Supported by multiple clinical trials and systematic reviews
Sleep Disorders
Sleep disorders encompass a broad set of conditions that disrupt sleep quality, timing, or duration, impairing daytime function. Common categories include insomnia disorder, obstructive sleep apnea (OSA), restless legs syndrome/periodic limb movement disorder (RLS/PLMD), narcolepsy and central hypersomnolence disorders, parasomnias, and circadian rhythm sleep-wake disorders. Western medicine relies on standardized diagnostic criteria (ICSD-3) and objective testing when indicated, and offers behavioral, circadian, device-based, and pharmacologic treatments. Among these, cognitive behavioral therapy for insomnia (CBT-I) is the gold-standard, first-line treatment for chronic insomnia. Pharmacologic options exist for select indications and short-term relief but carry important limitations. Circadian science underpins interventions such as timed light exposure and melatonin, which can be effective when precisely scheduled. Sleep studies (polysomnography, home sleep apnea testing, actigraphy, MSLT/MWT) help differentiate phenotypes and guide targeted care. Eastern and traditional approaches frame sleep through distinct models. In Traditional Chinese Medicine (TCM), insomnia may reflect disharmony among organ systems (notably the Heart–Kidney axis) and disturbance of shen (mind/spirit). Acupuncture is commonly used and shows moderate, though heterogeneous, evidence for improving sleep quality and insomnia severity compared with waitlist or some active controls; evidence versus sham controls is mixed but trending favorable in newer reviews. TCM herbal strategies often include jujube seed (Suan Zao Ren) and formulae; broader Western herbal traditions use valerian and passionflower, and magnolia bark is sometimes included in stress/sleep formulations. The human evidence base for individual botanicals ranges from mixed (valerian) to emerging (passionflower, jujube seed, magnolia), with issues of standardization and study quality. In Ayurveda, healthy sleep (nidra) is a core
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.
Western Medicine
Diagnosis
Diagnosis is based on ICSD-3 criteria, clinical history (sleep schedule, insomnia pattern, snoring/apneas, limb symptoms, parasomnias), validated scales (Insomnia Severity Index, Epworth Sleepiness Scale), and objective testing when indicated: overnight polysomnography or home sleep apnea testing for suspected OSA; actigraphy and sleep logs for circadian rhythm disorders; Multiple Sleep Latency Test (MSLT) for hypersomnolence/narcolepsy; Maintenance of Wakefulness Test (MWT) for treatment monitoring. Differential diagnosis includes depression, anxiety, pain, medication/substance effects, and medical/neurologic conditions.
Treatments
- CBT-I (sleep restriction, stimulus control, cognitive therapy, relaxation, sleep hygiene as an adjunct)
- Sleep hygiene education (consistent schedule, light management, caffeine/alcohol timing, exercise)
- Circadian interventions (timed bright light therapy, strategic darkness/blue-light reduction, timed melatonin for phase shift)
- Treatment of OSA (CPAP/APAP, oral appliance therapy, weight reduction, positional therapy; surgery in select cases)
- Management of RLS/PLMD (iron repletion if ferritin low; alpha-2-delta ligands; dopamine agonists with caution)
- Behavioral treatments for parasomnias and nightmare disorder (imagery rehearsal therapy; safety measures)
- Work/schedule interventions for shift-work disorder (anchor sleep, light timing, strategic naps, caffeine)
- Comorbidity management (pain, mood, cardiometabolic conditions) and medication review
Medications
- Melatonin (over-the-counter in many countries; timing-specific for circadian phase disorders; modest insomnia benefit)
- Melatonin receptor agonist (ramelteon) for sleep-onset insomnia
- Low-dose doxepin for sleep-maintenance insomnia
- Non-benzodiazepine hypnotics ("Z-drugs": zolpidem, eszopiclone, zaleplon) for short-term use
- Dual orexin receptor antagonists (suvorexant, lemborexant, daridorexant) for sleep initiation/maintenance
- Benzodiazepines (e.g., temazepam) short-term, with caution due to dependence and adverse effects
- Off-label agents sometimes used (e.g., trazodone, antihistamines) though not recommended by AASM for chronic insomnia
Limitations
CBT-I access can be limited by availability, cost, or patient adherence, though digital CBT-I expands reach. Hypnotics may cause next-day sedation, cognitive impairment, falls, complex sleep behaviors, tolerance, and dependence; they are generally recommended for short-term use and avoided in certain populations. Melatonin content and purity vary widely in supplements, complicating dosing and safety. Circadian interventions require precise timing and patient education. Misclassification is possible without adequate assessment (e.g., unrecognized OSA or RLS in a patient with insomnia), and single-modality approaches (e.g., sleep hygiene alone) are often insufficient.
