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Natural Good Sleep

Tips on Melatonin, Valerian, and More
A few natural remedies may help when you can't sleep.

By Jeanie Lerche Davis
WebMD FeatureReviewed by Michael W. Smith, MD

We've all been there -- you're too wired to drift to sleep. Or you wake up in the middle of the night. Insomnia can be debilitating.

What's your ploy for getting a decent night's sleep? Doctors say it's important to look at your lifestyle -- whether too much caffeine, too little exercise, or too much late-night work or TV is the problem. If lifestyle changes aren't enough, medications can help. Supplements may also have a place in providing a peaceful night's sleep.

For advice on sleep supplements, WebMD turned to Sharon Plank, MD, an integrative medicine physician with the University of Pittsburgh Medical School Center for Integrative Medicine. We also spoke with Alon Avidan, MD, a sleep researcher and professor of neurology at UCLA School of Medicine.

Supplements for Natural Good Sleep
First, they note that most over-the-counter sleep aids contain antihistamine -- and should only be taken short-term because they are not helpful for long-term sleep problems.

So, what's been proven to work? What's safe?
Plank is a big advocate of chamomile tea, as well as valerian and melatonin. "Both of those have good scientific evidence backing them up," Plank tells WebMD.

Start with low doses of any supplement, she advises. Always tell your health provider what you're doing, as some people should not take specific supplements. There may be interactions with other medications you're taking or other serious side effects. Also, keep these sleep solutions short-term.

"Any sleep aid should not be taken for long periods," Plank says. "You must address lifestyle, too. Make sure something else is not interfering with sleep."

Plank recommends:
Chamomile tea

For optimal nerve health (to help you relax), she also advises 100 to 400 milligrams of magnesium. "I don't know of studies of magnesium for sleep, but in my experience it helps," she tells WebMD.

Chamomile Tea for Sleep
For thousands of years, people have used chamomile tea medicinally. The tea and essential oil have been used for their calming effects and for insomnia relief.

One Japanese study of sleep-disturbed rats found that chamomile extract helped the rats drift off to sleep more quickly -- just as quickly as rats that got a dose of benzodiazepine (a tranquilizing medication). Better research of chamomile is needed, experts agree. The FDA considers chamomile to be safe with usually no side effects.

"Chamomile is safe as a tea," Plank says. "But the trick is to make sure you are brewing it properly. Use two or three teabags. Then put a lid on the pot to keep oils in the water -- so you get the medicinal effects of the tea."

A few cautions: If you have an allergy to ragweed, don't use chamomile. Also, don't take chamomile tea if you are pregnant as chamomile may act as a uterine stimulant. Plank also suggests you avoid chamomile when breastfeeding because its effect on nursing babies hasn't been well studied.  And, obviously, you shouldn't use chamomile when driving as it may cause drowsiness.

In addition, chamomile may increase the risk of bleeding so people on blood thinners should exercise caution. Chamomile may also increase blood pressure.

Melatonin for Sleep
Melatonin is a natural hormone that helps regulate the sleep-wake cycle (circadian cycles). Diseases, medications and advancing age can reduce our natural melatonin levels -- and jet lag, shift work, stress, and medications can upset the body's internal clock. It's a complex interaction that is not fully understood. However, melatonin is known to play a key role in keeping our sleep cycles regulated.

"Melatonin supplements can be effective in treating certain sleep disorders, including jet lag," says Avidan. Several studies have suggested that careful timing is necessary to prevent jet lag. Take melatonin on your day of departure -- but close to the bedtime at your destination. Continue taking it for several days. It works best when traveling eastward -- and when crossing four or more time zones.

Numerous studies have shown that melatonin helps with insomnia -- whether the trouble is falling asleep or staying asleep. Studies also show that melatonin enhances the quality of sleep, helping people sleep longer.

"Melatonin comes in two forms -- extended release and immediate release," says Plank. "If you're waking up in the middle of the night, you may want extended release. If you have trouble falling asleep, try immediate release."

A few cautions: Melatonin is considered generally safe for short-term use. However, there have been concerns about risks of bleeding (especially in people taking blood-thinners like warfarin). There also is increased risk of seizure, particularly in children with brain disorders.

Valerian for Sleep
For more than 2,000 years, valerian root has been used as a sedative and antianxiety treatment. While it is not a pleasant-smelling herb, valerian can be taken in capsules.

A review of 16 studies showed evidence suggesting that valerian may help sleep come more quickly -- and that it improves the quality of sleep. Valerian becomes more effective over time, so taking it nightly works best, rather than taking valerian only on random rough nights. The flaw with most studies that have found benefit in valerian: they have been small and not very scientific in measuring sleep improvements.

Since there are few adverse effects from valerian, it's safe to try as a sleep aid, says Plank. Start with the lowest dose, then increase over several days' time. It is considered safe to take for four to six weeks.

Kava for Sleep
Kava is a member of the pepper family and is native to many Pacific Ocean islands. The root stock is most often used for herbal remedies.

Kava has been shown to help relieve anxiety. One review of six studies showed a significant reduction in anxiety among patients who took kava, compared with those who got a placebo. For them, kava showed only rare, mild side effects. Another small study showed that both kava and valerian improved sleep in people with stress-related insomnia.

"Kava has been around for a long time," Plank says. "If anxiety is your problem, sure, try it."
The American Academy of Family Physicians reports that short-term use of kava is recommended for patients with mild to moderate anxiety -- but only for people not using alcohol or medicines metabolized in the liver, including many cholesterol medicines. In fact, the FDA has issued a warning that using kava supplements has been linked to a risk for severe liver damage.

"I tell patients this is a potential problem," says Avidan. "If they have a history of liver disease, they have to be careful."  Before taking kava, check with your doctor to make sure it's safe for you.

Lifestyle Tips for Better Sleep
What's best, experts agree, is taking steps to reduce stress and create a good sleep environment.

Some tips for a good night's sleep:
Keep noise and light to a minimum. Use earplugs, window blinds, heavy curtains, or an eye mask. Small night-lights in your bedroom and bathroom are a good idea.
Avoid large meals two hours before bedtime. A light snack is fine.
Don't drink caffeine (including tea and soft drinks) four to six hours before bedtime.
Regular exercise like walking will reduce stress hormones and help you sleep better. But don't exercise within two hours of bedtime. You may have more difficulty falling asleep.
Don't nap late in the afternoon.
Stop working on any task an hour before bedtime to calm your brain.
Don't discuss emotional issues right before bedtime.
Keep pets outside your sleeping area if you can.
Make sure your bedroom is well ventilated and at a comfortable temperature.
Learn a relaxation technique like meditation or progressive relaxation.
Another idea: "If you can't sleep because of pain, I advise Tylenol before bedtime," Plank says. "Especially in the senior population, this can be helpful. Many people toss and turn from aches and pains."

Plank (who is an acupuncturist as well as an MD) also advises trying acupuncture, which is known to help relieve pain -- and can also help with arthritis and headaches -- with the side effect of helping with insomnia.  "Acupuncture can improve your quality of life," she says.
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