For Patients Who Can't Sleep, Could Valerian Help?

Gayle N. Scott, PharmD

Disclosures

January 13, 2017

Question

Herbal infusions or "teas" containing valerian have been promoted to help with insomnia -- but is it safe and effective?

Response from Gayle N. Scott, PharmD
Assistant Professor, Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, Virginia

Herbal Tea vs Herbal Infusion

Strictly speaking, herbal teas for sleep are not teas; they are herbal infusions.

True teas are made from the leaves of the tea plant, Camellia sinensis, and all types of tea—black, green, white, and oolong—contain varying amounts of caffeine (unless chemically decaffeinated). "Tea" has come to mean a beverage prepared by soaking an herb in water, also called "steeping."

So for the linguistic purist, true teas are herbal infusions, but herbal infusions are not necessarily teas. Herbal infusions or "teas" for sleep, which are often blends of herbs, are unlikely to contain caffeine.

What Is Valerian?

Valerian (Valeriana officinalis) is a plant native to Europe and Asia, and naturalized to the United States. Hippocrates described the medicinal uses of the roots and rhizomes of valerian, and Galen wrote about its use for insomnia in the second century AD.[1]

Valerian is added to tea (ie, herbal infusion) products that are marketed to induce sleep (eg, Sleepytime® Extra Herbal Tea by Celestial Seasonings). Unlike true teas, which are marketed as foods, products that contain valerian are marketed in the United States as dietary supplements. Dietary supplement classification allows manufacturers to make structure and function claims, such as "promotes relaxation."

Like other plant products, valerian contains many chemicals, such as valerenic acid and valepotriates, that might contribute, either alone or collectively, to its pharmacologic activity. The mechanism of hypnotic activity is unknown, but increasing levels of gamma-aminobutyric acid (GABA) has been proposed. Activation of GABA receptors induces drowsiness. Whether GABA in valerian can cross the blood/brain barrier is unclear, and GABA concentrations in valerian can vary significantly depending on the time of plant harvesting.[1]

Efficacy and Safety

Clinical studies on the effectiveness of valerian as a hypnotic have yielded mixed results. A valerian extract (530 mg) improved sleep quality in postmenopausal women with sleep disturbances (30% experienced improvement vs 4% with placebo).[2] A trial of patients with sleep disturbances while undergoing cancer chemotherapy found that valerian extract (450 mg) was no better than placebo, but a secondary analysis suggested some improvement in fatigue.[3] A sleep laboratory study of older women with insomnia reported no difference between valerian extract (300 mg) and placebo in a randomized controlled trial.[4] A recent meta-analysis of clinical trials found that the effects of valerian were similar to those of placebo in terms of sleep onset latency, sleep duration, sleep efficiency, sleep quality, or duration of wakefulness after sleep onset.[5]

For short-term use, valerian appears to be safe.[5,6] Most clinical trials on sleep have spanned 4 weeks or less; one study evaluated safety and efficacy for 8 weeks.[3] The safety of long-term continuous use is unknown. The safety of valerian in pregnancy and lactation is also unknown.

Adverse effects associated with valerian have been similar to those of placebo in quality and frequency in clinical trials. Mild gastrointestinal adverse effects, such as diarrhea and nausea, have been reported. Unlike benzodiazepines, valerian causes little to no neurologic impairment.[5,6] A one-time 1600-mg valerian dose did not impair performance in a driving simulator.[7]

Valerian has not been associated with clinically significant drug interactions.[8] In theory, valerian could be additive with other central nervous system depressants, but this has not been demonstrated in clinical research.

Herbal infusions contain low amounts of valerian. For example, Sleepytime Extra Herbal Tea by Celestial Seasonings contains 25 mg of valerian root per tea bag; it also contains chamomile flower (Matricaria recutita) and tilia estrella flower (Ternstroemia pringlei), which is widely used in Mexico as a folk remedy for insomnia. Bedtime® Tea by Yogi Tea contains 20 mg of valerian root plus passion flower plant (Passiflora incarnata) and other herbs. The amount of valerian and the other ingredients that are steeped into the prepared beverage is unknown.

Unlike coffee and tea, herbal infusions marketed for sleep do not contain caffeine and are unlikely to hinder sleep. Valerian appears to be safe for most people, and the small amount of valerian in herbal infusion products further broadens its safety profile.

Remind patients that good sleep hygiene, such as going to bed around the same time every night; avoiding bright light (eg, a computer screen) at bedtime; and relaxing by reading, listening to soothing music, or taking a hot bath, also may be helpful.

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