Can’t sleep? You’re not alone. Some 70 million Americans have chronic sleep problems, according to the Centers for Disease Control and Prevention. And it’s about far more than feeling tired all the time. Sleep deprivation is a contributor to a host of medical issues ranging from obesity to mental illness to “poor quality of life and well-being.”
That explains the explosive market for prescription drugs that help you sleep. Driven by sales of Lunesta, the prescription sleep aid market hit $1.48 billion in 2013, according to IMS Health.
Prescription sleeping pills may be popular, but they can be dicey—the tales of side effects for drugs like Ambien and Halcion are legendary. This has led many to explore herbs, natural remedies, and over-the-counter products that, in theory, have fewer ill effects. But do they work?
I asked Dr. Shanon Makekau, medical director of the sleep laboratory at the Hawaii Permanente Medical Group, about supplements like valerian root, melatonin, and tryptophan, and whether they have any legitimate medical value. She’s pragmatic. “The bottom line is that the available alternatives are not really rooted in science,” she says. “The studies that are out there, particularly on valerian and chamomile, are limited and small in number, and the results are inconclusive. That being said, I generally tell my patients that if they find a sleep aid anecdotally to be helpful and not harmful, I don’t see anything wrong with it.”
Given some patients’ concern with prescription drugs, Makekau understands the desire for alternatives, but stresses caution. “There are effective prescription medications,” she notes, “but they are associated with negative side effects. But people need to know that even things over the counter can be harmful.” She points to kava (related to severe liver damage) and l-tryptophan (associated with a rare and fatal muscle-jellifying disease called Eosinophilia-myalgia syndrome) as drugs to treat with special caution.
Still, Makekau says most alternative sleep aids are thought to be safe, though they have little scientific backing. The exception is melatonin, which data suggest helps workers who must switch between day and night shifts, and for managing jet lag. “But the effect is very small in comparison to a prescription sleep aid,” she says, “and there’s no long-term safety data.”
“We don’t know how these things work, and there’s no evidence that the effect will predictable or repeatable from person to person,” she says. “If you’re looking for something that’s not prescription-based, have a conversation with your physician up front. The key is finding something that’s safe and doesn’t interact with any other medications you’re taking.”
Given that individuals tend to react differently to these supplements, I wondered how I would fare in a test group of one. I’ve long had trouble sleeping—rousing a lot during the night and waking much too early. I’m not interested in prescription sleep aids or over-the-counter drugs like diphenhydramine (Benadryl and Sominex) or doxylamine (Unisom), which can lead to tolerance issues if taken regularly. However, the thought of taking a chamomile capsule after dinner didn’t seem so bad. So I rounded up eight alternative sleep aids—five single-supplement products and three “cocktails” of a variety of supplements—and took them semi-randomly over the course of about six weeks. The cocktail supplement market is vast, but if you check ingredient labels you’ll find that the three I chose are fairly representative.
Clinicians and drug companies alike generally consider three categories when determining the effectiveness of a sleep aid: how much it shortens the time needed to fall asleep, how much it increases the total amount of sleep experienced, and the severity of drowsiness—the “hangover effect”—experienced the next day.
The quality and depth of sleep can be measured with sleep monitoring equipment; I used a Withings Aura to measure the amount of REM sleep I was getting each night. I then used this information in combination with a daily sleep log (which I highly recommend even if you aren’t experimenting with sleep aids) that I kept throughout the experiment, never taking the same sleep aid for two consecutive nights, and taking nothing at all for many nights to ensure my system was “clean” for the next go-round. In my sleep log, each night I gave the prior night’s sleep a “quality rating” from 1 (nonstop insomnia) to 10 (perfect sleep). As a sort of master measurement of the night, I multiplied this rating by the total amount of sleep I achieved in hours, so a total “sleep score” of 80 points—8 hours of level 10 sleep—would be perfect.
It can’t be noted strenuously enough that this is a thoroughly unscientific test and my experiences should not be seen as representative of how anyone else may respond to these supplements, or as a benchmark for their effectiveness. Rather, my intent is to investigate how widely variable sleep aids like these can be outside of the lab while offering my own anecdotal evidence about what worked as a baseline for further investigation.
As well, remember that many things can impact how you sleep. What you eat, what you drink, evening exercise, late-night brain stimulation (like watching TV or playing games), pets in the room, temperature, ambient noise and light, and who knows what else can each have a severe impact on how well you sleep. Supplements are only one piece of the puzzle, but the question is whether they can genuinely help to overcome those other elements.
Still, consider those elements before thinking about a supplement. “Look at your overall sleep habits and your environment before you engage with a sleep aid,” Makekau says. “Make sleep a priority, get exercise during the day, and avoid things like alcohol and caffeine.”
