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Herbal medicine for insomnia: A systematic review and meta-analysis

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... The ability of herbal extracts to reduce sleep latency, increase sleep duration, and improve sleep quality has been explored in numerous studies; however, robust clinical evidence supporting their use for the treatment of insomnia is currently lacking, emphasizing the need for research in this area [87,88]. Mechanistic studies have shown that herbal medicines used for the treatment of depression, anxiety, and insomnia may exert their effect through various mechanisms of action. ...
... Active components of lavender (Lavandula angustifolia Miller) can bind the glutamate N-methyl-D-aspartate receptors and serotonin transporters [93]. Finally, several herbal substances may interact with glutamic acid decarboxylase or modulate GABA and serotonin receptors [6,88,94]. Sleep-promoting GABAergic neurons represent the main cellular target of pharmacological therapies for insomnia, and GABA signaling appears to be the target of a large number of over-the-counter herbal sleep aids [1,2,13]. The exceptional safety profile of herbal medicines, especially when compared with pharmacotherapy for insomnia, and their wide acceptance by patients, serve as a strong argument in favor of further investigations that aim to define their mechanism of action more precisely and that aim to confirm their clinical efficacy in terms of specific sleep parameters. ...
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Sleep is an essential component of physical and emotional well-being, and lack, or disruption, of sleep due to insomnia is a highly prevalent problem. The interest in complementary and alternative medicines for treating or preventing insomnia has increased recently. Centuries-old herbal treatments, popular for their safety and effectiveness, include valerian, passionflower, lemon balm, lavender, and Californian poppy. These herbal medicines have been shown to reduce sleep latency and increase subjective and objective measures of sleep quality. Research into their molecular components revealed that their sedative and sleep-promoting properties rely on interactions with various neurotransmitter systems in the brain. Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter that plays a major role in controlling different vigilance states. GABA receptors are the targets of many pharmacological treatments for insomnia, such as benzodiazepines. Here, we perform a systematic analysis of studies assessing the mechanisms of action of various herbal medicines on different subtypes of GABA receptors in the context of sleep control. Currently available evidence suggests that herbal extracts may exert some of their hypnotic and anxiolytic activity through interacting with GABA receptors and modulating GABAergic signaling in the brain, but their mechanism of action in the treatment of insomnia is not completely understood.
... possessing respectable clinical evidence confirmed by metanalyses and indicated well-established use in EMA monographs (Ng et al., 2017;Nicolussi et al., 2020;Pittler and Ernst, 2003;Sarris, 2018;White, 2018). Other medicinal plant materials such as purple passionflower (Passiflora incarnata l.), hops (Humulus lupulus l.), lemon balm (Melissa officinalis l.) are applied due to their long traditional use supported by controlled clinical trials partially confirming their activity, however referring to some inconsistencies, which prevent their registration as a medicinal product of well-established use (Leach and Page, 2015;Miroddi et al., 2013;Sarris, 2018;Sarris et al., 2013;Shakeri et al., 2016). In recent years a renaissance in the research of antidepressant, anxiolytic and antiaddictive potential of psilocybin and psilocin (serotonin 2A receptor (5-HT 2A R) agonists) present in various fungi species belonging to Psilocybe and Panaeolus species has reemerged, giving very promising results in clinical studies (dos Santos and Hallak, 2020). ...
Article
Background: Clinical research in natural product-based psychopharmacology has revealed a variety of promising herbal medicines that may provide benefit in the treatment of mild mood disorders, however failed to unambiguously indicate pharmacologically active constituents. The emerging role of the microbiota-gut-brain axis opens new possibilities in the search for effective methods of treatment and prevention of mood disorders. Purpose: Considering the clinically proven effectiveness juxtaposed with inconsistencies regarding the indication of active principles for many medicinal plants applied in the treatment of anxiety and depression, the aim of the review is to look at their therapeutic properties from the perspective of the microbiota-gut-brain axis. Method: A literature-based survey was performed using Scopus, Pubmed, and Google Scholar databases. The current state of knowledge regarding Hypericum perforatum, Valeriana officinalis, Piper methysticum, Passiflora incarnata, Humulus lupulus, Melissa officinalis, Lavandula officinalis, and Rhodiola rosea in terms of their antimicrobial activity, bioavailability, clinical effectiveness in depression/anxiety and gut microbiota - natural products interaction was summarized and analyzed. Results: Recent studies have provided direct and indirect evidence that herbal extracts and isolated compounds are potent modulators of gut microbiota structure. Additionally, some of the formed postbiotic metabolites exert positive effects and ameliorate depression-related behaviors in animal models of mood disorders. The review underlines the gap in research on natural products - gut microbiota interaction in the context of mood disorders. Conclusion: Modification of microbiota-gut-brain axis by natural products is a plausible explanation of their therapeutic properties. Future studies evaluating the effectiveness of herbal medicine and isolated compounds in treating mild mood disorders should consider the bidirectional interplay between phytoconstituents and the gut microbiota community.
... Guidelines also mention phytopharmaceutical drugs for sleep disorders. A number of meta-analyses have been carried out on the topic of phytotherapy for insomnia [14][15][16], which show a slight superiority of valerian over placebo. However, the European Medical Agency (EMA) has approved a recommendation for the use of valerian in the treatment of sleep disorders based on its well-established use. ...
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The aim of the present study was to analyze the association between the prescription of Silexan and the recurrence of general practitioner (GP) repeat consultations because of disturbed sleep versus benzodiazepine receptor agonists including zolpidem, zopiclone, and zaleplon (Z-drugs). This retrospective cohort study was based on data from the IQVIA Disease Analyzer (DA) database. The study included adult patients treated by 1284 GPs in Germany with a documented sleep disorder and their first prescription of Silexan or Z-drug (prescription between January 2010 and October 2020). The recurrence of seeking medical advice because of sleep disorders in the 15–365 days after the first prescription was evaluated. Multivariate regression models were used, adjusted for age, sex, insurance status, and defined co-diagnoses. Data were available for 95,320 (Silexan: 5204; Z-Drug: 90,526) patients. In total, 15.6% of the Silexan patients and 28.6% of the Z-drug patients had a further documented GP consultation because of a sleep disorder. Silexan prescription was associated with significantly lower odds of recurrent sleep disorder diagnosis in the 15–365 days after the index date (Odds Ratio (OR): 0.56; 95% confidence intervals (CI): 0.51–0.60), although mental burden levels appeared higher in this group. Our study shows that the prescription of Silexan to adult patients consulting GPs for disturbed sleep results in less frequent repeat consultations than Z-drugs. This may support Silexan’s role as an efficacious, self-enabling, well-tolerated, and sustained treatment option. Because Silexan is a proven anxiolytic, its impact in improving undiagnosed anxiety disorders may have had a lasting effect for certain patients.
... The importance of CHM is evidenced by approval in the latest evidence-based guidelines in China for insomnia (Liu, 2011.). In recent years, the use of CHM has increased in the Western world, although the mechanism by which CHM improves sleep remains undefined (Frass et al., 2012;Leach and Page, 2015). However, a systematic review of CHM for insomnia showed that only eight studies had a Jadad score ≥ 3 among 217 randomized controlled trials (RCTs), and seven of these studies had a high risk of bias in at least one domain (Yeung et al., 2012). ...
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Background: Jiaotaiwan (JTW) is a classical tranquillizing prescription in traditional Chinese medicine (TCM) for the treatment of insomnia symptoms caused by disharmony of the heart and kidney (ISDHK). This study aimed to evaluate the effectiveness and safety of JTW for treating ISDHK in a double-blind, randomized, placebo-controlled trial. Methods: From September 2018 to February 2020, 128 participants with ISDHK were included in this single-center clinical trial. All participants were equally and randomly divided into either the JTW group (2-g JTW granules, b.i.d. for 7 days) or placebo group (2-g placebo granules, b.i.d. for 7 days). Pittsburgh Sleep Quality Index (PSQI) scores were set as the primary outcome, and polysomnography (PSG), 1H-magnetic resonance spectroscopy (1H-MRS), blood tests, and Disharmony of Heart and Kidney Scoring System (DHKSS) and clinical global impression (CGI) scores were used as secondary outcomes. Laboratory tests were used to evaluate the safety of JTW. All data were collected at baseline and posttreatment. Results: A total of 106 participants completed this clinical trial. Symptom relief was more apparent in the JTW group than the placebo group (PSQI total score: 9.34 ± 3.578 vs. 10.98 ± 3.073, respectively; p = 0.006). However, no PSG changes were observed between the two groups (p > 0.05). Higher CGI and lower DHKSS scores were observed after JTW treatment. Serum melatonin was increased in patients with ISDHK after JTW treatment (JTW, 339.09 ± 256.894 vs. placebo, 219.59 ± 169.045; p = 0.004). There were significant posttreatment differences in metabolites in the left cerebellum between the two groups (myoinositol: JTW, 13.47 ± 2.094 vs. placebo, 12.48 ± 2.449; p = 0.021; choline: JTW, 3.96 ± 0.657 vs. placebo, 3.65 ± 0.562; p = 0.008). In terms of safety, JTW had no noticeable adverse effects relative to placebo. Conclusion: JTW was effective and well tolerated for the treatment of ISDHK. The development of large-scale trials with longer follow-up durations is recommended to provide further evidence. Clinical Trial Registration: clinicaltrials.gov, identifier ChiCTR1800019239
... Sacc), Passiflora incarnata (passionflower), Humulus lupulus (hops), and Melissa officinalis (lemon balm) as sleep aid supplements, potential hepatotoxicity, slow onset of effect, and inconsistent efficacy compared to placebo limit their widespread application, leaving synthetic melatonin as the primary sleep aid choice available on the market. 4,5 As a result, there still is an unfulfilled vacancy in the demand for a safe and efficacious dietary supplement from natural sources with clinically proven efficacy on the state of mood and sleep to be considered a natural alternative to melatonin. ...
Article
UP165, a standardized Zea mays (corn) leaf extract, was evaluated for its effect on sleep quality and overall well-being in a double-blind, placebo-controlled clinical trial, administered orally at 250 and 500 mg/day. Participants (n = 45) (age range 19-73) consumed the supplement or placebo ∼60 minutes before bedtime daily for 4 weeks. Measurements that were evaluated were as follows: daily sleep quality, as monitored by a fitness tracker; the Pittsburgh Sleep Quality Index (PSQI) for sleep quality and efficiency; salivary cortisol levels for stress; and Profile of Mood States (POMS) to assess general well-being. Participants who received UP165 showed a statistically significant and dose-correlated reduction in salivary cortisol (up to 36%); an increase in deep sleep time (up to 30 minutes); increased total sleep time (up to 10%); an improvement in sleep quality (up to 49%), and an enhanced POMS (36-58%). Participants in the UP165 group showed a sevenfold increase in deep sleep time and a 10-fold increase in PSQI sleep quality improvement compared to placebo. Collectively, UP165 is a safe nutritional supplement clinically proven for a 24-hour support with better quality and efficiency of sleep at night and an improved mood state and overall well-being during the day. The clinical study has been ISRCTN registered with study ID ISRCTN68282897.
... Taavoni et al. investigated the effects of this herbal medicine on sleep disturbances in menopausal women and reported a relative improvement in the sleep status after the intervention (4). However, previous systematic reviews and meta-analyses have shown that there are conflicting results regarding the effects of different medicinal herbs on sleep problems, especially in the post-menopausal period, and more clinical trials are needed to investigate this line of treatment (i.e., herbal medications) for sleep disorders (20,21). Although the literature indicates the positive effects of Dracocephalum on the quality of sleep in people with sleep disorders, no study, to the best of our knowledge, has examined the effects of Dracocephalum on postmenopausal-related sleep disorders. ...
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Objective: Sleep disturbance is one of the most prevalent problems in post-menopausal females. The current research intended to evaluate the effects of Dracocephalum on sleep disorder in post-menopausal females. Method: The current study is a randomized, double-blind controlled trial, in which 110 post-menopausal women were randomly allocated to Dracocephalum or placebo groups. The intervention group took Dracocephalum capsules containing 250 mg Dracocephalum extract twice daily for one month. While, the placebo group took the same capsule containing 250 mg of starch twice daily for one month. Pittsburgh Sleep Quality Index was completed by the participants of both groups before and after the treatment and the data obtained were analyzed with Chi-square, paired and independent t-test in SPSS (version 20). Results: The mean score of sleep quality before and after the treatment was 12.69 ± 3.98 and 8.58 ± 1.97 in the treatment group, respectively. Also, the score of sleep quality in the placebo group was 13.48 ± 2.60 and 11.21 ± 2.74 at the beginning and end of the research, respectively. The symptoms of sleep disorder in the intervention group significantly improved after the treatment (P < 0.001), while this was not the case with the placebo group (P = 0.155). Besides, there was a significant difference between the two groups in the mean score of sleep quality after the treatment (P = 0.012). Conclusion: Dracocephalum extracts are effective in reducing symptoms of sleep disorders in post-menopausal women.
... Its volatile components are often considered to be its effect on insomnia. However, there are also some scholars who debate the effectiveness of valerian in treating insomnia (6)(7)(8). This may because of the lack of clarity regarding its composition and dosage in the treatment of insomnia. ...
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Valerian volatile oil can be used in the treatment of insomnia; however, the active components and mechanisms of action are currently unclear. Therefore, we used transcriptome sequencing and weight coefficient network pharmacology to predict the effective components and mechanism of action of valerian volatile oil in an insomnia model induced by intraperitoneal injection of para-Chlorophenylalanine (PCPA) in SD rats. Valerian essential oil was given orally for treatment and the contents of 5-hydroxytryptamine receptor 1 A (5-HT1AR), γ-aminobutyric acid (GABA), cyclic adenosine monophosphate (cAMP), and protein kinase A (PKA) in the hippocampus of rats in each group were detected by enzyme-linked immunosorbent assay (ELISA), western blot, Polymerase Chain Reaction (PCR), and immunohistochemistry. The results showed that after treatment with valerian essential oil, insomnia rats showed significantly prolonged sleep duration and alleviated insomnia-induced tension and anxiety. Regarding the mechanism of action, we believe that caryophyllene in valerian essential oil upregulates the 5-HT1AR receptor to improve the activity or affinity of the central transmitter 5-HT, increase the release of 5-HT, couple 5-HT with a G protein coupled receptor, convert adenosine triphosphate (ATP) into cAMP (catalyzed by ADCY5), and then directly regulate the downstream pathway. Following pathway activation, we propose that the core gene protein kinase PKA activates the serotonergic synapse signal pathway to increase the expression of 5-HT and GABA, thus improving insomnia symptoms and alleviating anxiety. This study provides a theoretical basis for the application of valerian volatile oil in health food.
