Alternatives || Valerian, aka "Nature's Valium" -- safe to use, effective? You be the judge

Many people suffering from insomnia turn to alternative medications to help them to either fall asleep or to stay asleep. Valerian is frequently touted as a useful treatment for insomnia, but does it work? Here is a breakdown of Valerian based on information that everyone should consider before taking any kind of over-the-counter supplement. Also, Dr. Timothy Morgenthaler for the Mayo Clinic offers this excellent general advice for people interested in using Valerian as a sleep aid: "Product claims may be misleading. Be a smart consumer and do a little homework. Don't just rely on a product's marketing. Look for objective, research-based information to evaluate a product's claims."

What Valerian is

Botanical illustration of  Valeriana officinalis

Valerian is a flowering plant found in grassland regions. Its root and leaves has been used for centuries to provide relief for insomniacs, often combined with hops or lemon balm to achieve a mild sedative effect. Germany's version of the FDA has approved of Valerian as an effective mild sedative; the USDA lists Valerian as "Generally Recognized As Safe" (GRAS).

How it works
Though the science is inconclusive on how Valerian works, some research shows that it can increase the amount of GABA in the brain much in the same way that some common anti-anxiety drugs work. Endogenous GABA is a chemical component of the brain which regulates nerve cells and promotes calm. Valerian may provide a similar, if lighter, effect on brain chemistry as Xanax or Valium. Some research points to using Valerian to help improve the sleep quality of people who are tapering their use of prescription sleeping pills. Other research points to the possibility that Valerian has no measurable efficacy except that it creates a placebo effect, meaning that the act of taking this medication (or others) is enough to convince the user the treatment is effective.

Research 

• The Natural Medicines Comprehensive Database rates Valerian as "possibly effective" as a treatment for insomnia. 
• "A randomized clinical trial of valerian fails to improve self-reported, polysomnographic, and actigraphic sleep in older women with insomnia." Taibi DM, Vitiello MV, Barsness S, Elmer GW, Anderson GD, Landis CA . Sleep Medicine 10 (2009) 319–328 [PDF]
• "A randomized, double blind, placebo-controlled, prospective clinical study to demonstrate clinical efficacy of a fixed valerian hops extract combination (Ze 91019) in patients suffering from non-organic sleep disorder." Koetter U, Schrader E, Käufeler R, Brattström A. Phytother Res. 2007 Sep;21(9):847-51. (abstract only)
• "A systematic review of valerian as a sleep aid: safe but not effective." Taibi DM, Landis CA, Petry H, Vitiello MV. Sleep Med Rev. 2007 Jun;11(3):209-30. (abstract only)
• "Critical evaluation of the effect of valerian extract on sleep structure and sleep quality." Donath F, Quispe S, Diefenbach K, Maurer A, Fietze I, Roots I. Pharmacopsychiatry. 2000 Mar;33(2):47-53. (abstract only)
• "Medicinal plants for insomnia: a review of their pharmacology, efficacy and tolerability." Wheatley D. J Psychopharmacol. 2005 Jul;19(4):414-21. (abstract only)
• "Valerian for insomnia: a systematic review of randomized clinical trials." Stevinson C, Ernst E. Sleep Med. 2000 Apr 1;1(2):91-99. (abstract only)
• "Valerian overdose: a case report." Willey LB, Mady SP, Cobaugh DJ, Wax PM. Vet Hum Toxicol. 1995 Aug;37(4):364-5. (abstract only)

Dosage

According to research cited at WebMD, dosage to treat inability to sleep is "400-900 mg Valerian extract up to 2 hours before bedtime for as long as 28 days, or Valerian extract 120 mg, with lemon balm extract 80 mg 3 times daily for up to 30 days, or a combination product containing Valerian extract 187 mg plus hops extract 41.9 mg per tablet, 2 tablets at bedtime for 28 days." In all cases, it is recommended that you take Valerian 30 minutes to 2 hours before bedtime.

The University of Maryland Medical Center offers these dosage recommendations: "For insomnia, Valerian may be taken 1 - 2 hours before bedtime, or up to 3 times in the course of the day, with the last dose near bedtime. It may take a few weeks before the effects are felt.

• Tea: Pour 1 cup boiling water over 1 teaspoonful (2 - 3 g) of dried root, steep 5 - 10 minutes.
• Tincture (1:5): 1 - 1 1/2 tsp (4 - 6 mL)
• Fluid extract (1:1): 1/2 - 1 tsp (1 - 2 mL)
• Dry powdered extract (4:1): 250 - 600 mg
• Once sleep improves, keep taking Valerian for 2 - 6 weeks.

Dr. Andrew Weil suggests using "products standardized to 1% valerenic acid."

Side effects

Use of Valerian may cause headache, excitability, uneasiness, insomnia, and next-day "hangover." It may impact performance, so users should not operate machinery or drive while taking Valerian. Pregnant women or women who are breast-feeding should be advised that there isn't enough information about the safety of taking Valerian during these situations to show that it is safe to use. Note that Valerian may depress the central nervous system and should be avoided prior to and during surgery as a safety precaution as it may dangerously impact the body's response to anesthesia.

