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Valerian for Insomnia and Other Sleep Disorders

Dietary Supplement Fact Sheet

Key points
This fact sheet provides an overview of the use of valerian for insomnia and other sleep disorders and contains the following key information:

• Valerian is an herb sold as a dietary supplement in the United States.
• Valerian is a common ingredient in products promoted as mild sedatives and sleep aids for nervous tension and insomnia.
• Evidence from clinical studies of the efficacy of valerian in treating sleep disorders such as insomnia is inconclusive.
• Constituents of valerian have been shown to have sedative effects in animals, but there is no scientific agreement on valerian's mechanisms of action.
• Although few adverse events have been reported, long-term safety data are not available.

What is valerian?
Valerian (Valeriana officinalis), a member of the Valerianaceae family, is a perennial plant native to Europe and Asia and naturalized in North America [1]. It has a distinctive odor that many find unpleasant [2,3]. Other names include setwall (English), Valerianae radix (Latin), Baldrianwurzel (German), and phu (Greek). The genus Valerian includes over 250 species, but V. officinalis is the species most often used in the United States and Europe and is the only species discussed in this fact sheet [3,4].

What are common valerian preparations?
Preparations of valerian marketed as dietary supplements are made from its roots, rhizomes (underground stems), and stolons (horizontal stems). Dried roots are prepared as teas or tinctures, and dried plant materials and extracts are put into capsules or incorporated into tablets [5].

There is no scientific agreement as to the active constituents of valerian, and its activity may result from interactions among multiple constituents rather than any one compound or class of compounds [6]. The content of volatile oils, including valerenic acids; the less volatile sesquiterpenes; or the valepotriates (esters of short-chain fatty acids) is sometimes used to standardize valerian extracts. As with most herbal preparations, many other compounds are also present.

Valerian is sometimes combined with other botanicals [5]. Because this fact sheet focuses on valerian as a single ingredient, only clinical studies evaluating valerian as a single agent are included.

What are the historical uses of valerian?
Valerian has been used as a medicinal herb since at least the time of ancient Greece and Rome. Its therapeutic uses were described by Hippocrates, and in the 2nd century, Galen prescribed valerian for insomnia [5,7]. In the 16th century, it was used to treat nervousness, trembling, headaches, and heart palpitations [8]. In the mid-19th century, valerian was considered a stimulant that caused some of the same complaints it is thought to treat and was generally held in low esteem as a medicinal herb [2]. During World War II, it was used in England to relieve the stress of air raids [9].

In addition to sleep disorders, valerian has been used for gastrointestinal spasms and distress, epileptic seizures, and attention deficit hyperactivity disorder. However, scientific evidence is not sufficient to support the use of valerian for these conditions [10].

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What clinical studies have been done on valerian and sleep disorders?
In a systematic review of the scientific literature, nine randomized, placebo-controlled, double-blind clinical trials of valerian and sleep disorders were identified and evaluated for evidence of efficacy of valerian as a treatment for insomnia [11]. Reviewers rated the studies with a standard scoring system to quantify the likelihood of bias inherent in the study design [12]. Although all nine trials had flaws, three earned the highest rating (5 on a scale of 1 to 5) and are described below. Unlike the six lower-rated studies, these three studies described the randomization procedure and blinding method that were used and reported rates of participant withdrawal.

The first study used a repeated-measures design; 128 volunteers were given 400 mg of an aqueous extract of valerian, a commercial preparation containing 60 mg valerian and 30 mg hops, and a placebo [13]. Participants took each one of the three preparations three times in random order on nine nonconsecutive nights and filled out a questionnaire the morning after each treatment. Compared with the placebo, the valerian extract resulted in a statistically significant subjective improvement in time required to fall asleep (more or less difficult than usual), sleep quality (better or worse than usual), and number of nighttime awakenings (more or less than usual).This result was more pronounced in a subgroup of 61 participants who identified themselves as poor sleepers on a questionnaire administered at the beginning of the study. The commercial preparation did not produce a statistically significant improvement in these three measures. The clinical significance of the use of valerian for insomnia cannot be determined from the results of this study because having insomnia was not a requirement for participation. In addition, the study had a participant withdrawal rate of 22.9%, which may have influenced the results.

Although the results of some studies suggest that valerian may be useful for insomnia and other sleep disorders, results of other studies do not. Interpretation of these studies is complicated by the fact the studies had small sample sizes, used different amounts and sources of valerian, measured different outcomes, or did not consider potential bias resulting from high participant withdrawal rates. Overall, the evidence from these trials for the sleep-promoting effects of valerian is inconclusive.

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1. Wichtl M, ed.: Valerianae radix. In: Bisset NG, trans-ed. Herbal Drugs and Phytopharmaceuticals: A Handbook for Practice on a Scientific Basis. Boca Raton, FL: CRC Press, 1994: 513-516.
2. Pereira J: Valeriana officinalis: common valerian. In: Carson J, ed. The Elements of Materia Medica and Therapeutics. 3rd ed. Philadelphia: Blanchard and Lea, 1854: 609-616.
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5. Blumenthal M, Goldberg A, Brinckmann J, eds.: Valerian root. In: Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications, 2000: 394-400.
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7. Turner W: Of Valerianae. In: Chapman GTL, McCombie F, Wesencraft A, eds. A New Herbal, Parts II and III. Cambridge: Cambridge University Press, 1995: 464-466, 499-500, 764-765. [Republication of parts II and III of A New Herbal, by William Turner, originally published in 1562 and 1568, respectively.]
8. Culpeper N: Garden valerian. In: Culpeper's Complete Herbal. New York: W. Foulsham, 1994: 295-297. [Republication of The English Physitian, by Nicholas Culpeper, originally published in 1652.]
9. Grieve M: Valerian. In: A Modern Herbal. New York: Hafner Press, 1974: 824-830.
10. Jellin JM, Gregory P, Batz F, et al.: Valerian In: Pharmacist’s Letter/Prescriber’s Letter Natural Medicines Comprehensive Database. 3rd ed. Stockton, CA: Therapeutic Research Faculty, 2000: 1052-1054.
11. Stevinson C, Ernst E: Valerian for insomnia: a systematic review of randomized clinical trials. Sleep Medicine 1: 91-99, 2000. [PubMed abstract]
12. Jadad AR, Moore RA, Carroll D, et al.: Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials 17: 1-12, 1996. [PubMed abstract]
13. Leathwood PD, Chauffard F, Heck E, Munoz-Box R: Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man. Pharmacology, Biochemistry and Behavior 17: 65-71, 1982. [PubMed abstract]
14. Leathwood PD, Chauffard F: Aqueous extract of valerian reduces latency to fall asleep in man. Planta Medica 2: 144-148, 1985. [PubMed abstract]
15. Vorbach EU, Gortelmeyer R, Bruning J: Treatment of insomnia: effectiveness and tolerance of a valerian extract [in German]. Psychopharmakotherapie 3: 109-115, 1996.

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