Insomnia: Symptoms, Causes and Care

Insomnia (a common sleep disorder) · also called Insomnia, sleeplessness, trouble sleeping, chronic insomnia, short-term insomnia, insomnio

Insomnia means regularly having trouble falling asleep, staying asleep or getting good-quality sleep, even with time and a suitable place to sleep. Guidelines list cognitive behavioural therapy for insomnia (CBT-I) first for chronic insomnia, and the NHS says sleeping pills are now rarely prescribed. Most natural options, such as valerian, melatonin and magnesium, have weak or mixed evidence. See a doctor if sleep problems last months or other signs appear, such as loud snoring with gasping or low mood.

General information, not medical advice. Last substantive update October 31, 2026 · Not medically reviewed. A named clinician has not signed off on this page. How this page is made

About Insomnia: Symptoms, Causes and Care

Insomnia is a common sleep disorder in which sleep is hard to start, hard to keep or poor in quality despite time and a good place to sleep. It is called chronic when it happens 3 or more nights a week for 3 months or more. Guidelines list CBT-I first, medicines only in some cases, and the evidence for natural products is mostly weak or mixed. See a doctor if it lasts months or you have other warning signs.

What insomnia is: meaning and common symptoms

NHLBI describes insomnia as a common sleep disorder in which people have trouble falling asleep, staying asleep or getting good-quality sleep, even with enough time and a suitable place. The NHS says it means regularly having problems sleeping and that it usually improves with changes to sleep habits.

Common features include lying awake before sleep, waking often, waking too early, waking unrefreshed, daytime tiredness, trouble concentrating and irritability. An occasional bad night is not insomnia, and only a clinician can say whether you have it.

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Short-term and chronic insomnia

The NHS calls insomnia that lasts under 3 months short-term and 3 months or longer long-term. NHLBI defines chronic insomnia as 3 or more nights a week for more than 3 months, not fully explained by another health problem.

Short-term insomnia is often linked to stress or to changes in schedule or surroundings.

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Causes and contributors

The NHS lists stress, anxiety or depression, noise, an uncomfortable temperature or bed, alcohol, caffeine or nicotine, jet lag and shift work. It also lists conditions and medicines that affect sleep, such as restless legs syndrome, an overactive thyroid, menopause, long-term pain, sleep apnea, and mental health or brain conditions.

NHLBI says chronic insomnia is linked to higher risk of high blood pressure, coronary heart disease, diabetes and cancer, so a lasting problem is worth raising with a clinician.

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What a clinician looks at

NHLBI says a clinician asks about sleep habits and may ask you to keep a sleep diary for 1 to 2 weeks, checks for other medical problems, and may order blood tests for thyroid problems. A wrist sensor (actigraphy) worn for 3 to 14 days is sometimes used. A sleep study looks for other sleep problems such as sleep apnea, circadian rhythm disorders or narcolepsy.

The NHS says a GP looks for the underlying cause and may offer CBT in person or as an online self-help program, with a sleep clinic referral if another sleep disorder is suspected.

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First-line care

The American College of Physicians (2016) recommends that all adults receive CBT-I as the first treatment for chronic insomnia (strong recommendation, moderate-quality evidence). The American Academy of Sleep Medicine (2021) strongly recommends multicomponent CBT-I and gives conditional suggestions for stimulus control, sleep restriction and relaxation therapy used alone, but suggests against sleep hygiene as the only treatment.

A meta-analysis of 20 trials found CBT-I shortened time to fall asleep by about 19 minutes and time awake after sleep onset by about 26 minutes.

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What medicines and supplements do

The NHS says GPs now rarely prescribe sleeping pills for insomnia because of serious side effects and dependence, and that when used it is only for days or weeks if insomnia is severe and other treatments have failed. The American College of Physicians suggests discussing the benefits, harms and costs of short-term medicines only where CBT-I alone was unsuccessful. Choosing any medicine is a decision for you and your clinician.

Pharmacy sleep aids may contain valerian, lavender or an antihistamine. The NHS says they cannot cure insomnia, may help for 1 to 2 weeks at most and can cause drowsiness. The AASM weakly suggests against melatonin, valerian, tryptophan and diphenhydramine as insomnia treatments.

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What natural approaches have and have not shown

Of the non-drug approaches, CBT-I has the strongest support. Relaxation, mindfulness, exercise, yoga and tai chi have low-certainty evidence. Acupuncture, valerian and melatonin have mixed results. Magnesium, chamomile, lavender and tart cherry juice rest on small or weak studies. For kava and L-theanine no insomnia trial was read.

In a 2014 trial of 123 older adults, CBT cleared insomnia better than tai chi.

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At a glance

Traditional uses history, not proof

Studied for research

CBT-I, moderate certainty (the approach guidelines list first)
Sleep habits alone, low certainty and not enough on their own for chronic insomnia
Relaxation and mindfulness, low certainty
Exercise, low certainty
Yoga and tai chi, low certainty
Acupuncture, low certainty and mixed
Valerian, mixed
Melatonin, mixed
Magnesium, very low certainty
Chamomile, lavender and tart cherry juice, insufficient to low certainty

Main compounds

CBT-I
Melatonin
Valerian root
Magnesium
Chamomile
Lavender
Tart cherry juice

Common forms

In-person or online CBT-I
Group yoga, tai chi or mindfulness classes
Acupuncture
Herbal teas and extracts
Magnesium supplements
Melatonin products
Inhaled lavender

Research links: 2016 guideline: American College of Physicians on chronic insomnia · 2015 meta-analysis: CBT-I for chronic insomnia (20 trials) · 2021 guideline: behavioural treatments for chronic insomnia · 2024 review of reviews: does valerian work for insomnia? · NHS: Insomnia · NCCIH: Sleep disorders and complementary approaches · Research Library · Genes & Biomarkers Library

What it is and its history

Accepted scientific name: Insomnia (a sleep disorder)
Common names: Insomnia (English); Sleeplessness (English); Insomnio (Spanish)
Family or group: Sleep disorder. NHLBI describes chronic insomnia as 3 or more nights a week for more than 3 months, not fully explained by another health problem; the NHS calls insomnia under 3 months short-term and 3 months or longer long-term.
Look-alikes and adulterants: Name: Sleep apnea; Note: Breathing pauses at night that disturb sleep; needs its own assessment.; Name: Restless legs syndrome; Note: An urge to move the legs that can keep people awake; has its own page.; Name: Circadian rhythm disorders; Note: Sleep timing out of step with the day, such as jet lag or shift work.

Traditional use and history history, not clinical proof

Tradition or era	Documented use	Source
Modern guidance	Current guidelines list CBT-I first for chronic insomnia, with short-term medicines considered only in some cases. No history older than current agency guidance was read for this page.	p27136449

Traditional use shows how it was used. It does not show that it works or is safe today.

What is inside, and how it may work

What it contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.

