Which alternative therapies are used for the treatment of insomnia?

5-HTP (5-hydroxytryptophan): 5-HTP is the precursor of the neurotransmitter serotonin. It is obtained commercially from the seeds of the plant Griffonia simplicifolia. Although many naturopathic regimens for sleep include 5-HTP, there is insufficient evidence in its use for sleep disorders. Additional studies are needed before a conclusion can be drawn. 5-HTP may cause drug interaction with medications such as antidepressants and sleep medicines. 5-HTP is not recommended during pregnancy or breastfeeding, unless otherwise advised by a doctor.    

Acupressure, Shiatsu: Shiatsu literally means finger (Shi) pressure (Atsu) in Japanese. Shiatsu technique involves finger pressure at acupoints and along body meridians (divisions). It can incorporate palm pressure, stretching, massaging and other manual techniques. Preliminary research supports the use of acupressure for improving sleep quality in elderly patients and possibly in healthy adults of all ages. Better-designed trials are needed to support these results. A small study reports that acupressure may also provide early prevention and treatment for sleep apnea, a common cause of insomnia.

Acupuncture: The practice of acupuncture, or the insertion of needles, originated in China 5,000 years ago. Traditional Chinese medicine commonly uses acupuncture to treat insomnia. A review of the available studies found reports of benefit, but major weaknesses in the design of the research makes the evidence insufficient for or against acupuncture for insomnia.

Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. The oils are applied to the skin, sprayed in the air, or inhaled. Based on human use, lavender and chamomile aromatherapy are thought to be effective sleep-aids. Although preliminary small studies suggest some hypnotic effects, there have been no well-designed human trials. Further research is needed. Do not use essential oils (aromatherapy) internally.

Ayurveda: Ayurveda, which originated in ancient India over 5,000 years ago, is probably the world's oldest system of natural medicine. There is evidence from one well-designed study that a traditional Ayurvedic formula (Blissful Sleep®, Maharishi Ayurvedic Products International) containing valerian (Valeriana wallichi), rose petals (Rosa centifolia), muskroot (Nardostachys jatamansi), heart-leaved moonseed (Tinospora cordifolia), winter cherry (Withania somnifera), pepper (Piper nigrum), ginger (Zingibar officinalis), aloeweed (Convolvulus pluricalis), and licorice root (Glycyrrhiza glabra) may decrease sleep latency (time needed to get to sleep) in people with sleep-onset insomnia, with no side effects. Further research is needed to confirm these results. 

Chamomile: Chamomile (Matricaria recutita) has been used medicinally for thousands of years, and is widely used in Europe. Traditionally, chamomile preparations, such as tea and essential oil aromatherapy, have been used for insomnia and sedation (calming effects). Better research is needed. Chamomile is not recommended for individuals allergic to flowers in the daisy family, or during pregnancy or breastfeeding, unless otherwise advised by a doctor.

Chiropractic: Chiropractic healthcare is a discipline that focuses on the relationship between musculoskeletal structure (primarily the spine) and body function (as coordinated by the nervous system), and how this relationship affects the preservation and restoration of health. The broad term "spinal manipulative therapy" incorporates all types of manual techniques, including chiropractic. Although physical manipulation is used traditionally for jet lag, there is not enough reliable scientific evidence.

Guided imagery: Therapeutic guided imagery uses the power of the imagination as a healing tool. Guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Early research supports the value of combined pharmacotherapy and relaxation training in the treatment of insomnia. Further research is necessary.

Hops: Animal studies and traditional uses of hops include insomnia, sedation, and alcoholic beverage production. Hops may have sedative and sleep-enhancing (hypnotic) effects. However, little human research has evaluated the effects of hops on sleep quality. Further study is needed in this area. Hops may cause drowsiness, so caution is used when operating an automobile or heavy machinery. Hops supplements are not recommended during pregnancy or breastfeeding, unless otherwise advised by a doctor.    

