Sleep: What the Science Says

Good quality, adequate sleep plays an integral role in cellular function and affects numerous body processes, such as immune function, metabolism, and cognitive function, including mood, learning, and memory. (24)(26) Chronic sleep deprivation or poor quality sleep has been associated with cognitive impairment, as well as an increased risk of all-cause mortality and several health conditions, such as obesity, diabetes, depression, hypertension, cardiovascular disease, and cancer. (15)(26)

Unfortunately, the prevalence of sleep disorders in the general population is high. Insomnia, the most common sleep disorder, affects approximately one third of all adults. (5)(21)  One survey conducted in 2007 reported that 56% of individuals living in the United States suffered from sleep difficulties over the previous year. (19

This article provides an overview of sleep disorders and integrative solutions for treatment, including evidence-based dietary supplements and sleep hygiene recommendations. 

Sleep disorders

Together, homeostatic mechanisms and circadian rhythms are responsible for regulating sleep and wakefulness. While sleep-wake homeostasis monitors each individual’s need for sleep, circadian rhythms regulate sleep timing, fluctuations in wakefulness, body temperature, metabolism, and levels of certain hormones. Several neurotransmitters are also involved in the regulation of sleep and wakefulness, including acetylcholine, adrenaline, cortisol, gamma-aminobutyric acid (GABA), histamine, norepinephrine, orexin (hypocretin), and serotonin. (26

Sleep disorders generally occur as a result of abnormalities or dysfunction of physiological pathways involved in sleep, including circadian rhythms (e.g., melatonin levels), cortisol levels, cytokines, excitatory amino acids (e.g., glutamate, aspartate), and GABA receptors. (21) There are approximately 80 different conditions characterized as sleep disorders, insomnia being the most common. Other common sleep conditions include circadian rhythm disorders, insufficient sleep syndrome, and obstructive sleep apnea. (38)

Dr. Holly Lucille discusses integrative solutions for treatment of sleep disorders.

Dietary supplements for sleep

Patients suffering from sleep disorders are often prescribed pharmaceutical medications to address their symptoms, however there remain numerous possible adverse effects related to these interventions. (31) Research has identified a number of evidence-based dietary supplements that may improve sleep. Below, we’ve outlined some of the research supporting the use of a number of these ingredients, including melatonin, magnesium, l-theanine, and various herbs. 

Melatonin

Melatonin is a hormone produced by the pineal gland in response to darkness. It plays an essential role in the regulation of sleep-wake rhythms. (9)(31) For this reason, several studies have examined the use of exogenous melatonin supplementation in the treatment of sleep disorders. In 2017, findings from a meta-analysis examining the therapeutic effects of melatonin supplementation in sleep disorders concluded that melatonin appears to be most effective in the treatment of primary sleep disorders, including primary insomnia and delayed sleep phase syndrome (DSPS), as well as the regulation of sleep-wake patterns in blind patients. (4)

Research also supports the use of melatonin supplementation in cases of beta-blocker-induced insomnia, a common side-effect experienced by patients taking this type of medication. One randomized controlled trial examined the effectiveness of melatonin supplementation in 16 hypertensive patients taking beta-blockers. Over three weeks, patients received 2.5 mg of melatonin or a placebo every night. Results demonstrated improvements in total sleep time and quality following melatonin supplementation. The benefits of supplementation also appeared to be maintained after discontinuation of treatment, indicating a positive carryover effect. (33)

Learn more about melatonin and its clinical applications. 

Magnesium

Magnesium is an essential mineral involved in over three hundred enzymatic reactions in the body. (34) Magnesium may improve insomnia and other sleep-related conditions, (1)(30) such as periodic limb movements during sleep (PLMS) and restless leg syndrome. (14)

A randomized, double-blind, placebo-controlled trial examined the effects of magnesium supplementation in 46 elderly patients with insomnia. Patients received 500 mg per day of magnesium or a placebo for eight weeks. Results demonstrated improvements in subjective measures of insomnia, such as total sleep time, sleep efficiency, sleep onset latency, early morning awakening, and Insomnia Severity Index (ISI) scores. Certain objective measures also improved, including serum renin, cortisol, and melatonin concentrations. (1)

In another seven-week study, 100 adults experiencing poor quality sleep were randomly assigned to receive 320 mg of magnesium citrate per day or a sodium citrate placebo. While overall subjective sleep quality scores improved in both magnesium and placebo groups, the results of the study highlight an association between sleep quality and magnesium status. However, further study is needed to determine cause and effect. (30)

Learn more about magnesium and its clinical applications. 