Main compounds

Compound	Family	Where it is concentrated	Activity studied	Level of evidence
CBT-I	behavioural program	At least three of cognitive therapy, stimulus control, sleep restriction, sleep hygiene and relaxation.	Changes habits and thoughts that keep insomnia going. ²²	Human data
Melatonin	hormone supplement	The body's own night-time hormone, also sold as a supplement.	Signals night to the body clock. ^{8 6}	Human data
Valerian root	herb	Root of Valeriana officinalis; products vary widely.	Proposed calming effects; not established. ²³	Human data
Magnesium	mineral	Sold in several forms.	Proposed nerve-calming role; not established. ¹⁵	Human data

Mechanisms, receptors and pathways

Target or pathway	Gene or receptor	What was found	Level
Why insomnia persists		Sources describe stress, worry, habits, other health problems and medicines as common contributors. The trials read measured sleep outcomes, not mechanisms. ^{34 33}	Not established

Isolated compounds versus whole extracts

CBT-I is a package of several parts. Herbal and supplement products differ between trials, so results for one product cannot be assumed for another.

13benefits and uses looked at

34studies and sources checked

Moderate certaintybest evidence rating found

4lab markers tracked in trials

1 moderate certainty2 mixed findings6 low certainty2 very low certainty2 not enough evidence

What was looked at

The 13 benefits and uses checked for Insomnia: Symptoms, Causes and Care, each with how strong the evidence is. Tap one to open it.

Cognitive behavioural therapy for insomnia (CBT-I)Moderate certainty
Sleep habits and a regular schedule (sleep hygiene)Low certainty
Relaxation techniques and mindfulnessLow certainty
Regular exerciseLow certainty
Yoga and tai chiLow certainty
AcupunctureLow certainty
Valerian (root)Mixed findings
MelatoninMixed findings
MagnesiumVery low certainty
ChamomileNot enough evidence
Lavender (inhaled and oral)Low certainty
Tart cherry juiceVery low certainty
L-theanine and kavaNot enough evidence

Lab markers tracked in the studies

Time to fall asleep (sleep onset latency)Time awake after sleep onsetSelf-rated sleep quality (PSQI)Insomnia severity (ISI score)

What is Insomnia: Symptoms, Causes and Care good for?

These are the main non-drug and natural approaches studied for insomnia and how strong the human evidence is for each. They describe what trials found, not advice to try anything. Established medical care is described in the About tab.

CBT-I (cognitive behavioural therapy for insomnia)Moderate certaintyGuidelines list it first. Pooled trials found about 19 minutes quicker sleep onset and 26 fewer minutes awake in the night. Sleep habits and a regular scheduleLow certaintyA sensible part of care, but the American Academy of Sleep Medicine suggests it is not enough as the only treatment for chronic insomnia. Relaxation and mindfulnessLow certaintyLow-quality evidence alone; a small trial of 49 older adults found mindfulness beat a sleep habits class. Regular exerciseLow certaintyReviews found better sleep scores in people with insomnia, but trials were small and varied. Yoga and tai chiLow certaintyPossible gains in sleep time and quality; in older adults tai chi did not clear insomnia as well as CBT. AcupunctureLow certaintyOne sham-controlled trial in insomnia with depression was positive; a review in cancer survivors found no benefit. ValerianMixed findingsReviews disagree; a 2024 review of reviews found no evidence it treats insomnia. MelatoninMixed findingsA few minutes' gain in pooled trials, no clear benefit in adults with chronic insomnia in a 2022 review. MagnesiumVery low certaintyThree small trials in older adults hinted at quicker sleep onset, graded low to very low quality. ChamomileNot enough evidenceOne insomnia trial found no change; sleep-quality scores improved in pooled trials. LavenderLow certaintyInhaled lavender and a lavender oil capsule were linked to better sleep, mostly outside insomnia disorder. Tart cherry juiceVery low certaintyTwo tiny pilot trials in older adults reported modest gains. L-theanine and kavaNot enough evidenceNo insomnia trial was read for either; kava carries a liver-safety warning.

Benefits, one by one

Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.

Cognitive behavioural therapy for insomnia (CBT-I)

Moderate certainty

A structured, non-drug talking and habit program is the approach guidelines list first for chronic insomnia. Pooled trials found people fell asleep about 19 minutes sooner and spent about 26 fewer minutes awake in the night.

4 studiesMulticomponent CBT-I combines at least three of: cognitive therapy, s…

Studies, doses and limits

What the trials found

A 2015 meta-analysis of 20 trials (1,162 adults, mean age 56) of face-to-face CBT-I found clinically meaningful improvements and no adverse outcomes reported. The 2016 American College of Physicians guideline recommends CBT-I first for all adults with chronic insomnia (strong recommendation, moderate-quality evidence). The 2021 American Academy of Sleep Medicine guideline strongly recommends multicomponent CBT-I. A 2022 meta-analysis of 24 studies found better quality of life (SMD 0.47) but with very high variation.

Results

Time to fall asleep improved by 19.03 minutes, time awake after sleep onset by 26.00 minutes, sleep efficiency by 9.91 percentage points; total sleep time rose by 7.61 minutes, not statistically significant.

Effect sizes as reported

2015: time to fall asleep 19.03 min (95% CI 14.12 to 23.93); awake after sleep onset 26.00 (15.48 to 36.52); sleep efficiency 9.91 percent (8.09 to 11.73).

Why this rating

The guideline authors grade the recommendation as strong with moderate-quality evidence. Trials compared CBT-I with inactive comparators, and people knew which treatment they had.

Form and dose studied

Multicomponent CBT-I combines at least three of: cognitive therapy, stimulus control, sleep restriction, sleep hygiene and relaxation. It has been delivered in person and online. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with chronic insomnia and no other major condition (2015 review); mostly women, mean age 56.

Limits

Insomnia with other conditions was excluded from the 2015 review; later time points were less certain; self-reported diaries.

Why researchers looked

Insomnia is kept going by worry about sleep and by habits such as long time in bed awake, so researchers tested a program that changes both.

Proposed mechanism Hypothesis

Proposed: it weakens the link between bed and wakefulness, and it reduces worry about sleep. The trials measured sleep, not these steps.

A proposed mechanism does not show that the effect happens in people.

No adverse outcomes were reported in the 2015 review. Sleep restriction can cause short-term sleepiness, which is why programs are best delivered by trained clinicians; this point is general knowledge and was not taken from a study read for this page.

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Sleep habits and a regular schedule (sleep hygiene)

Low certainty

Sleep hygiene means habits such as a regular wake time, a dark quiet bedroom and less caffeine and alcohol late in the day. It is a sensible part of care, but the American Academy of Sleep Medicine suggests it is not enough on its own for chronic insomnia.

3 studiesNHS lists: going to bed only when sleepy, a consistent wake time, win…

Studies, doses and limits

What the trials found

The 2021 AASM guideline gives a conditional suggestion against using sleep hygiene as a single treatment for chronic insomnia. The NHS page (reviewed March 2024) describes habit changes as the first step and usually help short-term insomnia. In a 2015 trial of 49 older adults, a sleep hygiene class was used as the comparison for mindfulness and improved less.

Results

Guideline-level statement; no pooled effect size for sleep hygiene alone was read.

Effect sizes as reported

Guideline: conditional recommendation against as the only treatment.

Why this rating

Evidence is a guideline suggestion plus its use as a comparison group; no pooled estimate was read. NHS describes habit changes as the usual first step for short-term insomnia.

