Updated: Sep 12, 2018
One of my biggest personal issues has always been sleep. Which, coincidentally, is always what students never get enough of. Not a great situation for someone pursuing 8+ years of college education, right? When constant thoughts are keeping you awake (even on good nights) and you’re finding yourself up two, three or even four times a night with no ease drifting back off, any added stress isn’t going to help. In my undergraduate days, I tried every pharmaceutical sleep aid in the books. I was desperate to get some rest instead of staying up in what I called “zombie mode” for days on end, and was willing to try any medication the medical world could come up with.
I feel the need to preface that I’m in no way saying prescription sleep aids can’t be helpful. I believe there’s a time and place for everything, and pharmaceuticals can be life-saving when used appropriately. But when we’re discussing the effectiveness of medicine (both pharmaceutical and botanical) it often comes down to an important and commonly overlooked factor: individual biochemistry. Another factor is weighing the positives of a medication vs the negatives of side effects, which for some medications can be pretty significant. So, whether it be my personal chemistry, lifestyle, or a hot mess of other combined factors, my experience with pharmaceutical sleep aids ended up being a disaster. Some helped, some didn’t, some helped TOO well and made we want to sleep three days straight, and with others, the side effects felt worse than the problem. Even when I found a medication I thought was finally (FINALLY) working for me, and I woke up refreshed in the morning thinking “THIS is what everyone else gets to feel like every day?!” it wasn't long before that honeymoon phase came crashing down, too.
After about eight months, I realized my prescription was impairing my ability to retain information (a well-documented effect of long-term benzodiazepine use) to the point where I was sitting down for tests and completely blanking on questions despite hours of studying. As a pre-med student, this was a horrifying connection to make. But at the time, I had no idea what to use as an alternative. I tried to use the prescription as little as possible, but I felt stuck in a no-win situation: either I didn’t use the medication, couldn’t sleep, and my grades tanked. Or I used the prescription, slept, and 90% of what I studied seemed to slide right out of my brain.
Before Naturopathic Medical school, I had tried a handful of natural sleeping aids to (sadly) no avail. Melatonin made my already vivid dreams horrendous nightmares. Chamomile barely took the edge off. Mindfulness wasn’t cutting it (or really, my attempt at it, but more on that in the future.) Soon enough, I was back to the “no sleep and then give in and take my prescription when I couldn’t handle it anymore” pattern, and I wasn’t too happy about it. Lucky for me, I had barely even scratched the surface of the potentials of nutraceuticals, supplements, and botanical medicine.
The first key for sleep relief in my personal journey for Zzz’s came when we reached the “Nervine Botanicals” unit of our botanical medicine class. I was introduced to my new personal Medical School BFF and master of calming the sympathetic “fight or flight” stress response, Passiflora incarnata. Now, as I previously mentioned, the efficacy of anything depends on your personal biochemistry. For me and for many people I know, a little bit of passionflower extract was exactly what was needed to ease the underlying anxiety that was keeping me from falling asleep at night. The efficacy of Passiflora has been well documented in modern scientific research. Clinical trials cite significant benefit in its use for various anxiety disorders, which for a stressed out medical student felt like an absolute godsend. I felt no haze, I felt no drowsiness, but I felt this untouchable calm that even traffic on the parkway couldn’t shake. I didn’t go into natural medicine with any knowledge of plants beyond what makes pasta sauce taste good. But, from the moment I tried passionflower, I was hooked on what a big impact botanical medicine can make on issues we sometimes start to believe we’ll just be stuck with forever.
There’s an entire world of herbal medicine that fits into the category of “nervines.” A nervine, aptly named, works to calm the nerves. In herbal medicine, a nervine is considered any plant that works to benefit the nervous system, which is an open-ended sort of definition, with the main point being that both coffee AND passionflower both have a home in this family. I’m sure you can imagine that one might work better than the other in times of stress, and thus passionflower belongs to the subcategory of nervine herbs referred to as relaxants. They’re widely considered our greatest herbal alternative to taking a literal “chill pill,” and at high doses can work as a sedative or hypnotic. Other plants that belong to this category include Lavender, Lemon balm, Hops, and Kava.
Kava, in particular, seems to be enjoying a recent upsurge in popularity, with “Kava Bars” opening up across the United States serving drinks infused with the herb in place of alcohol. Kava, or Piper methysticum, has been the subject of a number of recent studies investigating its effectiveness and safety. One study (a six-week long, double-blind, randomized control trial) was conducted where participants with a diagnosed generalized anxiety disorder were given either a daily dose of kava or a placebo pill. The results? No findings pointed to the liver being negatively impacted or aggravated by the herb, and no other significant unfavorable reactions could be contributed to the kava use.
A huge plus from the study was that no connection with addiction or withdrawal was observed in the kava group. The researchers were also interested to see that daily kava use seemed to significantly increase sexual drive in female participants compared to placebo (according to the Arizona Sexual Experience Scale, used in studies to gauge sexual function), with no negative effects seen in the sexual drive of the male population of the study. Considering many anti-anxiety drugs come with the common side effect of sexual dysfunction, that’s a pretty significant finding. Most interestingly, the kava study found that there was a highly significant correlation between this improved sexual function and anxiety reduction in the whole sample population. Which just goes to show, the right treatment can go a long way.
If you’re interested in exploring herbal therapy for your sleep issues, discuss with your local Naturopathic doctor or Functional Medicine practitioner what approach is right for you. Check out next weeks post for Part 2, where I’ll get into the herbs I found that help best with the challenge of staying asleep, and the science behind why they work!
*Though based in research, personal, and clinical experience, the opinions in this article should not be taken as medical advice. Botanical medicine and nutriceuticals should be treated with the same caution and care as pharmaceuticals, as both have the potential for strong, potentially adverse effects and allergic reactions. Please consult a trained herbal medicine practitioner, licensed Naturopathic Doctor, or licensed Doctor of Traditional Chinese Medicine before attempting treatment.
Crowe, S. F., & Stranks, E. K. (2017). The Residual Medium and Long-term Cognitive Effects of Benzodiazepine Use: An Updated Meta-analysis. Archives of Clinical Neuropsychology. https://www.ncbi.nlm.nih.gov/pubmed/29244060
Sarris, J. (2018). Herbal medicines in the treatment of psychiatric disorders: 10‐year updated review. Phytotherapy Research. https://www.ncbi.nlm.nih.gov/pubmed/29575228
Sarris, J., Stough, C., Teschke, R., Wahid, Z. T., Bousman, C. A., Murray, G., ... & Schweitzer, I. (2013). Kava for the treatment of generalized anxiety disorder RCT: analysis of adverse reactions, liver function, addiction, and sexual effects. Phytotherapy Research, 27(11), 1723-1728. https://www.ncbi.nlm.nih.gov/pubmed/23348842