment.
The researchers also found that valerian produced remarkably fewer side effects than placebo.
Therefore, they recommended valerian herbal extract for the treatment of insomnia.
There are other similar positive studies indicating that valerian is effective as a natural sleep aid. Some of these were presented in a meta-analysis published in 2006 in The American Journal of Medicine.
The reviewers combed databases of science journals to find 16 studies that met their criteria. This collection of studies involved 1,093 patients. The reviewers found that these studies varied in study design as well as methodology.
Even then they found significant evidence to suggest that valerian was useful in the treatment of insomnia.
A similar meta-analysis published in the journal, Sleep Medicine, in 2010 also found the same methodology inconsistencies in 18 randomized clinical trials.
After correcting for bias and giving more weight to better-designed studies, the reviewers concluded that valerian was effective for subjective improvements of insomnia. They called for more studies with better designs to conclusively demonstrate that valerian produces measurable improvements in sleep quality.
To improve the efficacy of valerian, it is sometimes combined with other sedative herbs. One of these companion herbs is kava.
A pilot study published in the journals, Phytotherapy Research and Human Psychopharmacology: Clinical and Experimental in 2001 investigated the effectiveness of valerian-kava combination in the treatment of insomnia induced by stress.
The researchers first gave 120 mg/day of kava to 24 stress-induced insomnia patients for 6 weeks.
Then they allowed a washout period of 2 weeks before giving these (19, the rest dropped out) patients 600 mg of valerian for another 6 weeks. Thereafter, a second 2-week washout period was allowed before the remaining (19) patients were given kava and valerian for another 6 weeks.
The results of the study showed that
The researchers called the results promising and called for further studies.
This study provides support for the popular use of combinations of sedative herbs in the treatment of insomnia.
Another sedative herb commonly combined with valerian is hop. The effectiveness of such combination was tested in a 2000 pilot study published in the European Journal of Medical Research.
The researchers recruited 30 patients suffering from mild to moderate insomnia. Over a period of 2 weeks, each of these participants was given 2 tablets of valerian-hops (250 mg valerian extract + 60 mg hop extract) combination in the evenings.
After treatment, the patients were given polysomnograph examinations. The results of the study showed that the combination of valerian and hop improved sleep efficiency.
Specifically, the researchers found that valerian and hop reduced the onset of sleep as well as the frequency of waking up during the night. In addition, slow-wave or “deep” sleep was improved and the participants confirmed that they felt refreshed in the morning. No side effects were observed.
The study confirms that the combination of valerian and hop was not only safe and well-tolerated but also effective in the treatment of insomnia.
Because valerian is safe and well-tolerated, it is commonly used as an alternative to prescription sleep medications. However, how well does it compare to these drugs?
In a 2002 study published in The European Journal of Medical Research, a group of German researchers compared the effectiveness of valerian to oxazepam as a sleep aid alternative. For the study, they recruited 202 outpatients with established insomnia from 24 hospitals.
These participants were given either 600 mg/day of valerian (Sedonium) or 10 mg/day of oxazepam for 6 weeks.
The results of this study showed that both treatments were effective and that the sedative effect of valerian was just as effective as that of oxazepam at the doses used.
In fact, both treatments were comparable on the subjective scales used to measure duration of sleep, refreshment after sleep, dream recall and evening psychic performances.
Only mild to moderate side effects were observed for both valerian and oxazepam with valerian producing fewer side effects. When asked to rate their treatments, valerian scored higher (82.8%) among the participants than oxazepam (73.4%).
The researchers, therefore, recommended valerian extract as a safe and effective sleep aid alternative to oxazepam in the treatment of insomnia.
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