Form and dose studied

NHS lists: going to bed only when sleepy, a consistent wake time, winding down, a dark quiet room, daytime exercise, and avoiding smoking, alcohol, tea or coffee within 6 hours of bed, large late meals, naps, and screens right before bed. These are agency tips, not trial results.

Who was studied

Adults with insomnia (guideline); older adults with sleep disturbance (comparison arm).

Limits

Hard to study alone because it is usually part of CBT-I; the guideline conclusion applies to chronic insomnia, not to a few bad nights.

Why researchers looked

Habits and the sleep setting are the most obvious things a person can change, so guidelines and trials have tested them.

Proposed mechanism Hypothesis

Proposed: fewer things that keep the body alert at night. Not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

No harms are described in the sources read.

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Relaxation techniques and mindfulness

Low certainty

Relaxation training has only a small amount of low-quality evidence on its own, though it is a part of CBT-I. A small trial found a mindfulness course improved sleep quality more than a sleep habits class in older adults.

4 studiesThe 2015 trial: 6 weekly 2-hour group sessions with homework. Amounts…

Studies, doses and limits

What the trials found

NCCIH says only a small amount of low-quality evidence supports relaxation techniques alone, and that evidence is insufficient to recommend mindfulness alone. The AASM suggests relaxation therapy as a single treatment (conditional). A 2015 trial of 49 older adults with moderate sleep disturbance found mindfulness beat a sleep hygiene class on sleep quality (difference 1.8 points). A 2019 review of 49 mind-body studies found better sleep quality and lower insomnia severity, but no significant change in sleep time.

Results

2015 trial: sleep quality score 7.4 after mindfulness versus 9.1 after the class. 2019 review: improved sleep quality and insomnia severity, no significant change in sleep quantity.

Effect sizes as reported

Black 2015: PSQI difference 1.8 (95% CI 0.6 to 2.9), effect size 0.89.

Why this rating

A small trial of 49 people, an agency page calling the evidence low-quality or insufficient, and a review with mixed designs.

Form and dose studied

The 2015 trial: 6 weekly 2-hour group sessions with homework. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Older adults with moderate sleep disturbance (2015 trial); adults with or without disease (2019 review).

Limits

Small trial, short follow-up; mind-body review mixed all study designs.

Why researchers looked

Racing thoughts and body tension are common in insomnia, so calming practices were tried.

Proposed mechanism Hypothesis

Proposed: lower alertness at bedtime and less reaction to worry. Not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

NCCIH says relaxation is usually safe, though some people report more anxiety, with rare reports of worsened symptoms in epilepsy or certain psychiatric conditions. Few studies of mindfulness looked for harm.

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Regular exercise

Low certainty

Pooled trials found regular exercise improved sleep scores in people with insomnia, but trials were small and varied, and most estimates are low certainty.

4 studiesTypes studied: walking, jogging, aerobic plus strength training, stre…

Studies, doses and limits

What the trials found

A 2024 meta-analysis of 19 trials in people with insomnia found better objective (SMD 0.37) and subjective (SMD 0.90) sleep, with high variation. A 2026 network meta-analysis of 22 trials (1,348 adults) found, with low certainty, that walking or jogging may lower insomnia severity scores. A 2021 meta-analysis of 22 trials in adults without disease found lower sleep-quality, insomnia and sleepiness scores, with physical and mind-body exercise working about equally.

Results

Subjective sleep SMD 0.90; objective SMD 0.37 (2024). Walking or jogging insomnia severity score -9.57 points (2026, low certainty). Sleep-quality score -2.19 points in healthy adults (2021).

Effect sizes as reported

2024: 0.61 to 1.19 and 0.17 to 0.57. 2026 walking or jogging: -12.12 to -7.02. 2021: -2.96 to -1.41.

Why this rating

Several reviews agree on benefit, but most estimates are low certainty with high variation and inactive controls.

Form and dose studied

Types studied: walking, jogging, aerobic plus strength training, strength training, Tai Chi and yoga. NHS advises avoiding exercise within 4 hours of bed. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with insomnia (2024, 2026 reviews); adults without disease (2021 review).

Limits

People cannot be blinded to exercise, so expectation may play a part; most outcomes were self-reported.

Why researchers looked

Activity is linked to better sleep in the general population, so researchers tested exercise as a treatment.

Proposed mechanism Hypothesis

Proposed: more tiredness at night, lower stress and a steadier body clock. Not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

Exercise carries its own injury and heart-health considerations for some people; sources read for this page did not cover them. Ask a clinician if you have a heart or joint condition.

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Yoga and tai chi

Low certainty

Some trials found yoga and tai chi raised sleep time or sleep quality. In older adults with insomnia, tai chi helped sleep quality, but CBT did better for clearing insomnia.

4 studiesTai Chi Chih in the 2014 trial: weekly 2-hour group sessions for 4 mo…

Studies, doses and limits

What the trials found

A 2026 network meta-analysis found yoga likely raised diary total sleep time (moderate certainty) and tai chi may have helped sleep scores (low certainty). A 2014 trial of 123 older adults with chronic insomnia found CBT beat Tai Chi Chih for insomnia remission, while Tai Chi Chih beat an education control for sleep quality, fatigue and mood but not for remission. NCCIH says yoga may improve sleep quality but not necessarily insomnia.

Results

Yoga: diary total sleep time +110.88 minutes (moderate certainty). Tai Chi: +52.07 minutes (low certainty). 2014 trial: Tai Chi Chih improved sleep quality versus education but did not clear insomnia.

Effect sizes as reported

Yoga total sleep time 58.66 to 163.09; Tai Chi 25.53 to 78.61 (2026).

Why this rating

Moderate certainty for one yoga outcome, low certainty for the rest, and a comparative trial where tai chi did not clear insomnia.

Form and dose studied

Tai Chi Chih in the 2014 trial: weekly 2-hour group sessions for 4 months. Yoga amounts in the pooled review varied. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with insomnia; older adults with chronic primary insomnia (2014 trial).

Limits

Polysomnography did not change in the 2014 trial; most estimates rely on sleep diaries.

Why researchers looked

Slow movement with breathing is calming, and these practices are popular for sleep.

Proposed mechanism Hypothesis

Proposed: lower arousal through slow movement and breath. Not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

NCCIH: yoga is generally safe with a qualified instructor, and sprains and strains are the commonest injuries. Tai chi appears safe, with minor muscle aches.

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Acupuncture

Low certainty

Results are mixed. One sham-controlled trial in people with insomnia and depression found electroacupuncture helped sleep, while a review in cancer survivors found no benefit over sham needling.

4 studiesTrial: 24 electroacupuncture sessions over 8 weeks, 3 a week. Amounts…

Studies, doses and limits

What the trials found

A 2021 review of 24 trials found acupuncture scored better than medicines on sleep quality after 3 to 4 weeks, with very high variation. A 2022 trial of 270 adults with insomnia and depression found electroacupuncture lowered sleep scores more than sham acupuncture (difference -3.6) and standard care (-5.1) at 8 weeks, sustained over 24 weeks. A 2022 review of 13 trials in cancer survivors found no evidence of benefit. NCCIH says evidence is limited and low quality.

Results

Electroacupuncture versus sham: PSQI -3.6 at 8 weeks (2022 trial). Cancer survivors review: no benefit found.

