Integrative sleep management: from molecular pathways to conventional and herbal treatments.
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.
Full Text
Figures
Fig. 1
Overview of molecular pathways involved in sleep regulation, including neurotransmitter systems and circadian clock mechanisms relevant to integrative sleep management.
diagram
Fig. 2
Diagram of conventional pharmacological treatments for sleep disorders, illustrating their mechanisms of action on GABAergic, melatonergic, and orexinergic pathways.
diagram
Fig. 3
Summary of herbal treatments used in integrative sleep management, detailing the active compounds and proposed mechanisms of botanicals such as valerian, passionflower, and chamomile.
diagram
Fig. 4
Comparative analysis of sleep-promoting properties across conventional and herbal interventions, organized by target receptor or pathway.
diagram
Fig. 5
Schematic of the sleep-wake homeostasis model and how various conventional and herbal therapies modulate sleep pressure and circadian rhythm.
diagram
Fig. 6
Integrative framework linking molecular sleep pathways with clinical treatment approaches, summarizing evidence for both conventional and herbal interventions.
diagramTables
Table 1
| Central sleep apnea (CSA) | Obstructive sleep apnea (OSA) |
|---|---|
| Happens when a temporary decrease in generation of beathing rhythm | Happens when there is a complete blockage of the upper airway (tongue falling backward) |
Table 1
| Sleep disorder | Pharmacological class | Examples | Guidelines and references |
|---|---|---|---|
| Insomnia | Benzodiazepines | Temazepam, triazolam | Riemann et al. |
| Benzodiazepine receptor agonists | Eszopiclone, zopiclone, zolpidem, zaleplone | ||
| Orexin receptor antagonist | Suvorexant, daridorexant | ||
| Sedative norepinephrine/serotonin enhancers | ◦ Tricyclic antidepressants: Doxepin ◦ Serotonin receptor antagonists and reuptake inhibitors (SARI): Trazodone | ||
| Melatonin and melatonin receptor agonists | Melatonin, ramelteon | ||
| Histamine receptor antagonist | Diphenhydramine | ||
| Dopamine (D2)/serotonin (5HT2 A) receptors antagonists | Olanzapine, quetiapine | ||
| Sleep apnea | Carbonic anhydrase inhibitors | Acetazolamide | Randerath et al. |
| Selective norepinephrine reuptake inhibitor/muscarinic receptor antagonist combination therapy | Atomoxetine/oxybutynin combination therapy | ||
| Selective serotonin reuptake inhibitors | fluoxetine | ||
| Norepinephrine and dopamine reuptake inhibitors | Solriamfetol | ||
| Dopamine reuptake inhibitors | Modafinil, armodafinil | ||
| Glucagon-like peptide- 1 agonists | Tirzepatide | ||
| H3-receptor antagonist/inverse agonist | Pitolisant | ||
| Restless leg syndrome | Dopamine agonists | Ropinirole, rotigotine | Lv et al. |
| α2δ ligands | Pregabalin, gabapentin enacarbil | ||
| Iron treatment | Oral ferrous sulphate | ||
| Low potency opioids | Tramadol, codeine | ||
| Narcolepsy | Norepinephrine and dopamine reuptake inhibitors | Methylphenidate, solriamfetol | Thorpy and Bogan |
| Dopamine reuptake inhibitors | Modafinil, armodafinil | ||
| Selective serotonin and norepinephrine reuptake inhibitors | Venlafaxine | ||
| H3-receptor antagonist/inverse agonist | Pitolisant | ||
| GABA-B receptor agonist | Sodium oxybate |
Table 2
| Plant name | Active compounds | Mechanism of action | Notable effects | Study type |
|---|---|---|---|---|
| Benzodiazepines | Acts on benzodiazepine receptors | Sedative effects in mice | Animal studies | |
| Limonene, β-pinene, β-myrcene | Anxiolytic via 5-HT1 A receptors | Increased sleep duration | Preclinical studies | |
| - | CNS depressant activity | Improved sleep quality in hypertensive patients | Clinical trial | |
| Alkaloids (e.g., protopine, sanguinarine) | Acts on GABAA receptors | Sedative and anxiolytic effects | In vitro, animal studies | |
| Xanthohumol | Potentiates GABAA receptor response | Enhanced pentobarbital sleep | Preclinical studies | |
| Eugenol, methyl eugenol, 1,8-cineole | - | Sedative properties | Preclinical studies | |
| Linalool, linalyl acetate | Interacts with NMDA receptors, blocks SERT | Anxiolytic and sedative properties | Clinical and preclinical studies | |
| Magnolol, honokiol | Modulates GABAA receptors | Induces REM sleep | Animal studies | |
| Apigenin | Benzodiazepine receptor ligand | Sedative and anxiolytic effects | Clinical and preclinical studies | |
| Polyphenols | Inhibits GABA transaminase | Improved sleep quality | Clinical and preclinical studies | |
| Oleic acid, β-sitosterol, stigmasterol | Acts on GABAA receptors | Improved sleep quality in animal models | Animal studies | |
| Nuciferine | Acts on GABAA receptors | Sedative-hypnotic effects | Preclinical studies | |
| Linalool, eugenol | - | Sedative and anxiolytic effects | Animal studies | |
| Alkaloids, flavones | Acts on GABAA, GABAB, and GABAC receptors | Reduced sleep latency, increased duration | In vitro, animal studies | |
| Tenufolin | Enhances GABA and GABA transporter levels | Prolonged sleep duration | Animal studies | |
| Schisandrin B, schizandrin | Modulates GABAergic system, raises GABA/Glu ratio | Prolonged sleep duration, improved patterns | Animal studies | |
| Flavonoids (e.g., quercetin, rutin) | Modulates GABAergic and serotonergic systems | GABA-like activity | Preclinical studies | |
| Valerenic acid, valerenol | Modulates GABAA receptors and serotonergic systems | Improved sleep quality, reduced latency | Clinical and preclinical studies | |
| Withanolide A, withaferin A | Acts on GABAA and GABAC receptors | Enhanced sleep quality | Clinical and preclinical studies | |
| Sanjoinine A, suanzaorentang | Enhances GABA synthesis, acts on serotonin receptors | Prolonged sleep time | Animal studies |
Table 3
