Polysomnography

Katarzyna Janda et al. (2020) · Nutrients

This systematic review pooled nine randomised clinical trials to ask whether passionflower (Passiflora incarnata) helps with anxiety, sleep and related neuropsychiatric symptoms. Passionflower is a perennial climbing vine whose aerial parts, flowers and fruit are used medicinally, and whose activity is attributed to flavonoids such as apigenin and luteolin and to flavonoid glycosides including vitexin and isovitexin. The European Medicines Agency recognised it as a medicinal product in a 2014 herbal monograph. The review frames the problem as stress — the body's response to physical and psychological stressors, which becomes pathological when prolonged and can impair concentration and memory. The authors searched PubMed, Embase and ClinicalTrials.gov to October 2019 and screened 417 records down to nine trials run between 2017 and 2019, five of them in Iran. Participants were all adults, between 16 and 128 per trial, and eight of the nine trials enrolled healthy volunteers rather than diagnosed patients. Preparations varied widely — drops, tablets, syrup, a standardised extract and herbal tea — over periods from a single day to 30 days. Anxiety was measured with instruments including the State-Trait Anxiety Inventory and the Corah Dental Anxiety Scale, sedation with the Ramsey scale, and sleep with polysomnography. Most trials found reduced anxiety, though the benefit was smaller in people whose anxiety was mild to begin with. In generalised anxiety disorder, 45 drops daily for 28 days matched oxazepam without impairing work performance. Before surgery, 500 mg tablets lowered anxiety more than oxazepam, and a 700 mg per 5 mL syrup given 30 minutes before spinal anaesthesia reduced anxiety with haemodynamics unchanged. Compared with midazolam before wisdom-tooth extraction, 260 mg gave similar calming with markedly less somnolence (50% versus 82.5%) and no amnesia at all, against 20% on midazolam — although more participants would still choose midazolam again (52% versus 27.5%), which the authors attribute to that same amnesia preventing negative memories. Herbal tea drunk nightly for a week improved self-reported sleep quality by 5.2% over placebo. No adverse effects, memory loss or collapse of psychometric function were reported anywhere in the review. The practical reading is that passionflower performs comparably to two established sedatives for procedural anxiety, with a different side-effect profile — less somnolence, no amnesia — which may matter where alertness is wanted afterwards. The evidence is genuinely limited, though: nine small trials, too heterogeneous to pool statistically, three of them rated low quality, and most never recorded which part of the plant was used. Its anxiolytic action is thought to work through the GABA system. Larger trials across more varied populations are needed before firm dosing guidance is possible.

Harshith Chandra Shekhar et al. (2023) · Advances in therapy

This double-blind randomized trial with 80 adults tested whether valerian — the root extract that has been Europe's traditional sleep herb for centuries — measurably improves sleep when held to modern trial standards. Participants with ongoing sleep complaints took either 200 mg of standardized Valeriana officinalis extract or an identical placebo capsule daily for eight weeks, with neither participants nor researchers knowing who received which. What sets this trial apart is how sleep was measured. Beyond the standard Pittsburgh Sleep Quality Index questionnaire, everyone wore wrist actigraphy devices that objectively track sleep and wake, and half the participants underwent polysomnography — the full laboratory sleep study with brain-wave monitoring that sleep medicine treats as its gold standard. Anxiety, daytime sleepiness, and the feeling of waking refreshed were tracked alongside, with blood work and vital signs monitoring safety throughout. Valerian delivered on nearly every front. Sleep quality scores improved significantly versus placebo by day 14 and stayed better through day 56 (p<0.05). The objective measures agreed: actigraphy showed people falling asleep faster and sleeping longer from day 3 onward, and the laboratory sleep studies confirmed longer total sleep, quicker sleep onset, and better sleep efficiency at eight weeks. Anxiety scores dropped, daytime drowsiness eased, and participants reported waking up more refreshed. No safety signals appeared in any blood test, vital sign, or examination — a meaningful contrast with prescription sleep aids and even melatonin's daytime-drowsiness complaints. This trial offers unusually convergent evidence for valerian in mild sleep complaints: subjective ratings, wrist-worn tracking, and laboratory measurement all pointed the same direction at a modest 200 mg daily dose. The caveats are a moderately sized sample of younger adults with mild symptoms and an eight-week window — the findings do not extend to severe or chronic insomnia.