Effect sizes as reported

Trial: -3.6 (95% CI -4.4 to -2.8) versus sham; -5.1 (-6.0 to -4.2) versus standard care.

Why this rating

One good sham-controlled trial but in a special group, one null review, and an agency rating of low-quality evidence.

Form and dose studied

Trial: 24 electroacupuncture sessions over 8 weeks, 3 a week. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with insomnia and depression (trial); mixed insomnia groups (2021 review); cancer survivors (2022 review).

Limits

Many trials compare with medicines, not sham; sham needling is hard to blind; high variation.

Why researchers looked

Acupuncture is widely used in East Asia for sleep, so trials have tested it.

Proposed mechanism Hypothesis

Proposed: effects on the nervous system. Not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

NCCIH: serious complications are uncommon but can arise from non-sterile needles or poor technique, such as infection or punctured organs. Adverse events were minor in the cancer review.

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Valerian (root)

Mixed findings

Valerian is one of the most studied herbs for sleep, but results disagree. A 2024 review of reviews found no evidence it treats insomnia, and a sleep medicine guideline suggests not using it.

6 studiesPreparations varied widely in the trials (root, extracts, combination…

Studies, doses and limits

What the trials found

A 2006 review of 16 trials (1,093 people) found a benefit on a yes/no sleep-quality measure but with publication bias and poor trials. A 2020 review of 60 studies (6,894 people) leaned positive for subjective sleep quality. A 2024 umbrella review of 8 systematic reviews found no evidence of efficacy for insomnia and only subjective gains. The 2017 AASM guideline weakly suggests not using valerian for insomnia. NCCIH says trial results are inconsistent and benefit is not shown.

Results

2006: relative risk of improved sleep 1.8. 2024: no evidence of efficacy for insomnia on objective measures.

Effect sizes as reported

2006: 95% CI 1.2 to 2.9.

Why this rating

Reviews disagree, preparations differ, and the guideline suggests against use.

Form and dose studied

Preparations varied widely in the trials (root, extracts, combinations with other herbs). Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults, mostly with sleep complaints; some trials included children aged 7 and up (2020 review).

Limits

Variable products and quality; publication bias; some trials of combinations.

Why researchers looked

Valerian root has been used for centuries for sleep, so many trials exist.

Proposed mechanism Hypothesis

Proposed: calming effects on brain chemistry. Not established in the sources read.

A proposed mechanism does not show that the effect happens in people.

Few side effects were reported; LiverTox lists rare cases of liver injury. NHS says pharmacy sleep aids with valerian or lavender can cause drowsiness and may help for 1 to 2 weeks at most.

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Melatonin

Mixed findings

Melatonin shortened the time to fall asleep by a few minutes in pooled trials, but a 2022 review found no benefit in adults with chronic insomnia. Two guidelines suggest not using it for chronic insomnia.

4 studiesAmounts and timing varied; longer trials and higher amounts showed la…

Studies, doses and limits

What the trials found

A 2013 meta-analysis of 19 trials (1,683 people with primary sleep disorders) found about 7 minutes quicker sleep onset and about 8 more minutes of sleep. A 2022 review of 24 trials in chronic insomnia found it helped only children and adolescents, not adults. The 2017 AASM guideline weakly suggests not using melatonin for chronic insomnia. NCCIH says it may help jet lag and shift work and may shorten time to fall asleep in insomnia, but not other aspects.

Results

2013: time to fall asleep 7.06 min shorter, total sleep time 8.25 min longer, quality SMD 0.22. 2022: not significant in adults.

Effect sizes as reported

2013: 4.37 to 9.75 min; 1.74 to 14.75 min; 0.12 to 0.32.

Why this rating

Small average gains in one review, none in adults in another, and guideline advice against use.

Form and dose studied

Amounts and timing varied; longer trials and higher amounts showed larger effects on time to fall asleep in the 2013 review. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults and children with sleep disorders (2013); adults and children with chronic insomnia (2022).

Limits

Mixed populations and products.

Why researchers looked

Melatonin is the body's own night signal, so it is a natural candidate for sleep.

Proposed mechanism Hypothesis

Proposed: it signals night to the body clock. This is a known role of the hormone, but the trials measured sleep.

A proposed mechanism does not show that the effect happens in people.

NCCIH: relatively safe short-term; long-term safety not established. Child overdoses and emergency visits have risen, and a 2023 study found 22 of 25 gummies mislabelled, some with about 3.5 times the labelled amount.

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Magnesium

Very low certainty

Small, poor-quality trials suggest magnesium may help older adults fall asleep sooner, but the evidence is very low quality.

3 studiesMagnesium forms and amounts varied. Amounts and durations are given o…

Studies, doses and limits

What the trials found

A 2021 review pooled 3 trials of 151 older adults with insomnia and found about 17 minutes quicker sleep onset, with low to very low quality evidence. A 2024 review of 15 trials found 5 of 8 sleep studies reported better sleep, with 2 finding no change. NCCIH says research is very limited and conflicts.

Results

Time to fall asleep 17.36 minutes shorter; total sleep time 16.06 minutes longer, not significant.

Effect sizes as reported

Time to fall asleep: -27.27 to -7.44.

Why this rating

Three small trials at moderate-to-high risk of bias, graded low to very low quality by the reviewers.

Form and dose studied

Magnesium forms and amounts varied. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Older adults with insomnia (2021); varied groups with anxiety or sleep complaints (2024).

Limits

Few, small trials; varied forms; some formulas had other ingredients.

Why researchers looked

Magnesium is linked to nerve calming and is widely promoted online for sleep.

Proposed mechanism Hypothesis

Proposed: calming of nerve signalling. Not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

NCCIH gives upper limits for supplement magnesium and says higher intakes can cause diarrhoea, nausea and cramps; very high intakes can disturb the heart rhythm. People with kidney disease should ask a clinician first (general caution, not from a source read).

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Chamomile

Not enough evidence

Only one trial looked at insomnia and it found no change. Pooled trials suggest better self-rated sleep quality, but evidence is thin.

2 studiesChamomile preparations varied. Amounts and durations are given only a…

Studies, doses and limits

What the trials found

A 2019 review of 12 trials found one trial on insomnia severity with no significant change, and a pooled improvement in sleep quality scores. NCCIH says there is no conclusive trial evidence.

Results

Sleep quality SMD -0.73; insomnia severity no significant change.

Effect sizes as reported

Sleep quality: -1.23 to -0.23.

Why this rating

Only one insomnia trial; small studies.

Form and dose studied

Chamomile preparations varied. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Adults with sleep complaints, anxiety or insomnia.

Limits

Small studies; mixed outcomes.

Why researchers looked

Chamomile tea is a traditional bedtime drink.

Proposed mechanism Hypothesis

Proposed: mild calming plant compounds. Not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

NCCIH: people allergic to ragweed or related plants may react. Mild adverse events were reported in three trials.

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Lavender (inhaled and oral)

Low certainty

Inhaled lavender and a patented lavender oil capsule were linked to better sleep in some trials, mostly in people with anxiety or general sleep complaints, not insomnia disorder.

