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Integrative sleep management: from molecular pathways to conventional and herbal treatments.

Yasmina M Ebrahim, Mohamed A Sadek, Miral O Sabry, Rana M Lotfy, Ahmed M El-Dessouki et al.
Review Naunyn-Schmiedeberg's archives of pharmacology 2025 4 citations
PubMed DOI CC-BY PDF
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Study Design

Study Type
Review
Intervention
Integrative sleep management: from molecular pathways to conventional and herbal treatments. None
Comparator
Placebo
Effect Direction
Positive
Risk of Bias
Unclear

Abstract

Sleep is regarded as one of the most crucial factors in keeping a healthy lifestyle. To function normally, a person needs at least 6-8 h of sleep per day. Sleep influences not only our mood but also the efficiency with which we complete tasks. Sleep disorders exhibit diverse etiologies across different conditions and populations, with genetic and environmental factors playing a significant role in their development. Many issues emerge as a result of inadequate sleep. Unhealthy food and lifestyle choices have increased our susceptibility to sleep disorders. A well-balanced diet rich in essential vitamins and minerals can have a profound impact on sleep patterns, enhancing both the duration and quality of rest. The primary categories of sleep disorders include insomnia, sleep apnea (SA), narcolepsy, parasomnias, circadian rhythm disorders, and restless legs syndrome (RLS). The drugs used to treat sleep disorders are primarily habit-forming and have a history of withdrawal effects. This insufficiency in medication has prompted the hunt for newer, better options. Nutraceuticals are well-suited to the treatment of such illnesses. Its non-toxic, non-habit-forming properties, and practical efficiency have made it an outstanding choice. This review provides nutraceuticals used in sleep disorders. A comprehensive literature search was conducted utilizing several databases, including Google Scholar, Elsevier, Springer Nature, Wiley, PubMed, and EKB. Nutraceuticals are products that employ food or dietary components to treat or prevent disease. In the therapy of sleep disorders, nutraceuticals such as Artemisia annua, valerian, rosemary, jujube, Passionflower, lemon balm, ashwagandha, kava-kava, lavender, and chamomile have been shown to have remarkable benefits. These remedies exert their effects through multiple mechanisms, both directly by modulating neurotransmitter and hormonal pathways within sleep circuits, and indirectly by enhancing sleep quality through the alleviation of stress, inflammation, and oxidative stress. Clinical studies were piloted to validate the efficacy of natural sleep aids. Future research should focus on elucidating the precise mechanisms through which natural products influence sleep.

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Figures

Tables

Table 1

Central sleep apnea (CSA)Obstructive sleep apnea (OSA)
Happens when a temporary decrease in generation of beathing rhythmHappens when there is a complete blockage of the upper airway (tongue falling backward)

Table 1

Sleep disorderPharmacological classExamplesGuidelines and references
InsomniaBenzodiazepinesTemazepam, triazolamRiemann et al. 2023; Madari et al. 2021; Sateia et al. 2017
Benzodiazepine receptor agonistsEszopiclone, zopiclone, zolpidem, zaleplone
Orexin receptor antagonistSuvorexant, daridorexant
Sedative norepinephrine/serotonin enhancers

◦ Tricyclic antidepressants: Doxepin

◦ Serotonin receptor antagonists and reuptake inhibitors (SARI): Trazodone

Melatonin and melatonin receptor agonistsMelatonin, ramelteon
Histamine receptor antagonistDiphenhydramine
Dopamine (D2)/serotonin (5HT2 A) receptors antagonistsOlanzapine, quetiapine
Sleep apneaCarbonic anhydrase inhibitorsAcetazolamideRanderath et al. 2022; Nobre 2024; Arredondo, et al. 2022; Liu et al. 2024
Selective norepinephrine reuptake inhibitor/muscarinic receptor antagonist combination therapyAtomoxetine/oxybutynin combination therapy
Selective serotonin reuptake inhibitorsfluoxetine
Norepinephrine and dopamine reuptake inhibitorsSolriamfetol
Dopamine reuptake inhibitorsModafinil, armodafinil
Glucagon-like peptide- 1 agonistsTirzepatide
H3-receptor antagonist/inverse agonistPitolisant
Restless leg syndromeDopamine agonistsRopinirole, rotigotineLv et al. 2021; Winkelman et al. 2016; Silber et al. 2021
α2δ ligandsPregabalin, gabapentin enacarbil
Iron treatmentOral ferrous sulphate
Low potency opioidsTramadol, codeine
NarcolepsyNorepinephrine and dopamine reuptake inhibitorsMethylphenidate, solriamfetolThorpy and Bogan 2020; Bhattarai and Sumerall 2017; Maski et al. 2021
Dopamine reuptake inhibitorsModafinil, armodafinil
Selective serotonin and norepinephrine reuptake inhibitorsVenlafaxine
H3-receptor antagonist/inverse agonistPitolisant
GABA-B receptor agonistSodium oxybate