... Valerian from Valeriana officinalis L. is indicated beneficial for anxiety and insomnia with limited outcomes. The sedative action is attributed to valerenic acid by activation of GABA receptors along with other actions like blocking GABA transaminase and increasing the activity of GABA decarboxylase [90,91]. Although, existing data need to be further validated by multiple doses of Valerian and vital parameters to estimate sleep quality [92]. ...
Article
Ageing comes with degeneration in many biological activities like impairment of cognition, intelligence, attention, and memory. The decline in all those mental capabilities would be due to the abnormal changes in neuronal architecture with increasing age, chronic oxidative stress and inflammatory state of the tissue, nutritional deficiency. Nootropics or smart drugs enhance memory, attention, creativity, and cognitive performance by affecting the synthesis and receptor binding of neurotransmitters in the brain, especially dopamine, serotonin, gamma-aminobutyric acid, glutamate, and acetylcholine. Nootropics have shown their positive effects in parkinson's, autism, alzheimer's, huntington's disorders, where impaired memory is the primary concern. Synthetic class of nootropics has limitations and reported exacerbation of other brain disorders (off label effects) or therapeutic failure in some instances. Nutraceuticals are dietary derived vitamins, minerals, herbal products, proteins, marine products, and probiotics. The health benefits derived from Nutraceuticals are increasing brain blood flow, reducing inflammation in nervous tissues, detoxifying toxins from the brain, balancing neurotransmitter turnover rate, correcting neuronal and receptor damages and facilitating synaptic transmission, good antioxidant properties and power of improving neuroplasticity of the brain that combat neurodegeneration. The demands for effective nootropics will remain high as the number of cases are increased tremendously.
... For patients with insomnia, clinic visits may be delayed as they usually take over-thecounter drugs and herbal medicines first [4][5][6]. Cognitive behavioral therapy (CBT) is the recommended initial treatment [7][8][9] and requires the patient's time and effort. ...
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Binaural beat (BB) stimulation, which has two different frequencies for each ear, is reportedly effective in reducing anxiety and controlling mood. This study aimed to evaluate the brain wave entrainment effect of binaural beats and to propose an effective and safe supplementary therapy for relieving the symptoms of insomnia. Subjects between 20 and 59 years of age with subclinical symptoms of insomnia were recruited from the community. Quantitative electroencephalography was measured twice, before and two weeks after the BB intervention. Participants used the apparatus with or without 6 Hz BB for 30 min before going to bed for two weeks. When music with BB was played, the relative theta power increased (occipital, p = 0.009). After two weeks of intervention with music, the theta power increased when listening to music with BB (parietal, p = 0.009). After listening to music with BB for two weeks, the decrease in the beta power was more noticeable than after using music-only devices when participants listened to music in the laboratory (occipital, p = 0.035). When BB were played, the entrapment of the theta wave appeared. Therefore, exposure to music with BB is likely to reduce the hyper-arousal state and contribute to sleep induction.
... Recent studies have shown that medicinal herbs may have beneficial effects on various diseases due to having active ingredients. However, these compounds are mostly applied in treatment as only or in combination with chemical drugs [7]. The animal or human studies have reported that medicinal herbs have positive effects on the improvement of insomnia [8][9][10][11]. ...
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Background: Insomnia leads to the development of mental problems and missing of accuracy in affected persons. Various investigations have previously revealed which medicinal plants play a role in the improvement of insomnia. In this study, we evaluated the effect of hydro-alcoholic extract of Datura stramonium on insomnia in mice. Methods: The extracts and fractions at different concentrations were injected intraperitoneally (i.p.) to mice 30 min before the sodium pentobarbital (30 mg/kg, i.p.). Additionally, the blood was collected from cardiac and serum separated to measure brain-derived neurotrophic factor (BDNF). The LC-MS was done to identify the active components. Flumazenil or naloxone were also applied to study the possible mechanism of extract. The PC12 cells were then exposed to different doses of extract and fractions, in order to evaluate cytotoxicity by MTT assay and the measured LD50. Results: The hydro-alcoholic extracts of calyx, seed and petal elevated sleep duration and decreased sleep latency. In addition, water, ethyl acetate and n-butanol fractions of hydro-alcoholic extract of petal increased sleep duration. Of note, Naloxone significantly reversed the hypnotic effect of the extract. The extract increased the level of BDNF in serums. As well, the toxicity assessment revealed that the extracts had not toxic on PC12 cells. The LD50 value was obtained as 4.8 g/kg. Conclusion: This research demonstrated that D. stramonium (including seed, petal and calyx) increased the hypnotic effect without neurotoxicity on PC12 cells. Sleep induction may be related to its active ingredients as well as the effect on opioid receptors.
... A recent study reported the association between dietary supplements and sleep duration 12 , suggesting that ingested nutrients play a pivotal role in better sleep. Moreover, several herbal extracts or resources have shown a positive effect on the improvement of insomnia 13 . The prevalence of sleep disturbance in patients with chronic pain ranges from 50% to 80%, and the severity of sleep disturbance is associated with pain intensity. ...
Article
Introduction: Valeriana officinalis is known to be one of the most famous herbal supplements for the treatment of anxiety and insomnia. Despite its widespread use in most countries all around the world, there is little scientific information and research on how this medication affects sleep patterns, and there are almost no studies on its effects on the characteristics of sleep spindles. Material and Methods: The present study was conducted to investigate the effects of Valerian extract (VAL) on sleep spindles and induced anxiety in chronic neuropathic pain model in rats. 24 male rats were divided into three groups: neuropathic group (n=9) in which the rats underwent chronic constriction injury (CCI), sham group (n=7) in which the sciatic nerves of the animals were exposed without any constriction and also fed with the vehicle, and the third group was under CCI condition and treated with Valerian (n=8). All the rats underwent electrode implant surgery so that we could record electroencephalogram and electromyography waves. In all the three groups, EEG and EMG recordings were recorded three times (150min each time). The initial recording was just prior to the CCI surgery and the rest were 3 and 6 days following CCI surgery. Moreover, cold allodynia and elevated plus maze tests were performed 3 and 6 days following the CCI surgery. Results: Valerian treatment could repair the allodynia induced by neuropathy. On the other hand, by Valerian treatment (400mg/kg) during neuropathy, the REM sleep, decreased and the non-REM sleep increased. Moreover, there was an increment in sleep spindle density and spindle frequency even in neuropathic condition. Discussion: This herbal supplement improves the quality of sleep in neuropathy conditions.
... Over the past few years, the use of natural or herbal remedies as a form of self-treatment of various stress-related afflictions has become increasingly popular in Western societies [18,19]. Nowadays, herbal medicine represents one of the most frequently used complementary or alternative treatments of insomnia [20]. However, the efficacy of traditional medicinal herbs in complementary and alternative medicine of the mental health disorders has not been exhaustively explored yet, especially concerning the mechanism of actions of phytocomponents. ...
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Anxiety and insomnia are among the most common mental health disorders and are a major cause of disability around the world. Traditional herbal medicines are receiving significant attention in global health debates. Several Italian regions maintain rural traditions and are among the most extensively studied areas of Europe regarding medicinal plant uses. The present overview aims to highlight the use of wild and cultivated plants, specifically as sedatives and for insomnia treatment in Italy, and to collect, analyze, and summarize the available literature about their pharmacological activity as well as clinical and pre-clinical studies concerning the most cited plants. In total, 106 wild taxa are used in Italy for sedative purposes. The plant species belong to 76 genera and 32 families, of which the most cited are Asteraceae (24.2%) and Lamiaceae (21.1%). Leaves (29%) and flowers (27%) are the plant parts mostly used as infusion (70%) and decoction (25%). Out of 106 taxa documented, only the most cited are analyzed in this overview (A. arvensis L., C. nepeta L., C. monogyna Jacq., H. lupulus L., L. nobilis L., L. angustifolia Mill., M. sylvestris L., M. chamomilla L., M. officinalis L., O. basilicum L., P. rhoeas L., P. somniferum L., R. officinalis L., T. platyphyllus Scop., and V. officinalis L.). Among the fifteen species selected, only seven have been studied for their pharmacological activity as hypnotic-sedatives. Future pre-clinical and clinical studies are needed to better clarify the mechanism of action of bioactive compounds and confirm the potential of these alternative therapies.
... It is important to highlight that the currently existing meta-analyses emphasize the fact that there is no solid evidence regarding the effectiveness of Valerian in the insomnia´s treatment, since no controlled trial was conducted beyond six weeks, thus, there is a lack of evidence regarding its long-term safety and effectiveness. It is particularly necessary to design more robust studies about the impact of Valerian on insomnia, especially in younger individuals [50][51][52][53]. Likewise, the consumption of Melatonin for insomnia is not approved by AAMS or the FDA, and there is no evidence that its performance is superior to placebo in insomnia treatment [ 16 , 19 , 24 ]. ...
Article
The present study aims to characterize the prevalence, the pattern of medically prescribed and over-the-counter medication/supplements in Higher Education students, as well as to relate the consumption of sleeping medication with insomnia severity, sleep effort, sleep locus of control, anxiety, and depression. Data was collected from a sample of 2029 Portuguese Higher Education students, aged ≥18 years old, being approximately 75% women and 25% men. Thirty-one percent of the sample considered suffering from insomnia, 6% consumed sleeping medication prescribed by a physician, 4% consumed OTC (over-the-counter) medication/supplements, and 2% undergone psychotherapy. Among the Higher Education students with insomnia, 19% reported consuming sleep medication prescribed by a physician, benzodiazepines were the most prescribed drug class, and the General Practitioner the physician who prescribed most frequently. Twelve percent of students with insomnia consumed OTC medication/supplements, with Valerian being the most consumed substance. Among students with insomnia, only 8% undergone psychotherapy.
... Traditional herbal medicine (THM) has been widely used to treat insomnia (Leach and Page, 2015). THM has been reported to modulate 5-hydroxytryptamine and gamma-aminobutyric acid (GABA) receptors (Cho et al., 2010), and affects brain enzymes associated with the GABA system (Awad et al., 2007). ...
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Background: Insomnia is one of the most prevalent cancer-related symptoms and has a severe impact on the quality of life. This study aimed to evaluate the efficacy and safety of traditional herbal medicine (THM) for improving sleep quality in patients with cancer. Methods: Randomized controlled trials (RCTs) evaluating orally administered THM in a cancer population with insomnia were searched using nine electronic databases up to November 30, 2020. The outcome measurements were sleep quality measured by validated questionnaire such as the Pittsburgh Sleep Quality Index (PSQI), total effective rate, and adverse effects. The included studies were appraised using the Cochrane risk of bias tool and meta-analyzed. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Results: Fourteen RCTs were included in the systematic review, and 10 RCTs were analyzed quantitatively. Compared to hypnotics, THM showed a significant improvement in sleep quality by reducing the PSQI score [mean difference (MD) -2.25, 95% confidence interval (CI) −3.46 to −1.05, I 2 = 84%] and increasing the total effective rate [risk ratio (RR) 1.26, 95% CI 1.07 to 1.48, I 2 = 70%] with low quality of evidence. Compared to placebo, THM also reduced the PSQI score significantly (MD −2.56, 95% CI −3.81 to −1.31, I 2 = 91%) with moderate quality of evidence. The most frequently used herbs were Ziziphus jujuba Mill. No serious adverse events were observed. Conclusion: This review suggests that THM may be an effective therapeutic option for insomnia in patients with cancer. However, considering the limited methodological qualities and inconsistent results of the included trials, further rigorous RCTs are required. Systematic Review Registration: [ https://www.crd.york.ac.uk/prospero ], PROSPERO 2021 [CRD42021265070]
... Likewise, the use of valerian and chamomile for the treatment of insomnia has not been supported by evidence. Specifically, in a systematic review, no differences in either daytime functioning or insomnia severity were found for valerian or chamomile vs. placebo [76]. Melatonin may be a therapeutic option in COMISA comorbid with circadian rhythm sleep-wake disorders [77]. ...
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Obstructive sleep apnea (OSA) and insomnia are the two most common sleep disorders among the general population, and they may often coexist in patients with sleep-disordered breathing (SDB). The higher prevalence of insomnia symptoms in patients with OSA (40-60%) compared to that observed in the general population has thus led researchers to identify a new disorder named comorbid insomnia and OSA (COMISA), whose true burden has been so far largely underestimated. The combined treatment of COMISA patients with positive-airway pressure ventilation (PAP) with cognitive behavioral therapy for insomnia (CBTi) has shown a better patient outcome compared to that obtained with a single treatment. Furthermore, recent evidence has shown that an innovative patient-centered approach taking into consideration patient characteristics, treatment preferences and accessibility to treatment is recommended to optimize clinical management of COMISA patients. However, in this complex mosaic, many other sleep disorders may overlap with COMISA, so there is an urgent need for further research to fully understand the impact of these therapies on outcomes for OSA patients with comorbidity. In light of this need, this review focuses on the major sleep disorders comorbid with OSA and the recent advances in the management of these insomniac patients.
... Aiming to eliminate these disorders as a result of consumption of various types of medicines, nowadays herbal medicines are applied as a broad range of complementary/alternative treatments of insomnia. However, there is a question about the fact that which of the introduced herbal medicines are a safer and more effective treatment option for insomnia [42]. ...
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Background: Insomnia is a universal health problem that affects the health and quality of life of people worldwide. During the last decade treatment of insomnia with herbal has been introduced to be effective but unfortunately, the safety and efficacy of these medicines are currently uncertain. However, the administration of various herbal medicines for insomnia is increasing mainly due to the diversity of various adverse effects of western medication. Objective: The present study is aimed to investigate available herbal medicine options for the treatment of chronic insomnia. Method: All demanded data were retrieved from electronic databases, Natural Medicines, TCMID, Natural Medicines Comprehensive Database, MedlinePlus, PubMed, EMBASE, and Google Scholar. Among them, randomized clinical trials were chosen precisely to be investigated more for seeking any additional information related to the treatment of chronic insomnia. All related papers in English and Persian languages included in the study criteria. At first, 162 articles were chosen to be investigated, then after screening all articles based on the PRISMA method, 83 qualified articles remained to be investigated carefully. Results: Herbal plants with medical properties as sedative agents are obtaining more and more attention because they contain various types of natural bioactive metabolites with the lowest rate of adverse effects. Moreover, these novel medicines are highly economic, with high efficacy while could be available easily. Conclusion: The data from this study demonstrated that medical plants could yield sedative activity and some of them are effective for insomnia, but we must not forget that further clinical trials are demanded to approve this. Keywords: Sleep disorders, Chronic insomnia, Herbal medicine, Alternative medication, Treatment.