4 studiesInhaled lavender and a capsule product were studied. Amounts and dura…

Studies, doses and limits

What the trials found

A 2021 review of 34 aromatherapy studies found better sleep overall (effect size 0.65), with lavender doing best. A 2015 trial of 170 people with anxiety-related restlessness and disturbed sleep found a lavender oil capsule (Silexan) lowered anxiety more than placebo; the sleep score also favoured it. NCCIH says larger studies are needed.

Results

Aroma inhalation effect size 0.65; capsule trial anxiety decrease 12.0 versus 9.3 points.

Effect sizes as reported

Not given in the abstracts.

Why this rating

Pooled benefit but hard-to-blind scent trials and one product-specific trial in anxiety rather than insomnia.

Form and dose studied

Inhaled lavender and a capsule product were studied. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

People with sleep problems (review); anxiety-related restlessness (capsule trial).

Limits

Scent cannot be blinded well; the capsule trial studied a patented product with unstated funding.

Why researchers looked

Lavender scent is popular for relaxation and sleep.

Proposed mechanism Hypothesis

Proposed: calming effects of scent and its plant compounds. Not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

NCCIH: essential oils have few side effects as directed, but skin contact can cause allergy or irritation, and breast tissue swelling was reported in a few children using topical lavender products.

^{5 12 31 28}

Tart cherry juice

Very low certainty

Two very small trials of tart cherry juice in older adults with insomnia reported modest gains, but they are far too small to rely on.

2 studiesJuice was taken for 2 weeks in each trial; 2018: 240 mL twice a day a…

Studies, doses and limits

What the trials found

A 2010 pilot of 15 older adults found less time awake after sleep onset and lower insomnia severity with a proprietary juice blend than placebo, but no difference in time to fall asleep or total sleep time. A 2018 pilot of 8 completers found 84 more minutes of sleep time on polysomnography, with most questionnaires unchanged.

Results

2010: lower insomnia severity and less time awake after sleep onset. 2018: +84 minutes of sleep time on polysomnography.

Effect sizes as reported

2018: P 0.0182.

Why this rating

Two pilot crossover trials with 15 and 8 completers.

Form and dose studied

Juice was taken for 2 weeks in each trial; 2018: 240 mL twice a day as reported. Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Older adults with chronic insomnia.

Limits

Tiny trials; proprietary product in 2010; part of the mechanism work was in cell cultures.

Why researchers looked

Tart cherries contain natural melatonin and other compounds, and juice is a popular bedtime drink.

Proposed mechanism Hypothesis

Proposed: natural melatonin and effects on tryptophan breakdown. The 2018 trial tested part of this in cell cultures.

A proposed mechanism does not show that the effect happens in people.

No harms are described in the abstracts. Cherry juice contains sugar (general fact).

^{16 14}

L-theanine and kava

Not enough evidence

Evidence for insomnia is insufficient. The one L-theanine trial read was in healthy adults, not people with insomnia. Kava has a serious liver-safety warning.

3 studiesL-theanine was 200 mg a day for 4 weeks in the trial (as reported). A…

Studies, doses and limits

What the trials found

A 2019 trial of 30 healthy adults found lower sleep-quality scores after 4 weeks of L-theanine tablets than placebo. No trial of kava for insomnia was read; the NIH LiverTox record warns of severe liver injury and NCCIH says there is little research on kava for insomnia.

Results

L-theanine: PSQI lowered versus placebo (P 0.013) in healthy adults.

Effect sizes as reported

Not given in the abstract.

Why this rating

L-theanine was not tested in people with insomnia; no kava insomnia trial was read.

Form and dose studied

L-theanine was 200 mg a day for 4 weeks in the trial (as reported). Amounts and durations are given only as what each study used. They are not advice.

Who was studied

Healthy adults (L-theanine).

Limits

Small crossover study, not an insomnia group.

Why researchers looked

Both are promoted for relaxation and sleep.

Proposed mechanism Hypothesis

Proposed: calming effects. Not tested in the sources read.

A proposed mechanism does not show that the effect happens in people.

NCCIH calls kava a serious safety concern, linked to severe and sometimes fatal liver damage.

^{9 30 31}

Connections to the rest of health

How Insomnia: Symptoms, Causes and Care connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.

Explore every connection: goals, body systems, organs, symptoms, genes

Kind of connection Connected to Search

A. Wellness goals

Connected to	Kind of connection	Evidence status	Context	Studies
Better Sleep		Moderate certainty	Cognitive behavioural therapy for insomnia (CBT-I): A structured, non-drug talking and habit program is the approach guidelines list first for chronic insomnia. Pooled trials found people fell asleep about 19 minutes sooner and spent about 26 fewer minutes awake in the night. Sleep habits and a regular schedule (sleep hygiene): Sleep hygiene means habits such as a regular wake time, a dark quiet bedroom and less caffeine and alcohol late in the day. It is a sensible part of care, but the American Academy of Sleep Medicine suggests it is not enough on its own for chronic insomnia.	^{22 17 7 1 3 34 31 25 19 4 26 11 27 13 24 23 2 21 20 29 8 6 15 18 10 5 12 28 16 14 9 30}

B. Body systems

Connected to	Kind of connection	Evidence status	Context	Studies
Nervous System	Biological association	Moderate certainty	Studied for: Cognitive behavioural therapy for insomnia (CBT-I) Studied for: Sleep habits and a regular schedule (sleep hygiene)	^{22 17 7 1 3 34 31 25 19 4 26 11 27 13 24 23 2 21 20 29 8 6 15 18 10 5 12 28 16 14 9 30}

E. Health conditions

Connected to	Kind of connection	Evidence status	Context	Studies
Sleep apnea		Health agency guidance	A sleep study is used when sleep apnea or another sleep disorder is suspected. Preparation or compound: Evaluation	^{34 32}

I. Biomarkers

Connected to	Kind of connection	Evidence status	Context	Studies
Time to fall asleep (sleep onset latency)	Biological association	Moderate certainty	Measured in trials: Shorter is better. A lab change is not the same as a health benefit.	²²
Time awake after sleep onset	Biological association	Moderate certainty	Measured in trials: Shorter is better. A lab change is not the same as a health benefit.	²²
Self-rated sleep quality (PSQI)	Biological association	Low certainty	Measured in trials: Lower is better. A lab change is not the same as a health benefit.	^{3 26}
Insomnia severity (ISI score)	Biological association	Low certainty	Measured in trials: Lower is better. A lab change is not the same as a health benefit.	^{4 16}

L. Active compounds

Connected to	Kind of connection	Evidence status	Context	Studies
CBT-I	Biological association	Human	Changes habits and thoughts that keep insomnia going.	²²
Melatonin	Biological association	Human	Signals night to the body clock.	^{8 6}
Valerian root	Biological association	Human	Proposed calming effects; not established.	²³
Magnesium	Biological association	Human	Proposed nerve-calming role; not established.	¹⁵

Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 31, 2026).

Evidence at a glance: what the research found for 13 outcomes

1Moderate certainty

6Low certainty

2Very low certainty

2Mixed findings

2Not enough evidence

Each outcome below is one thing researchers measured. Certainty is how far the evidence can be trusted, not how well it works. The full studies are on the next tab.