Sources
- AASM. International Classification of Sleep Disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014 (and 2023 Text Revision).
- Edinger JD, Arnedt JT, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: An AASM clinical practice guideline. J Clin Sleep Med. 2021;17(2):255-262.
- Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults. J Clin Sleep Med. 2017;13(2):307-349.
- Auger RR, Burgess HJ, et al. Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders. J Clin Sleep Med. 2015;11(10):1199-1236.
- Kapur VK, Auckley DH, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea. J Clin Sleep Med. 2017;13(3):479-504.
- Erland LAE, Saxena PK. Melatonin natural health products—Variability in content and presence of serotonin. J Clin Sleep Med. 2017;13(2):275-281.
- Cohen PA, Sharfstein JM, Mande JR. Mislabeled melatonin and CBD gummies. JAMA. 2023;329(8):651-653.
Eastern & Traditional Medicine
Traditional Chinese Medicine (TCM) theory
Insomnia and disturbed sleep are viewed as patterns such as Heart–Kidney disharmony, Liver qi stagnation with heat, phlegm-heat, or blood/yin deficiency leading to disturbed shen (mind/spirit). Assessment emphasizes pulse, tongue, and symptom patterns. Treatment seeks to restore balance with individualized acupuncture and herbal formulas, diet, movement (e.g., qigong), and lifestyle (regular sleep–wake timing, emotional regulation).
Techniques
- Pattern differentiation and individualized treatment plans
- Lifestyle and dietary guidance aligned with TCM principles
- Adjunct mind-body practices (qigong, breathing)
Acupuncture for insomnia
Body and auricular acupuncture aim to calm shen, regulate the Heart–Kidney axis, and modulate autonomic balance. Common points include HT7 (Shenmen), SP6, Anmian, PC6, and GV20, tailored by pattern.
Techniques
- Manual or electroacupuncture sessions 1–3 times weekly for several weeks
- Auricular acupuncture or acupressure (ear seeds) as adjuncts
- Integration with sleep scheduling and relaxation training
Herbal approaches (TCM and Western herbalism)
Botanicals are used to reduce hyperarousal, support relaxation, and, in TCM, to nourish yin/blood and calm shen. Evidence varies by herb and preparation; standardization is a key challenge.
Techniques
- Valerian (Valeriana officinalis) extracts for sleep latency and quality
- Passionflower (Passiflora incarnata) as a mild anxiolytic/sedative
- Jujube seed (Ziziphus jujuba var. spinosa; Suan Zao Ren) and classic formulas (e.g., Suan Zao Ren Tang) in TCM
- Magnolia bark (Magnolia officinalis; honokiol/magnolol) often in combination formulas aimed at stress-related sleep disturbance
Ayurveda (including lifestyle and bodywork)
Sleep (nidra) is a pillar of health; insomnia is often attributed to vata/pitta imbalance and aggravated by irregular routines, stimulants, and stress. Interventions emphasize dinacharya (daily routines), evening winding-down rituals, warm oil self-massage (abhyanga), and calming diet/herbs. Warm milk with spices (e.g., nutmeg, cardamom) is a traditional sleep aid.
Techniques
- Abhyanga (warm oil self-massage) before bedtime
- Regular sleep-wake timing and calming evening routine
- Warm milk or plant alternatives with gentle spices
- Breathwork and gentle yoga asanas to reduce hyperarousal
Sources
- Maciocia G. The Practice of Chinese Medicine. 2nd ed. Elsevier; 2008.
- ICCMR/WHO. WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region. 2007.
- Cheuk DKL, Yeung WF, Chung KF, Wong V. Acupuncture for insomnia. Cochrane Database Syst Rev. 2012; (9):CD005472; updates indicate mixed-to-moderate quality evidence.
- Sun Y, et al. Acupuncture for primary insomnia: A systematic review and meta-analysis. Sleep Med. 2020;67:15-23.
- Yuan X, et al. Acupuncture for chronic insomnia: Systematic review and meta-analysis. Complement Ther Med. 2021;56:102615.
- Shinjyo N, Waddell G, Green J. Valerian root in treating sleep problems and associated disorders: A systematic review and meta-analysis. Sleep Med. 2020;78:82-92.