| Sleep disorder | Study | Study design | No. of participants | Special population | Agent(s) and dose | End point/outcome(s) | Main result(s) |
|---|---|---|---|---|---|---|---|
| Impaired sleep | Taavoni et al. | Randomized, triple-blind, placebo-controlled clinical trial | (50 in the intervention group, 50 in the control group) | Women undergoing menopause | Valerian/Lemon Balm capsules (160 mg/80 mg) | PSQI | The valerian/lemon balm combination improved sleep quality compared to control |
| Impaired sleep | Adib-Hajbaghery and Mousavi | Randomized controlled trial | (30 in the intervention group, 30 in the control group) | Older adults | Chamomile extract capsules (200 mg, twice daily) | PSQI | 8-week administration of chamomile extract can significantly improve the quality of sleep in elderly patients |
| Impaired sleep | Haybar et al. | Randomized, Double-blind placebo-controlled clinical trial | (35 in the intervention group, 38 in the control group) | Patients with chronic stable angina | Lemon balm “ dried aerial parts (3 g) | PSQI DASS- 21 | Consumption of |
| Impaired sleep | Feyzabadi et al. | Randomized, double-blind, placebo-controlled study | (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 sleep | Umigai et al. | Randomized, double-blind, placebo-controlled, cross-over study | - | 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 sleep | Um et al. | Randomized, double-blind, placebo-controlled, polysomnographic study | (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 sleep | Ha, et al. | Randomized, double-blind, placebo-controlled trial | (40 in the intervention group, 40 in the control group) | - | AIS (1ry) TST SE WASO | Mild insomnia might be controlled by 4-week administration of PS rhizome extract | |
| Impaired sleep | Taherzadeh et al. | Randomized, double-dummy, double-blind placebo controlled clinical trial | (25 in the intervention group, 25 in the control group) | - | Dried violets ( | ISI (1ry) PSQI | The administration of the herbal intranasal formula decreased insomnia severity and improved quality of sleep |
| Impaired sleep | Lopresti et al. | Randomized, double-blind, placebo-controlled trial | (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 sleep | Elmi, et al. | Randomized, triple-blind, placebo-controlled clinical trial | (38 in Coronary Artery Bypass Graft (CABG) intervention group, 38 in control group) | Patients after CABG surgery | Valerian root extract powder (530 mg) | PSQI PT/PTT | Valerian root extract improved Sleep quality with no effect on coagulation profile |
| Impaired sleep | Shirazi, et al. | Randomized, double-blind, placebo-controlled clinical trial | (20 in the | Postmenopausal women | lemon balm leaf and fennel fruit capsule (500 mg) | Changes in MENQOL domains | |
| Impaired sleep | Lopresti et al. | Randomized double-blind placebo-controlled multi-dose study | (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 sleep | Pachikian, et al. | Randomized double-blind placebo-controlled multi-dose study | (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 sleep | Langade et al. | Randomized, parallel, double-blind, controlled clinical trial | 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 ( (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 sleep | Karimi et al. | Randomized triple-blind placebo-controlled trial | (30 in the intervention group, 30 in the control group) | menopausal women | (250 mg) | PSQI III | O. basilicum leaf extract improved sleep quality and reduced the severity of insomnia in the study participants |
| Impaired sleep | Gutiérrez-Romero et al. | Randomized, placebo-controlled trial | (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 sleep | Chandra Shekhar et al. | Randomized, double-blind, placebo-controlled study | (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 sleep | Pierro, et al. | Randomized double-blind, placebo-controlled, and cross-over study | (14 in the intervention group, 16 in the control group) | - | Lemon balm “ | Changes in ISI Sleep Quality Parameters | Melissa officinalis extract improved ISI score and extended deep sleep duration |
| Impaired sleep | Uchida et al. | Randomized, parallel, double-blind, controlled clinical trial | (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 sleep | Dehghan et al. | Randomized controlled clinical trial | (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 sleep | Can et al. | Randomized placebo-controlled clinical trial | (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 sleep | Kavuran and Yurttaş | Randomized controlled trial | (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 sleep | Pérez-Piñero et al. | Randomized double-blind Placebo-controlled study | (33 in the intervention group, 38 in the control group) | - | extract of lemon verbena ( (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 sleep | Xiong et al. | Randomized triple-blind parallel-group placebo-controlled trial | (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 sleep | Lucena et al. | Randomized double-blind controlled study | (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 Sleep | Yildirim et al. | Randomized, parallel, single-blind, controlled clinical trial | (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 |
| RLS | Cuellar and Ratcliffe | Randomized, triple-blind, placebo-controlled clinical trial | (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 |
| RLS | Hajizadeh et al. | Randomized, cross-over clinical trial | Hemodialysis patients | Valeriana officinalis L. Capsules (530 mg) compared to Gabapentin | RLS Score | Both agents were able to treat RLS with Gabapentin being more effective Both agents improved sleep quality |
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