DEAR DOCTOR K:
I’m a woman in my 60s who struggles with insomnia. A friend recommended melatonin. What do you think of this and other natural sleep aids?
Many of my patients have trouble with insomnia. Now and then, so do I. There are different types of sleep problems, each treated differently. People can have trouble falling asleep, staying asleep or waking up tired.
Like you, some of my patients are interested in natural sleep remedies. The most commonly used herbal sleep aid is valerian root. Some studies suggest that valerian is mildly sedating and can help people fall asleep and improve their sleep quality. But the evidence is mixed. An analysis of multiple studies of valerian’s effect on sleep published in 2010 concluded that people fell asleep only about a minute sooner than with a sugar pill. There also is some risk of liver damage from valerian, and some women report headaches after using the herb.
I’m not aware of good studies of the long-term use of valerian. Finally, the manufacture of herbal treatments, unlike conventional drugs, is not regulated by the U.S. Food and Drug Administration. Impurities have been found in some herbal preparations that are available over-the-counter. For all these reasons, I don’t recommend valerian.
Another popular natural sleep aid is the one you mentioned, melatonin, which is a hormone made in the brain. It influences body temperature, sleep and daily body rhythms (circadian rhythms). The question is whether melatonin taken as a pill can help with sleep.
For most types of sleep problems, I don’t think melatonin has been shown in scientific studies to help sleep. Over-the-counter melatonin is sold as a food supplement in the United States, and like valerian, its manufacture is not regulated.
One condition where melatonin may help sleep is in older adults. People over 60 with insomnia often have lower levels of nighttime melatonin (as measured in the urine) than those without insomnia. Some studies have found that such people may sleep better if they take melatonin supplements. I would check with a sleep specialist if you’re interested in pursuing this treatment.
If melatonin and valerian root don’t help, you can try alternative approaches. However, their track record is less established.
Acupressure appears promising. In acupressure, pressure is placed on acupuncture points without needles.
Tai chi and yoga may help you fall asleep faster and improve your quality of sleep. Both have the added benefits of promoting mental relaxation as well as muscle relaxation. Meditation may help as a calming and relaxing technique as well.
You can also try drinking a cup of chamomile tea before bed. This age-old home remedy appears to help people relax and become drowsy. Chamomile is both mild and safe. (But avoid it if you’re allergic to plants in the daisy family.)
An excellent, short and inexpensive e-book about treatments for women battling insomnia is “Successful Sleep Strategies for Women” by Harvard Medical School’s Dr. Julia Schlam Edelman. You can find it on Amazon.com.