Risk of addiction

Valerian has not been shown to be overly addictive physiologically, but Dr. Andrew Weil suggests it might become addictive psychologically.

Risk of overdose

Research has not shown evidence of Valerian overdose aside from one case which showed benign results.

Drug interactions

It is recommended that you avoid taking Valerian when drinking alcohol. Other drugs that may interact with Valerian include sedatives in the benzodiazepine and CNS depressant families. It is also important to note that Valerian may decrease the liver's ability to break down other medications, which can lead to unwanted increased effects or side effects from those medications. Dr. Andrew Weil advocates against using Valerian with kava. Other herbs and supplements which might have negative interactions with Valerian include these popular remedies: L-tryptophan, melatonin, St. John's wort, and skullcap (please note that this list is not exhaustive).



Sources consulted

Mayo Clinic/Timothy Morgenthaler, MD || Diseases and Conditions--Insomnia
Medline Plus || Valerian
National Institutes of Health/Office of Dietary Supplements || Valerian
University of Maryland Medical Center || Valerian
WebMD || Valerian
Dr. Andrew Weil || Valerian





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SleepyHeadCENTRAL strongly encourages people with ongoing sleep health problems to approach a medical professional to determine appropriate differential diagnoses and treatment. This post, like all other posts on SHC, is not intended to substitute for medical advice.  

SLEEP Rx || Mother's Little Helper: Things you should know

Worry and stress are as ubiquitous to the parenting landscape as stepping on Legos, cleaning out Cheerios from the backseat of the car, and dealing with seemingly endless bouts of insomnia and sleep deprivation.

Some parents find they are overwhelmed with the burdens of managing family life, especially if they are working part- or full-time, volunteering in the community, or caring for elderly parents as well. Exhausted is perhaps too lightweight a term to describe what it can feel like trying to stay on top of all the tasks that today's parenting lifestyles demand.

Getting enough sleep is perhaps the best way to manage these kinds of day-to-day stresses. But sleep takes time, and in today's time-pressed society, it's the first thing sacrificed to keep up with the demands of raising kids. Perhaps cutting back on commitments or getting more outside help is one solution? This probably won't happen until the opportunity to "enhance" our performance with drugs becomes less socially acceptable.

This is not a new problem. Back in the old days, overwhelmed parents might have taken a nip at the cooking sherry to get through the nerves of the day. Even a cigarette or a pot of coffee could help with exhaustion.

But we've moved on from there in the 21st century. Valium ("Mother's Little Helper") became the housewife's drug of choice in the 1960s as more women entered the workforce or became single parents. Since then, other prescription medicines have become a socially normalized way for parents to find the energy or decompression they need to get through the day.

Opiates like OxyContin or Vicodin, sedatives (think Xanax), even stimulates like Adderall or Ritalin are Mother's latest Little Helpers. Even energy drinks, used purposefully in excess, have become the new amped up alternative to old-fashioned coffee drinking.

How does this kind of "behavior modification" during the day influence sleep?

Too many anti-anxiety or pain-relieving prescription medications (sedatives and opiates) during the day can seriously throw the body's sleep drive off kilter at night, leading to insomnia, which leads to excessive daytime sleepiness. You can see what a terribly endless loop of poor sleep habits might emerge.

Whether used to depress the central nervous system or to manage pain, sedatives and opiates also disrupt sleep architecture, interfere with critical REM sleep and the deeper non-REM stages where all healing and release of human growth hormone occur (read more).

These drugs are not meant to be used on a daily basis, but that doesn't stop a lot of people form using them regularly. And that means the chance of becoming dependent on them is high. If parents opt to stop using these drugs, they can throw their bodies into a terrible state of withdrawal that will further mess with their sleep staging. Also, risky drug interactions (including with alcohol or marijuana) are further reason to avoid using these anti-anxiety or pain management meds off label.

In addition, consider this: many people have sleep breathing issues they are not aware of; taking these meds can be extremely dangerous for them because, while they sleep, the upper airway may become so relaxed that severe sleep apnea and respiratory distress can be a direct result.

Too many stimulants, by the very nature of what they do, will lead to wakefulness at night as well. If one is advised to not have caffeine products after 5pm, just imagine how hard it will be for users of stimulants taken in the late afternoon to fall asleep at a decent hour? Suddenly the kids are in bed, the house is clean, the bills are paid, and it's now 3am and Mom still can't sleep.

Ongoing sleep deprivation from regular stimulant use is guaranteed to show up later in countless dangerous ways: motor vehicle accidents, major errors in judgment during times of stress, the exacerbation of other underlying health conditions and other problems which can only serve to make family life even harder--for everyone.

Parents in 2014 need to rethink sleep as a critical best practice for relieving anxiety and stress. Sleep, exercise and meditation together can work to give the body ample opportunities to detox, heal and manage the daily stresses of parenthood. A strong, well-rested mind and body are always going to manage the challenges of life better than a mind and body which relies on enhancing drugs to achieve artificial energy or relaxation.