- Sarris J, Panossian A, Schweitzer I, Stough C, Scholey A. Passiflora incarnata in clinical practice: A systematic review. Phytother Res. 2011;25(10):1523-1532.
- Ni X, et al. Suanzaoren decoction for insomnia: A meta-analysis of randomized controlled trials. BMC Complement Altern Med. 2012;12:18.
- Talbott SM, Talbott JA, George A, Pugh M. Effect of Magnolia and Phellodendron bark on cortisol and sleep: A randomized, placebo-controlled trial. Nutr J. 2013;12:61.
- Lad V. Textbook of Ayurveda, Vol. 1. The Ayurvedic Press; 2002.
- Tiwari P. A Textbook of Ayurveda: Principles of Ayurvedic Lifestyle. 2017.
- Ng QX, et al. A systematic review of herbal remedies for insomnia. Complement Ther Med. 2019;45:1-8.
Integrative Perspective
Pragmatic integration typically starts with a clear diagnosis and ruling out conditions like OSA or RLS that require specific therapies. For chronic insomnia, use CBT-I as the core intervention (strongest evidence). Complement it with: (1) circadian optimization—morning bright light, evening light reduction, and, when indicated, precisely timed low-dose melatonin for phase shifting (not as a general hypnotic); (2) acupuncture to reduce hyperarousal and improve sleep quality during the initial CBT-I adaptation period, with scheduling coordinated to avoid napping and preserve sleep drive; (3) mind-body practices such as yoga nidra or breathwork in the wind-down routine to support relaxation without undermining CBT-I’s stimulus control; and (4) judicious short-term pharmacotherapy if daytime function is severely impaired, tapered as CBT-I takes effect. For botanicals, consider evidence strength and safety: valerian (mixed but generally safe), passionflower (limited human data), TCM jujube seed/formulas (low-to-moderate quality trials), and magnolia bark (limited human data often in combinations). Screen for interactions (e.g., additive CNS depression with sedatives, anticoagulant effects with some herbs), pregnancy/lactation, and liver disease. Regarding melatonin, address quality and regulation: in many countries (e.g., the U.S.) melatonin is an unregulated dietary supplement with wide variability in labeled vs actual content and reports of serotonin contamination; prefer pharmaceutically manufactured or third-party–verified products, use the lowest effective dose, and time it based on circadian goals rather than as a general sedative. Document all therapies, monitor outcomes (sleep diary, ISI), and adjust based on response and adverse effects.
Sources
- AASM. International Classification of Sleep Disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014 (and 2023 Text Revision).
- Edinger JD, Arnedt JT, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: An AASM clinical practice guideline. J Clin Sleep Med. 2021;17(2):255-262.
- Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults. J Clin Sleep Med. 2017;13(2):307-349.
- Auger RR, Burgess HJ, et al. Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders. J Clin Sleep Med. 2015;11(10):1199-1236.
- Kapur VK, Auckley DH, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea. J Clin Sleep Med. 2017;13(3):479-504.
- Erland LAE, Saxena PK. Melatonin natural health products—Variability in content and presence of serotonin. J Clin Sleep Med. 2017;13(2):275-281.
- Cohen PA, Sharfstein JM, Mande JR. Mislabeled melatonin and CBD gummies. JAMA. 2023;329(8):651-653.
- Cheuk DKL, Yeung WF, Chung KF, Wong V. Acupuncture for insomnia. Cochrane Database Syst Rev. 2012; (9):CD005472; subsequent meta-analyses show mixed-to-moderate quality evidence.
- Sun Y, et al. Acupuncture for primary insomnia: A systematic review and meta-analysis. Sleep Med. 2020;67:15-23.
- Shinjyo N, Waddell G, Green J. Valerian root in treating sleep problems and associated disorders: A systematic review and meta-analysis. Sleep Med. 2020;78:82-92.
- Ni X, et al. Suanzaoren decoction for insomnia: A meta-analysis of randomized controlled trials. BMC Complement Altern Med. 2012;12:18.
- Talbott SM, Talbott JA, George A, Pugh M. Effect of Magnolia and Phellodendron bark on cortisol and sleep: A randomized, placebo-controlled trial. Nutr J. 2013;12:61.
- Wang F, et al. The effect of yoga on sleep quality and insomnia: A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2020;54:101354.
Health Disclaimer
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.