Complementary and alternative treatments for insomnia disorder: a systematic umbrella review

Abstract

SummaryInsomnia is a common disorder and cognitive behavioural therapy for insomnia (CBT‐I) is recommended as first‐line treatment. However, CBT‐I is not widely distributed and infrequently available while medication is not indicated for long‐term use. To close this evident gap in supply, alternative treatments could be utilised. High‐quality research on this topic is scarce, and there is currently no comprehensive publication on the effectiveness of alternative treatments. To address this pressing question, we systematically summarised the existing research on alternative treatments for insomnia. A comprehensive search of systematic reviews and (network) meta‐analyses of randomised controlled trials investigating the efficacy of alternative treatments compared to waiting‐list control or placebo in adults with insomnia disorder with or without comorbidities was conducted in PubMed, MEDLINE, PsycInfo, and PsycArticles on December 6, 2022, yielding 391 records. Finally, 15 eligible studies were included. Evidence on acupuncture, exogenous melatonin, mind–body interventions and exercise, repetitive transcranial magnetic stimulation (rTMS), valerian, and light exposure was found. Acupuncture, rTMS and mind–body exercises significantly improved sleep quality and insomnia severity but effects on objectively assessed outcomes were inconclusive. Melatonin led to a reduction in both self‐reported and objectively assessed sleep onset latency. Light exposure and valerian did not significantly improve sleep outcomes. Overall, the quality of studies was rated as low. Results indicate that alternative treatments are effective mostly on subjective outcomes. However, evidence on the efficacy of some intervention types is sparse and there is a need for high‐quality original studies. Future research could investigate whether combining different alternative treatment aspects with CBT‐I improves individual treatment.

Commercial Chinese polyherbal preparation Zao Ren An Shen prescription for primary insomnia: a systematic review with meta-analysis and trial sequential analysis

“…CBT-i is the front-line treatment for PI ( Zhao et al, 2021 ), yet its limited accessibility makes CAM remedies more appealing in some regions where traditional medicine practices are widely accepted ( Ell et al, 2023 ). Chinese medicines have been used to manage insomnia for over 2,000 years ( Ni et al, 2015 ).…”

“…ZRAS has been listed with the Australian Registry of Therapeutic Goods under the name "Zao Ren An Shen" (AUST L301484) (Birling et al, 2022), providing a foundation for studying its applicability to diverse consumer populations. Frontiers in Pharmacology frontiersin.org 13 6.3 Interpretation of findings CBT-i is the front-line treatment for PI (Zhao et al, 2021), yet its limited accessibility makes CAM remedies more appealing in some regions where traditional medicine practices are widely accepted (Ell et al, 2023). Chinese medicines have been used to manage insomnia for over 2,000 years (Ni et al, 2015).…”

Sleep health challenges among women: insomnia across the lifespan

“…Additionally, a variety of alternative, non-pharmacologic treatments for insomnia in adults have been explored, with varying levels of evidence supporting their effectiveness. One study examined, among other treatments, the impact of acupuncture and repetitive transcranial magnetic stimulation (rTMS), on sleep quality and insomnia severity and found some benefit (Ell et al, 2023). Yoga was found to positively influence sleep symptoms in an elderly population of insomnia patients (Gulia and Sreedharan, 2021).…”

Dietary Supplementation with an Extract of Aloysia citrodora (Lemon verbena) Improves Sleep Quality in Healthy Subjects: A Randomized Double-Blind Controlled Study

“…Complementary and alternative medicine strategies based on dietary supplements and popular herbal remedies have progressively gained attention to improve symptoms of either stress or sleep problems, particularly as multimodal interventions used by subjects seeking adjunct nonpharmacological natural therapies [16][17][18][19]. Among the potential herbs available, Aloysia citrodora Paláu (Lippia citriodora Kunth), commonly known as "lemon verbena" has shown multiple biological activities, including antioxidant, anxiolytic, neuroprotective, anticancer, anesthetic, antimicrobial, and sedative effects, which have been mainly attributed to verbascoside, an abundant polyphenol found in lemon verbena leaves [20][21][22].…”