... Insomnia is caused by a wide variety of psychological factors, such as stress, depression, anxiety, and environmental factors, such as caffeine, alcohol, and cigarettes [1]. Pharmacological treatments, such as benzodiazepines, non-benzodiazepines, and antidepressants, are used to suppress disruption of biological rhythms and the onset of diseases due to insomnia; however, chronic use of these drugs show many side effects due to resistance and dependence [2,3]. Therefore, various studies have been conducted to screen and utilize natural substances that not only alleviate and treat insomnia but also have no side effects. ...
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Current pharmacological treatments for insomnia carry several and long-term side effects. Therefore, natural products without side effects are warranted. In this study, the sleep-promoting activity of the lotus leaf (Nelumbo nucifera) extract was assessed using ICR mice and Sprague Dawley rats. A pentobarbital-induced sleep test and electroencephalogram analysis were conducted to measure sleep latency time, duration, and sleep architecture. The action mechanism of the extract was evaluated through ligand binding experiments. A high dose (300 mg/kg) of the ethanolic lotus leaf extract significantly increased sleep duration compared to the normal group (p < 0.01). Administration of low (150 mg/kg) and high doses (300 mg/kg) of the extract significantly increased sleep quality, especially the relative power of theta waves (p < 0.05), compared to the normal group. Furthermore, caffeine and lotus leaf extract administration significantly recovered caffeine-induced sleep disruption (p < 0.001), and the sleep quality was similar to that of the normal group. Additionally, ligand binding assay using [3H]-flumazenil revealed that quercetin-3-O-glucuronide contained in the lotus leaf extract (77.27 μg/mg of extract) enhanced sleep by binding to GABAA receptors. Collectively, these results indicated that the lotus leaf extract, particularly quercetin-3-O-glucuronide, exhibits sleep quantity- and quality-enhancing activity via the GABAergic pathway.
... While there are multiple nutritional supplements that are marketed for sleep, the most commonly used include valerian root, chamomile, and kava. Valerian root is the most extensively studied in placebo-controlled trials [65]. A metaanalysis of 5 trials did not find any significant difference between valerian root and placebo in sleep-related outcomes. ...
Article
Insomnia is a highly prevalent condition associated with significant morbidity, reduction in quality of life, and increase in healthcare costs, and is a risk factor for multiple physical and mental disorders. The primary treatment modality is cognitive behavioral therapy for insomnia (CBT-I) but this is associated with difficulties with access and higher cost as well as poor response in some patients. Therefore, pharmacotherapy for insomnia is common and hypnotic agents are among the most frequently prescribed medications in the United States. Older medications for insomnia are limited by their side effect burden and narrow therapeutic window. Newer hypnotics, on the other hand, have been shown to have a better safety profile and longer term efficacy. While some studies have shown that long-term hypnotic use is associated with adverse outcomes, the current evidence is equivocal. The decision to treat chronic insomnia disorder with long-term hypnotics should be individualized and balance the potential risks of continuing hypnotic medication use with the risks of untreated persistent insomnia and associated functional limitations. This clinical review discusses the currently available medication options to treat insomnia, their mechanisms of action, dosing, and side effect profiles. This review also provides guidance on long-term management of hypnotics and the use of these medications in the elderly, those with medical comorbidities, and other special populations.
... showed insufficient evidence to support the use of herbal medicine for insomnia. 76 This study identified 4 orally administered herbal monopreparations: valerian, chamomile, kava, and wuling. There was no statistically significant difference between any herbal medicine and placebo, nor any herbal medicine and active control, for any outcome measures. ...
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Insomnia in the elderly is a prevalent condition that poses treatment challenges to practitioners across medical fields. There are many behavioral and other nonpharmacological therapies, 18 Food and Drug Administration-approved pharmacotherapies, and numerous off-label, over the counter and alternative treatments. Most reviews on this subject focus either on pharmacological treatments or behavioral treatments. The authors provide a combined review of available pharmacological and nonpharmacological treatments. The authors narratively reviewed each treatment from our literature search, tabled results with the highest level of available evidence on 5 major sleep outcomes and evaluated these results for clinical significance. The authors also evaluated the safety of pharmacotherapies within the context of the 2019 Beers Criteria for Potentially Inappropriate Medications in the Elderly. The authors found the most rigorous evidence supporting Cognitive Behavioral Therapy for Insomnia as a first-line treatment option, with longer lasting therapeutic effects than treatment with pharmacologic agents alone. The authors also found evidence of similar outcomes from other behavioral interventions, such as Brief Behavioral Therapy for Insomnia and relaxation training. The authors found 4 studies, 2 on relaxation training, 1 on sleep restriction, and 1 on stimulus control limited to the elderly with clinically significant results. The authors found no pharmacological studies limited to the elderly on treatments not contraindicated by Beers criteria with clinically significant results. The authors discussed the challenges of determining clinical significance in sleep studies, the lack of studies restricted to the elderly, and the role of placebo effect.
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Despite the lack of guidance available for practitioners, extensive polypharmacy has become the primary method of treating patients with severe and chronic mood, anxiety, psychotic or behavioral disorders. This ground-breaking new book provides an overview of psychopharmacology knowledge and decision-making strategies, integrating findings from evidence-based trials with real-world clinical presentations. It adopts the approach and mind-set of a clinical investigator and reveals how prescribers can practice 'bespoke psychopharmacology', tailoring care to the individualized needs of patients. Practitioners at all levels of expertise will enhance their ability to devise rationale-based treatments, targeting manifestations of dysfunctional neural circuitry and dimensions of psychopathology that cut across conventional psychiatric diagnoses. Presented in a user-friendly, practical, full-colour layout and incorporating summary tables, bullet points, and illustrative case vignettes, it is an invaluable guide for all healthcare professionals prescribing psychotropic medications, including psychiatry specialists, primary care physicians, and advanced practice registered nurses.
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Ethnopharmacological relevance Paeoniae Radix Rubra (PRR), the root of Paeonia lactiflora Pall., is a traditional Chinese medicine which has the effects of regulating various inflammatory diseases, treating blood stasis, and enhancing blood circulation. Aim of the study This study examined whether Paeoniae Radix rubra extract (PRRE) and Paeoniflorin (PF) affect mucin production, gene expression including MUC5AC, and protein expression related to the ERK pathway induced by TNF-α from human airway epithelial cells. Materials and methods NCI–H292 cells induced by TNF-α were treated with each agent. MUC5AC mucin gene expression and mucin protein production were measured by reverse transcription polymerase chain reaction, staining, and enzyme-linked immunosorbent assay. Western blot was used to investigate the cell signaling pathways. Results PRRE and PF inhibited the production of MUC5AC mucin protein and gene expression in TNF-α-induced H292 cells. In Western blot, PRRE was involved in protein expression related to the ERK pathway. Conclusions Overall, PRRE effectively inhibited the MUC5AC, and inflammatory cytokines expression caused by TNF-α, which was closely involved in the ERK pathway. PRRE may have the potential for treating mucus producing respiratory inflammation.
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Sleep can be influenced and impaired in countless ways. Sleep disorders often severely impair quality of life and lead to high morbidity, as well as increased mortality. The indication for pharmacological treatment is based on the diagnosis of a sleep disorder, which often varies in symptoms, intensity, and duration. This chapter discusses medications for the treatment of sleep disorders and related symptoms. For more detailed information about sleep medicine diagnostics, as well as for nonpharmacological therapy modalities, please refer to the relevant sleep medical literature. We herein propose a new classification and terminology for medicines for the treatment of sleep disorders: Somnologics (lat. somnologica). With a focus on insomnia disorders, trouble falling and staying asleep, we review substances that promote sleep (anti-insomnics), either by increasing sleep pressure (somnics) or by reducing wake pressure (antivigilantics). With regards to circadian rhythm disorders, we discuss substances for the realignment of the sleep phase (chronotherapeutics). After that, medications for the treatment of hypersomnia disorders, associated with an increased need for sleep, are reviewed (antihypersomnics). Herein, we include medications for the reduction of the sleep drive (vigilantics), as well as for the treatment of cataplexy (anticataplectics).
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Hypnotics are drugs that are intended to promote or improve sleep. Despite this clear definition, it is often not possible to exactly assign drugs to this group because the distinctions between sedatives, tranquilizers, and hypnotics are diffuse. None of the substances comes close to the “ideal” hypnotic, which exists only in theory. The attempt to classify hypnotics into three major groups is made: hypnotics in the classical meaning (e.g., benzodiazepines, Z-drugs, melatonin agonists), psychotropic drugs from the group of antidepressants and antipsychotics with a sedative profile, and other substances used as hypnotics (e.g., antihistamines, orexin receptor antagonists). The indications of the substances used as hypnotics are based on the classification of sleep disorders according to ICD -10 (International statistical classification of diseases) or DSM-5 (diagnostic and statistical manual of mental disorders). Further evidence-based recommendations of the guidelines on pharmacological interventions are shown and questions such as “which groups or substances are useful for which indication” are addressed. Differential indications such as the use of hypnotics in old age, in children and adolescents, as well as in pregnancy are presented with their special features.
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Insomnia is a relatively common disorder, its prevalence in industrialized nations estimated to be at least 5−10%. In medically and psychiatrically ill populations, as well as in women and older age groups, the prevalence is significantly higher. Hypnotics play an important role in the treatment of short-term insomnia, although cognitive-behavioral therapy is recommended as first-line treatment. The aim of this chapter is to give an overview of recommendations for using hypnotics in the various guidelines for the clinical management of insomnia in adults. Some more recent guidelines for the treatment of insomnia also assess the various pharmacological therapy options and provide evidence-based recommendations for treatment: the European guideline for the diagnosis and treatment of insomnia of the European Sleep Research Society, the guideline of the German Association for Sleep Research and Sleep Medicine, the clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults by the American Academy of Sleep Medicine, the clinical practice guideline for the management of chronic insomnia disorder in adults from the American College of Physicians, and the consensus statement on evidence-based treatment of insomnia of the British Association for Psychopharmacology. These guidelines are presented in a comparative manner and, where reasonable and useful, current reviews are consulted.
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Background: Cannabidiol (CBD), one of the major cannabinoids derived from the cannabis plant, is available over the counter. CBD is often used by patients for the management of insomnia, yet research supporting CBDs effectiveness as a treatment for insomnia is inadequate. Objective: The objective of this review was to critically evaluate the literature regarding the therapeutic benefits of CBD in the management of insomnia. Methods: A comprehensive search of the following databases from inception to December 29, 2021, was conducted: Ovid MEDLINE® and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. The search included randomized controlled trials, nonrandomized experimental studies, cross-sectional studies, cohort studies, case series, and case reports. Risk of bias was assessed with the Agency for Healthcare Research and Quality design-specific recommended criteria. Results: Thirty-four studies were eligible for inclusion. All studies reported improvement in the insomnia symptoms of at least a portion of their participants. Of the 34 studies, 19 studies used CBD predominant therapy and 21 studies used nearly equal ratios of CBD to Δ9-tetrahydrocannabinol (THC). Of the studies that performed hypothesis testing, 4 of 7 studies with a CBD predominant arm and 12 of 16 studies with a nearly equal ratio of CBD to THC arm reported significant improvement in insomnia outcomes. However, only 2 of the 34 studies focused on patients with insomnia, of which 1 study was a case report. Additionally, several studies used nonvalidated subjective measures, and most studies failed to include objective measures for symptom assessment. Conclusions: The results of our systematic review suggest that CBD alone or with equal quantities of THC may be beneficial in alleviating the symptoms of insomnia. Nevertheless, future research assessing CBDs effectiveness in population of patients specifically with insomnia utilizing validated subjective and objective measures is necessary before definitive inferences can be made.
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اختلالات خواب، یکی از شکایات شایع دوران یائسگی می باشد. امروزه افراد مبتلا تمایل بیشتری به استفاده از طب مکمل و جایگزین برای درمان خود دارند. مطالعه حاضر با هدف بررسی کارآزمایی های بالینی انجام شده در زمینه استفاده از گیاهان دارویی در درمان اختلالات خواب دوران یائسگی در ایران انجام شد.
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Pattern identification (PI) is a diagnostic method used in Traditional East Asian medicine (TEAM) to select appropriate and personalized acupuncture points and herbal medicines for individual patients. Developing a reproducible PI model using clinical information is important as it would reflect the actual clinical setting and improve the effectiveness of TEAM treatment. In this paper, we suggest a novel deep learning-based PI model with feature extraction using a deep autoencoder and k-means clustering through a cross-sectional study of sleep disturbance patient data. The data were obtained from an anonymous electronic survey in the Republic of Korea Army (ROKA) members from August 16, 2021, to September 20, 2021. The survey instrument consisted of six sections: demographics, medical history, military duty, sleep-related assessments (Pittsburgh sleep quality index (PSQI), Berlin questionnaire, and sleeping environment), diet/nutrition-related assessments [dietary habit survey questionnaire and nutrition quotient (NQ)], and gastrointestinal-related assessments [gastrointestinal symptom rating scale (GSRS) and Bristol stool scale]. Principal component analysis (PCA) and a deep autoencoder were used to extract features, which were then clustered using the k-means clustering method. The Calinski-Harabasz index, silhouette coefficient, and within-cluster sum of squares were used for internal cluster validation and the final PSQI, Berlin questionnaire, GSRS, and NQ scores were used for external cluster validation. One-way analysis of variance followed by the Tukey test and chi-squared test were used for between-cluster comparisons. Among 4,869 survey responders, 2,579 patients with sleep disturbances were obtained after filtering using a PSQI score of >5. When comparing clustering performance using raw data and extracted features by PCA and the deep autoencoder, the best feature extraction method for clustering was the deep autoencoder (16 nodes for the first and third hidden layers, and two nodes for the second hidden layer). Our model could cluster three different PI types because the optimal number of clusters was determined to be three via the elbow method. After external cluster validation, three PI types were differentiated by changes in sleep quality, dietary habits, and concomitant gastrointestinal symptoms. This model may be applied to the development of artificial intelligence-based clinical decision support systems through electronic medical records and clinical trial protocols for evaluating the effectiveness of TEAM treatment.