Table 2

Plant nameActive compoundsMechanism of actionNotable effectsStudy type
Artemisia annuaBenzodiazepinesActs on benzodiazepine receptorsSedative effects in miceAnimal studies
Citrus aurantiumLimonene, β-pinene, β-myrceneAnxiolytic via 5-HT1 A receptorsIncreased sleep durationPreclinical studies
Crataegus monogyna-CNS depressant activityImproved sleep quality in hypertensive patientsClinical trial
Eschscholzia californicaAlkaloids (e.g., protopine, sanguinarine)Acts on GABAA receptorsSedative and anxiolytic effectsIn vitro, animal studies
Humulus lupulusXanthohumolPotentiates GABAA receptor responseEnhanced pentobarbital sleepPreclinical studies
Laurus nobilisEugenol, methyl eugenol, 1,8-cineole-Sedative propertiesPreclinical studies
Lavandula angustifoliaLinalool, linalyl acetateInteracts with NMDA receptors, blocks SERTAnxiolytic and sedative propertiesClinical and preclinical studies
Magnolia sp.Magnolol, honokiolModulates GABAA receptorsInduces REM sleepAnimal studies
Matricaria chamomillaApigeninBenzodiazepine receptor ligandSedative and anxiolytic effectsClinical and preclinical studies
Melissa officinalisPolyphenolsInhibits GABA transaminaseImproved sleep qualityClinical and preclinical studies
Moringa oleiferaOleic acid, β-sitosterol, stigmasterolActs on GABAA receptorsImproved sleep quality in animal modelsAnimal studies
Nelumbo nuciferaNuciferineActs on GABAA receptorsSedative-hypnotic effectsPreclinical studies
Ocimum basilicumLinalool, eugenol-Sedative and anxiolytic effectsAnimal studies
Passiflora incarnataAlkaloids, flavonesActs on GABAA, GABAB, and GABAC receptorsReduced sleep latency, increased durationIn vitro, animal studies
Polygala tenuifoliaTenufolinEnhances GABA and GABA transporter levelsProlonged sleep durationAnimal studies
Schisandra chinensisSchisandrin B, schizandrinModulates GABAergic system, raises GABA/Glu ratioProlonged sleep duration, improved patternsAnimal studies
Tilia platyphyllosFlavonoids (e.g., quercetin, rutin)Modulates GABAergic and serotonergic systemsGABA-like activityPreclinical studies
Valeriana officinalisValerenic acid, valerenolModulates GABAA receptors and serotonergic systemsImproved sleep quality, reduced latencyClinical and preclinical studies
Withania somniferaWithanolide A, withaferin AActs on GABAA and GABAC receptorsEnhanced sleep qualityClinical and preclinical studies
Zizyphus jujubeSanjoinine A, suanzaorentangEnhances GABA synthesis, acts on serotonin receptorsProlonged sleep timeAnimal studies

Table 3

Sleep disorderStudyStudy designNo. of participantsSpecial populationAgent(s) and doseEnd point/outcome(s)Main result(s)
Impaired sleepTaavoni et al. 2013Randomized, triple-blind, placebo-controlled clinical trial

100

(50 in the intervention group, 50 in the control group)

Women undergoing menopauseValerian/Lemon Balm capsules (160 mg/80 mg)PSQIThe valerian/lemon balm combination improved sleep quality compared to control
Impaired sleepAdib-Hajbaghery and Mousavi 2017Randomized controlled trial

60

(30 in the intervention group, 30 in the control group)

Older adultsChamomile extract capsules (200 mg, twice daily)PSQI8-week administration of chamomile extract can significantly improve the quality of sleep in elderly patients
Impaired sleepHaybar et al. 2018

Randomized,

Double-blind placebo-controlled clinical trial

73

(35 in the intervention group, 38 in the control group)

Patients with chronic stable angina

Lemon balm “Melissa officinalis

dried aerial parts

(3 g)

PSQI

DASS- 21

Consumption of Melissa officinalis can improve depression, anxiety, stress, and insomnia in patients with chronic stable angina
Impaired sleepFeyzabadi et al. 2018Randomized, double-blind, placebo-controlled study

75

(25 in the Violet oil group, 25 in the Almond oil group, 25 in the control group)

-

Violet Oil

(Intranasal drops)

