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natural sleep aids : which ones work?

the COVID-19 lockdown has impacted people's sleeping patterns, with more than 33% of 12,000 respondents in 6 countries saying they go to bed later than usual and 20% saying they find it harder to sleep [1]. Here is a review of how nutrition and stress reduction can improve sleep duration, sleep latency (the length of time taken to fall asleep), and sleep quality.

melatonin reduces the time taken to fall asleep.

melatonin is the bodies sleep hormone. It is triggered by photosensitive receptors in the eyes that detect a reduction in UV light and this evolutionary adaptation converts the brains store of serotonin into melatonin [2]

orally ingested melatonin has been shown to benefit people with sleep disorders and 5mg of melatonin 30 minutes before bed can benefit patients suffering from insomnia [7]. A 2014 review of melatonin studies also concluded participants who took melatonin on average fell to sleep 7 minutes earlier, slept 8 minutes longer, and had an improved quality of sleep [6]. However, whilst synthetic melatonin or natural forms extracted from the pineal gland of pigs are wildly available as a dietary supplement in the US & EU, in the UK it has been classed as a medicine since 1995.

how else can you increase melatonin?

serotonin is the building block to melatonin [8] and it's produced in the brain from tryptophan which is readily available in protein rich-foods [9]. Tryptophan has a challenge in increasing serotonin in the brain as it is unable to freely cross the blood-brain-barrier without binding to a transporter molecule and needs to be converted to 5-HTP before serotonin (5-HT)

5-HTP is an amino acid that can be taken as a food supplement,  it freely crosses the blood-brain-barrier and it is the immediate building block of serotonin so it is a more effective serotonin precursor. Research suggests that 100mg 5-HTP may be helpful before bedtime [11].

can products aimed at relaxation help you sleep?

there are a number of non-sedative, non-drowsy products which are frequently reviewed as a solution for sleep. It is important to note that none of the following play a role in melatonin production, release but they focus on an alternative mechanism of action – the bodies stress response.

what is the impact of stress on sleep?

a study published in the Frontiers in Neuroscience demonstrated that stress in healthy adults led to longer sleep latencies and sleep disturbances [13] whilst high cortisol levels have been shown to reduce sleep duration by 1.5 – 2 hours [14] and as much as 5 hours in stressed workers [15].

theanine aids relaxation without sedation

theanine increases the relative concentration of GABA and decreases the impact of the excitatory pathway, glutamate, in the brain. GABA's primary role in the nervous system is to promote relaxation without sedation. Some studies suggest that L-theanine can limit the stress response by reducing blood pressure, heart rate, and muscle contraction [16].

when GABA is broken down in the muscles it also aids relaxation and therefore the prevailing theory suggests that it may help you to sleep better. At the National Institute of Mental Health & the National Centre of Neurology and Psychiatry in Japan, 200mg of theanine 1 hour before bed showed improved sleep quality [17] whilst the same dose of theanine for 4 weeks appears to reduce sleep latency but has no impact on sleep duration [18].

what about magnesium?

the evidence is inconclusive for magnesium preparations, such as bath salts or supplements for relaxation [19]. A single short-term study did demonstrate that patients with insomnia who consumed 500mg magnesium slept longer and took less time to fall asleep [20]. However, 500mg is 42% higher than the EU's safe upper limit for magnesium for men (350mg/day) and over 57% for women (300mg/day) [21].

valerian root

a limited body of evidence showed that people with and without sleep problems that consumed valerian root had improved sleep quality and fell asleep 16 minutes faster [22]. As promising as this seems, some research suggests it has no benefits on sleep, such as sleep duration and there is a fundamental research challenge when comparing herbal remedy studies. Valerian contains 150 different compounds which can alter depending on the growing region, soil and climate [23].

does camomile help you to fall asleep?

camomile contains a compound called apigenin, a mild sedative with a similar lock and key effect to drugs used to treat insomnia [24]. Camomile preparations, such as teas and essential oils, have a historical use to calm nerves to treat insomnia [25] and is considered to be a natural sleep aid. However, the evidence for effective camomile extracts on sleep is limited. Adults with insomnia that consumed 270mg camomile twice daily for 28 days experienced no benefits on sleep duration [26] but elderly people that consumed 200mg camomile experience better sleep [27]. Further clinical research is needed to confirm the mechanism of apigenin in camomile and the recommended dose of camomile to reap sleep benefits.

what else can be done to improve sleep?

cut off caffeine a minimum of 6 hours before bedtime [28 ]. Caffeine has been shown to increase the time taken to fall asleep and disrupt sleep quality [29]. Avoid eating sugar 2 hours before bed [30] and reduce screen time before you go to bed. The blue light emitted from electronic devices can reduce or delay the production of melatonin [32].