Article
Zusammenfassung Hintergrund Phytotherapeutika werden aufgrund ihrer Beliebtheit bei PatientInnen und ihrer langen traditionellen Verwendung zunehmend in medizinische Leitlinien aufgenommen. Methode Die vorliegende Übersichtsarbeit gibt einen systematischen Überblick über phytotherapeutische Empfehlungen und Inhalte in deutschen (AWMF) und internationalen (WFSBP, CANMAT) medizinischen Leitlinien für psychische Erkrankungen. Ergebnisse Phytotherapeutika können bei leichten bis mittelschweren psychischen Störungen wie folgt empfohlen werden: Depressionen [(+++): Johanniskraut (Hypericum perforatum L.), (++ ): Safran (Crocus sativus L.) und Curcuma (Curcuma longa L.), (+): Lavendel (Lavandula angustifolia Mill.) und (+/–): Rosenwurz (Rhodiola rosea L.)], Angststörungen [(++ ): Lavendel und Ashwagandha (Withania somnifera (L.) Dunal), (+): Galphimia (Galphimia glauca Cav.), (+/–): Kamille (Matricaria spp.); „nicht empfohlen“ (–) wird Kava-Kava (Piper methysticum G. Forst.) wegen möglicher Lebertoxizität], Schlafstörungen [(+/–): Baldrian (Valeriana officinalis L.)] und Demenz [(+++): Ginkgo (Ginkgo biloba L.) zur Verbesserung der Kognition]. Sicherheit und Verträglichkeit wurden überwiegend als sehr gut bis tolerabel bewertet. Schlussfolgerung Internationale Leitlinien zeigen die mögliche Vielfalt an empfehlenswerten Phytotherapeutika für die Behandlung von psychischen Erkrankungen auf. Die derzeitige Überarbeitung einer Vielzahl nationaler Leitlinien zu psychischen Erkrankungen bietet die Chance, bestehende Empfehlungen für Phytotherapeutika systematisch zu aktualisieren und neue zu integrieren, um TherapeutInnen eine evidenzbasierte Nutzen-Risiko-Bewertung für ihre PatientInnen zu ermöglichen.
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Insomnia is a prevalent sleep disorder. Insomnia results in distress and daytime impairment and is often comorbid with other sleep, medical, and mental health disorders. This chapter describes best practices for the treatment of insomnia disorder. Practices for non-medication and medication treatments are described, including the first line treatment, Cognitive Behavioral Therapy for Insomnia (CBT-I). Treatment recommendations are presented in the context of common comorbidities with insomnia. Additionally, recommendations are provided in the context of first line treatment non-responders. The risks associated with non-medication treatments and medication treatments and strategies to mitigate potential harms are described. The goals of the current chapter are to provide sleep medicine clinicians with (1) knowledge of evidence-based treatments for insomnia disorder and (2) a decision-making framework for the delivery of preparatory, concurrent, and/or supplemental treatments for patients who experience insomnia disorder.
Article
Objective To compare the efficacy of different dosage regimens of saffron supplementation on improving sleep quality among healthy adults, patients with insomnia or type 2 diabetes and patients under Methadone maintenance treatment (MMT). Methods PubMed, Embase, The Cochrane Library and other databases were searched from inception until October 2021. Randomized controlled trials (RCTs) investigating the efficacy saffron supplementation on sleep quality were included. Data were extracted independently by 2 investigators and assessed the study quality by the Cochrane risk-of-bias tool. The measurements include Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Restorative Sleep Questionnaire (RSQ). Results The pooling of the effect sizes showed that saffron group achieve a notable treatment effect on PSQI (MD: -2.14; 95% CI: -2.86 to -1.42; P < 0.01), ISI (MD: -2.63; 95% CI: -3.70 to -2.55; P < 0.01) and RSQ (MD: 7.05; 95% CI: 1.48 to 12.62; P = 0.01) compared with placebo group. Conclusion Saffron supplementation as a treatment for improving sleep quality have promising clinical application as its great improvement on all efficacy outcomes and no serious adverse advents occurred as the dose was increased. The dose of 100 mg saffron supplementation per day was proved to achieve excellent and more stable curative effect on improving sleep quality in our subgroup analysis. However, further investigation is necessary to confirm the efficacy and long-term safety of different doses of saffron for insomnia.
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Understanding the mechanisms and circuits of neurotransmitters and neuromodulators involved in the control of sleep–wake states can enhance the pharmacological and behavioral treatments for sleep disorders. Pharmacological effects include inducing sleep, promoting wakefulness, and altering endogenous sleep–wake rhythms. These effects are the primary therapeutic effects, but side effects often include sleep disturbances and daytime sleepiness. The drug's receptor-binding profile, half-life, active metabolite properties, and interactions with other drugs also affect the sleep–wake effects. Here, we discuss the effects of various drugs on wakefulness and sleep, focusing on the relationship between neurotransmitter systems and pharmacological mechanisms.
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Auf einen Blick Trend Schlafstörungen kommen in vielfältigen Formen und Ausprägungen vor. Zunehmend setzt sich bei ihrer Behandlung die Erkenntnis durch, dass nichtmedikamentöse Strategien im Vordergrund stehen sollten. Zahlreiche Studien und Metaanalysen zeigen, dass verhaltenstherapeutische Verfahren wirksam und insgesamt der Behandlung mit Hypnotika überlegen sind. Eine Therapie mit Hypnotika ist in aller Regel nur kurzfristig oder bei Versagen oder mangelnder Verfügbarkeit anderer Verfahren indiziert. Entsprechend dieser Erkenntnis ist seit 25 Jahren ein starker Verordnungsrückgang um 80 % zu beobachten. Die Rückgänge betrugen im vergangenen Jahr bei den Benzodiazepinen wiederum über 10 % und bei den Benzodiazepinagonisten Zolpidem und Zopiclon 4 %. Die Verordnungen von Melatonin haben wiederum sehr deutlich zugenommen. Pflanzliche Hypnotika sind nur noch mit einem homöopathischen Präparat vertreten. Bewertung Insgesamt zeigen die Zahlen, dass nur ein Bruchteil der Patienten mit Schlafstörungen Hypnotika verordnet bekommt. Die Umschichtung zu den kurzwirksamen Z-Substanzen ist durch ihre selektivere hypnotische Wirkung und das vermutlich geringere Abhängigkeitspotenzial gerechtfertigt.
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Sleep disturbance is one of the most commonly reported and most bothersome symptoms of the menopausal transition, and menopause is a unique contributor to the greater prevalence of sleep disorders and general sleep dissatisfaction in midlife women. Sleep is a complex process affected by physiological, psychological, social, and cultural factors. The purpose of this chapter is to describe the consequences and characteristics of sleep in the menopausal timeframes—the quantity, quality, and prevalence of disorders. Additionally, we consider the broader biopsychosocial context affecting sleep in the menopause transition. Lastly, we end with a discussion of the assessment and treatment of sleep disturbance.
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Growing understanding of the finely orchestrated and integrated mechanisms governing sleep and wakefulness allow for new insights into sleep disorders and their pharmacological treatments. While sleep related conditions are many and diverse, this chapter focuses on the common ailments of insomnia and circadian rhythm disorders. We provide a brief overview of these conditions followed by a review of current pathophysiologic understandings for these conditions, which provide context to the subsequent medication review. While an in-depth review of the pharmacologic options is provided, section summaries and tables are included to allow for ease of accessibility and retrieval of the information.
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Valerian (Valeriana officinalis) is a perennial flowering plant native to Europe and Asia that has had widespread use for insomnia since 400 BCE. Valerian is also used for anxiety, often in combination with other herbal products with which it has the strongest evidence. It may be beneficial for premenstrual syndrome, dysmenorrhea, menopause, postoperative cognitive impairment, restless legs syndrome, anxiety, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder (with lemon balm). In vitro, valerian shows antioxidant, cytoprotective, and neuroprotective effects. In animal research, valerian has shown antihypertensive, anxiolytic, antidepressant, and antispasmodic effects. This chapter examines some of the scientific research conducted on valerian, both alone and in combination formulas, for treating numerous health conditions. It summarizes results from several human studies of valerian’s use in treating genitourinary, neurological, psychiatric, and infectious disorders. Finally, the chapter presents a list of valerian’s Active Constituents, different Commonly Used Preparations and Dosages, and a Section on “Safety and Precaution” that examines side effects, toxicity, and disease and drug interactions.
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There are two types of chamomile most commonly used medicinally: German chamomile (Matricaria recutita/chamomilla) and Roman chamomile (Chamaemelum nobile). The former is the more well-known variety often used in teas, tinctures, creams, and essential oils. Chamomile is known to be safe for producing calming effects on the central nervous system, skin, and gastrointestinal tract. This chapter examines some of the scientific research conducted on chamomile, both alone and in combination formulas, for treating numerous health conditions. It summarizes results from several human studies of the herb’s use in treating oral and dental, ENT, cardiometabolic, gastrointestinal, genitourinary, musculoskeletal, and dermatologic disorders, among others. Finally, the chapter presents a list of chamomile’s Active Constituents, different Commonly Used Preparations and Dosage, and a Section on “Safety and Precaution” that examines side effects, toxicity, and disease and drug interactions.
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Are you or a loved one having trouble sleeping? Do you want to know how to improve sleep without using drugs? This guide could help you gain more restful sleep. The guide first discusses how vital sleep is to your well-being. Next, you will learn about sleep health problems and the latest research evidence on methods for improving your sleep. These include sleep health practices, psychological therapy, and changes to diet and exercise. Each section of this guide explores a topic by reviewing the research, summarizing key information, and posing questions for you to consider.
Article
Background: Dietary supplements promoted for brain health and enhanced cognitive performance are widely available. Claims made for these products are directed not only to the elderly wishing to prevent or mitigate cognitive decline, but also young healthy populations looking to boost their cognitive performance. It is unclear whether these claims made on product bottles and through advertising match the science. Objectives: To explore the evidence on the efficacy and safety of single dietary supplement ingredients frequently marketed with claims of enhanced cognitive performance among healthy adults. Design: A systematic review. Results: Nine of 54 dietary supplement ingredients identified through a scoping review met the eligibility criteria with at least 3 published studies identified per ingredient, yielding 69 unique publications. Ingredients evaluated included Bacopa monnieri, choline, creatine, omega-3 fatty acids, Ginkgo biloba, ginseng, Rhodiola rosea, tyrosine, and valerian root, all in supplement form and compared with a placebo, at various serving sizes and durations of use. Conclusions: The low level of certainty in the state of the science, coupled with not always knowing what is in a dietary supplement product, make weighing risks and benefits difficult; these data hinder the ability to develop recommendations about using such ingredients for consumers interested in boosting their cognitive performance. Whereas certain trends regarding promising serving sizes or duration for use, are pointed to in this synthesis, when combined, studies are inconsistent and imprecise, and many are methodologically flawed. Potential solutions to address research gaps are offered, for future research next steps, which is needed to strengthen the evidence and inform decisions.
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Ethnopharmacological relevance The burden of disease caused by mental and neurological disorders is increasing globally, to a disproportionate degree in Latin America. In contrast to the many psychoactive plants with a use history in Mesoamerican cultures, the translation to the wider population of knowledge around numerous botanicals used contemporarily by indigenous Mesoamerican societies to treat psychological and neurological disorders did not receive the same attention. Material and methods We used the previously published Mesoamerican Medicinal Plant Database to extract species and associated botanical drugs used as treatments for illnesses associated with the nervous system by Mesoamerican cultures in Belize, Guatemala, and Mexico. With the critical use of published pharmacological literature, the cross-culturally most salient genera are systematically reviewed. Results From 2188 plant taxa contained in the database 1324 are used as treatments for illnesses associated with the nervous system. The ethnomedical data was critically confronted with the available biomedical literature for the 58 cross-culturally most salient genera. For a considerable proportion of the frequently used taxa, preclinical data are available, mostly validating ethnomedicinal uses. Conclusion This quantitative approach facilitates the prioritization of taxa for future pre-clinical, clinical and treatment outcome studies and gives patients, practitioners, and legislators a fundamental framework of evidence, on which to base decisions regarding phytomedicines.
Article
Sleep disorders are common among the general population and can generate health problems such as insomnia and anxiety. In addition to standard drugs and psychological interventions, there are different complementary plant-based therapies used to treat insomnia and anxiety. This review aimed to find and examine the most recent research on the use of herbal medicines for treating anxiety and insomnia as compiled from clinical trials, as well as to assess the safety and efficacy of these medicines and to elucidate their possible mechanisms of action. The process entailed a search of PubMed, Scopus, and the Cochrane Library databases from 2010 to 2020. The search terms included “sleep disorder”, “insomnia”, “sedative”, “hypnotic”, “anxiety”, “anxiolytic”, and “clinical trial”, combined with the search terms “herbs” and “medicinal plants”, in addition to individual herbal medicines by both their common and scientific names. This updated review, which focuses mainly on clinical trials, includes research on 23 medicinal plants and their combinations. Essential oils and their associations have also been reviewed. The efficacy of medicinal plants depends on treatment duration, types of study subjects, administration route, and treatment method. More clinical trials with an adequate, standardized design are necessary, as are more preclinical studies to continue studying the mechanisms of action. As a result of our work, we can conclude that the 3 plants with the most potential are valerian, passionflower, and ashwagandha, with the combination of valerian with hops and passionflower giving the best results in the clinical tests.
