Diana M. Taibi

A randomized clinical trial of valerian fails to improve self-reported, polysomnographic, and actigraphic sleep in older women with insomnia

OBJECTIVE To test the effects of nightly valerian (Valeriana officinalis) extract to improve sleep of older women with insomnia. METHODS Participants in this phase 2 randomized, double-blind, crossover controlled trial were 16 older women (mean age=69.4+/-8.1 years) with insomnia. Participants took 300 mg of concentrated valerian extract or placebo 30 min before bedtime for 2 weeks. Sleep was assessed in the laboratory by self-report and polysomnography (PSG) at baseline and again at the beginning and end of each treatment phase (total of nine nights in the laboratory) and at home by daily sleep logs and actigraphy. RESULTS There were no statistically significant differences between valerian and placebo after a single dose or after 2 weeks of nightly dosing on any measure of sleep latency, wake after sleep onset (WASO), sleep efficiency, and self-rated sleep quality. In comparing each treatment to baseline in separate comparisons, WASO significantly increased (+17.7+/-25.6 min, p=.02) after 2 weeks of nightly valerian, but not after placebo (+6.8+/-26.4 min, NS). Side effects were minor and did not differ significantly between valerian and placebo. CONCLUSION Valerian did not improve sleep in this sample of older women with insomnia. Findings from this study add to the scientific evidence that does not support use of valerian in the clinical management of insomnia.

A pilot study of gentle yoga for sleep disturbance in women with osteoarthritis.

OBJECTIVES The purpose of this study was to test the feasibility and acceptability of a gentle yoga intervention for sleep disturbance in older women with osteoarthritis (OA) and to collect initial efficacy data on the intervention. METHODS All participants completed an 8-week yoga program that included 75-min weekly classes and 20 min of nightly home practice. Participants were women with OA and symptoms consistent with insomnia. Symptom questionnaires and 1 week of wrist actigraphy and sleep diaries were completed for 1 week pre- and post-intervention. RESULTS Fourteen women were enrolled of whom 13 completed the study (mean age 65.2 ± 6.9 years). Participants attended a mean of 7.2 ± 1.0 classes and practiced at home 5.83 ± 1.66 nights/week. The Insomnia Severity Index and diary-reported sleep onset latency, sleep efficiency, and number of nights with insomnia were significantly improved at post-intervention versus pre-intervention (p < .05). Other sleep outcomes (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, diary-reported total sleep time and wake after sleep onset) showed improvement on mean scores at post-intervention, but these were not statistically significant. Actigraphic sleep outcomes were not significantly changed. CONCLUSIONS This study supports the feasibility and acceptability of a standardized evening yoga practice for middle-aged to older women with OA. Preliminary efficacy findings support further research on this program as a potential treatment option for OA-related insomnia.

Sleep Disturbances in Persons Living With HIV

Up to 70% of persons living with HIV (PLWH) experience sleep disturbances. Insomnia and obstructive sleep apnea syndrome (OSAS) are common disorders seen in the primary care of PLWH. This paper reviews the current evidence and practice recommendations for treating these conditions. Insomnia is evaluated by clinical interview, questionnaires, and sleep diaries. The recommended first-line treatment is cognitive-behavioral therapy for insomnia (CBT-I) delivered by a trained therapist. Certain sedative medications may be useful, but over-the-counter treatments (particularly those containing antihistamines) are not recommended. OSAS is diagnosed by overnight sleep study but can be screened for in primary care. The STOP-BANG is a useful eight-item screening tool. The gold standard of treatment for OSAS is the use of a continuous positive airway pressure device. Treatment of insomnia and OSAS is important for improving quality of life and preventing associated health problems (especially cardiovascular disease in OSAS) in PLWH.

Pharmacokinetics of Valerenic Acid After Single and Multiple Doses of Valerian in Older Women

