Whether meditating before bed or sipping a kava kava nightcap, more than 1.6 million Americans use some form of alternative medicine when they have trouble sleeping.
In analyzing data from 31,000 Americans interviewed for the 2002 National Health Interview Survey, researchers found that nearly one-fifth of adults reported difficulty sleeping in the last 12 months, and of those, about 5% used complementary and alternative medicine to treat their sleeplessness. The majority of those who tried the therapies said they helped, with nearly half saying they helped "a great deal."
Nearly 65% of people using alternative methods to help them sleep used "biological therapies," such as herbs or supplements, and 39% used "mind-body therapies," such as self-hypnosis, guided imagery or other relaxation techniques.
The findings also shed some light on why people turn to complementary and alternative medicine to treat their sleep problems. Forty percent of those who tried alternative therapies said they had not found conventional treatments helpful. Thirty-five percent said their doctor had suggested the approach. One-quarter thought conventional medicine was too expensive, and two-thirds thought it would be "interesting to try."
The report, published last week in the Archives of Internal Medicine, was part of a larger look at the nation's sleep habits. Researchers also found a strong connection between reports of insomnia or sleep troubles and other health conditions, such as obesity, hypertension, congestive heart failure and anxiety or depression.
"This is giving us a nice snapshot of the characteristics of people who have insomnia in general, as well as those who use complementary and alternative medicine for insomnia and sleep problems," said Richard Nahin, senior advisor for scientific coordination and research at the National Center for Complementary and Alternative Medicine.
Although the report didn't rank the popularity of specific herbal or behavioral remedies, doctors who recommend complementary and alternative medicine said some alternative therapies -- such as melatonin, kava kava and valerian -- can be effective in treating sleep problems and are typically safer than sleep drugs.
"People are aware that a lot of conventional therapies do have side effects, and there is a potential for a dependency to develop," said Dr. Mary Hardy, director of integrative medicine at the Ted Mann Family Resource Center at UCLA's Jonsson Comprehensive Cancer Center. "If they want to be able to take something on a regular basis, they look to natural therapies to help with that."
Dr. Jay Udani, who runs the Integrative Medicine Program at the Northridge Hospital Medical Center, said he would recommend anyone with sleep problems start with mind-body techniques such as self-hypnosis, meditation or guided imagery. If that were not sufficient, he might recommend mind-body techniques combined with an herbal remedy -- and melatonin would be his first choice. Even a low dose (1 to 5 milligrams) of melatonin can be effective, he says.
But doctors cautioned against mixing sleep-inducing herbs or supplements with sleep drugs. Consumers should talk with their physicians first, they said.
Dr. Soram Khalsa, an internist at Cedars-Sinai Medical Center who has integrated natural and conventional medicine for the last 30 years, said he often recommends tryptophan and theanine, two amino acids that can be bought over the counter. He said peri-menopausal women who have a slight hormonal imbalance -- they are low in progesterone relative to estrogen -- might benefit from natural progesterone before bed. He also recommends meditating at night.
"If you meditate for even 15 minutes with some deep breathing, that will help induce the alpha rhythm brain wave which will help you sleep," he said.
Hardy said her recommendations depend on the sleep disorder. People who have trouble falling asleep because of anxiety should consider relaxation therapies, such as meditation, or calming yoga poses before bed, she says. Aromatherapy, such as lavender or geranium oils, can also help, she added, as can a pre-bedtime snack of foods that promote the release of seratonin, such as crackers, bread, tuna or a little milk.
Hops can be helpful, but valerian is the single best herbal medicine for sleep, Hardy said, because it doesn't excessively sedate, and over time it helps restore normal "sleep architecture." She said the herb is best for those who fall into a deep sleep, but wake up not feeling rested.
The new data will help generate more interest in complementary and alternative medicine and sleep disorders, Nahin said, particularly in the realm of mind-body therapies.