Article
Puntos para una lectura rápida •El DSM-5 define el insomnio como una alteracion del sueno persistente (>3 veces/semana, durante ≥ 3 meses), que provoca repercusiones en la vida cotidiana de la persona, sin poder atribuirse a patologia medica o mental. •Las caracteristicas y estructura del sueno se modifican a lo largo de la vida, aunque eso no significa que el insomnio forme parte del proceso normal de envejecimiento. •Es imprescindible descartar otros factores causales, como enfermedades medicas, trastornos mentales y consumo de sustancias o farmacos. En el caso del paciente de edad avanzada, que suele presentar una mayor comorbilidad y polifarmacia, esta valoracion es especialmente importante. •Es necesario implicar al paciente en el proceso de decision, mediante la elaboracion de un plan de intervencion personalizado en el que el paciente reciba toda la informacion necesaria adaptada a su nivel de comprension y pueda establecer sus preferencias en la seleccion de las estrategias de tratamiento. •La terapia cognitivo-conductual se considera la primera linea de tratamiento para todos los pacientes con insomnio. •Si se requieren farmacos, hay que intentar emplear la menor dosis efectiva y se recomiendan reducciones del 50% respecto a la dosis del adulto joven. Siempre que sea posible, se deben realizar prescripciones de corta duracion y/o valorar emplear el tratamiento de manera intermitente.
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A Doença de Alzheimer (DA) caracteriza-se como um processo neurodegenerativo, potencialmente fatal, provocado pelo depósito de B-amilóide e pela hiperfosforilação da tau no encéfalo. A neurodegeneração afeta diferentes regiões cerebrais, provocando prejuízos cognitivos. Alguns estudos indicam que o sistema glinfático está relacionado com esse acúmulo proteico inadequado, já que é uma via complexa de movimentação do Líquido Cefalorraquidiano (LCR) dos espaços perivasculares para o interstício. Esse controle, efetuado principalmente pelos astrócitos, envolve a proteína de membrana Aquaporina 4 (AQP4) que atua na depuração dos metabólitos teciduais e está mais ativo durante o sono. Estudos têm relacionado uma redução na expressão dessa proteína com o aumento na quantidade de B-amilóide e agravamento da DA. Como a função sináptica requer a plasticidade dos neurônios pré-sinápticos e pós-sinápticos, além de células gliais e a matriz extracelular, as alterações na depuração do LCR levarão a modificações que culminam em déficits cognitivos. Além disso, essas alterações, por tornarem desfavorável o ambiente celular, podem levar à morte neuronal. Portanto, o sistema glinfático e a AQP4 são de considerável importância para a compreensão do processo fisiopatológico da DA. Outros estudos, porém, são importantes para esclarecer a relação entre o sono, quando ocorre maior atividade da via glinfática, com o desenvolvimento da DA.
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PurposeThis study investigates the influence of sleep disorders on the acceptance of complementary medicine among patients with weight problems. Patient preference is an important cornerstone of evidence-based medicine.Participants and methodsA subgroup analysis of an anonymous survey from the German-language BARBQTCM multicenter study examined patients from two Swiss obesity centers in Zurich and Solothurn. The cross-sectional study compared respondents with and without sleep problems.ResultsOf the 172 respondents, 42% reported sleep disorders. The median body mass index (BMI) reached 34 kg/m2 and the median age was 44 years. Almost three quarters were female, 130 respondents had undergone bariatric surgery, and 45% had prior experience with complementary medicine.Seventy-five percent were interested in traditional Chinese medicine (TCM). Experience with complementary medicine (p < 0.001) and manifest sleep disorders (p < 0.001) were positive influencing factors. Age, gender, BMI, weight loss medication, and surgery had no effect on interest. The cohort with sleep disorders would significantly more often treat the complaints surveyed with TCM than the patients without sleep disorders (p < 0.001). This group of patients would also invest more money and time to TCM outpatient visits and therapies (p < 0.001). A review of the S3 guidelines for sleep disorders showed significant effects of medicinal herbs (valerian, TCM decoctions) and acupuncture. Due to the unclear data situation (high risk of study bias), complementary medicine is not recommended as a therapy option yet (recommendation grade B).Conclusion External evidence and patient preference underline the role of TCM in sleep disorders and weight problems. Nevertheless, an optimization of the study quality by reducing the study bias and inducing coordinated study activities is essential to anchor the concepts of integrative medicine in the international guidelines.
Article
Background Despite the remarkable advances made in the diagnosis and treatment of cancer during the past couple of decades, it remains the second largest cause of mortality in the world, killing approximately 9.6 million people annually. The major challenges in the treatment of the advanced stage of this disease are the development of chemoresistance, severe adverse effects of the drugs, and high treatment cost. Therefore, the development of drugs that are safe, efficacious, and cost-effective remains a ‘Holy Grail’ in cancer research. However, the research over the past four decades shed light on the cancer-preventive and therapeutic potential of natural products and their underlying mechanism of action. Apigenin is one such compound, which is known to be safe and has significant potential in the prevention and therapy of this disease. Aim To assess the literature available on the potential of apigenin and its analogs in modulating the key molecular targets leading to the prevention and treatment of different types of cancer. Method A comprehensive literature search has been carried out on PubMed for obtaining information related to the sources and analogs, chemistry and biosynthesis, physicochemical properties, biological activities, bioavailability, and toxicity of apigenin. Key findings The literature search resulted in many in vitro, in vivo, and a few cohort studies that evidenced the effectiveness of apigenin and its analogs in modulating important molecular targets and signaling pathways such as PI3K/AKT/mTOR, JAK/STAT, NF-κB, MAPK/ERK, Wnt/β-catenin, etc., which play a crucial role in the development and progression of cancer. In addition, apigenin was also shown to inhibit chemoresistance and radioresistance and make cancer cells sensitive to these agents. Reports have further revealed the safety of the compound and the adaptation of nanotechnological approaches for improving its bioavailability. Significance Hence, the present review recapitulates the properties of apigenin and its pharmacological activities against different types of cancer, which warrants further investigation in clinical settings.
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Sleep and wakefulness are complex physiological processes involving multiple neurotransmitters, neuromodulators and neural pathways that affect virtually all functions of the brain and the body. Dysregulation of these intricate networks can disturb sleep and waking quality. The pharmacological treatments of primary sleep-wake disorders are typically intended to rectify disturbed sleep and waking functions. Nevertheless, the desired effects of such pharmacotherapies can turn into unwanted actions when they last too long or interfere with the opposite state (e.g., insomnia provoked by a wake-promoting medication). Sleep-wake disturbances are also common in patients suffering from psychiatric and medical diseases. The pharmacological treatment of such disease states can alleviate sleep-wake symptoms (e.g., improved sleep quality in asthma patients treated with theophylline), but medications often also have unintended effects on the quality of sleep and wakefulness. The site of action, dosage, duration of treatment, as well as pharmacokinetic and pharmacodynamic properties of pharmacological agents are important factors determining the effects of pharmacotherapies on sleep-wake states. This chapter starts with a brief overview of the neuroanatomy and neurochemistry of the sleep-wake regulatory systems, to familiarize the reader with the basic targets mediating pharmacological treatment effects on sleep. Afterwards, the desired and undesired actions of various classes of medications and drugs on sleep and waking quality are summarized. Given the importance of good quality sleep for general health, knowledge of the complex interactions between sleep-wake regulation, disease states, and the mechanisms of action of the drugs used to treat these diseases can facilitate optimal, patient-centered personalized care.
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Zusammenfassung Hintergrund: Der Einsatz von Phytotherapeutika hat in den letzten Jahren auch in der Behandlung psychiatrischer Erkrankungen erheblich an Bedeutung gewonnen. Methodik: Dieser narrative Überblick fasst die bisherige Evidenzlage zu Wirkungen und Nebenwirkungen pflanzlicher Arzneimittel bei der Behandlung von depressiven Störungen, Angstzuständen, Schlafstörungen und Hyperaktivitäts- und Aufmerksamkeitsstörungen auf Basis von Metaanalysen und systematischen Übersichtsarbeiten zusammen. Ergebnisse: Bei der Behandlung von leichten bis mittelschweren depressiven Episoden ist Johanniskraut evidenzbasiert und gut verträglich. Wechselwirkungen mit anderen Medikamenten sollten unbedingt beachtet werden. Für andere Phytotherapeutika ist die Datenlage bisher weniger ausreichend, um konkrete Aussagen treffen zu können. Schlussfolgerungen: Phytotherapeutika stellen in der Behandlung psychiatrischer Erkrankungen möglicherweise eine gute Alternative oder Ergänzung zu konventionellen Psychopharmaka dar. Sie sind im Vergleich oft nebenwirkungsärmer, gut verträglich und haben eine große therapeutische Breite. Weitere randomisiert kontrollierte Studien sind allerdings dringend indiziert.
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Study objective: To study prospectively the relations of insomnia to the development of anxiety disorders and depression in a population-based sample. Design: Cohort study based on data from 2 general health surveys of the adult population. Setting: Two general health surveys in the adult population in Nord-Trøndelag County of Norway, HUNT-1 performed in 1984-6 and HUNT-2 in 1995-7 Participants: Participants without significant anxiety and depression in HUNT-1 were categorized according to the presence and absence of insomnia in the 2 surveys (N=25,130). Measurements and results: Anxiety disorders and depression in HUNT-2 were assessed by the Hospital Anxiety and Depression Scale and analyzed using multivariate logistic regression analysis adjusted for age, gender, education, comorbid depression/anxiety, and history of insomnia. Anxiety disorders in HUNT-2 were significantly associated with the group with insomnia in HUNT-1 only (OR 1.6; 95% CI, 1.1-2.3), the group with insomnia in HUNT-2 only (OR 3.4; 95% CI, 3.1-3.8), as well as with the group with insomnia in both surveys (OR 4.9; 95% CI, 3.8-6.4). Depression in HUNT-2 was significantly associated with the group with insomnia in HUNT-2 only (OR 1.8; 95% CI, 1.6-2.0), but not with the groups with insomnia in HUNT-1 only or with insomnia in both surveys. Conclusions: Only a state-like association between insomnia and depression was found. In addition to being a state marker, insomnia may be a trait marker for individuals at risk for developing anxiety disorders. Results are consistent with insomnia being a risk factor for the development of anxiety disorders.
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The Z-drugs zolpidem, zopiclone, and zaleplon were hailed as the innovative hypnotics of the new millennium, an improvement to traditional benzodiazepines in the management of insomnia. Increasing reports of adverse events including bizarre behavior and falls in the elderly have prompted calls for caution and regulation. Z-drugs have significant hypnotic effects by reducing sleep latency and improving sleep quality, though duration of sleep may not be significantly increased. Z-drugs exert their effects through increased γ-aminobutyric acid (GABA) transmission at the same GABA-type A receptor as benzodiazepines. Their pharmacokinetics approach those of the ideal hypnotic with rapid onset within 30 min and short half-life (1-7 h). Zopiclone with the longest duration of action has the greatest residual effect, similar to short-acting benzodiazepines. Neuropsychiatric adverse events have been reported with zolpidem including hallucinations, amnesia, and parasomnia. Poisoning with Z-drugs involves predominantly sedation and coma with supportive management being adequate in the majority. Flumazenil has been reported to reverse sedation from all three Z-drugs. Deaths from Z-drugs are rare and more likely to occur with polydrug overdose. Z-drugs can be detected in blood, urine, oral fluid, and postmortem specimens, predominantly with liquid chromatography-mass spectrometry techniques. Zolpidem and zaleplon exhibit significant postmortem redistribution. Zaleplon with its ultra-short half-life has been detected in few clinical or forensic cases possibly due to assay unavailability, low frequency of use, and short window of detection. Though Z-drugs have improved pharmacokinetic profiles, their adverse effects, neuropsychiatric sequelae, and incidence of poisoning and death may prove to be similar to older hypnotics.
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Despite being the most commonly used herbal for sleep disorders, chamomile's (Matricaria recutita) efficacy and safety for treating chronic primary insomnia is unknown. We examined the preliminary efficacy and safety of chamomile for improving subjective sleep and daytime symptoms in patients with chronic insomnia. We performed a randomized, double-blind, placebo-controlled pilot trial in 34 patients aged 18-65 years with DSM-IV primary insomnia for ≥ 6-months. Patients were randomized to 270 mg of chamomile twice daily or placebo for 28-days. The primary outcomes were sleep diary measures. Secondary outcomes included daytime symptoms, safety assessments, and effect size of these measures. There were no significant differences between groups in changes in sleep diary measures, including total sleep time (TST), sleep efficiency, sleep latency, wake after sleep onset (WASO), sleep quality, and number of awakenings. Chamomile did show modest advantage on daytime functioning, although these did not reach statistical significance. Effect sizes were generally small to moderate (Cohen's d ≤ 0.20 to < 0.60) with sleep latency, night time awakenings, and Fatigue Severity Scale (FSS), having moderate effect sizes in favor of chamomile. However, TST demonstrated a moderate effect size in favor of placebo. There were no differences in adverse events reported by the chamomile group compared to placebo. Chamomile could provide modest benefits of daytime functioning and mixed benefits on sleep diary measures relative to placebo in adults with chronic primary insomnia. However, further studies in select insomnia patients would be needed to investigate these conclusions.
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To examine the joint effect of insomnia and objective short sleep duration on hypertension risk. Representative cross-sectional study. Sleep laboratory. 1,741 men and women randomly selected from central Pennsylvania. None. Insomnia was defined by a complaint of insomnia with a duration > or = 1 year, while poor sleep was defined as a complaint of difficulty falling asleep, staying asleep, or early final awakening. Polysomnographic sleep duration was classified into 3 categories: > or = 6 h sleep (top 50% of the sample); 5-6 h (approximately the third quartile of the sample); and < or = 5 h (approximately the bottom quartile of the sample). Hypertension was defined based either on blood pressure measures or treatment. We controlled for age, race, sex, body mass index, diabetes, smoking, alcohol use, depression, sleep disordered breathing (SDB), and sampling weight. Compared to the normal sleeping and > 6 h sleep duration group, the highest risk of hypertension was in insomnia with < 5 h sleep duration group (OR [95% CI] 5.1 [2.2, 11.8]), and the second highest in insomnia who slept 5-6 hours (OR 3.5 [1.6, 7.9] P < 0.01). The risk for hypertension was significantly higher, but of lesser magnitude, in poor sleepers with short sleep duration. Insomnia with short sleep duration is associated with increased risk of hypertension, to a degree comparable to that of other common sleep disorders, e.g., SDB. Objective sleep duration may predict the severity of chronic insomnia a prevalent condition whose medical impact has been apparently underestimated.