Cognitive behavioural therapy for insomnia (CBT-I) 4 studies Moderate certainty Sleep habits and a regular schedule (sleep hygiene) 3 studies Low certainty Relaxation techniques and mindfulness 4 studies Low certainty Regular exercise 4 studies Low certainty Yoga and tai chi 4 studies Low certainty Acupuncture 4 studies Low certainty Valerian (root) 6 studies Mixed findings Melatonin 4 studies Mixed findings Magnesium 3 studies Very low certainty Chamomile 2 studies Not enough evidence Lavender (inhaled and oral) 4 studies Low certainty Tart cherry juice 2 studies Very low certainty L-theanine and kava 3 studies Not enough evidence

The evidence

The research centre for Insomnia: Symptoms, Causes and Care. Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.

Evidence by outcome

Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).

How we rate evidence

High certainty

Several well-run trials or reviews agree; further research is unlikely to change the picture much.

Moderate certainty

Good trials point the same way, but some doubt remains.

Low certainty

Small, short or inconsistent trials. The finding could change with better research.

Very low certainty

Very little or very weak human data. Treat as a possibility only.

Mixed findings

Trials or reviews disagree with each other.

Not enough evidence

Not enough human research to say either way.

Evidence against

Good research found no benefit, or found harm.

We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We searched PubMed, re-read the abstract of every review and trial cited, and read the NHS, NHLBI and NCCIH pages through a tool that summarises pages. Full texts were not read. Certainty ratings are the compiler's own reading, except where a guideline gives its own grade (stated in the text). Funding is not stated in most abstracts, and this is noted where relevant.

