Insomnia, valerian with

Wheatley D. Stress-induced insomnia treated with kava and valerian singly and in combination. Hum Psychopharmacol 2001 16 353-356. 

The term pasaon flower is used to denote many of the approximately 400 species of the herb. F saon flower has been used in medicine to treat pain, anxiety, and insomnia. Some herbalists use the herb to treat symptoms of parkinsonism. F saon flower is often used in combination with other herbs , such a valerian, chamomile, and hops, for promoting relaxation, rest and sleep. Although no adverse reactions have been reported, large doses may cause CNS depression. The use of passion flower is contraindicated in pregnancy and in patientstaking the monoamine oxidase inhibitors (MAOIs). Fission flower contains coumarin, and the risk of bleeding may be increased when used in patientstaking warfarin and pasaon flower. 

Clinicians should ask patients if they take any herbs and supplements, as they may not volunteer this information. The most common herbs and supplements that patients ask about are vitamins, melatonin, valerian, and coenzyme Q10. There is very little support for using creatinine, gingko, ginseng, green tea, ginger, yohimbine, and St lohn s wort in patients with PD. Patients should be cautioned that supplements and herbs are not well controlled by the FDA and may not contain the amounts indicated on the label. Melatonin and valerian may improve insomnia, but they are not commonly used because there is insufficient information in PD patients.39... 

Antihistamines such as diphenhydramine are known for their sedating properties and are frequently used over-the-counter medications (usual doses 25-50 mg) for difficulty sleeping. Diphenhydramine is approved by the FDA for the treatment of insomnia and can be effective at reducing sleep latency and increasing sleep time.43 However, diphenhydramine produces undesirable anticholinergic effects and carryover sedation that limit its use. As with TCAs and BZDRAs, diphenhydramine should be used with caution in the elderly. Valerian root is an herbal sleep remedy that has inconsistent effects on sleep but may reduce sleep latency and efficiency at commonly used doses of 400 to 900 mg valerian extract. Ramelteon, a new melatonin receptor agonist, is indicated for insomnia characterized by difficulty with sleep onset. The recommended dose is 8 mg at bedtime. Ramelteon is not a controlled substance and thus may be a viable option for patients with a history of substance abuse. 

Side effects may be as mild and rare as headache, nausea, and stomach upset for saw palmetto [23,24], However, some supplements may have serious side effects. Hypertension, euphoria, restlessness, nervousness, insomnia, skin eruptions, edema, and diarrhea were reported in 22 patients following long-term ginseng use at an average dose of 3 g of ginseng root daily [38]. Side effects reported with valerian use include headaches, hangover, excitability, insomnia, uneasiness, and cardiac disturbances. Valerian toxicity including ataxia, decreased sensibility, hypothermia, hallucinations, and increased muscle relaxation have been reported [39]. 

As with studies of many other herbs and nutritional supplements, interpretation of clinical trials of valerian is hampered by small sample sizes, suboptimal study design, lack of specified inclusion and exclusion criteria, and unknown composition of valerian extract (Plushner, 2000). Furthermore, none of the trials have included children or teenagers. Nevertheless, several studies have showed a mild hypnotic action in persons with insomnia and in normal sleepers, as well as a mild sedative effect (Leathwood and Chauffard, 1983, 1985 Balderer and Borbely, 1985). One report has described an anxiolytic effect (Kohnen and Oswald, 1988). There are suggestions that valerian may have beneficial effects on sleep latency, frequency of waking, nighttime motor activity, and overall sleep quality. 

Once recognized as a tonic, tranquilizer, and antispasmodic, skullcap was therefore used as an ingredient in many patent medicines for female weakness. It was also combined with other reputedly calming herbs, such as hops and valerian, and promoted as a sedative or anxiolytic. Other traditional uses include treatment of epilepsy, headache, insomnia, various other neurological and psychiatric disorders, hypertension, fever, rheumatism, and stress. 