PSQI

ISI

Significant improvement in insomnia was noticed across the 3 groups with the Violet Oil intervention being more significant
Impaired sleepUmigai et al. 2018Randomized, double-blind, placebo-controlled, cross-over study30-

Crocetin

(7.5 mg)

OSA-MA

EEG

Study participants reported improvement in sleepiness on rising and fatigue recovery (subjective sleep parameters)

EEG data showed increased delta power during REM sleep latency which enhances sleep maintenance

Impaired sleepUm et al. 2019Randomized, double-blind, placebo-controlled, polysomnographic study

50

(25 in the intervention group, 25 in the control group)

-

Rice Bran Extract Supplement

(1000 mg)

PSQI

ESS

FSS

SE

TST

WASO

TWT

Rice bran extract supplement may improve sleep onset and sleep maintenance in patients with impaired sleep
Impaired sleepHa, et al. 2019Randomized, double-blind, placebo-controlled trial

80

(40 in the intervention group, 40 in the control group)

-Polygonatum sibiricum (PS) rhizome extract (500 mg)

AIS (1ry)

TST

SE

WASO

Mild insomnia might be controlled by 4-week administration of PS rhizome extract
Impaired sleepTaherzadeh et al. 2020Randomized, double-dummy, double-blind placebo controlled clinical trial

50

(25 in the intervention group, 25 in the control group)

-Dried violets (Viola odorata L.), saffron (Crocus sativus L.) and lettuce seeds (Lactuca sativa L.) oil preparation for intranasal administration

ISI (1ry)

PSQI

The administration of the herbal intranasal formula decreased insomnia severity and improved quality of sleep
Impaired sleepLopresti et al. 2020Randomized, double-blind, placebo-controlled trial

63

(33 in the intervention group, 30 in the control group)

-

Saffron extract

(14 mg, twice daily)

ISI (1ry)

RSQ

PSD

DASS- 21

8-week supplementation of saffron extract reduced insomnia, and improved sleep quality
Impaired sleepElmi, et al. 2021Randomized, triple-blind, placebo-controlled clinical trial

76

(38 in Coronary Artery Bypass Graft (CABG) intervention group, 38 in control group)

Patients after CABG surgeryValerian root extract powder (530 mg)

PSQI

PT/PTT

Valerian root extract improved Sleep quality with no effect on coagulation profile
Impaired sleepShirazi, et al. 2021Randomized, double-blind, placebo-controlled clinical trial

60

(20 in the Melissa officinalis L. group, 20 in Citalopram group, 20 in the control group)

Postmenopausal womenlemon balm leaf and fennel fruit capsule (500 mg)Changes in MENQOL domainsMelissa officinalis L. can improve the quality of life of postmenopausal women with sleep disturbances compared to other groups
Impaired sleepLopresti et al. 2021Randomized double-blind placebo-controlled multi-dose study

120

(40 in 14 mg saffron extract group, 40 in 28 mg saffron extract group, 40 in the control group)

-

Saffron extract

(14 mg, 28 mg)

PSD (1ry)

ISQ-W

FOSQ- 10

POMS-A

Salivary Cortisol

Salivary Melatonin

Saffron extract can improve sleep quality and mood after awakening in addition to increasing melatonin levels
Impaired sleepPachikian, et al. 2021Randomized double-blind placebo-controlled multi-dose study

66

(32 in the intervention group, 34 in the control group)

-

Saffron extract

(15.5 mg)

SOL

SE

TIB

FRAGI

TST

WASO

LSEQ

PSQI

SF- 36

Saffron extract supplementation for 6 weeks improved sleep quality-related parameters when assessed by actigraphy or questionnaires
Impaired sleepLangade et al. 2021Randomized, parallel, double-blind, controlled clinical trial

80

40 healthy subjects (20 in the intervention group, 20 in the control group)

40 patients with insomnia (20 in the intervention group, 20 in the control group)

-

Ashwagandha (Withania somnifera (L.) Dunal.) root extract

(300 mg)

SOL

TST

WASO

TIB

SE

PSQI

8-week consumption of ashwagandha root extract improved various parameters of sleep quality in healthy and insomnia patients
Impaired sleepKarimi et al. 2023Randomized triple-blind placebo-controlled trial

60

(30 in the intervention group, 30 in the control group)

menopausal women

Ocimum basilicum leaf extract

(250 mg)

PSQI

III

O. basilicum leaf extract improved sleep quality and reduced the severity of insomnia in the study participants
Impaired sleepGutiérrez-Romero et al. 2024Randomized, placebo-controlled trial

64

(31 in intervention group, 27 control group)

-

Nutraceutical Formulation

(green tea, lemon balm, valerian, and saffron extracts)

