According to recent reports, many people today have a serious problem getting a good night's sleep. Our lives are simply too busy for us to get the 8 hours we really need. To make matters worse, many of us suffer from insomnia. When we do get to bed, we may stay awake thinking for hours. Sleep itself may be restless instead of refreshing.

Most people who sleep substantially less than 8 hours a night experience a variety of unpleasant symptoms. The most common are headaches, mental confusion, irritability, malaise, immune deficiencies, depression, and fatigue. Complete sleep deprivation can lead to hallucinations and mental collapse.

The best way to improve sleep involves making lifestyle changes: eliminating caffeine and sugar from your diet, avoiding stimulating activities before bed, adopting a regular sleeping time, and gradually turning down the lights. More complex behavioral approaches to improving sleep habits can be adopted as well.

Many drugs can also help with sleep. Such medications as Sonata, Lunesta, Ambien, Restoril, Ativan, and Xanax are widely used for sleep problems. Of these, only Lunesta has been tested for long-term use. All of these medications are in essence tranquilizers, and therefore, have potential for dependence and abuse; the newer sleep-inducing drug Rozerem (ramelteon) acts like an enhanced version of the supplement melatonin ( see below) and is not thought to have such potential.

Antidepressants can also be used to correct sleep problems. Low doses of certain antidepressants immediately bring on sleep because their side effects include drowsiness. However, this effect tends to wear off with repeated use. For chronic sleeping problems, full doses of antidepressants can sometimes be helpful. Antidepressants are believed to work by actually altering brain chemistry, which produces a beneficial effect on sleep. Trazadone and amitriptyline are two of the most commonly prescribed antidepressants when improved sleep is desired, but most other antidepressants can be helpful as well.

Although the scientific evidence isn't yet definitive, the herb valerian and the hormone melatonin are widely accepted as treatments for certain forms of insomnia.

Valerian

Valerian has a long traditional use for insomnia, and today it is an accepted over-the-counter treatment for insomnia in Germany, Belgium, France, Switzerland, and Italy. However, the evidence that it really works remains inconsistent and incomplete.83,96A systematic review published in 2007 concluded that valerian is safe but probably not effective for treating insomnia.85And in a subsequent review of 18 randomized trials, researchers found that people who took valerian did report an improvement in their sleep. But, this finding was not supported by more objective measures of sleep quality.96

However, there have been some positive results, both with valerian alone and valerian combined with other herbs.

Valerian is most commonly recommended to be used as needed for occasional insomnia. Interestingly, however, the results of the largest and best designed positive study only found benefits regarding long-term improvement of sleep.5 In this double-blind, placebo-controlled trial, half of the participants took 600 mg of an alcohol-based valerian extract 1 hour before bedtime while the other half took placebo. Valerian didn't work right away. For the first couple of weeks, valerian and placebo were running neck and neck. However, by day 28 valerian pulled far ahead. Effectiveness was rated as good or very good by participant evaluation in 66% of the valerian group and in 61% by doctor evaluation, whereas in the placebo group, only 29% were so rated by participants and doctors.

Although positive, these results are a bit confusing, because in another large study valerian was effective on an immediate basis, which is more in keeping with how the herb is typically used.6Other studies, most of relatively low quality, found immediate benefits as well.7,9,66-68 And to make matters even murkier, four more recent studies of valerian failed to find evidence of anybenefit,69,70,76,90including a 4-week study in which 135 people were given valerian and 135 given placebo.77 The most recent trial, a 2-week study of 405 people, reported “modest benefits at most [italics added].” 88

A study of 184 people that tested a standardized combination of valerian and hops, with mixed results.82 Researchers tested quite a few aspects of sleep (such as time to fall asleep, length of sleep, number of awakenings) and found evidence of benefit in a few. This use of “multiple outcome measures” makes the results somewhat unreliable.

Other studies have compared valerian (either alone or in combination with hops or melissa) against benzodiazepine drugs.8,10-11,71 Most of these studies found the herbal treatment approximately as effective as the drug, but due to the absence of a placebo group these results are less than fully reliable.

Mixed results like these suggest that valerian is at most modestly helpful for improving sleep.

For more information, including dosage and safety issues, see the full Valerian article.

Melatonin

The body uses melatonin as part of its normal control of the sleep-wake cycle. The pineal gland makes serotonin and then turns it into melatonin when exposure to light decreases. Strong light (such as sunlight) slows melatonin production more than weak light does, and a completely dark room increases the amount of melatonin made more than a partially darkened room does. Taking melatonin as a supplement seems to stimulate sleep when the natural cycle is disturbed. It may also have a direct sedative effect.

Although not all studies were positive, reasonably good evidence indicates that melatonin is helpful for insomnia related to jet lag, according to a major review published in 2001.59One of the best supporting studies was a double-blind, placebo-controlled study that enrolled 320 travelers crossing 6 to 8 time zones.27 The participants were divided into four groups and given a daily dose of 5 mg of standard melatonin, 5 mg of slow-release melatonin, 0.5 mg of standard melatonin, or placebo. The group that received 5 mg of standard melatonin slept better, took less time to fall asleep, and felt more energetic and awake during the day than the other three groups.

Mixed results have been seen in studies involving the use of melatonin for ordinary insomnia, insomnia in swing-shift workers, and insomnia in elderly people.32,34-42,53,55,56,60,72,78-79,93

A 4-week, double-blind trial evaluated the benefits of melatonin for children with difficulty falling asleep.43A total of 40 children who had experienced this type of sleep problem for at least a year were given either placebo or melatonin at a dose of 5 mg. The results showed that use of melatonin helped participants fall asleep significantly more easily. Benefits were also seen in a similar study of 62 children with this condition.54Note: The long-term safety of melatonin usage has not been established. Do not give your child melatonin except under physician supervision.

Many individuals stay up late on Friday and Saturday nights, and then find it difficult to go to sleep at a reasonable hour on Sunday. A small double-blind, placebo-controlled study found evidence that use of melatonin 5.5 hours before the desired Sunday bedtime improved the ability of participants to fall asleep.44

Benefits were seen in a small double-blind trial of patients in a pulmonary intensive care unit.45 It is famously difficult to sleep in an ICU, and the resulting sleep deprivation is not helpful for those recovering from disease or surgery. In this study of 8 hospitalized individuals, 3 mg of controlled-release melatonin significantly improved sleep quality and duration.

Blind people often have trouble sleeping on any particular schedule because there are no light cues available to help them get tired at night. A small double-blind, placebo-controlled crossover trial found that the use of melatonin at a dose of 10 mg per day was able to synchronize participants sleep schedules.48

Some individuals find it impossible to fall asleep until early morning, a condition called delayed sleep phase syndrome (DSPS). Melatonin may be beneficial for this syndrome.49

In addition, people trying to quit using sleeping pills in the benzodiazepine family may find melatonin helpful. A double-blind, placebo-controlled study of 34 individuals who regularly used such medications found that melatonin at a dose of 2 mg nightly (controlled-release formulation) could help them discontinue the use of the drugs.50

Note: There can be risks in discontinuing benzodiazepine drugs. Consult your physician for advice.

For more information, including dosage and safety issues, see the full Melatonin article.