Aiding sleep Part Two — herbal medicine

I am presenting this information in a way that promotes the intricacy of herbal medicine, and not simply listing a bunch of herbs that are known for sleep with the expectation that taking them once will solve your sleep problems. In this way I am honouring the integrity of herbalism, also promoting that individualised treatment for sleep problems should be undertaken with a qualified practitioner (and not through simplistic advice off the internet…!) Reality is that chronic issues will take long-term and consistent treatment of natural medicines, that is both their beauty (and maybe in some views, their downfall). And as I have often said before, working holistically means addressing more than one system or element at a time.

Herbs ARE powerful, they work synergistically (using all their constituents) to create a range of effects through the body — physiologically, mentally and energetically. Often herbalists may combine a few herbs as a treatment with a similar action (i.e. sedative/ hypnotic) along with the consideration of other secondary actions, depending on the individual person and case. Perhaps chamomile tea will help some of us to fall asleep and that’s the end of the story. For others, and I’d say especially those with chronic sleep issues, I’d rather not create the expectation that drinking one cup of chamomile tea will put you to sleep instantly.

I’ve put together a group of herbal actions that may assist with sleep, and described how they work, so that addressing the sleep issue becomes a much more specific yet also holistic approach. Herbs for sleep can be taken in a variety of ways, which includes as a tea (especially useful when winding down at night), as well as tablet, liquid extract or powder. The method will depend on the individual requirements and likelihood of compliance.

HERBAL SEDATIVES
Reduces activity in some way, particularly in the nervous system, to decrease nervous tension; thus used to treat nervousness, anxiety and sleeplessness (along with pain or spasm). Studies have shown that the neurotransmitter GABA changes/ modifies/ activates when we ingest the extracts of herbal plants that are reported to possess sedative properties. GABA has been identified to promote sleep, through its inhibitory activity on the central nervous system (Shi et al., 2014).

In fact, the GABA receptor is a target of the majority of pharmaceutical sleep medications. However, we know that pharmaceutical sleep treatment can be quite addictive and work in a reductionist way which may not promote long term changes and effect.

Nervous system sedatives include:
Californian poppy
Chamomile
Hops
Jamaican dogwood
Kava
Lavender
Lemon Balm
Lobelia
Passionflower
Skullcap
St Johns wort
Wild Cherry
Valerian

HERBAL HYPNOTICS
Induce drowsiness and sleep; the mode of action for these herbs vary from mild muscle relaxing properties through volatile oils that ease psychological tension, to remedies that contain strong alkaloids that work directly on the nervous system to induce sleep (Hoffman, D. The Herbal Handbook, 1989) and there is definitely some crossover with herbal sedatives.

Valerian has been widely used as a folk remedy for its hypnotic properties. The exact biochemical action of valerian remains unclear but effects on GABA metabolism and re-uptake, 5HT1a and adenosine receptors have been postulated (Bent et al., 2006).
Kava was shown to significantly increase the delta activity (deepest sleep stage) during non-REM sleep, in an animal study (Tsutsui et al., 2009).
Other hypnotics (and sedatives) include Corydalis, St Johns Wort, Wild lettuce and Zizyphus

HERBAL ANXIOLYTICS
Living in a constant state of stress and sympathetic nervous system (fight or flight) will create prolonged states of anxiety through the constant release of cortisol and disruption of the Hypothalamus-Pitutitary-Axis (HPA) — this can be a major factor in the ability to fall asleep. Therefore, many herbalists will consider an anxiolytic (treats anxiety) when working on sleep issues.

Similar to sedatives, anxiolytics work on the GABAergic system, along with Serotonin (5-hydroxytryptamine, 5-HT) modulation and possibly through regulation of elevated corticotropin releasing hormone and the hyper-activity of the HPA axis (Liu et al., 2015).

Common anxiolytics include:
Chamomile
Ginkgo biloba
Hops
Kava
Lemon balm
Passionflower
Skullcap
Valerian
Withania
(again, there is crossover with the sedatives group based on similar mechanisms of action).

HERBAL ADAPTOGENS
Increase the body’s resistance and adaption to physical, environmental, emotional, or biological stress through the body, whilst also maintaining homeostasis and not causing any harm to normal functioning of the body. Managing the body’s way of managing stress through adaptogenic herbs may assist or address sleep issues and insomnia through the support and balance of the HPA axis and GABAergic system (as anxiolytics and sedatives).

Common adaptogens include:
Korean ginseng
Rhodiola rosea
Siberian ginseng
Schisandra
Withania

PHYTOMELATONINS
Phytomelatonin (plant melatonin) is chemically related to the amino acid tryptophan and has many diverse properties (see previous post about melatonin, a hormone that we produce naturally within us). Phytomelatonin is an interesting compound due to its protective effect in plants exposed to diverse stress situations. Phytomelatonin is absorbed from the gastrointestinal tract in humans, modulating blood melatonin levels (Arnao & Hernández-Ruiz, 2018).

Synthetic melatonin is commonly prescribed for jet lag and occasionally as a temporary fix to insomnia. There has been increasing interest around plant-based melatonin and in particular tart cherries, rice, alfalfa and green alga (Pérez-Llamas, et al., 2020) with some products made from these natural substances promoting a natural realignment of circadian rhythm and assisting to reset sleep cycle.

Other herbs shown to increase/ modulate melatonin include Chaste tree (Dericks-Tans et al., 2003), Hops (Brattström, 2009) and St. Johns Wort (Heiligenstein & Guenther, 1998).

Utilising herbal medicine should be considered in the context of an overall approach to addressing the sleep problem which may also involve relaxation methods, circadian rhythm regulation, emotional wellbeing, sleep environment, food and lifestyle in general.