Valerian is used in the treatment of insomnia and stress and anxiety. The important active compounds of valerian are the valepotriates (iridoid molecules) and valeric acid. These compounds are found exclusively in valerian. Originally, it was thought that just the valepotriates were responsible for valerian s sedative effects but, recently, an aqueous extract of valerian has also been shown to have a sedative effect. As the valepotriates are not soluble in water, it was concluded that valeric acid also possesses sedative action and is the chemical factor responsible for the sedative effect noted in human clinical trials with aqueous extracts of valerian (Murray, 1995). Valerian inhibits the uptake of GABA and enhances the release of GABA. 

This book compares the hypnotic and sedative actions of valerian used for thousand years to treat insomnia with those of benzodiazepine derivatives in altering GABAergic transmission. 

The properties of Scullcap are said to have been first appreciated by Vandesveer in 1772 for use against hydrophobia. Scullcap is now employed, often with Valerian, in hysteria and insomnia, and is reputed to be effective in the treatment of epilepsy. 

Diazepam is better indicated if insomnia is associated with daytime anxiety. Other benzodiazepines prescribed for insomnia include nitrazepam, flur-azepam, loprazolam, lormetazepam and temazepam. The non-benzodiazepine hypnotics zaleplon, zolpidem and zopiclone are not licensed for long-term use. The sedative antipsychotic promethazine hydrochloride is sometimes used to facilitate sleep, with a 25-50 mg recommended dose. Melatonin has proved effective for some clients, mostly in regulating the sleep/waking cycle. Although evidence of efficacy is limited, some clients use herbs such as valerian and chamomile. If Mr AB will finally be diagnosed with depression, a trial with an antidepressant will be indicated. 

Valerian Insomnia, anxiety Fatigue, tremor, headache, paradoxical insomnia (not advised with other sedative-hypnotics)... 

In a pilot study, 24 patients with stress-induced insomnia were treated for 6 weeks with kava 120 mg/day, followed by a 2-week washout period and then treatment with valerian 600 mg/day for another 6 weeks (4). Stress was measured in three areas, including social, personal, and life events, and insomnia was assessed by evaluating the time taken to fall... 

Valerian originated in Europe and Asia, where it has been used for more than 1,000 years for a variety of purposes but primarily to treat insomnia and anxiety. Valerian preparations, derix ed from the root of the plant, contain active chemicals that collectively appear to enhance inhibitory neurotransmission through the GABA system. Valerian is not well studied, but several reports support the claim that it reduces sleep latency and improves sleep quality, albeit with many of the same side effects associated with benzodiazepines (Julien, 2005 Spinella, 2001). 

Kava is currently promoted for relief of anxiety, stress, and insomnia. Stress may be prolonged and difficult to cope with and affected individuals may suffer from insomnia. Kava has been promoted as an axiolytic agent with little risk for dependence or adverse reactions. An unblinded, comparative, crossover trial of kava (120 mg) and valerian (600 mg) was conducted, each agent administered for 6 weeks with a 2-week wash-out period between. This was followed with administration of a combination of the two compounds. Both stress and insomnia were measured regarding social, personal, and life... 

Valerian is promoted in the United States primarily as a sedative-hypnotic for treatment of insomnia, and as an anxiolytic for restlessness and sleeping disorders associated with anxiety (4,7). 

Valerian is an herbal sleep remedy that has been studied for its sedative-hypnotic properties in patients with insomnia. The mechanism of action of this herb is still unknown, but it may involve inhibition of the enzyme that breaks down y-aminobutyric acid (GABA). The recommended dose for insomnia ranges from 300 to 600 mg. An equivalent dose of dried herbal valerian root is 2 to 3 grams soaked in 1 cup of hot water for 20 to 25 minutes. As with melatonin, and other herbal products not regulated by the Food and Drug Administration (FDA), valerian is not regulated for quality or consistency. 

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