Sleep Disorders and CAM: At a Glance
People who have trouble sleeping may try dietary supplements, relaxation therapies, or other forms of complementary
and alternative medicine (CAM) in an effort to fall asleep faster, stay asleep longer, and
improve the overall quality of their sleep. This fact sheet provides basic information on sleep disorders and "what the science says"
about the effectiveness of CAM practices people use as sleep aids. If you are considering a CAM therapy for
sleep problems, this information can help you talk with your health care provider about it.
About Sleep Disorders
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Chronic, long-term sleep disorders affect millions of Americans each year. These disorders
and the sleep deprivation they cause can interfere with work, driving, social activities, and overall quality of
life, and can have serious health implications. Sleep disorders account for an estimated $16 billion in medical
costs each year, plus indirect costs due to lost productivity and other factors.
There are more than 80 defined sleep disorders. Insomnia—difficulty falling asleep, difficulty
staying asleep, and/or poor sleep quality—is one of the most common sleep disorders. Insomnia
tends to increase with age, and is often associated with an underlying medical or psychiatric condition. Other
sleep disorders include sleep apnea (breathing interruptions during sleep), restless leg
syndrome (a tingly or prickly sensation in the legs), and narcolepsy (daytime "sleep
attacks"). This fact sheet focuses on insomnia.
To learn more about healthy sleep, visit the National Heart, Lung, and Blood Institute's Your Guide to Healthy Sleep (a pdf file).
Lifestyle changes—for example, establishing a regular sleep schedule, relaxing before bedtime,
exercising regularly, and avoiding alcohol, caffeine, and nicotine—can sometimes improve sleep quality. (A common
misconception is that drinking alcohol will aid sleep; although it can bring on a light sleep, alcohol actually
robs people of the deeper stages of sleep.) Many prescription medications and over-the-counter sleep aids are
widely advertised and used for insomnia; most have side effects and are intended for short-term use. Evidence
suggests that cognitive-behavioral (nondrug) therapies for insomnia may have long-term benefits. People with
insomnia may also try dietary supplements and other CAM therapies.
CAM Use for Insomnia
In 2002 and 2007, the National Health Interview Survey (NHIS) asked participants about CAM use. In 2002, 2.2
percent of respondents who used some form of CAM in the past 12 months said they used it for insomnia or trouble
sleeping; in 2007, that figure was 1.4 percent.
An analysis of data from the 2002 NHIS found that 17.4 percent of all participants said they regularly had insomnia
or trouble sleeping in the past 12 months; most who reported insomnia also reported other medical/psychiatric
conditions, such as anxiety or depression, chronic heart failure, diabetes, hypertension, and obesity. Among
participants with insomnia, 4.5 percent (which translates to a total of 1.6 million U.S. adults) used some form of
CAM to treat their condition—primarily biological/herbal therapies (64.8 percent) or mind-body/relaxation therapies
(39.1 percent). Most found these therapies helpful.
Among the CAM approaches that people use for insomnia are
- Herbs, including aromatherapy, chamomile
tea, and herbal supplements such as valerian and various "sleep formula" products
- Melatonin and related dietary supplements
- Other CAM modalities, such as acupuncture, music therapy, and relaxation techniques.
What the Science Says About CAM and Insomnia
Research on CAM and insomnia has produced promising results for some CAM therapies. However, evidence of
effectiveness is still limited for most therapies, and additional research is needed. This section summarizes what
is known about some of the CAM approaches that people use for insomnia.
- Aromatherapy using essential oils from herbs such as lavender or
chamomile is a popular sleep aid; preliminary research suggests some sleep-inducing effects, but more
studies are needed.
- The herb chamomile is commonly used as a bedtime tea, but scientific evidence of its
effectiveness for insomnia is lacking.
- The herb kava has been used for insomnia, but there is no evidence of its efficacy. The U.S. Food and Drug
Administration has issued a warning that kava supplements have been linked to a risk of severe liver
- The herbal supplement valerian is one of the most popular CAM therapies for insomnia.