Study library: every study we checked 34

Design Research type Year from Search

Study	Design	People	Product, dose, length	Result
Alimoradi 2022 Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis Sleep Med Rev · PMID 35653951 · DOI	Systematic review meta analysis	1977 24 studies from 12 countries comparing CBT-I with control groups	CBT-I, in person or online Not given in the abstract · vs Control groups or before-and-after designs	CBT-I improved quality of life with a pooled SMD of 0.47; face-to-face and online delivery gave similar sizes. Results varied a lot between studies. SMD 0.47 (95% CI 0.22 to 0.72) Methods, limits and funding Outcomes: Quality of life Limitations: Very high heterogeneity (I2 about 85 percent). Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Bent 2006 Valerian for sleep: a systematic review and meta-analysis Am J Med · PMID 17145239 · DOI	Systematic review meta analysis	1093 16 placebo-controlled trials of valerian for sleep	Valerian extracts of varied preparation Varied · vs Placebo	Six studies reported a yes/no sleep quality outcome and showed benefit (relative risk of improved sleep 1.8), but there was evidence of publication bias. Most studies had significant methodological problems and used different preparations. Relative risk 1.8 (95% CI 1.2 to 2.9) Methods, limits and funding Outcomes: Sleep quality (improved or not) Limitations: Publication bias; mixed products and doses. Funding and conflicts: Research support listed from the NIH; no conflict statement in the record read. Read: abstract
Black 2015 Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial JAMA Intern Med · PMID 25686304 · DOI	Randomised controlled trial	49 49 adults (mean age 66) with moderate sleep disturbance, not necessarily insomnia disorder	Mindful awareness practices compared with sleep hygiene education 6 weeks, 2 hours a week, with homework · vs Sleep hygiene education	Sleep quality improved more with mindfulness than with sleep hygiene education (PSQI difference 1.8 points). Insomnia symptoms, depression and fatigue also improved more. Anxiety, stress and an inflammation marker did not differ between groups. PSQI group difference 1.8; effect size 0.89 (95% CI 0.6 to 2.9) Methods, limits and funding Outcomes: Sleep quality (PSQI) after the program; insomnia symptoms, depression, fatigue Limitations: Small trial of 49 people; short follow-up. Funding and conflicts: No funding or conflict statement in the record read; the record lists NIH research support. Read: abstract
Bu 2026 Effects of various exercise interventions in insomnia patients: a systematic review and network meta-analysis BMJ Evid Based Med · PMID 40664502 · DOI	Systematic review network meta analysis	1348 22 randomised trials in adults with insomnia; 4 low risk of bias, 15 some concerns, 3 high risk	Yoga, Tai Chi, walking or jogging, aerobic plus strength exercise, strength training and combinations Not given in the abstract · vs Active controls such as usual care and lifestyle advice	Yoga likely gave a large increase in diary total sleep time (moderate certainty) and, with low certainty, better sleep efficiency, less time awake and shorter time to fall asleep. Walking or jogging may have lowered insomnia severity scores (low certainty). Tai Chi may have lowered sleep quality scores and raised diary total sleep time (low certainty). The authors conclude exercise is effective, with yoga, Tai Chi and walking or jogging doing best, and call for larger trials. Yoga total sleep time MD 110.88 min; Tai Chi total sleep time MD 52.07 min; walking or jogging ISI MD -9.57 (Yoga 58.66 to 163.09; Tai Chi 25.53 to 78.61; walking or jogging -12.12 to -7.02) Methods, limits and funding Outcomes: Sleep quality, insomnia severity, sleep-diary and objective sleep Limitations: Most estimates are low certainty and rest on sleep-diary data; many small trials. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Cheong 2021 A systematic literature review and meta-analysis of the clinical effects of aroma inhalation therapy on sleep problems Medicine (Baltimore) · PMID 33655928 · DOI	Systematic review meta analysis	34 studies of inhaled aromatherapy for sleep problems such as insomnia	Inhaled aromas; single-aroma, lavender gave the largest effect Varied · vs Varied	Aroma inhalation was linked to better sleep (effect size 0.65). Single aromas worked better than mixes, and lavender had the largest effect. Stress, depression, anxiety and fatigue also improved. Effect size 0.6491 (Not given in the abstract) Methods, limits and funding Outcomes: Sleep quantity and quality Limitations: Mixed study designs and populations; blinding is hard with a scent. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Choi 2022 Efficacy of melatonin for chronic insomnia: Systematic reviews and meta-analyses Sleep Med Rev · PMID 36179487 · DOI	Systematic review meta analysis	24 placebo-controlled trials in chronic insomnia, including 4 with another condition	Melatonin Varied · vs Placebo	In insomnia without another condition, melatonin helped time to fall asleep and total sleep time only in children and adolescents. In adults it was not significantly effective for time to fall asleep, total sleep time or sleep efficiency. The authors say melatonin did not appear effective in adults. No pooled numbers in the abstract (Not given in the abstract) Methods, limits and funding Outcomes: Time to fall asleep, total sleep time, sleep efficiency, sleep quality Limitations: Few trials per age group; high heterogeneity. Funding and conflicts: Research support (non-US government) listed; no conflict statement in the record read. Read: abstract
Edinger 2021 Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline J Clin Sleep Med · PMID 33164742 · DOI	Clinical practice guideline	Adults with chronic insomnia disorder; GRADE-based guideline	Behavioural and psychological treatments Not a trial, so no comparator · vs Not given in the abstract	Strong recommendation for multicomponent CBT-I. Conditional suggestions for brief multicomponent therapies, stimulus control alone, sleep restriction alone and relaxation therapy alone. Conditional suggestion NOT to use sleep hygiene as a single-component therapy. Recommendation grades only (Not given in the abstract) Methods, limits and funding Outcomes: Recommendation strength by treatment Limitations: Guideline abstract only; evidence tables not read. Funding and conflicts: Funded by the American Academy of Sleep Medicine; the abstract lists several authors with research ties to drug and device companies, managed during development. Read: abstract
Ferracioli-Oda 2013 Meta-analysis: melatonin for the treatment of primary sleep disorders PLoS One · PMID 23691095 · DOI	Systematic review meta analysis	1683 19 placebo-controlled trials in adults and children with primary sleep disorders	Melatonin Varied; longer trials and higher amounts showed larger effects on sleep latency and sleep time · vs Placebo	Melatonin shortened time to fall asleep by about 7 minutes, added about 8 minutes of sleep, and gave a small gain in sleep quality (SMD 0.22). The authors call the effects modest. Latency WMD 7.06 min; total sleep time WMD 8.25 min; quality SMD 0.22 (4.37 to 9.75; 1.74 to 14.75; 0.12 to 0.32) Methods, limits and funding Outcomes: Time to fall asleep, total sleep time, sleep quality Limitations: Mixed adults and children and mixed disorders, not only insomnia. Funding and conflicts: Research support listed from the NIH; no conflict statement in the record read. Read: abstract
Hidese 2019 Effects of L-Theanine Administration on Stress-Related Symptoms and Cognitive Functions in Healthy Adults: A Randomized Controlled Trial Nutrients · PMID 31623400 · DOI	Randomised controlled trial	30 30 healthy adults without major psychiatric illness (not people with insomnia)	L-theanine tablets (200 mg a day, as reported) 4 weeks · vs Placebo tablets	PSQI sleep scores and some sleep subscores were lower after L-theanine than placebo. The people studied did not have insomnia. PSQI P 0.013 (Not given in the abstract) Methods, limits and funding Outcomes: Stress symptoms, sleep quality (PSQI), cognition Limitations: Healthy adults, not insomnia; small crossover study. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Hieu 2019 Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials Phytother Res · PMID 31006899 · DOI	Systematic review meta analysis	12 randomised and quasi-randomised trials	Chamomile Varied · vs Placebo or other	Only one trial looked at insomnia and found no significant change in insomnia severity. A pooled analysis showed better sleep quality scores. Mild adverse events were reported in three trials. The authors say there is little evidence for insomnia. Sleep quality SMD -0.73 (-1.23 to -0.23) Methods, limits and funding Outcomes: Insomnia severity, sleep quality, anxiety Limitations: Only one insomnia trial; small studies. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Irwin 2014 Cognitive behavioral therapy vs. Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial Sleep · PMID 25142571 · DOI	Randomised controlled trial	123 123 older adults with chronic primary insomnia, Los Angeles	Tai Chi Chih (a group Tai Chi program) compared with CBT and with a sleep seminar education control 2-hour weekly group sessions over 4 months, follow-up at 7 and 16 months · vs CBT; sleep seminar education	CBT did better than Tai Chi Chih and the education control for insomnia remission and for sleep quality, fatigue and depressive symptoms. Tai Chi Chih improved sleep quality, fatigue and depressive symptoms compared with the education control, but not insomnia remission. Polysomnography measures did not change. CBT better on all main measures (P under 0.01) (Not given in the abstract) Methods, limits and funding Outcomes: Insomnia remission, sleep quality, fatigue, depressive symptoms, polysomnography, C-reactive protein Limitations: One setting; people knew which group they were in. Funding and conflicts: No funding or conflict statement in the record read; the record lists non-US-government research support. Read: abstract
Kasper 2015 Efficacy of orally administered Silexan in patients with anxiety-related restlessness and disturbed sleep--A randomized, placebo-controlled trial Eur Neuropsychopharmacol · PMID 26293583 · DOI	Randomised controlled trial	170 170 outpatients with anxiety-related restlessness and disturbed sleep	Silexan, a patented lavender (Lavandula angustifolia) oil capsule 10 weeks, once daily · vs Placebo	Anxiety scores fell more with Silexan than with placebo (12.0 versus 9.3 points). All outcome measures favoured Silexan, including PSQI sleep quality (numbers not in the abstract). Adverse events were reported by 33.7 and 35.7 percent. HAMA decrease 12.0 vs 9.3 points; responders 48.8 vs 33.3 percent (Not given in the abstract) Methods, limits and funding Outcomes: Anxiety score (HAMA), sleep quality (PSQI) Limitations: People had anxiety-related restlessness, not insomnia disorder; the trial tested one patented product. Funding and conflicts: Funding not stated in the abstract; the product is patented and the record does not list the funder. Read: abstract