Image of L-theanine and green tea
L-theanine is an amino acid found in green tea.

L-theanine

L-theanine, an amino acid found in green tea, has been studied for its use in sleep disorders. One clinical trial examined the effects of l-theanine supplementation in patients with major depressive disorder (MDD). For eight weeks, patients were given 250 mg per day of l-theanine in addition to their current medication. Results demonstrated that l-theanine supplementation was well-tolerated and positively affected several symptoms of MDD, including sleep disturbance, indicated by Pittsburgh Sleep Quality Index (PSQI) scores. (13)

The benefits of l-theanine supplementation were also demonstrated in a population of boys with attention-deficit/hyperactivity disorder (ADHD). In a randomized, double-blind, placebo-controlled trial, 98 male children between the ages of eight and 12 were given 400 mg of l-theanine per day in divided doses. After six weeks, those receiving l-theanine supplementation demonstrated better sleep percentage and efficiency scores compared to a placebo. (23)

Lemon balm (Melissa officinalis)

Lemon balm has been suggested as a natural sleep aid due to its anti-stress and anxiolytic properties. In a 15-day prospective, open-label study, participants with sleep disturbances and mild-to-moderate anxiety were given a formulation of lemon balm extract. Results of the study demonstrated the effectiveness of lemon balm in relieving symptoms of anxiety and insomnia. (6) Similarly, a randomized, controlled study, found that 20% of postmenopausal women included in the study experienced an improvement in sleep quality, compared to only 8% of women in the placebo group. (35)

Valerian root (Valeriana officinalis

Valerian root extract is a commonly used sleep aid, and research has shown that supplementing with valerian root may improve sleep quality. Results from a systematic review of randomized, placebo-controlled trials concluded that valerian is safe and effective in improving sleep quality. (5) In one study specifically, 530 mg of valerian root administered twice per day improved sleep quality in 30 percent of postmenopausal women who participated in the study. Comparatively, only four percent of participants in the placebo group demonstrated improvements. (37)

Several studies have also examined the effectiveness of valerian in combination with other herbs, namely hops and lemon balm. Compared to isolated valerian extract, one study found that the combination of valerian and hops extract was superior to placebo in improving sleep latency, while the isolated valerian extract was not. (18) Studies have demonstrated that formulations containing valerian and lemon balm also appear to be effective in improving sleep quality (8) and symptoms of sleep disorders. (25)(36)

Passionflower (Passiflora incarnata)

Passionflower has been used traditionally for its sedative and anxiolytic properties in the treatment of sleep disorders. A double-blind, placebo-controlled study, examined the effects of passionflower tea in 41 participants between the ages of 18 and 35. Participants consumed one cup of tea every day for seven days and kept a sleep diary. Results demonstrated that subjective sleep quality improved significantly compared to placebo. (29

In addition to the ingredients highlights above, other nutrients, herbs, and ingredients have been suggested to improve sleep disorders, including alpha-s1 casein hydrolysate (ACH), (17) GABA, (39) vitamin B6, (20) catnip, chamomile, gotu-kola, lavender, L-tryptophan, skullcap, and 5-hydroxytryptamine (5-HTP). (7

For further guidance on dosing and administration, see Fullscript’s Sleep Support protocol.

Passionflower has been used traditionally for its sedative and anxiolytic properties.

7 lifestyle tips for better sleep

Studies have noted that certain lifestyle practices, collectively referred to as sleep hygiene, are correlated with superior sleep quality. (2) Sleep hygiene is defined as a set of practices and behaviors that help promote adequate and good quality sleep. (3)(28) The recommendations below outline common sleep hygiene practices that may help your patients achieve a better and more restorative night’s sleep.