Several studies suggest that valerian (for up to 4-to-6 weeks) can improve the quality of sleep and slightly
reduce the time it takes to fall asleep. However, not all of the evidence is positive. One systematic review of
the research concluded that although valerian is commonly used as a sleep aid, the scientific evidence does not
support its efficacy for insomnia. Researchers have concluded that valerian appears to be safe at recommended
doses for short-term use. Some "sleep formula" products combine valerian with other herbs such as hops,
lavender, lemon balm, and skullcap. Although many of these other herbs have sedative properties, there is no
reliable evidence that they improve insomnia or that combination products are more effective than valerian
Melatonin and Related Supplements
- Like valerian, melatonin supplements (melatonin is a naturally occurring hormone
associated with sleep) are widely used and researched for insomnia. Although more research is still needed,
studies suggest that melatonin can help elderly people with insomnia fall asleep faster, and may also be
beneficial for other people with insomnia; however, effects are generally small, with larger effects observed
in patients whose sleep problems are caused by a circadian rhythm abnormality (disruption of the body's
internal "clock"). Studies indicate that melatonin also appears to be safe at recommended doses for short-term
- Dietary supplements containing melatonin "precursors"—L-tryptophan and 5-HTP—are also used
as sleep aids. (The amino acid L-tryptophan is converted to 5-HTP, which is converted to serotonin and then
melatonin.) However, these supplements have not been proven effective in treating insomnia, and there are
concerns that they may be linked to eosinophilia-myalgia syndrome (EMS), a complex and debilitating systemic
condition with multiple symptoms including severe muscle pain.
Other CAM Approaches
- Traditional Chinese
medicine commonly uses acupuncture to treat insomnia. A review of available studies found
some evidence of benefits, but many studies had design flaws that make it difficult to draw firm
- There is scientific evidence that music therapy can have sleep benefits for older adults
- Studies suggest that relaxation techniques may help people with insomnia, although the
effects appear to be short-lived. Cognitive forms of relaxation (such as meditation) have had slightly better results than
somatic forms (such as progressive muscle relaxation). Preliminary studies suggest that yoga may also improve sleep quality. In
addition, when these forms of relaxation are combined with other components of cognitive-behavioral therapy
(e.g., sleep restriction and stimulus control), lasting improvements in sleep have been observed. Again,
additional research is needed in these areas.
NCCAM Research on Sleep Disorders
The National Center for Complementary and Alternative Medicine (NCCAM) funds clinical trials that look at CAM for
sleep disorders. Recent projects include studies of:
- High-intensity light therapy to help Alzheimer's disease patients
- Hypnosis to relieve sleep impairment in people with posttraumatic stress
- Melatonin supplements as a sleep aid for people with hypertension
- Mindfulness-based stress reduction to improve sleep quality
- Valerian for improving sleep in healthy, older adults and in patients with
- Yoga as a treatment for insomnia.
In addition to clinical trials, NCCAM also supports basic science research aimed at understanding the underlying
biological mechanisms of CAM therapies, including those used to treat sleep disorders. NCCAM also participates in
the National Institutes of Health (NIH) Trans-NIH Sleep Research Coordinating Committee.
If You Are Considering CAM for Sleep Problems
- Talk to your health care providers. Tell them about the therapy you are considering and ask any questions
you may have. They may know about the therapy and be able to advise you on its safety, use, and likely
effectiveness in relieving your sleep problems. Because trouble sleeping can be an indication of a more serious
condition, it is especially important to discuss any sleep-related symptoms (such as snoring or daytime
fatigue) with your health care providers before trying a CAM approach.
- Be cautious about using any sleep product—prescription medications, over-the-counter drugs, or CAM dietary
supplements. Find out about potential side effects and the effects of long-term use and use of more than one
product at a time.
- If you are considering herbal or other dietary supplements, keep in mind that "natural" does not always
mean safe. For example, the herbs comfrey and kava can cause serious harm to the liver. Also, a manufacturer's
use of the term "standardized" (or "verified" or "certified") does not necessarily guarantee product quality or
consistency. Herbal or other dietary supplements can act in the same way as drugs. They can cause medical
problems if not used correctly, and some may interact with medications you are already taking. The health care
providers you see about your sleep problems can advise you. It is especially important to consult your health
care provider if you are pregnant or nursing a child, or if you are considering giving a child a dietary
supplement. For more information, see the NCCAM fact sheet Using Dietary Supplements Wisely.
- If you are considering a practitioner-provided CAM therapy such as acupuncture, check with your insurer to
see if the services will be covered, and ask a trusted source (such as your doctor or a nearby hospital or
medical school) to recommend a practitioner.
- Tell your health care providers about any complementary and alternative practices you use. Give them a full
picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about
talking with your health care providers about CAM, see NCCAM's Time to Talk campaign.
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Effects of exogenous melatonin on sleep: a
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