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To evaluate the association between adolescent insomnia and mental health during adolescence and young adulthood. Cross-sectional and prospective study. School and in home. Nationally based population sample of 4494 adolescents, 12 to 18 years old at baseline (mean = 15.83 years), with 3582 young adults, 18 to 25 years old (mean = 21.25 years) at 6- to 7-year follow-up. Self-report measures of mental health. Insomnia symptoms were reported by 9.4% of the adolescents. Cross-sectionally, adolescent insomnia symptoms were associated with use of alcohol, cannabis, and drugs other than cannabis; depression; suicide ideation; and suicide attempts (all P values < 0.01) after controlling for sex. Prospectively, insomnia symptoms during adolescence were a significant risk factor for depression diagnosis (odds ratio = 2.3) in young adulthood after controlling for sex and baseline depression. This study is the first to longitudinally evaluate insomnia symptoms during adolescence as a risk factor for mental health problems in young adulthood. The findings indicate that insomnia is a prevalent problem for adolescents and argue for future treatment-outcome studies to evaluate the efficacy and effectiveness of various insomnia interventions in this age group.
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This study examined the national age- and sex-specific prevalence rates of insomnia and excessive daytime sleepiness (EDS), the associations of insomnia symptoms with daytime consequences, and the impact of insomnia on EDS and psychological well-being. Data of 36,743 men and women aged 18 years and above from the 2005 Survey of Social Development Trends-Health Security in Taiwan were analyzed. Over 25% of the Taiwanese adults experienced insomnia. Difficulty initiating sleep (14.6%) was the most common type of insomnia, followed by early morning awakening (13.9%) and difficulty maintaining sleep (13.4%). The risk of EDS was three times as high for individuals with insomnia as for those without (95% confidence interval of odds ratio: 2.77-3.71). Insomnia status predicted poor psychological well-being even after controlling for sociodemographic factors and health status. Taiwanese adults had a high prevalence of insomnia. Insomnia contributed at least partially to an individual's psychological well-being.
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The effect of acute and repeated treatment (seven days) with a valerian extract (Valdispert forte, 405 mg t.i.d.) on objective and subjective measures of sleep was studied. Polysomnography was conducted in 14 elderly poor sleepers on three nights, at one-week intervals (N0, N1, N2). N0 was an adaptation night, N1 and N2 the first and last night under treatment. Six subjects received placebo and eight subjects valerian. Subjects in the valerian group showed an increase in slow-wave sleep (SWS) and a decrease in sleep stage 1. Density of K-complexes was increased under active treatment. There was no effect on sleep onset time or time awake after sleep onset. REM sleep was unaltered. There was also no effect on self-rated sleep quality. We hypothesize that valerian increases SWS in subjects with low baseline values.
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Insomnia, a highly prevalent disorder with direct and indirect economic and professional consequences, affects daytime functioning, behavior, and quality of life. Several studies have shown that insomnia affects the workforce and is associated with an increased risk of accidents. Insomnia may also play a role in other disorders. Our study attempted to evaluate the socio-professional correlates of insomnia by comparing a group of insomniacs to a group of good sleepers. With a questionnaire focused on the socio-professional and medical consequences of insomnia, we surveyed a group of severe insomniacs and a group of good sleepers. Persons with psychiatric disorders according to the DSM-IV minimum criteria for anxiety and depression were eliminated from each group. After screening, 240 insomniacs and 391 good sleepers remained and were then compared. Compared to good sleepers, severe insomniacs reported more medical problems, had more physician-office visits, were hospitalized twice as often, and used more medication. Severe insomniacs had a higher rate of absenteeism, missing work twice as often as did good sleepers. They also had more problems at work (including decreased concentration, difficulty performing duties, and more work-related accidents). Our study showed that insomnia has socio-professional consequences and is correlated with lower medical status.
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The study is part of a nationwide evaluation of complementary and alternative medicine (CAM) in primary care in Switzerland. Patient health status with respect to demographic attributes such as gender, age, and health care utilisation pattern was studied and compared with conventional primary care. The study was performed as a cross-sectional survey including 11932 adult patients seeking complementary or conventional primary care. Patients were asked to document their self-perceived health status by completing a questionnaire in the waiting room. Physicians were performing conventional medicine and/or various forms of complementary primary care such as homeopathy, anthroposophic medicine, neural therapy, herbal medicine, or traditional Chinese medicine. Additional information on patient demographics and yearly consultation rates for participating physicians was obtained from the data pool of all Swiss health insurers. These data were used to confirm the survey results. We observed considerable and significant differences in demographic attributes of patients seeking complementary and conventional care. Patients seeking complementary care documented longer lasting and more severe main health problems than patients in conventional care. The number of previous physician visits differed between patient groups, which indicates higher consumption of medical resources by CAM patients. The study supports the hypothesis of differences in socio-demographic and behavioural attributes of patients seeking conventional medicine or CAM in primary care. The study provides empirical evidence that CAM users are requiring more physician-based medical services in primary care than users of conventional medicine.
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To quantify and compare potential benefits (subjective reports of sleep variables) and risks (adverse events and morning-after psychomotor impairment) of short term treatment with sedative hypnotics in older people with insomnia. Medline, Embase, the Cochrane clinical trials database, PubMed, and PsychLit, 1966 to 2003; bibliographies of published reviews and meta-analyses; manufacturers of newer sedative hypnotics (zaleplon, zolpidem, zopiclone) regarding unpublished studies. Randomised controlled trials of any pharmacological treatment for insomnia for at least five consecutive nights in people aged 60 or over with insomnia and otherwise free of psychiatric or psychological disorders. 24 studies (involving 2417 participants) with extractable data met inclusion and exclusion criteria. Sleep quality improved (effect size 0.14, P < 0.05), total sleep time increased (mean 25.2 minutes, P < 0.001), and the number of night time awakenings decreased (0.63, P < 0.001) with sedative use compared with placebo. Adverse events were more common with sedatives than with placebo: adverse cognitive events were 4.78 times more common (95% confidence interval 1.47 to 15.47, P < 0.01); adverse psychomotor events were 2.61 times more common (1.12 to 6.09, P > 0.05), and reports of daytime fatigue were 3.82 times more common (1.88 to 7.80, P < 0.001) in people using any sedative compared with placebo. Improvements in sleep with sedative use are statistically significant, but the magnitude of effect is small. The increased risk of adverse events is statistically significant and potentially clinically relevant in older people at risk of falls and cognitive impairment. In people over 60, the benefits of these drugs may not justify the increased risk, particularly if the patient has additional risk factors for cognitive or psychomotor adverse events.
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Insomnia and other disorders that result in trouble sleeping are common in the United States and are often associated with chronic health conditions. Some individuals with insomnia or trouble sleeping use complementary and alternative medicine (CAM) therapies to treat their condition, but the prevalence of such use and the most common types of CAM therapies selected are not known. Prevalence of insomnia or trouble sleeping and of CAM use for treating such conditions was examined using the 2002 National Health Interview Survey. Logistic regression was used to examine associations between insomnia or trouble sleeping, comorbid conditions, and use of CAM treatments. The 12-month prevalence rate of insomnia or trouble sleeping was 17.4%. There was a strong positive association between adults who reported having insomnia or trouble sleeping and adults who reported 4 of 5 common conditions: obesity (adjusted odds ratio [OR], 1.15; 99% confidence interval [CI], 1.01-1.31), hypertension (OR, 1.32; 99% CI, 1.16-1.51), congestive heart failure (OR, 2.24; 99% CI, 1.60-3.14), and anxiety or depression (OR, 5.64; 99% CI, 5.07-6.29). Of those with insomnia or trouble sleeping, 4.5% used some form of CAM therapy to treat their condition. According to the National Health Interview Survey analysis, over 1.6 million civilian, noninstitutionalized adult US citizens use CAM to treat insomnia or trouble sleeping. The details of this analysis will serve as a guide for future research on CAM therapies for sleep disorders.
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Insomnia affects approximately one-third of the adult population and contributes to increased rates of absenteeism, health care use, and social disability. Extracts of the roots of valerian (Valeriana officinalis) are widely used for inducing sleep and improving sleep quality. A systematic review of randomized, placebo-controlled trials of valerian for improving sleep quality is presented. An extensive literature search identified 16 eligible studies examining a total of 1093 patients. Most studies had significant methodologic problems, and the valerian doses, preparations, and length of treatment varied considerably. A dichotomous outcome of sleep quality (improved or not) was reported by 6 studies and showed a statistically significant benefit (relative risk of improved sleep = 1.8, 95% confidence interval, 1.2-2.9), but there was evidence of publication bias in this summary measure. The available evidence suggests that valerian might improve sleep quality without producing side effects. Future studies should assess a range of doses of standardized preparations of valerian and include standard measures of sleep quality and safety.
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This trial was conducted as part of a project that aims to enhance public understanding and use of research in decisions about healthcare by enabling viewers to participate in research and to follow the process, through television reports and on the web. Valerian is an herbal over-the-counter drug that is widely used for insomnia. Systematic reviews have found inconsistent and inconclusive results about its effects. Participants were recruited through a weekly nationally televised health program in Norway. Enrolment and data collection were over the Internet. 405 participants who were 18 to 75 years old and had insomnia completed a two week diary-keeping run-in period without treatment and were randomised and mailed valerian or placebo tablets for two weeks. All participants and investigators were blind to treatment until after the analysis was completed. For the primary outcome of a minimally important improvement in self-reported sleep quality (> or = 0.5 units on a 7 point scale), the difference between the valerian group (29%) and the placebo group (21%) was not statistically significant (difference 7.5%; 95% CI-0.9 to 15.9; p = 0.08). On the global self-assessment question at the end of the treatment period 5.5% (95% CI 0.2 to 10.8) more participants in the valerian group perceived their sleep as better or much better (p = 0.04). There were similar trends favouring the valerian group for night awakenings (difference = 6.0%, 95% CI-0.5 to 12.5) and sleep duration (difference = 7.5%, 95% CI-1.0 to 16.1). There were no serious adverse events and no important or statistically significant differences in minor adverse events. Based on this and previous studies, valerian appears to be safe, but with modest beneficial effects at most on insomnia compared to placebo. The combined use of television and the Internet in randomised trials offers opportunities to answer questions about the effects of health care interventions and to improve public understanding and use of randomised trials. Controlled-Trials.com ISRCTN72748991.
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In Canada, the use of botanical natural health products (NHPs) for anxiety disorders is on the rise, and a critical evaluation of their safety and efficacy is required. The purpose of this study was to determine whether commercially available botanicals directly affect the primary brain enzymes responsible for gamma-aminobutyric acid (GABA) metabolism. Anxiolytic plants may interact with either glutamic acid decarboxylase (GAD) or GABA transaminase (GABA-T) and ultimately influence brain GABA levels and neurotransmission. Two in vitro rat brain homogenate assays were developed to determine the inhibitory concentrations (IC50) of aqueous and ethanolic plant extracts. Approximately 70% of all extracts that were tested showed little or no inhibitory effect (IC50 values greater than 1 mg/mL) and are therefore unlikely to affect GABA metabolism as tested. The aqueous extract of Melissa officinalis (lemon balm) exhibited the greatest inhibition of GABA-T activity (IC50 = 0.35 mg/mL). Extracts from Centella asiatica (gotu kola) and Valeriana officinalis (valerian) stimulated GAD activity by over 40% at a dose of 1 mg/mL. On the other hand, both Matricaria recutita (German chamomile) and Humulus lupulus (hops) showed significant inhibition of GAD activity (0.11-0.65 mg/mL). Several of these species may therefore warrant further pharmacological investigation. The relation between enzyme activity and possible in vivo mode of action is discussed.
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Use of complementary and alternative medicine (CAM), and especially CAM practitioners, has continued to rise in recent years. Although several motivators of CAM use have been identified, little is known about how and if the motivations for using CAM have changed over time. The purpose of the current study was to compare the reasons for consulting CAM practitioners in consumers in 1997-8 and eight years later in 2005. Surveys were displayed in CAM and conventional medicine offices and clinics in Ontario, Canada in 1997-8 and again in 2005, and self-selected participants returned the surveys by mail. In 1997-8, 141 CAM consumers were identified from the 199 surveys returned, and 185 CAM consumers were identified from the 239 surveys returned in 2005. Five of the six CAM motivations were more likely to be endorsed by the 2005 CAM consumers compared to the 1997-8 CAM consumers (all p's < .0001). In 1997-8 the two top reasons for using CAM were that CAM allowed them to take an active role in their health (51.8%), and because conventional medicine was ineffective for their health problem (41.8%). In 2005, the treatment of the whole person (78.3%) was the top reason for using CAM followed by taking an active role in one's health (76.5%). The 2005 consumers were less educated, had slightly more chronic health complaints, had been using CAM for longer, and were more likely to consult chiropractors, reflexologists, and therapeutic touch practitioners than the 1997-8 consumers. Otherwise, the socio-demographic and health profiles of the two groups of CAM consumers were similar, as was their use of CAM. Compared to consumers in 1997-8, consumers in 2005 were more likely to endorse five of the six motivations for consulting CAM practitioners. A shift towards motivations focusing more on the positive aspects of CAM and less on the negative aspects of conventional medicine was also noted for the 2005 consumers. Findings suggest that CAM motivations may shift over time as public knowledge of and experience with CAM also changes.
Use of complementary and alternative medicine (CAM), and especially CAM practitioners, has continued to rise in recent years. Although several motivators of CAM use have been identified, little is known about how and if the motivations for using CAM have changed over time. The purpose of the current study was to compare the reasons for consulting CAM practitioners in consumers in 1997–8 and eight years later in 2005. Methods: Surveys were displayed in CAM and conventional medicine offices and clinics in Ontario, Canada in 1997–8 and again in 2005, and self-selected participants returned the surveys by mail. Results: In 1997–8, 141 CAM consumers were identified from the 199 surveys returned, and 185 CAM consumers were identified from the 239 surveys returned in 2005. Five of the six CAM motivations were more likely to be endorsed by the 2005 CAM consumers compared to the 1997– 8 CAM consumers (all p's < .0001). In 1997–8 the two top reasons for using CAM were that CAM allowed them to take an active role in their health (51.8%), and because conventional medicine was ineffective for their health problem (41.8%). In 2005, the treatment of the whole person (78.3%) was the top reason for using CAM followed by taking an active role in one's health (76.5%). The 2005 consumers were less educated, had slightly more chronic health complaints, had been using CAM for longer, and were more likely to consult chiropractors, reflexologists, and therapeutic touch practitioners than the 1997–8 consumers. Otherwise, the socio-demographic and health profiles of the two groups of CAM consumers were similar, as was their use of CAM. Conclusion: Compared to consumers in 1997–8, consumers in 2005 were more likely to endorse five of the six motivations for consulting CAM practitioners. A shift towards motivations focusing more on the positive aspects of CAM and less on the negative aspects of conventional medicine was also noted for the 2005 consumers. Findings suggest that CAM motivations may shift over time as public knowledge of and experience with CAM also changes.