Hypnotherapy: Hypnotherapy or hypnosis uses the power of suggestion to help individuals overcome all types of adversity, including health issues such as insomnia. Several early studies report that hypnosis may decrease the amount of time it takes to fall asleep, increase the duration of sleep, and improve sleep quality. However, this research is not well designed or reported, and cannot be considered definitive.

Kundalini yoga: Kundalini yoga is one of many traditions of yoga that share common roots in ancient Indian philosophy. It is comprehensive in that it combines physical poses with breath control exercises, chanting (mantras), meditations, prayer, visualizations, and guided relaxation. One small study suggests improved sleep quality with the help of a regime of Kundalini yoga practices. However, there is insufficient evidence for or against this intervention for insomnia.    

Lemon balm: Lemon balm (Melissa officinalis) is a commonly used herb with a lemon like smell. High-quality clinical evidence supporting the use of lemon balm as a sedative/hypnotic is lacking, although it has been used with positive results with valerian for sleep. Rigorous clinical studies are required to better support the use of lemon balm as a sedative/hypnotic.

Melatonin: The natural hormone known as melatonin helps regulate the sleep/wake cycles (circadian rhythm). Certain diseases such as cancer, prescription medications such as benzodiazepines, and age may decrease melatonin levels. Melatonin is used to help regulate sleep due to jet lag, delayed sleep phase syndrome (DSPS), sleep disturbances in children with neuro-psychiatric disorders including attention deficit hyperactivity disorder (ADHD), bipolar disorder, mental illness such as schizophrenia and depression, REM sleep behavior disorder, asthma, and work shift disorder. Multiple human studies have measured the effects of melatonin supplements on sleep in healthy individuals. Melatonin is often taken by mouth, 30 to 60 minutes prior to sleep time. Most trials have been small, brief in duration, and have not been rigorously designed or reported. However, the weight of scientific evidence does suggest that melatonin decreases the time it takes to fall asleep ("sleep latency"), increases the feeling of "sleepiness," and may increase the duration of sleep. Caution is advised when taking melatonin supplements, as numerous adverse effects including drug interactions are possible. Melatonin is not recommended during pregnancy or breastfeeding, unless otherwise advised by a doctor. Melatonin should not be used long-term (nightly for more than four weeks).

Music therapy: Music is used to influence physical, emotional, cognitive and social well-being, and improve quality of life for healthy people, as well as those who are disabled or ill. It may involve either listening to or performing music, with or without the presence of a music therapist. In older adults music may result in significantly better sleep quality as well as longer sleep duration, greater sleep efficiency, shorter time needed to fall asleep, less sleep disturbance and less daytime dysfunction. There is also evidence of benefit in elementary age children who use music during naptime and bedtime.    

Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. Most techniques share the components of repetitive focus (on a word, sound, prayer phrase, body sensation, or muscular activity), adoption of a passive attitude towards intruding thoughts, and return to the focus. Several human trials suggest that relaxation techniques may be beneficial in people with insomnia, although effects appear to be short-lived. Research suggests that relaxation techniques may produce improvements in some aspects of sleep such as sleep latency and time awake after sleep onset. Better research is necessary before a firm conclusion can be drawn.

Valerian: Valerian root (Valerian officinalis) has been used as a sedative and anti-anxiety treatment for more than 2,000 years. Several studies in adults suggest that valerian may improve the quality of sleep and reduce the time to fall asleep (sleep latency), for up to four to six weeks. Ongoing nightly use may be more effective than single-dose use, with effects increasing and then leveling out over the first four weeks of use. Better effects have been found in poor sleepers. However, most studies have not used scientific ways of measuring sleep improvements, such as sleep pattern data in a sleep laboratory. Caution is advised when taking valerian supplements, as numerous adverse effects including drowsiness and drug interactions are possible. Caution is also advised when operating heavy machinery or an automobile if taking valerian supplements. Valerian is not recommended during pregnancy or breastfeeding, unless otherwise advised by a doctor.

Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Preliminary research reports that yoga may benefit sleep efficiency, total sleep time, number of awakenings, and quality of sleep. Well-designed research is necessary before a firm recommendation can be made.

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