1. Follow a regular sleep schedule

Insomnia and poor sleep have been associated with an irregular sleep schedule. Establishing a regular bedtime routine, as well as consistent bedtimes and waking times can be helpful. A relaxing bedtime routine may include meditation, light stretching, a warm shower or bath, and autonomous sensory meridian response (ASMR) stimulation. ASMR is a sensory experience triggered by auditory or visual stimuli. It is characterized by a calming “tingling” feeling in the neck or scalp areas. (3)(15)(16)(22)(28)(40)

2. Create an environment conducive to better sleep

Excess noise in the bedroom should be reduced as it may increase nighttime arousals and contribute to insomnia. Engaging in highly demanding activities or using screens (e.g., TV, cellphones, computers) in the bedroom should also be avoided. A proper mattress and pillow, a comfortable temperature (e.g., between 60 and 67 degrees), humidifiers, fans or “white noise” machines, earplugs, and blackout curtains are all techniques that may contribute to a more comfortable and relaxing environment. (3)(15)(16)(28)(40)

3. Avoid stimulants and other substances that may impair sleep

Consuming caffeine, nicotine, and alcohol, particularly close to bedtime, may contribute to sleep difficulties. The effects of caffeinated beverages, such as black tea, coffee, and soda, may last several hours after intake. Citrus fruit and very heavy, rich, or spicy foods may also contribute to sleep disruption in some individuals prone to digestive issues when consumed close to bedtime. Sleep disturbances may also occur as a side-effect of certain over-the-counter medications.  (3)(15)(16)(28)(40)

Image of coffee brewing
Consuming caffeine close to bedtime may contribute to sleep difficulties.

4. Avoid napping during the day

Daytime naps may result in difficulties falling asleep and fragmented sleep patterns, which may contribute to sleep deprivation and insomnia. If a nap is required, the National Sleep Foundation recommends limiting daytime naps to a maximum of 30 minutes. (3)(28)(40)

5. Ensure adequate exposure to sunlight

Exposure to natural light and darkness helps to regulate healthy sleep-wake cycles. (28) Additionally, vitamin D deficiency has been associated with sleep disorders and symptoms, such as short sleep duration, poor sleep quality, and sleepiness. (11) Allowing natural light in the house and spending time outdoors during the day, even in colder climates, may help reduce the risk of vitamin D deficiency, improve sensitivity to light, and help synchronize the body’s circadian rhythms. (10)

Note: Certain individuals may be at an increased risk of vitamin D deficiency, including dark-skinned individuals, aging adults, and individuals with impaired digestion of fat (e.g., inflammatory bowel disease). (27)

6. Engage in regular physical activity

Regular exercise may help improve sleep in both healthy individuals and those with sleep concerns. (15)(28) Strenuous exercise close to bedtime may lead to difficulties falling asleep due to circulating levels of endorphins. (3)(28)

7. Incorporate stress management and relaxation techniques

Psychosocial stress has been shown to negatively impact sleep. (15) To minimize exposure to stress, incorporate stress management and relaxation techniques, such as:

  • Accepting imperfection
  • Balancing time between work and rest
  • Changing negative thought patterns (e.g., through cognitive behavioral therapy (CBT)) (32)
  • Engaging in regular physical activity, at least 30 minutes, three to four times per week (e.g., biking, hiking, jogging, stretching)
  • Establishing a daily routine and daily priorities
  • Finding ways to communicate emotions and concerns 
  • Maintaining a balanced diet
  • Setting realistic goals
  • Utilizing body relaxation exercises (e.g., mindful breathing, progressive muscle relaxation) (12)

To view this content in a summarized format or to share it, download this patient handout on sleep hygiene

The big picture

Sleep disorders, such as insomnia, are commonly associated with negative health outcomes. An integrative approach to the treatment of sleep concerns may include various dietary supplements, such as melatonin, magnesium, l-theanine, and certain herbs. Incorporating sleep hygiene practices into treatment plans may also help your patients achieve better sleep and quality of life, as well as prevent associated health conditions. 

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