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To avoid taking drugs for sleep problems many people turn to complementary and alternative medicine (CAM) treatments such as melatonin, L-tryptophan, kava, acupuncture and Tai Chi. Is there any evidence that any of these work and are they worth trying?

It’s a very common problem

Most people have suffered from sleep problems at one time or another. It is estimated that every year 85% of the adult population experience difficulty with sleeping, and 10% are affected by long-term sleep problems.  Typically the problem is either delay in getting to sleep, or difficulty staying asleep ie waking up and not being able to get back to sleep. 

Apparently sleep problems are more common in women than in men, and are generally first encountered between the ages of 20 and 40.  The problem becomes much more common as people become older.

Relief from insomnia

While there are many effective drugs to treat insomnia, some of these, such as benzodiazepines (e.g. temazepam) have acquired bad reputation for causing ‘hangover’ effects the next day. Many also quickly lead to dependence

As a result some people instead seek help from the realms of complementary and alternative medicine, known as CAM.  

In fact, because of concerns about drug therapy, people are more likely to use CAM for insomnia, than for self-treatment of any other condition.

In a US National Health Interview Survey 4.5% of people admitted to having tried CAM remedies for their insomnia, and it is estimated that the national figure is 1.6 million people using CAM for sleep problems.

In another survey, of people who used CAM for sleep problems, one third to one half reported it as helping a ‘great deal.’ The biggest draw of CAM may be that people believe that even if it does not help, it will not harm.

Which CAM therapies are used for sleep problems?

Of the vast range of CAM therapies, the most popular for insomnia include preparations derived from plants such as valerian and kava; melatonin, L-tryptophan and homeopathy.  There are also physical relaxing therapies, such as yoga, tai chi, massage and aromatherapy, while others seek acupuncture or variations of it like acupressure.

Do CAM therapies work for sleep problems?

A review of a large database of scientific studies on CAM insomnia remedies found that the quality of the studies was generally poor and many were too small for reliable conclusionsto be drawn.  

But of those that were sufficiently rigorous, the strongest evidence was found in support of acupressure for chronic insomnia, and evidence of varying quality was found for acupuncture and L-tryptophan. 

The weakest evidence was for the herb, valerian.

But lack of evidence for other promising therapies such as massage, aromatherapy and homeopathy cannot be taken as meaning they do not work, it just indicates that good quality trial data are lacking.

The most reliable study evidence of effectiveness in treating insomnia is thought to come from polysomnography, the name for sleep studies.  While the study participants sleep, multiple measurements such as breathing, heart rate, and electrical brain activity are taken.

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