Complementary and alternative medicine for insomnia Original paper

Although conventional treatment for insomnia often involves pharmacologic interventions, medications used for sleep can cause side effects such as daytime sleepiness and dependence. Therefore, complementary and alternative medicine (CAM) interventions such as herbal treatments, acupuncture, acupressure, yoga, tai chi, and mind-body practices are of interest in treating insomnia.

This systematic review of 35 randomized controlled trials assessed the effects of CAM interventions on improving sleep quality in adults. The authors included interventions classified as “manual practices,” “natural practices,” and “mind-body practices” and excluded psychological and psychoeducational interventions such as cognitive behavioral therapy, relaxation therapy, or mindfulness. They additionally excluded studies assessing bright light treatment, exercise, music therapy, sensory art therapies, aromatherapy, or melatonin, indicating that these therapies were not considered classical CAM interventions. They ultimately included 35 studies, all of which were ≥1 week in duration.

Sleep quality was assessed using a variety of outcome measures, the most common of which were the Pittsburgh Sleep Quality Index and the Insomnia Severity Index.

• Acupressure: Four studies assessed acupressure, all of which reported a positive effect on sleep quality
• Acupuncture: Seven studies assessed acupuncture, 5 of which reported that acupuncture was superior to sham acupuncture, estazolam, or a non-specified control. One study reported that acupuncture was as effective as sleep hygiene advice, and another reported that although estazolam was superior to acupuncture in prolonging sleep time, acupuncture was superior to a nonspecified control group in improving somnipathy (disordered sleep) and daytime functionality.
• Kava and valerian: Three studies assessed Kava and valerian, 2 of which reported no effect on sleep quality. One study reported that Kava was more effective than a placebo in improving sleep quality.
• Tai chi: Five studies assessed tai chi, 4 of which reported that it was superior to exercise or a nonspecified control in improving sleep quality. One study reported that tai chi and exercise were as effective as a waitlist control group in reducing sleep disturbance among participants undergoing radiotherapy for prostate cancer.
• Tryptophan: Three studies assessed tryptophan, all of which reported an improvement in sleep quality.
• Valerian (as a standalone intervention): Six studies assessed valerian, 3 of which reported that valerian was superior to a placebo or nonspecified control group in improving sleep quality.
• Yoga: Seven studies assessed yoga, 6 of which reported that yoga was superior to a nonspecified control or herbal medicine in improving sleep quality.