The Big Problem With Natural Sleep Supplements
At a time when people are becoming more health conscious by the day, the market for nutritional supplements has never been stronger. In the U.S. alone, supplements are a $30 billion-dollar industry, with surveys suggesting that at least 52% of Americans consume these products as part of their diet. In addition, supplements are playing a bigger role in mainstream medical treatment, with one poll showing that 95% of physicians recommend vitamins or minerals to their patients, and 45% recommend herbal supplements.
The risk of supplements
However, many researchers warn that—except for patients with severe nutrient deficiencies—supplements carry more risks than rewards. As it stands, the industry is almost completely unregulated. The problem stems mostly from a law passed in 1994 that lowered the burden of proof for supplement manufacturers, allowing them to market their products as healthy without having to submit evidence to the FDA. As long as companies don't claim their supplements can “treat" specific conditions, and as long as the product isn't mislabelled or dangerous, supplements can be marketed in whatever way the company sees fit. After the law passed, supplement sales skyrocketed.
Since supplements don't undergo rigorous testing before release, they're recalled only after they've been shown to be dangerous to consumers. And the dangers are real. The CDC estimates that dietary supplements (mostly those marketed for weight loss or fatigue) are responsible for roughly 23,000 ER visits annually. An investigation published in the New England Journal of Medicine in the 1990s found that 70 brands of calcium supplements were contaminated with lead. In 2014, a premature infant died after nurses fed him a probiotic tainted with a rare fungus. Even aside from a general lack of proven benefits, tests show that supplements often don't contain what their labels indicate.
What about natural sleep supplements?
Doctors express similar concerns about natural sleep supplements. The problem is that there isn't enough research to support most claims made for these products, and even when research exists, it's often inconclusive or untrustworthy. For example, one study claims to show that glycine—an amino acid—is beneficial for sleep. However, the study was conducted by a company that manufactures amino acids like glycine, and the test subjects (all seven of them) were employees of that same company. Nevertheless, a quick Google search for glycine will net dozens of results touting its benefits as a sleep supplement and for health in general.
For their part, the National Sleep Foundation (NSF) offers several precautions when considering over-the-counter sleep aids. At all points they stress close collaboration with your doctor, and suggest exhausting other available medical and non-medical approaches before resorting to natural sleep supplements. Sleep aids, they say, can't replace healthy habits and good sleep hygiene. If you do decide to take sleep supplements, the NSF urges consumers to read packaging material carefully (Consumer Reports has a helpful list of supplement ingredients to avoid) and follow all safety guidelines—just because supplements aren't prescribed, doesn't mean they lack side effects. Look for certifications like those granted by the United States Pharmacopeial Convention (USP) as marks of quality, and remember that most supplements are meant to be taken on a short-term basis.
Let's look at what experts have to say about four of the most popular natural sleep supplements:
A hormone produced naturally by the pineal gland in order to regulate sleep/wake cycles, melatonin is probably the most popular sleep aid today. A doctor speaking to Consumer Reports notes that melatonin can cause side effects, such as dizziness, nausea, vivid dreaming and next-day grogginess. Melatonin can also interfere with other medication for blood pressure and diabetes. Melatonin should not be used as a treatment for general insomnia—studies show it doesn't help you get to sleep that much faster. However, Consumer Reports found that the hormone can be helpful as a means of alleviating jet lag when taken “at bedtime starting on the evening of arrival." Likewise, melatonin can be a useful natural sleep supplement for people with unusual work schedules or circadian rhythm disorder. Doctors advise sticking to low doses, especially since as little as 0.1 to 0.3 milligrams of melatonin can be effective. The drug is often sold in doses as high as 1-3 mg, which can cause more side effects without necessarily being more effective.
Chamomile is often brewed as a tea in order promote relaxation and sleepiness. It's one of the oldest and most popular sleep aids, but there's little research on its effectiveness. There are two common varietals: “Roman" chamomile and “German" chamomile, of which the latter is most common in the U.S. One study, following 57 participants over eight weeks, found that chamomile capsules eased anxiety symptoms. There are some minor risks associated with chamomile, such as rare allergic reactions and interactions with Warfarin, a blood-thinning medication. As with all supplements, if you take chamomile regularly, be sure to let your doctor know.
Another ancient herbal remedy, valerian is a plant that's been used to treat insomnia, anxiety, depression and menopause symptoms. It's typically brewed in teas or ground in capsules. There's little evidence to suggest that valerian is an effective treatment for anything, and the few studies that exist are inconclusive. However, doctors consider the herb to be safe, as there are only rare reports of harmful side effects. Since it's possible (though not proven) that the herb has a sleep-inducing effect, it's generally a good idea to avoid alcohol when taking valerian. In addition, pregnant women should avoid taking the drug, since its effects on infants are not known.
A member of the pepper family native to islands of the South Pacific, Kava is used to treat anxiety. Although the drug is popular among Islanders as part of social ceremonies, and as a means of promoting relaxation, Kava has serious health risks associated with it. The drug has been banned in some European countries, and the FDA released an advisory in 2002 warning consumers of these risks. Although the research is disputed, there have been several reports of severe liver damage associated with kava consumption. There are also well-documented side effects, including dry, scaly skin and eye irritation. In short, don't use Kava as a natural sleep aid.
What to do instead
Sleep aids should be a last resort. There are far more effective ways to promote healthy sleep, including:
- Consistent bedtimes and wake-times
- Light exercise during the day
- Avoiding alcohol and caffeine before bed
- Simple relaxation techniques
- Limiting exposure to bright lights and screens in the evening
If you have questions about a specific supplement, consult this list of factsheets from the National Institute of Health.
And, as always, talk to your doctor if you have trouble getting to sleep.