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To study prospectively the relations of insomnia to the development of anxiety disorders and depression in a population-based sample. Cohort study based on data from 2 general health surveys of the adult population. Two general health surveys in the adult population in Nord-Trøndelag County of Norway, HUNT-1 performed in 1984-6 and HUNT-2 in 1995-7 Participants without significant anxiety and depression in HUNT-1 were categorized according to the presence and absence of insomnia in the 2 surveys (N=25,130). Anxiety disorders and depression in HUNT-2 were assessed by the Hospital Anxiety and Depression Scale and analyzed using multivariate logistic regression analysis adjusted for age, gender, education, comorbid depression/anxiety, and history of insomnia. Anxiety disorders in HUNT-2 were significantly associated with the group with insomnia in HUNT-1 only (OR 1.6; 95% CI, 1.1-2.3), the group with insomnia in HUNT-2 only (OR 3.4; 95% CI, 3.1-3.8), as well as with the group with insomnia in both surveys (OR 4.9; 95% CI, 3.8-6.4). Depression in HUNT-2 was significantly associated with the group with insomnia in HUNT-2 only (OR 1.8; 95% CI, 1.6-2.0), but not with the groups with insomnia in HUNT-1 only or with insomnia in both surveys. Only a state-like association between insomnia and depression was found. In addition to being a state marker, insomnia may be a trait marker for individuals at risk for developing anxiety disorders. Results are consistent with insomnia being a risk factor for the development of anxiety disorders.
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Insomnia is one of the most common sleep complications which are defined as a problem in the beginning of sleep or its permanence.AimsThe aim of this study was the effects of herbal medicine (Valeriana officinalis) and homeopathic remedy (Coffea cruda) on insomnia.Methods This is a single blind clinical trial study, conducted on 90 students who suffered on insomnia. They were chosen by volunteer sampling and randomly allocated in two groups. One group received homeopathic remedy Coffea cruda drop and placebo capsule and other ones used allopathic medicine Valeriana officinalis capsule and placebo drop. Both groups used one capsule one hour before sleep every night and one drop every 8 hours for one month. The ethical committee of the university approved the study. Data were collected through 3 questionnaires: Demographic, Petersburg sleep quality index and Standard Insomnia Severity Index (ISI). Content validity and test-retest methods were used for validity and reliability. Data analysis using descriptive and inferential statistics.ResultsBefore usage, the quality and severity average of Sleep in Valeriana officinalis group was mean =11.78and15/14 before and 7.56and8/6 after a period of 1 months. The quality and severity average of Sleep in Coffea curada group was mean =11/51 and14/53 before usage and 5.51and 6/05 after a period of 1 months. We have obtained a significant difference between 2 groups 1 month after the start of consumption (P < 0/05).Conclusion The results of this study suggested, Cafea cruda, is more and low side effect methods than herbal medicine.
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The diversity within CAM use in the community, and the beliefs, concerns, and characteristics of the users of individual CAM modalities was explored via a survey mailed to a randomly selected sample of 1,308 people in different metropolitan and rural localities in Victoria, Australia. The response rate was 40% (n = 459). The respondents' overall current CAM use was 52% and lifetime use was 85%. Chiropractic (50%), massage therapy, (50%), and vitamin or herbal supplements (39%) were the most frequently used modalities. A set of beliefs labeled holistic health care beliefs strongly predicted the use of Natural Remedy and Wellness modalities. Users of these modalities were more likely to be female, under the age of 60, and tertiary educated. Rurality characteristics did not predict rural CAM usage and were equally present in metropolitan and rural respondents. The respondents' decisions concerning CAM involved choosing a modality that fit their self-assessed health care needs.
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Ethnopharmacological relevance: Wuling Capsule is a single herbal formula from mycelia of precious Xylaria nigripes (Kl.) Sacc and its pharmacological function have a tranquilizing effect on the central nervous system. The aim of the study to evaluate the efficacy and safety of Wuling capsule in treatment of insomnia. Materials and methods: We performed a multicenter, randomized, double-blind, placebo-controlled study. The participants received either placebo (n=92) or Wuling capsule (n=94) for 4 weeks and a follow-up period for 2 weeks. Results: Compared between pre-treatment and post-treatment, the global Pittsburgh sleep quality index (PSQI) scores in both Wuling capsule group and placebo group improved significantly (P<0.01). However, there was no significant difference between Wuling capsule group and placebo group (P>0.05). Scores of clinical global impressions scale (CGI-I) at each week in Wuling capsule group was similar to those in placebo group (P>0.05). Compared between pre-treatment and post-treatment, scores of the four components of world health organization on quality of life brief scale (WHOQOL-BREF) in both Wuling capsule group and placebo group improved significantly (P<0.01). However, there were no difference between the two groups (P>0.05). The rate of adverse events was 10.10% in Wuling group, and 6.73% in placebo group (P>0.05). Conclusions: Wuling capsule can improve insomnia when compared with pre-treatment for 4 weeks and be a well tolerated by all the patients at the 6 weeks of study period. However, there are no significant in the results of the variables tested when compared with placebo control. Further additional rigorous randomized clinical trials are still required.
Article
Anxiety disorders and sleep problems are common in the general population and are a cause of frequent consultations in primary care. These problems have significant impact on quality of life and functionality of individuals. The extracts of valerian root have been widely used for a long time by the population and physicians, for their sedative effects, hypnotic and anxiolytic. It is therefore urgent to know what are the benefits and the risks of using this substance for the treatment of anxiety and sleep disorders. To investigate the efficacy and safety of valerian for the treatment of anxiety and sleep disorders. A research was carried out for clinical practice guidelines, systematic reviews (SR), meta-analysis (MA) and randomized controlled trials (RCT) in Pubmed, sites of evidence-based medicine and Índex das Revistas Médicas Portuguesas using the MeSH terms valerian, anxiety and sleep disorders, and respective DeCS, analyzing articles in English, Spanish, French or Portuguese, published between January 2000 and March 31, 2010. We also reviewed references of relevant articles. We used the Strength of Recommendation Taxonomy (SORT) from American Family Physician to evaluate the level of evidence and assigning the strength of a recommendation. We found 173 articles of which four were selected which met the inclusion criteria: a meta-analysis, a SR and a RCT concerning the use of valerian in sleep disorders, and an SR on the use of valerian in anxiety disorders. The evidence is insufficient regarding the efficacy of valerian in the treatment of anxiety disorders (SOR A). There seems to be some evidence of the effectiveness of valerian for treating insomnia, which is limited by the quality of existing studies (SOR B). Valerian root is well tolerated and safe, with infrequent and benign side effects (SOR A). The evidence is currently insufficient to recommend the use of valerian for the treatment of anxiety disorders. The evidence in insomnia is limited by the contradictory results of studies reviewed and their methodological problems, although it seems to have some effect in mild to moderate insomnia. Despite that, valerian is a safe substance. More RCT are needed, with samples of adequate size, with standardization of measures to assess quality of sleep and levels of anxiety and standardization of dose, type of preparation of valerian used and the time for its use.
Article
Chronic insomnia has a recognized impact on health-related quality-of-life (HRQoL) but data on utility scores across countries are lacking. The objective of the present study was to assess health related quality of life (HRQoL) and utility scores in individuals from three different countries (USA, France, and Japan), comparing sufferers of chronic insomnia to good sleepers. A cross-sectional survey (SLEEPI-i) of 4067 persons in the US (n=1298; 478 good sleepers and 820 patients with insomnia), France (n=1858; 998 good sleepers and 860 patients with insomnia) and Japan (n=911; 506 good sleepers and 405 patients with insomnia). Enrollment and data collection using consumer panels were web-based in the US and France, and gathered via a postal survey in Japan. People with chronic insomnia (>6 months) were selected based on Insomnia Severity Index scores (ISI). Severity of insomnia was assessed using the ISI score and HRQoL was assessed using the self-administered Short-Form SF-36 Health Survey. Utility scores were derived using the algorithm developed by Brazier et al. Multivariate analyses were used to adjust for potential confounding factors. In all countries, people with chronic insomnia (40% treated) reported lower SF-36 scores in each of eight domains compared with good sleepers (P<.0001). Chronic insomnia was associated with significantly lower utility scores compared with good sleepers (mean scores 0.63 versus 0.72 in the US, 0.57 versus 0.67 in France, and 0.67 versus 0.77 in Japan, P<.0001). This survey suggests that chronic insomnia is associated with significant impairment of HRQoL and decreased utilities across the different geographical regions studied.
Article
Sleep disturbances reduce the quality of life. About 50% of postmenopausal women experience sleep disturbances such as insomnia. Complementary and alternative medical therapies may be useful for the management of sleep disturbances among postmenopausal women. The aim of the present study was to evaluate the effects of valerian extract taken nightly on the improvement of sleep quality in postmenopausal women experiencing insomnia. A randomized, triple-blind, controlled trial design was used for this study. Participants consisted of 100 postmenopausal women aged 50 to 60 years who were experiencing insomnia. A demographic data form and the Pittsburgh Sleep Quality Index were used to collect data. The women were randomly divided into two groups. Each group received either 530 mg of concentrated valerian extract or a placebo twice a day for 4 weeks. Descriptive and inferential statistics were used to analyze the data. A statistically significant change was reported in the quality of sleep of the intervention group in comparison with the placebo group (P < 0.001). Also, 30% of the participants in the intervention group and 4% in the placebo group showed an improvement in the quality of sleep (P < 0.001). Valerian improves the quality of sleep in women with menopause who are experiencing insomnia. Findings from this study add support to the reported effectiveness of valerian in the clinical management of insomnia.
Article
In concert with growing public interest in complementary and alternative medicine (CAM), these therapies and products have been increasingly studied over the past two decades for the treatment of sleep disorders. While systematic reviews have been conducted on acupuncture and valerian in the treatment of insomnia, to date no comprehensive review has been conducted on all major CAM treatments. We sought to address this via a rigorous systematic review of hypnotic CAM interventions, including herbal and nutritional medicine, acupuncture, acupressure, yoga, tai chi, massage, aromatherapy and homoeopathy. The electronic databases MEDLINE (PubMed), CINAHL, PsycINFO, and The Cochrane Library were accessed during late 2009 for CAM randomized controlled trials (RCTs) in the treatment of chronic insomnia. Sixty-four RCTs were identified, of which 20 studies involving eight CAM interventions met final inclusion criteria. Effect size calculations (where possible) and a quality control analysis using a modified Jadad scale were undertaken. Many RCTs lacked methodological rigor, and were commonly excluded due to small sample size or an inadequate control condition. Among the studies that met inclusion criteria, there was evidentiary support in the treatment of chronic insomnia for acupressure (d=1.42-2.12), tai chi (d=0.22-2.15), yoga (d=0.66-1.20), mixed evidence for acupuncture and L-tryptophan, and weak and unsupportive evidence for herbal medicines such as valerian. Surprisingly, studies involving several mainstream CAM therapies (e.g., homoeopathy, massage, or aromatherapy) were not located or did not meet basic inclusion criteria. If CAM interventions are to be considered as viable stand-alone or adjuvant treatments for sleep disorders, future researchers are urged to use acceptable methodology, including appropriate sample sizes and adequate controls. RCTs evaluating other untested CAM therapies such as massage, homoeopathy, or osteopathy are encouraged, as is the exploration of using CAM therapies adjuvantly with conventional therapies.
Article
Many medicinal plants have been used for treatment of insomnia in Asia. However, scientific evidence and precise mechanism for their sedative-hypnotic activity have not been fully investigated. Thus, we investigated the binding activity of the oriental plant extracts (mainly from Korea and Japan) to the well-known molecular targets for sleep regulation, GABA(A) and 5-HT(2C) receptors. Following the binding assay, sedative-hypnotic effects of the extracts with high affinity were examined in an animal model of sleep. Aqueous and ethanol extracts of 15 medicinal plants were tested for binding at the benzodiazepine site of GABA(A) receptor and 5-HT site of 5-HT(2C) receptor. The sedative-hypnotic effects of selected extracts were evaluated by measuring the sleep latency and sleep duration during pentobarbital-induced sleep in mice after oral administration of extracts. In the GABA(A) assay, the ethanol extracts of licorice and danshen displayed concentration-dependent, high affinity binding, whereas in the 5-HT(2C) assay, the ethanol extracts of ginseng and silk tree showed high affinity. Among these extracts we tested previously uncharacterized licorice and silk tree for hypnotic effects. We found the ethanol extracts of licorice and silk tree significantly decreased sleep latency and increased sleep duration in pentobarbital-induced sleep. We demonstrate for the first time that licorice and silk tree have the sedative-hypnotic activity possibly by modulating GABA(A) and 5-HT(2C) receptors. We propose that licorice and silk tree might be effective candidates for treatment of insomnia.
Article
Insomnia is an often seen primary health care problem. Valerian might be an alternative treatment with fewer secondary effects. The aim of this study is to evaluate its effectiveness on insomnia through a meta-analysis of published literature. Search for randomized clinical trials (RCTs) of Valerian preparations compared with a placebo on Medline, the Cochrane Library, Embase and Biosis. Outcomes: sleep-quality improvement (SQ, yes/no), sleep-quality improvement quantified through visual analogical scales (SQS) and the latency time (LT) in minutes until getting to sleep. Three meta-analyses were carried out using inverse-variance weighted random effects models. Heterogeneity was determined with the Q-statistic and was explored through a sub-groups analysis. Publication bias was evaluated using the funnel plot. Eighteen RCTs were selected; eight had a score of 5 on Jadad's scale. The mean differences in LT between the Valerian and placebo treatment groups was 0.70 min (95% CI, -3.44 to 4.83); the standardized mean differences between the groups measured with SQS was -0.02 (95% CI, -0.35 to 0.31); treatment with Valerian showed a relative risk of SQ of 1.37 (95% CI, 1.05-1.78) compared with the placebo group. There was heterogeneity in the three meta-analyses, but it diminished in the sub groups analysis. No publication bias was detected. The qualitative dichotomous results suggest that valerian would be effective for a subjective improvement of insomnia, although its effectiveness has not been demonstrated with quantitative or objective measurements. We recommend future investigations oriented toward improving insomnia with other more promising treatments.
