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Sleep disorders rob the individual of quality of life and health and
cost our economy $5.1 billion a year. The most common, insomnia,
has traditionally been managed with herbs that feature in many soporific
complementary medicines. Steven Chong reviews what the research has
discovered to date.
Botanicals have been used to relax excited
nervous systems since prehistory, and
earliest recorded Western, Middle Eastern,
Chinese and Indian herbal medicine
traditions include treatments to induce
sleep or improve its length and/or quality.
These purposes fit with the treatment
of contemporary insomnia, the most
common sleep disorder that until recently
was perceived as a symptom, and that the
DSM-5 now defines as a single diagnosis.1
Prevalence is estimated at between
13 and 33% of Australians1, and the sleep
category in pharmacy is a healthy one
commercially, with AZTEC pharmacy
sales data showing some $70 million in
the year to December 2013.2 Total herbals
were worth nearly $21m of this sum,
and valerian -- the root of Valeriana
officinalis, whose anxiolytic effects were
first described by Hippocrates3 and so
widely employed in North America and
Europe that it was called the 'Valium of
the 19th century'4 -- accounts for almost
$12m.2 A 2008 survey of 2,526 Victorians
indicated that 4.3% reported using
valerian in the previous year, primarily for
Along with kava root, valerian is one of
the most researched of sedative herbs --
German Commission E has approved it
as a non-prescription agent for sleeping
disorders4, for which Natural Medicines
Comprehensive Database rates it possibly
effective.6 In-vitro pharmacological
research has demonstrated it stimulates
the release of GABA, inhibits its reuptake
and may have an effect at GABA receptors
and the A1 adenosine receptor.7
The phytochemistry of valerian varies
significantly according to its growing
and harvesting, processing and
storage conditions, as its constituents
are chemically unstable.7 In addition,
in practice valerian is rarely used alone and
is often formulated with other sedative
herbs (e.g. chamomile, passionflower,
skullcap, lemon balm and hops) or even
nutraceuticals that act as neurotransmitter
precursors such as 5-HTP and glycine.
Hence standardised extracts
are common, LI 156 (Sedonium)
and Ze 91019 (ReDormin) are two of
the most studied but differ in their
extraction methods and solvents used.
Ze91019 is the fixed combination of hops
(Humulus lupulus) and valerian whereas
LI 156 is a single extract of valerian.
The evidence for valerian inducing sleep
is variable, and a 2010 Australian literature
review8 of randomised controlled trials
(RCTs) found that subjects reported
improvement in at least one sleep
parameter, often sleep latency and quality
-- either alone or in combination with
hops -- but further quality studies were
needed before doctors could confidently
recommend them as effective and reliable.
A 2011 Australian review9 of herbal
medicine psychopharmacology and
clinical evidence found valerian to be the
only botanical with sufficient research of
adequate rigour for insomnia, and cited
a Spanish 2010 meta-analysis that found
it would be effective for a subjective
improvement of insomnia, although
quantitative or objective measurements
were yet to demonstrate its effectiveness.10
Steven Chong, BA (Communications), is Editor of
Healthy & Heartwise and Pure Animal, Founding
Editor of The Journal of Complementary Medicine
(2002--2009) and a writer for the Australian Journal of
An exception was a recent two-week
crossover study using passionflower
(Passiflora incarnata) tea (2 g) versus a
parsley placebo tea in healthy volunteers.11
Positive results were only significant on
subjective sleep quality outcomes, however
there was no baseline measurements,
herb standardisation and short duration of
treatment with one treatment per day.
1. Bartlett D. Managing insomnia: What we've learnt in the last 10
years. InPsych Apr 2014, Australian Psychological Society. At:
4 Apr 2015.
2. AZTEC Australian Pharmacy MAT to Dec 2013. Total Sleep Category.
3. National Center for Complementary and Integrative Health.
Valerian. National Institutes of Health, Maryland. At: https://
nccih.nih.gov/health/valerian, accessed 7 April 2015.
4. Ulbricht CE, Basch E (eds). Natural Standard Herb & Supplement
Reference. Valerian. St Louis, Mosby: 2005:753.
5. Zhang A, Story D, Lin V, et al. A population survey on the use of
24 common medicinal herbs in Australia. Pharmacoepidemiol
Drug Saf 2008;17:1006--13.
6. Natural Medicines Comprehensive Database. Valerian. Therapeutic
Research Faculty, reviewed 30/5/2014, accessed 7/4/2015.
7. Braun L, Cohen M. Herbs & Natural Supplements: An evidence-
based guide, 2nd edn. Sydney: Elsevier, 2005.
8. Salter S, Brownie S. Treating primary insomnia: The efficacy of
valerian and hops. Aust Fam Physician 2010;39(6):433--7.
9. Sarris J, Panossian A, Schweitzer I, et al. Herbal medicine
for depression, anxiety and insomnia: A review of
psychopharmacology and clinical evidence. Europ
10. Fernandez-San-Martin MI, Masa-Font R, Palacios-Soler L, et
al. Effectiveness of Valerian on insomnia: A meta-analysis
of randomized placebo-controlled trials. Sleep Med
11. Ngan a, Conduit R. A double-blind, placebo-
controlled investigation of the effects of Passiflora
incarnata (passionflower) herbal tea on subjective sleep quality,
Phytother Res 2011;25(8):1153--9.
To sleep, perchance to dose
BY STEVEN CHONG
This column was supported through an
unrestricted grant from Flordis.
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