Can valerian improve the sleep of insomniacs after benzodiazepine withdrawal?

• Published in: Progress in neuro-psychopharmacology & biological psychiatry Vol. 26; no. 3; pp. 539 - 545
• Main Authors: Poyares, Dalva R, Guilleminault, Christian, Ohayon, Maurice M, Tufik, Sergio
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.04.2002; Elsevier
• Subjects: Adult; Analysis of Variance; Benzodiazepines; Benzodiazepines - adverse effects; Biological and medical sciences; Double-Blind Method; Drug withdrawal; Electroencephalography - drug effects; Electroencephalography - statistics & numerical data; Female; General pharmacology; Humans; Insomnia; Iridoids - pharmacology; Iridoids - therapeutic use; Male; Medical sciences; Middle Aged; Period amplitude analysis; Pharmacognosy. Homeopathy. Health food; Pharmacology. Drug treatments; Phytotherapy - methods; Phytotherapy - statistics & numerical data; Plant Roots; Sleep - drug effects; Sleep - physiology; Sleep EEG; Sleep Initiation and Maintenance Disorders - chemically induced; Sleep Initiation and Maintenance Disorders - drug therapy; Sleep Initiation and Maintenance Disorders - physiopathology; Substance Withdrawal Syndrome - drug therapy; Substance Withdrawal Syndrome - physiopathology; Valerian; Electrooculogram; Nonrapid eye movement; Electroencephalogram; Benzodiazepine; Electromyogram; Drug withdrawal; Sleep EEG; First-Derivative Analysis; Benzodiazepines; Rapid eye movement; Period amplitude analysis; Insomnia; Electrocardiogram; Valerian; Wake time after sleep onset; Human; Poison withdrawal; Pharmacognosy; Toxicity; Sleep disorder; Valerianaceae; Long term; Subjective evaluation; Chemotherapy; Sleep; Treatment; Dicotyledones; Angiospermae; Plant origin; Valeriana; Benzodiazepine derivatives; Spermatophyta; Phytotherapy; Sedative; Withdrawal syndrome
• ISSN: 0278-5846
• DOI: 10.1016/S0278-5846(01)00305-0

Purpose: The authors studied the sleep of patients with insomnia who complained of poor sleep despite chronic use of benzodiazepines (BZDs). The sample consisted of 19 patients (mean age 43.3±10.6 years) with primary insomnia (DSM-IV), who had taken BZDs nightly, for 7.1±5.4 years. The control group was composed of 18 healthy individuals (mean age 37±8 years). Sleep electroencephalogram (EEG) of the patients was analyzed with period amplitude analysis (PAA) and associated algorithms, during chronic BZD use (Night 1), and after 15 days of a valerian placebo trial (initiated after washout of BZD, Night 2). Sleep of control subjects was monitored in parallel. Results: Valerian subjects reported significantly better subjective sleep quality than placebo ones, after BZD withdrawal, despite the presence of a few side effects. However, some of the differences found in sleep structure between Night 1 and Night 2 in both the valerian and placebo groups may be due to the sleep recovery process after BZD washout. Example of this are: the decrease in Sleep Stage 2 and in sigma count; the increase in slow-wave sleep (SWS), and delta count, which were found to be altered by BZD ingestion. There was a significant decrease in wake time after sleep onset (WASO) in valerian subjects when compared to placebo subjects; results were similar to normal controls. Nonetheless, valerian-treated patients also presented longer sleep latency and increased alpha count in SWS than control subjects. Conclusions: The decrease in WASO associated with the mild anxiolytic effect of valerian appeared to be the major contributor to subjective sleep quality improvement found after 2-week of treatment in insomniacs who had withdrawn from BDZs. Despite subjective improvement, sleep data showed that valerian did not produce faster sleep onset; the increase in alpha count compared with normal controls may point to residual hyperarousabilty, which is known to play a role in insomnia. Nonetheless, we lack data on the extent to which a sedative drug can improve alpha sleep EEG. Thus, the authors suggest that valerian had a positive effect on withdrawal from BDZ use.