SE (1ry)

PSQI (2ry)

WASO (2ry)

Salivary Cortisol (2ry)

SF- 36 (2ry)

No significant effect on sleep efficiency or quality compared to placebo
Impaired sleepChandra Shekhar et al. 2024Randomized, double-blind, placebo-controlled study

80

(40 in intervention group, 40 in control group)

-

Valerian root extract

(200 mg with 2% total valerenic acid)

PSQI (1ry)

SL (1ry)

SE (2ry)

ESS (2ry)

BAI (2ry)

VAS (2ry)

Significant improvement in sleep quality, sleep efficiency, sleep latency and total sleep time
Impaired sleepPierro, et al. 2024Randomized double-blind, placebo-controlled, and cross-over study

30

(14 in the intervention group, 16 in the control group)

-Lemon balm “Melissa officinalis” Phytosome™

Changes in ISI

Sleep Quality Parameters

Melissa officinalis extract improved ISI score and extended deep sleep duration
Impaired sleepUchida et al. 2024Randomized, parallel, double-blind, controlled clinical trial

99

(49 in the intervention group, 50 in the control group)

Older Adults with cognitive decline

Match green tea capsules

(2 g)

MoCA-J (1ry)

ADCS-MCI-ADL (1ry)

Change in PSQI (2ry)

12 months consumption of matcha green tea improved emotional perception and sleep quality
Impaired sleepDehghan et al. 2024Randomized controlled clinical trial

60

(30 in the intervention group, 30 in the control group)

Mothers of infants admitted to the neonatal intensive care unit (NICU)Bitter orange blossom distillate syrup

STAI

General Sleep Disorder Scale

The intervention had no significantly different effect on the participants’ anxiety but improved their sleep disorder state
Impaired sleepCan et al. 2024Randomized placebo-controlled clinical trial

63

(21 in the Lavender group, 21 in the rosemary, 21 in the control group)

Older adults with type 2 diabetes

Lavender oil

Rosemary oil

(for aromatherapy)

BOMCT

PSQI

STAI

Aromatherapy improved quality of sleep and cognitive functions of the participants while decreasing anxiety
Impaired sleepKavuran and Yurttaş 2024Randomized controlled trial

66

(33 in the intervention group, 33 in the control group)

Patients with multiple sclerosis (MS)

Lavender oil

(for aromatherapy)

FSS

PSQI

Aromatherapy improved quality of sleep and reduced fatigue in patients with MS
Impaired sleepPérez-Piñero et al. 2024Randomized double-blind Placebo-controlled study

71

(33 in the intervention group, 38 in the control group)

-

extract of lemon verbena (Aloysia citrodora) capsule

(400 mg)

VAS (1ry)

SL

SE

PSQI

PSS

STAI

Plasma cortisol Nocturnal melatonin

The intervention significantly improved sleep quality and elevated nocturnal melatonin levels in participating individuals
Impaired sleepXiong et al. 2024Randomized triple-blind parallel-group placebo-controlled trial

116

(96 in the intervention group, 20 in the control group)

-Prescription of Chinese Herbal Medicine

TST (1ry)

SOL

WASO

SE

PSQI

BDI

SAS

Chinese medicine prescribed based on symptom differentiation can improve quality of sleep and total sleep time in patients with insomnia
Impaired sleepLucena et al. 2024Randomized double-blind controlled study

35

(17 in the intervention group, 18 in the control group)

Postmenopausal women

Lavender oil

(for aromatherapy)

ESS

Changes in MENQOL domains

SOL

TST

SE

Aromatherapy improved the total sleep time, sleep efficiency and quality of life of the participants with no effect on daytime sleepiness
Impaired SleepYildirim et al. 2025Randomized, parallel, single-blind, controlled clinical trial

100

(50 in the intervention group, 50 in the control group)

Patients with hematological malignancies

lavender oil

(For aromatherapy)

Changes in RCSQ domains

Changes in PFS

Aromatherapy with Lavender oil improved sleep quality and reduced fatigue levels
RLSCuellar and Ratcliffe 2009Randomized, triple-blind, placebo-controlled clinical trial

37

(17 in the intervention group, 20 in the control group)

-

Valerian capsules

(800 mg)

PSQI

ESS

International RLS Symptom Severity Scale

Valerian capsules improved the sleep quality and RLS symptoms
RLSHajizadeh et al. 2023Randomized, cross-over clinical trial40Hemodialysis patientsValeriana officinalis L. Capsules (530 mg) compared to GabapentinRLS Score

Both agents were able to treat RLS with Gabapentin being more effective

Both agents improved sleep quality

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