Jose G. Veliz, M.D. M.S.A.
Medical Director
Palomar Pain Management Center

Posted January 05, 2009

Melatonin and Valerian are natural remedies which improve insomnia symptoms in certain populations.  There are not enough studies available to support other natural products in the field of insomnia.  Chamomile, passion flower, coenzyme Q10, hops, lemon balm, lavender, skullcap, kava and L-tryptophan are examples of natural remedies which have been promoted to improve insomnia symptoms, despite any evidence in well performed studies to prove their efficacy.

Melatonin

Melatonin is a hormone, produced in our bodies, which is responsible for modulating the sleep-wake cycle.  Light and dark signals which reach our eyes eventually result in the release of melatonin from the pineal gland in our brains. 

The dose of melatonin varies from .3 - .5 mg nightly and should be taken 30 - 120 minutes before bedtime.  The dosage should be reduced in the elderly to .1 - .3 mg nightly.  Melatonin is not recommended in children younger than 18 years because adequate studies have not been performed to evaluate its safety in this age group. 

The evidence supports short term benefits in elderly patients, shift work, and jet lag.  Larger, longer and more controlled studies need to be performed before melatonin can be recommended for all types of insomnia. 

Despite the fact that it is a “natural” remedy, there can be adverse effects.  These include dizziness, headache, drowsiness, fatigue, and irritability.  Discuss the adverse effects with your doctor before beginning melatonin therapy. 

Valerian

Valerian root (Valeriana Officinalis) is used commonly for the symptoms of anxiety and insomnia.  There is a characteristic unpleasant odor associated with it. 

The dosages which have been studied range from 600 mg to 3 grams of actual herb or root per day, taken one hour prior to bedtime.   As with melatonin, valerian therapy has not been studied enough in children younger than 18 years and is not recommended. 

Numerous studies support the use of valerian for the treatment of insomnia.  It is commonly used in Germany to treat sleeping disorders and nervous restlessness. 

Studies support the use of valerian for up to six weeks.  Once again, despite the fact that it is a “natural” remedy, there are mild adverse effects which include headache, hangover, dizziness, excitability, and insomnia.  Prior to instituting the use of valerian, the dosages and possible adverse effects should be discussed with your doctor. 

Causes of Insomnia:

1. Noise.
2. Frequent Urination.
3. Uncomfortable Mattress or Pillow.
4. Excessive Use of Caffeine.
5. Excessive Use of Alcohol.
6. Excessive Use of Stimulants.
7. Late Night Large Meals.
8. Excessive Napping During the Daytime.
9. Extreme Heat.
10. Extreme Cold.
11. Medication Side-Effects.
12. Work Schedules.
13. Depression.
14. Pain.
15. Restless Leg Syndrome.
16. Sleep Apnea.
17. Asthma.
18. Kidney Disease.
19. Parkinson’s Disease.
20. Heart Failure.
21. Anxiety.
22. Nicotine Use Prior to Bedtime.

Treatments:

1. Eliminate the Use of Caffeine.
2. Limit Alcohol Use.
3. Eliminate the Use of Stimulants.
4. Avoid Late Night Meals.
>
5. Use White Noise Devices.
6. Melatonin.
7. Valerian.
8. Exercise during the Day.
9. Yoga.
10. Meditation.
11. Breathing Exercises.
12. Create a Comfortable, Quiet, Dark and Temperature Controlled Bedroom Environment.
13. Use the Bedroom Only for Sleep and Intimacy.
14. Cognitive Behavioral Therapy.

References: 

Morin, AK et al.  Therapeutic Options for Sleep Maintenance and Sleep Onset Insomnia.  Pharmacotherapy.  2007:27(1): 89-110.

http://www.drweil.com/drw/u/ART02004/insomnia?print=1