Insomnia is a commonly reported clinical problem with as many as 50% of older adults reporting difficulty in falling and/or remaining asleep. Valerian (Valeriana officinalis) is a commonly used herb that has been advocated for promoting sleep. Valerenic acid is used as a marker for quantitative analysis of valerian products with evidence of pharmacological activity relevant to the hypnotic effects of valerian. The objective of this study was to determine the pharmacokinetics of valerenic acid in a group of elderly women after receiving a single nightly valerian dose and after 2 weeks of valerian dosing. There was not a statistically significant difference in the average peak concentration (Cmax), time to maximum concentration (Tmax) area under the time curve (AUC), elimination half‐life (T1/2) and oral clearance after a single dose compared with multiple dosing. There was considerable inter‐ and intra‐subject variability in the pharmacokinetic parameters. Cmax and AUC deceased and T1/2 increased with increased body weight. The variability between the capsules was extremely low: 2.2%, 1.4% and 1.4%, for hydroxyvalerenic acid, acetoxyvalerenic acid and valerenic acid, respectively. In conclusion, large variability in the pharmacokinetics of valerenic acid may contribute to the inconsistencies in the effect of valerian as a sleep aid. Copyright

A pilot study of sleep quality and rest-activity patterns in persons living with HIV.

&NA; As much as 73% of persons living with HIV (PLWH) experience sleep disturbances. It has been more than 10 years since the last study that objectively measured sleep behaviors in persons with HIV. The purpose of this pilot study was to explore sleep quality and rest–activity patterns in PLWH. Eight participants completed a sleep diary and 24‐hour actigraphy for 1 week. Compared to accepted norms for “good sleepers,” sleep diaries described moderate sleep disturbance, and actigraphy revealed severe sleep disturbance. Bedtime was variable from day to day. Analysis of 24‐hour rest–activity patterns from actigraphy also indicated disorganization of sleep timing across days. Results of this pilot study suggest that sleep disturbance remains problematic in PLWH despite advancements in the disease management. Pharmacological interventions are effective but generally recommended for short‐term use. Behavioral treatments may be useful for longer‐term management of sleep patterns in PLWH, but further research is needed.

Yoga for Osteoarthritis: Nursing and Research Considerations

Osteoarthritis (OA) is a leading cause of pain and disability worldwide. Current treatment guidelines recommend nonpharmacological approaches such as yoga for firstline treatment of OA. Yoga is a promising mind-body practice that includes physical postures, breathing practices, and meditative mental focus. This article presents the current evidence, as well as a proposed conceptual model for future research. Current research on yoga for OA is scant but promising, showing some evidence of reduced pain, sleep disturbance, and disability. The conceptual model described here proposes musculoskeletal effects (strengthening, flexibility, relaxation), reduction of autonomic arousal, and therapeutic cognitive patterns (distraction, mindfulness) as potentially important mechanisms of yoga. This article also describes considerations for patients and health care providers when evaluating the potential usefulness and safety of yoga programs: yoga style, instructor qualifications, and amount of time spent in yoga practice.

A Feasibility Study of Valerian Extract for Sleep Disturbance in Person With Arthritis

Objectives: To present a pilot study of valerian to explore issues of feasibility and efficacy in studies of sedative herbs for arthritis-related sleep disturbance. Methods: Fifteen persons with arthritis and mild sleep disturbance were randomized to receive 600 mg valerian (Valeriana officinalis, n = 7) or placebo (n = 8) for five nights. Results: Protocol adherence (dosing and data collection) was high. Allocation concealment was successful using a novel approach for matching the placebo on the distinctive odor of valerian. Nonsignificant differences between the groups were found on all sleep outcomes, measured by daily diaries and wrist actigraphy. Conclusion: The study methods were feasible, except for recruitment issues (addressed in the discussion), and may guide the testing of other sedative herbs for persons with arthritis. Although efficacy outcomes were inconclusive due to the small sample size of this study, recent evidence from larger trials of valerian also does not support its efficacy.

Valerian and Other CAM Botanicals in Treatment of Sleep Disturbances

Publisher Summary This chapter focuses on a commonly used herbal sedative, valerian for sleep disorders, with an emphasis on older people. One of the most prevalent health problems of older adults is mentioned to be sleep disturbance and the use of prescription drugs further aggravates the condition and so many people use herbal products as an alternative therapy for the disorder. An overview of the botanical products commonly used for this condition and the effectiveness and safety of these products in older people is given. A general description of the various sleep disorders, including insomnia, which is a sleep-wake disorder, advanced sleep phase disorder (ASPD) and periodic limb movements in sleep (PLMS) and Restless legs syndrome (RLS) is presented. It also gives information on the numerous herbs having sedating qualities as recommended by the German Commission E, known internationally for monographs on medicinal herbs. Valerian is mentioned to be the top-selling herbs in the United States and various studies of the effect of valerian on sleep is mentioned. Some other herbal sedatives being discussed include hops, lemon balm, lavender, passion flower and kava.