I investigated five single-product supplements. Prices are approximate based on larger capacity bottles.
• Melatonin (4¢/dose). The big name in alternative sleep aids, this is a hormone that builds in the body as it gets darker outside.
• Valerian Root (8¢/dose). A flowering herb that has sedative effects. The root is powdered and put into a capsule.
• Chamomile (10¢/dose). The same stuff that’s in herbal tea. The flowers of this plant are used for a wide variety of ailments, including indigestion and anxiety.
• Lemon balm (18¢/dose). Also known as Melissa. It’s part of the mint family (not the lemon family) and finds a home in aromatherapy and culinary uses. Tea made from lemon balm is used as a mild sedative.
• L-tryptophan (45¢/dose). An amino acid and a precursor to serotonin and melatonin in the brain. Famously thought to be in high concentrations in turkey (but not really), it’s also used to improve mood.
The three “cocktails” I sampled included these products:
• Somnis (30¢/dose). A mix of L-tryptophan, melatonin, and gamma aminobutyric acid (GABA).
• Serenity ($1.33/dose). Valerian root, passion flower extract, magnolia bark, jujube, chamomile, L-theanine, 5-HTP, melatonin, and something called BioPerine (a black pepper extract), plus a smattering of vitamins.
• Luna (73¢/dose). L-theanine, valerian root, chamomile, passion flower, lemon balm, hops flower, L-taurine, and melatonin, plus magnesium.
After weeks of testing, my personal results were far from what I expected. The biggest surprise was that, based on my sleep log and the Aura data, I found I’d been sleeping better than I thought, even when I didn’t take anything. With no supplement, I was getting a baseline of 6.85 hours of sleep at an average 6.6 quality rating for a total sleep score of 46 points. Not bad, and the Aura reported 1.46 hours of REM sleep each night, which was also surprisingly good.
When looking at the overall amount of sleep I got while using a single supplement, L-tryptophan came out on top. On nights I took L-tryptophan, I got 7.53 hours of sleep, significantly above any other alternative. The downside was the quality of that sleep, which I rated at only a 6.5, for an average sleep score of 49 points. That’s all pretty good, but the whole jellied muscles business put me off a bit, so ultimately I’m not sure it’s a great option for sustained use.
How about sleep quality? Looking at all the single-product supplements, chamomile gave me the soundest night’s sleep—so deep one night that my wife reported she was unable to rouse me during a snoring jag. I gave those nights an average quality rating of 7.3, and the 7.18 average hours of sleep I got was also noticeably higher than the no-meds nights. The net sleep score of 52 points earned chamomile the top spot among the single-supplement products.
Surprisingly, none of the other three supplements were effective for me, and all netted lower total sleep times and lower quality ratings than using nothing at all.
Melatonin was the big surprise. Some of my worst nights I experienced during testing were ones in which I’d taken this drug. After melatonin, I tossed and turned in bed, waking repeatedly throughout the night—once close to a dozen times. The next morning I invariably experienced a severe hangover effect, groggy for hours.
Valerian was not much better. On this drug I experienced wild dreams, lots of waking, and extreme next-morning fatigue. The valerian pills also smelled awful, like pungent, wet cardboard, a problem not to be underestimated when you have to choke it down at bedtime. But the absolute worst was lemon balm. The first night I tried it I woke repeatedly with an unbearably full bladder. Three lengthy trips to the bathroom later, lemon balm’s apparent diuretic effect started causing significant concern. I discontinued it soon after for fear of kidney damage or worse.
The three cocktails performed better than most of the individual supplements, but only Serenity and Luna did significantly better at giving me extra time asleep, and only Serenity offered any improvement in sleep quality. In fact, Serenity provided some of my best numbers across the board—7.26 hours of total sleep, 1.80 hours of REM sleep (vs. 1.46 hours with no supplement), a 7.7 sleep quality rating, and a total sleep score of 56. The only problem is that, as with valerian, Serenity smells so hideous it is physically difficult to choke down. At $1.33 per dose, it’s by far the most expensive solution I tested.
Luna had similar total sleep numbers to Serenity, but provided less REM and only a 6.4 quality rating for a net sleep score of 46, the same as sleeping without a supplement. Somnis’s 6.88 total sleep hours made it an also ran—largely thanks to one night where I spent more than two hours trying to get to sleep—with a total sleep score of 43.
What happens now? While I’ll probably keep both Serenity and chamomile in my arsenal in case of insomnia—and to attempt to help with jet lag when traveling internationally—I’m not planning to take any of these supplements on a regular basis, as it seems, in the end, I sleep well enough without them. Just remember that if you decide to try any of these for yourself, your mileage will, without a doubt, vary.