[1]Roy, S. (2020) Here's What 12,000 Respondents in 6 Countries Say About Their Sleep During the Pandemic. Sleep Review. [2]Zhao et al. (2019) Melatonin Synthesis and Function: Evolution History in Animals and Plants. Frontiers in Endocrinology. [3]National Centre for Complementary and Integrative Health (2021) Melatonin what you need to know. [4]The Guardian (2018) Losing sleep over the illegal sale on melatonin on eBay. [5]National Institute for Health and Care Excellence (2013) Sleep disorders in children and young people with attention deficit hyperactivity disorder: melatonin. [6]Ferracioli-Oda et al. (2013) Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders. PLoS One. [7]Costello et al. (2014) The effectiveness of melatonin for promoting healthy sleep: a rapid evidence assessment of the literature. Nutrition Journal[8]Paredes et al. (2009) Assessment of the Potential Role of Tryptophan as the Precursor of Serotonin and Melatonin for the Aged Sleep-wake Cycle and Immune Function: Streptopelia Risoria as a Model. International Journal of Tryptophan Research. [9]WebMD (2019) Top foods high in tryptophan. [10]Wyatt et al. (1971) Effects of 5-hydroxytryptophan on the sleep of normal human subject. Electroencephalography and Clinical Neurophysiology. [11]Birdsall, T.C. (2014) 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Alternative Medicine Review: a Journal of Clinical Therapeutic. [12]Psypost (2020) Neuroscience study uncovers new details about intimate link between sleep and anxiety. [13]Goldberg et al. (2020) Bedtime Stress Increases Sleep Latency and Impairs Next-Day Prospective Memory Performance. Frontiers in Neuroscience. [14]Hirotsu et al (2015) Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Science. [15]Choi et al. (2018) Association between Sleep Duration and Perceived Stress: Salaried Worker in Circumstances of High Workload. International Journal of Environmental Research and Public Health. [16]Adhikary et al (2017) L-theanine: A potential multifaceted natural bioactive amide as health supplement. Asian Pacific Journal of Tropical Biomedicine. [17]Rao et al. (2015) In Search of a Safe Natural Sleep Aid. Journal of the American College of Nutrition. [18]Hidese et al. (2019) Effects of L-Theanine Administration on Stress-Related Symptoms and Cognitive Functions in Healthy Adults: A Randomized Controlled Trial. Nutrients. [19]WebMd (2017) Why take an epsom salt bath?[16]Boyle et al. (2017) The Effects of Magnesium Supplementation on Subjective Anxiety and Stress—A Systematic Review. Nutrients. [20]Abbasi et al. (2012) The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. Journal of Research in Medical Sciences. [21]European Food Safety Authority (2015) Scientific Opinion on Dietary Reference Values for magnesium. [22]Bent et al. (2006) Valerian for Sleep: A Systematic Review and Meta-Analysis. American Journal of Medicine. [23]Chen et al. (2015) Chemical Components and Cardiovascular Activities of Valeriana spp. Evidence-Based Complementary and Alternative Medicine. [24]The Conversation (2021) Having trouble sleeping? Here's the science on 3 traditional bedtime remedies. [25]Srivastava et al. (2010) Chamomile: A herbal medicine of the past with bright future. Molecular Medical Reports. [26]Zick et al. (2011) Preliminary examination of the efficacy and safety of standardised chamomile extract for chronic primary insomnia: a randomised placebo-controlled pilot study. BMC Alternative Medicine. [27]HajbagherySeyedh, M. and NesaMousavi, N. (2017) The effects of chamomile extract on sleep quality among elderly people: A clinical trial. Complementary Therapies in Medicine.  [28]Sleep Foundation How much caffeine is safe to drink? [29]Clark et al. (2017) Coffee, caffeine, and sleep: A systematic review of epidemiological studies and randomized controlled trials. Sleep Medicine Reviews. [30]The Guardian (2020) The alarming truth about how sugar ruins your sleep. [31]Roy, S. Research Sheds Light on Artificial Sweeteners' Impact in Brain, Including How They Promote Insomnia. Sleep Review. [32]Sleep Foundation (2020) How electronics affect sleep. 

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