Article
To investigate the relationship between sleep duration and insomnia severity and the risk of all-cause death and cardiovascular disease (CVD) events. Prospective cohort study. Community-based. A total of 3,430 adults aged 35 years or older. None. During a median 15.9 year (interquartile range, 13.1 to 16.9) follow-up period, 420 cases developed cardiovascular disease and 901 cases died. A U-shape association between sleep duration and all-cause death was found: the age and gender-adjusted relative risks (95% confidence interval [CI]) of all-cause death (with 7 h of daily sleep being considered for the reference group) for individuals reporting < or = 5 h, 6 h, 8 h, and > or = 9 h were 1.15 (0.91-1.45), 1.02 (0.85-1.25), 1.05 (0.88-1.27), and 1.43 (1.16-1.75); P for trend, 0.019. However, the relationship between sleep duration and risk of CVD were linear. The multivariate-adjusted relative risk (95% CI) for all-cause death (using individuals without insomnia) were 1.02 (0.86-1.20) for occasional insomnia, 1.15 (0.92-1.42) for frequent insomnia, and 1.70 (1.16-2.49) for nearly everyday insomnia (P for trend, 0.028). The multivariate adjusted relative risk (95% CI) was 2.53 (1.71-3.76) for all-cause death and 2.07 (1.11-3.85) for CVD rate in participants sleeping > or = 9 h and for those with frequent insomnia. Sleep duration and insomnia severity were associated with all-cause death and CVD events among ethnic Chinese in Taiwan. Our data indicate that an optimal sleep duration (7-8 h) predicted fewer deaths.
Article
Purpose of review: The purpose of this review is to examine how sleep disorders in children are affected by age and comorbid medical influences, and to discuss current understanding of how the clinical manifestations, pathophysiology, and treatment of common childhood sleep disorders differ from those of the adult population. Recent findings: Recently established age-specific norms are required for accurate interpretation of polysomnograms and multiple sleep latency tests in children. Summary: Sleep disorders such as insomnia, obstructive sleep apnea, and excessive daytime somnolence are common in both children and adults, but the clinical manifestations and underlying pathophysiology of these disorders vary substantially with age. For example, the bedtime struggles of a temperamental toddler are associated with different symptoms and causative factors compared to psychophysiologic insomnia affecting a middle-aged person. Similarly, a 6-year-old child with obstructive sleep apnea is more likely to exhibit daytime inattention and hyperactivity as a referable daytime symptom than the clear-cut lethargy or sleepiness that most affected adults experience. This review will examine how insomnia, excessive sleepiness, and obstructive sleep apnea differ in children compared to adults.
Article
Despite a paucity of data on efficacy and safety of natural (herbal and dietary) products, their use appears to be widespread. This study aimed at examining the frequency of natural products' use for sleep and their correlates in a population-based sample. A randomly selected sample of adults (n=997; 59.9% women) from the province of Quebec completed a postal survey on sleep, use of sleep-promoting products (natural products, prescribed medication, over-the-counter medication and alcohol), physical and mental health, lifestyle habits and demographics. A total of 18.5% of participants reported having used natural products as sleep aids in the past 12months, with chamomile being the most popular product. Participants who exclusively used natural products as sleep aids (10.3% of the sample) were predominantly females, younger and had a higher educational level than those using prescribed medications. Natural products users reported engaging in more health-promoting behaviors than the nonusers of sleep aids and, despite the presence of subthreshold insomnia symptoms (mean Insomnia Severity Index score=9.33), they tended to perceive themselves as healthier when compared with prescribed medication users and nonusers of sleep aids. The use of natural products as sleep aids is a common practice. Often associated with a general health-promoting lifestyle, it may reflect the common perception that natural products are necessarily beneficial for sleep and without risks.
Article
Recent epidemiologic studies have found that self-reported duration of sleep is associated with obesity, diabetes, hypertension, and mortality. The extent to which self reports of sleep duration are similar to objective measures and whether individual characteristics influence the degree of similarity are not known. Eligible participants at the Chicago site of the Coronary Artery Risk Development in Young Adults Study were invited to participate in a 2003-2005 ancillary sleep study; 82% (n = 669) agreed. Sleep measurements collected in 2 waves included 3 days each of wrist actigraphy, a sleep log, and questions about usual sleep duration. We estimate the average difference and correlation between subjectively and objectively measured sleep by using errors-in-variables regression models. Average measured sleep was 6 hours, whereas the average from subjective reports was 6.8 hours. Subjective reports increased on average by 34 minutes for each additional hour of measured sleep. Overall, the correlation between reported and measured sleep duration was 0.47. Our model suggests that persons sleeping 5 hours over-reported their sleep duration by 1.2 hours, and those sleeping 7 hours over-reported by 0.4 hours. The correlations and average differences between self-reports and measured sleep varied by health, sociodemographic, and sleep characteristics. CONCLUSIO: In a population-based sample of middle-aged adults, subjective reports of habitual sleep are moderately correlated with actigraph-measured sleep, but are biased by systematic over-reporting. The true associations between sleep duration and health may differ from previously reported associations between self-reported sleep and health.
Article
A carefully designed study assessed the short-term (single dose) and long-term (14 days with multiple dosage) effects of a valerian extract on both objective and subjective sleep parameters. The investigation was performed as a randomised, double-blind, placebo-controlled, cross-over study. Sixteen patients (4 male, 12 female) with previously established psychophysiological insomnia (ICSD-code 1.A.1.), and with a median age of 49 (range: 22 to 55), were included in the study. The main inclusion criteria were reported primary insomnia according to ICSD criteria, which was confirmed by polysomnographic recording, and the absence of acute diseases. During the study, the patients underwent 8 polysomnographic recordings: i.e., 2 recordings (baseline and study night) at each time point at which the short and long-term effects of placebo and valerian were tested. The target variable of the study was sleep efficiency. Other parameters describing objective sleep structure were the usual features of sleep-stage analysis, based on the rules of Rechtschaffen and Kales (1968), and the arousal index (scored according to ASDA criteria, 1992) as a sleep microstructure parameter. Subjective parameters such as sleep quality, morning feeling, daytime performance, subjectively perceived duration of sleep latency, and sleep period time were assessed by means of questionnaires. After a single dose of valerian, no effects on sleep structure and subjective sleep assessment were observed. After multiple-dose treatment, sleep efficiency showed a significant increase for both the placebo and the valerian condition in comparison with baseline polysomnography. We confirmed significant differences between valerian and placebo for parameters describing slow-wave sleep. In comparison with the placebo, slow-wave sleep latency was reduced after administration of valerian (21.3 vs. 13.5 min respectively, p<0.05). The SWS percentage of time in bed (TIB) was increased after long-term valerian treatment, in comparison to baseline (9.8 vs. 8.1% respectively, p<0.05). At the same time point, a tendency for shorter subjective sleep latency, as well as a higher correlation coefficient between subjective and objective sleep latencies, were observed under valerian treatment. Other improvements in sleep structure - such as an increase in REM percentage and a decrease in NREM1 percentage - took place simultaneously under placebo and valerian treatment. A remarkable finding of the study was the extremely low number of adverse events during the valerian treatment periods (3 vs. 18 in the placebo period). In conclusion, treatment with a herbal extract of radix valerianae demonstrated positive effects on sleep structure and sleep perception of insomnia patients, and can therefore be recommended for the treatment of patients with mild psychophysiological insomnia.
Article
Objective: To systematically review the evidence for the effects of the herb valerian (Valeriana officinalis) on insomnia, based on randomized, placebo-controlled, double-blind trials.Background: Valerian has long been advocated and used for promoting sleep but until quite recently evidence was solely anecdotal. However, during the last two decades a number of clinical trials have been conducted.Materials and methods: Systematic literature searches were performed to locate randomized, placebo-controlled, double-blind trials measuring the effect of valerian monopreparations on sleep in human participants. Data were extracted in a standardized manner and methodological quality was assessed by the Jadad score.Results: Nine trials were located meeting the selection criteria. The findings of the studies were contradictory and there was great inconsistency between trials in terms of patients, experimental design and procedures and methodological quality.Conclusion: The evidence for valerian as a treatment for insomnia is inconclusive. There is a need for rigorous trials to determine its efficacy.
Article
Valeriana edulis ssp. procera, commonly known as "valeriana mexicana", is widely used in Mexican traditional medicine for the treatment of insomnia and anxiety. To evaluate the hypnotic effect and safety of 450 mg of Valeriana edulis standardized hydroalcoholic extract in patients with insomnia, a double-blind, cross-over, controlled study was carried out. Valeriana officinalis extract, at the same doses, was used as a positive control. In a sleep laboratory, polysomnographic (PSG) recordings were performed for analyzing the quantity and architecture of sleep as well as evaluating morning sleepiness, memory quotient, and side effects. The experimental procedures were conducted on four consecutive nights of 8 h each. Twenty patients were admitted. Based on the PSG results, V. edulis reduced the number of awaking episodes while both treatments increased the rapid eye movement (REM) sleep; this last parameter was better improved by V. officinalis extract. Other PSG data did not achieve outstanding statistical differences, but the clinical tendency with both treatments was to increase the sleep efficiency index. These Valeriana extracts produced beneficial effects on sleep architecture because they diminished the time of stages 1 and 2 in non-REM sleep while they increased delta sleep. Validated clinical tests showed that both species reduced notoriously the morning sleepiness, that was further improved by V. officinalis extract, and did not affect anterograde memory. In only three cases were slight side effects observed, one due to the experimental extract. Chemical analysis of the hydroalcoholic extract of V. edulis indicated that this extract contains 0.26 % of dihydroisovaltrate as the main valepotriate, and that it does not contain valerenic acid. In general, the results support the hypnotic effect and safety of acute treatment of Valeriana edulis and Valeriana officinalis on patients suffering insomnia.
Article
The authors studied the sleep of patients with insomnia who complained of poor sleep despite chronic use of benzodiazepines (BZDs). The sample consisted of 19 patients (mean age 43.3+/-10.6 years) with primary insomnia (DSM-IV), who had taken BZDs nightly, for 7.1+/-5.4 years. The control group was composed of 18 healthy individuals (mean age 37+/-8 years). Sleep electroencephalogram (EEG) of the patients was analyzed with period amplitude analysis (PAA) and associated algorithms, during chronic BZD use (Night 1), and after 15 days of a valerian placebo trial (initiated after washout of BZD, Night 2). Sleep of control subjects was monitored in parallel. Valerian subjects reported significantly better subjective sleep quality than placebo ones, after BZD withdrawal, despite the presence of a few side effects. However, some of the differences found in sleep structure between Night 1 and Night 2 in both the valerian and placebo groups may be due to the sleep recovery process after BZD washout. Example of this are: the decrease in Sleep Stage 2 and in sigma count; the increase in slow-wave sleep (SWS), and delta count, which were found to be altered by BZD ingestion. There was a significant decrease in wake time after sleep onset (WASO) in valerian subjects when compared to placebo subjects; results were similar to normal controls. Nonetheless, valerian-treated patients also presented longer sleep latency and increased alpha count in SWS than control subjects. The decrease in WASO associated with the mild anxiolytic effect of valerian appeared to be the major contributor to subjective sleep quality improvement found after 2-week of treatment in insomniacs who had withdrawn from BDZs. Despite subjective improvement, sleep data showed that valerian did not produce faster sleep onset; the increase in alpha count compared with normal controls may point to residual hyperarousabilty, which is known to play a role in insomnia. Nonetheless, we lack data on the extent to which a sedative drug can improve alpha sleep EEG. Thus, the authors suggest that valerian had a positive effect on withdrawal from BDZ use.
Article
The current study was concerned with factors associated with the use of complementary medicine (CM). The reasons for CM use were examined by dividing complementary medicine clients into two groups based on the frequency and length of their use of complementary therapies, and comparing them with conventional medicine clients as well as to each other. New/infrequent CM clients (n = 70), established CM clients (n = 71), and orthodox medicine clients (n = 58) were distinguished on the basis of health beliefs, socio-demographic, medical, and personality variables. Different patterns of predictors of CM use emerged depending on which client groups were compared. In general, health-aware behaviors and dissatisfaction with conventional medicine were the best predictors of overall and initial/ infrequent CM use, and more frequent health-aware behaviors were associated with continued CM use. Medical need also influenced the choice to use CM, and was the best predictor of committed CM use, with the established CM clients reporting more health problems than the new/infrequent CM group. Overall, income was a significant discriminator, but did not predict initial or continued CM use. Openness to new experience was associated with CM use in general, but was most notable in the decision to initially try or explore using CM. The findings support the utility of the three components (predisposing, enabling, and need factors) of the socio-behavioral model for explaining why some people choose CM. Overall, the results of the current study suggest that CM clients need to be looked at in more sophisticated ways, rather than being treated simply as a homogenous group with similar beliefs, motivations and needs.
Article
Epidemiologists have published more than 50 studies of insomnia based on data collected in various representative community-dwelling samples or populations. These surveys provide estimates of the prevalence of insomnia according to four definitions: insomnia symptoms, insomnia symptoms with daytime consequences, sleep dissatisfaction and insomnia diagnoses. The first definition, based on insomnia criteria as defined by the DSM-IV, recognizes that about one-third of a general population presents at least one of them. The second definition shows that, when daytime consequences of insomnia are taken into account, the prevalence is between 9% and 15%. The third definition represents 8-18% of the general population. The last definition, more precise and corresponding to a decision-making diagnosis, sets the prevalence at 6% of insomnia diagnoses according to the DSM-IV classification. These four definitions of insomnia have higher prevalence rates in women than in men. The prevalence of insomnia symptoms generally increases with age, while the rates of sleep dissatisfaction and diagnoses have little variation with age. Numerous factors can initiate or maintain insomnia. Mental disorders and organic diseases are the factors that have been the most frequently studied. The association between insomnia and major depressive episodes has been constantly reported: individuals with insomnia are more likely to have a major depressive illness. Longitudinal studies have shown that the persistence of insomnia is associated with the appearance of a new depressive episode. Future epidemiological studies should focus on the natural evolution of insomnia. Epidemiological genetic links of insomnia are yet to be studied.