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CONTINUING PROFESSIONAL DEVELOPMENT
THE COMPLEMENTARY APPROACH
Alterations in diurnal cortisol levels that are
consistent with changes in hypothalamic-pituitary-
adrenal axis (HPA) regulation result in shorter sleep
duration, lower sleep efficiency, and insomnia.
cortisol is affected by stress, the CAM practitioner
will often focus on addressing stress as a causative
factor in sleep disorders.
As part of an overall strategy, relaxation techniques
may be recommended to assist with emotional
regulation and stress reduction. These may include
meditation, progressive muscle relaxation, deep
breathing, guided imagery, tai chi and yoga.
Mindfulness-based stress reduction (MBSR)
programs have gained particular attention in recent
years with several studies highlighting benefits for
improving sleep duration,
as well as reducing pain
(a common cause of sleep disturbance).
adults, mindfulness interventions are significantly
better than sleep hygiene education in improving
sleep disturbance and related daytime impairment.
Sour cherry (Prunus cerasus) contains both melatonin
and anti-inflammatory substances, and its use has
been associated with modest improvements in self-
reported sleep, although further research is required
to confirm and elucidate the benefits.
Many of the herbal medicines utilised for sleep
disorders have an anxiolytic effect and several have
been investigated for their effects on sleep and
anxiety. These include valerian (Valeriana officinalis),
kava (Piper methysticum) and passionflower
(Passiflora incarnata), which were previously
discussed in detail in Australian Pharmacist (February
Although the evidence is inconclusive, some studies
have reported that 600 mg daily of a concentrated
valerian extract (LI 156) taken for 6 weeks improves
subjective measures of sleep quality and is at least
as efficacious as 10 mg daily of oxazepam taken
for 6 weeks.22 Valerian may be used alone or in
combination with other herbs such as passionflower,
hops and lemon balm.23,24 For some, valerian may
have a paradoxical stimulating effect, and ongoing
use of valerian over several weeks may be required
to experience benefits.
Limited evidence exists for the use of kava in sleep
disturbances associated with anxiety.26,27 When
taken at recommended doses (120–240 mg of
kavalactones daily), kava is likely to be safe, however
use in patients with compromised liver function is
Passionflower is another popular herbal option
for insomnia and anxiety. Anxiolytic effects may
be responsible for improvements in short-term
subjective sleep quality associated with the use of
passionflower tea (2 g daily).
As a general rule, most herbal medicines used for
sleep disturbance tend to be more relaxing, creating
an environment where sleep may come more easily,
rather than overtly sedating. For this reason, they
may not be as effective for acute use as the stronger
pharmaceutical sedative medicines, but also tend to
be less likely to cause next morning drowsiness.
Sleep disorders can cause significant impairment
in daytime functioning and can have an impact
on mood and performance, as well as increasing
the risk of depression and cardiovascular disease.
People with persistent insomnia may benefit from
referral for CBT training, and from recommendations
for sleep hygiene and stress management
strategies. Several herbal medicines have also
been investigated for their use in sleep disorders,
although current evidence is limited and further
high-quality human trials are needed to confirm
effects. These herbs are most likely to be effective
when they address the underlying cause of insomnia
such as anxiety.
herbal option for
Find more information in APF23
Further information about kava (page 487) and valerian (page 505),
including counselling points, is available in the 23rd edition of the
Australian Pharmaceutical Formulary and Handbook (APF23).
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