Kim 2021 Efficacy of Acupuncture for Insomnia: A Systematic Review and Meta-Analysis Am J Chin Med · PMID 34049475 · DOI	Systematic review meta analysis	24 randomised trials of acupuncture in people with insomnia (15 compared with medicines in the pooled analysis, 1,475 people)	Acupuncture Effect appeared after about 3 weeks of treatment · vs Medicines; sham acupuncture	Acupuncture scored better than medicines on sleep quality after 3 to 4 weeks, but not after 1 or 2 weeks. The pooled analysis compared acupuncture with medicines, not with sham needling. PSQI -0.74 overall; -0.97 at week 3; -0.70 at week 4 (-1.07 to -0.40; -1.65 to -0.28; -1.15 to -0.25) Methods, limits and funding Outcomes: Sleep quality (PSQI) Limitations: Very high heterogeneity (I2 about 85 to 91 percent); the pooled comparison was against medicines, so it cannot show effects beyond expectation. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Losso 2018 Pilot Study of the Tart Cherry Juice for the Treatment of Insomnia and Investigation of Mechanisms Am J Ther · PMID 28901958 · DOI	Randomised controlled trial	11 11 people over 50 with insomnia randomised; 8 completed, 3 excluded for sleep apnea	Montmorency tart cherry juice (240 mL twice a day for 2 weeks, as reported) 2 weeks versus 2 weeks placebo with washout · vs Placebo	Among 8 completers, polysomnography showed 84 more minutes of sleep time; one questionnaire (PSQI) showed better sleep efficiency and the other four questionnaires showed no difference. Blood and cell experiments are proposed explanations only. Sleep time +84 min on polysomnography (P 0.0182) (Not given in the abstract) Methods, limits and funding Outcomes: Polysomnography and questionnaires Limitations: Eight completers; mechanism work partly in cell cultures. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Mah 2021 Oral magnesium supplementation for insomnia in older adults: a Systematic Review & Meta-Analysis BMC Complement Med Ther · PMID 33865376 · DOI	Systematic review meta analysis	151 3 randomised trials in older adults with insomnia, in 3 countries	Oral magnesium supplements Varied · vs Placebo	Time to fall asleep was about 17 minutes shorter with magnesium than with placebo. Total sleep time rose by about 16 minutes, which was not statistically significant. All trials had moderate-to-high risk of bias and the evidence was low to very low quality. A published correction to this paper exists; its text was not read beyond the title. Time to fall asleep -17.36 min; total sleep time +16.06 min (not significant) (-27.27 to -7.44) Methods, limits and funding Outcomes: Time to fall asleep, total sleep time, adverse events Limitations: Only 3 small trials; substandard quality. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Pigeon 2010 Effects of a tart cherry juice beverage on the sleep of older adults with insomnia: a pilot study J Med Food · PMID 20438325 · DOI	Randomised controlled trial	15 15 otherwise healthy older adults with chronic insomnia	A proprietary tart cherry juice blend 2 weeks of juice and 2 weeks of placebo, with 2 weeks washout · vs Placebo beverage	Compared with placebo, the cherry juice reduced insomnia severity and time awake after sleep onset; time to fall asleep, total sleep time and sleep efficiency did not differ. Effects were moderate or negligible and far smaller than for sleep medicines or CBT. Effect sizes moderate to negligible (Not given in the abstract) Methods, limits and funding Outcomes: Sleep-diary measures, Insomnia Severity Index Limitations: Only 15 people; a proprietary product; short. Funding and conflicts: Research support from the NIH is listed in the record; the juice was a commercial product and the abstract does not state who paid for it. Read: abstract
Qaseem 2016 Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians Ann Intern Med · PMID 27136449 · DOI	Clinical practice guideline	Adults with chronic insomnia disorder; guideline based on a systematic review of randomised trials published 2004 to September 2015	Cognitive behavioural therapy for insomnia (CBT-I), then short-term medicines only if CBT-I alone was unsuccessful Not a trial, so no comparator · vs Not given in the abstract	ACP recommends that all adults receive CBT-I as the initial treatment for chronic insomnia disorder (strong recommendation, moderate-quality evidence). ACP recommends shared decision making about short-term medicines only where CBT-I alone was unsuccessful (weak recommendation, low-quality evidence). Recommendation grades only; no pooled numbers in the abstract (Not given in the abstract) Methods, limits and funding Outcomes: Global outcomes, patient-reported sleep outcomes, harms Limitations: Guideline from a US medical society; the abstract does not list trial-level detail. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Rawji 2024 Examining the Effects of Supplemental Magnesium on Self-Reported Anxiety and Sleep Quality: A Systematic Review Cureus · PMID 38817505 · DOI	Systematic review	15 interventional trials; 8 measured sleep, 7 anxiety, 1 both	Supplemental magnesium (various forms, some with other ingredients) Varied · vs Varied	Five of eight sleep studies reported better sleep, two found no change and one was mixed. The authors say firm conclusions were limited by small, varied studies, and that magnesium is likely useful for mild anxiety and insomnia, particularly with low magnesium status. That conclusion goes further than the data support. 5 of 8 sleep studies positive (No pooled numbers in the abstract) Methods, limits and funding Outcomes: Self-reported sleep quality and anxiety Limitations: Small, varied studies; some formulas had added ingredients. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Riedel 2024 The effect of physical exercise interventions on insomnia: A systematic review and meta-analysis Sleep Med Rev · PMID 38749363 · DOI	Systematic review meta analysis	19 randomised trials in people diagnosed with insomnia or with insomnia symptoms	Exercise interventions meeting the WHO definition Not given in the abstract · vs Inactive control	Exercise improved objective sleep measures (SMD 0.37) and subjective sleep measures (SMD 0.90). The effect rose with intensity, mean age and share of women, but results varied a lot between studies. Objective SMD 0.37; subjective SMD 0.90 (Objective 0.17 to 0.57; subjective 0.61 to 1.19) Methods, limits and funding Outcomes: Objective and subjective sleep measures Limitations: High heterogeneity; control groups were inactive, so attention effects are not separated out. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Sateia 2017 Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline J Clin Sleep Med · PMID 27998379 · DOI	Clinical practice guideline	Adults with chronic insomnia; GRADE-based guideline on individual medicines	Individual medicines, some also covered as supplements or herbs Not a trial, so no comparator · vs Versus no treatment	All recommendations were WEAK. The guideline suggests clinicians use several named prescription medicines for certain sleep problems, and suggests clinicians NOT use trazodone, tiagabine, diphenhydramine, melatonin, tryptophan or valerian for sleep onset or sleep maintenance insomnia. Recommendation grades only (Not given in the abstract) Methods, limits and funding Outcomes: Sleep onset and sleep maintenance Limitations: Weak recommendations; the guideline notes evidence is downgraded because most drug trials are industry funded and there is publication bias. Funding and conflicts: Funded by the AASM; see the guideline for author disclosures. Read: abstract
Shinjyo 2020 Valerian Root in Treating Sleep Problems and Associated Disorders-A Systematic Review and Meta-Analysis J Evid Based Integr Med · PMID 33086877 · DOI	Systematic review meta analysis	6894 60 studies (10 in the sleep-quality meta-analysis, 1,065 people)	Valerian root (Valeriana officinalis), whole root or extracts Varied · vs Placebo and others	Pooled analysis suggested better subjective sleep quality. The authors say inconsistent outcomes were possibly due to variable extract quality and that more reliable effects might come from whole root. No severe adverse events were linked to valerian in people aged 7 to 80. The authors conclude valerian could be safe and effective. Numbers not given in the abstract (Not given in the abstract) Methods, limits and funding Outcomes: Subjective sleep quality; anxiety Limitations: Includes combination products with other herbs; the authors' own interpretation is more favourable than the 2024 umbrella review. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Trauer 2015 Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis Ann Intern Med · PMID 26054060 · DOI	Systematic review meta analysis	1162 20 randomised trials of face-to-face multicomponent CBT-I in adults with chronic insomnia (mean age 56, 64 percent female); insomnia with other conditions excluded	Face-to-face CBT-I with at least 3 of cognitive therapy, stimulus control, sleep restriction, sleep hygiene, relaxation Not given in the abstract · vs Inactive comparators	After treatment, time to fall asleep improved by about 19 minutes, time awake after sleep onset by about 26 minutes, sleep efficiency by about 9.9 percentage points; total sleep time rose by about 7.6 minutes, which was not statistically significant. Changes seemed sustained later. No adverse outcomes were reported. Time to fall asleep 19.03 min; awake after sleep onset 26.00 min; total sleep time 7.61 min; sleep efficiency 9.91 percent (95% CI 14.12 to 23.93; 15.48 to 36.52; -0.51 to 15.74; 8.09 to 11.73) Methods, limits and funding Outcomes: Sleep-diary time to fall asleep, time awake after sleep onset, total sleep time, sleep efficiency Limitations: Narrow inclusion; people with insomnia plus other conditions were excluded; later time points less certain. Funding and conflicts: Primary funding source: none. Read: abstract
Valente 2024 Does valerian work for insomnia? An umbrella review of the evidence Eur Neuropsychopharmacol · PMID 38359657 · DOI	Umbrella review	8 systematic reviews of valerian for sleep disturbances	Valerian Varied · vs Placebo	Valerian had a good safety profile, but the reviews showed no evidence of efficacy for insomnia. It seemed to improve subjective sleep quality, but this was not shown with quantitative or objective measures. Primary studies were few, varied and of low quality. No pooled numbers in the abstract (Not given in the abstract) Methods, limits and funding Outcomes: Insomnia and subjective sleep quality Limitations: A review of reviews; underlying trials are small. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Wan 2022 Association of Acupuncture and Auricular Acupressure With the Improvement of Sleep Disturbances in Cancer Survivors: A Systematic Review and Meta-Analysis Front Oncol · PMID 35664757 · DOI	Systematic review meta analysis	961 13 randomised trials in cancer survivors with sleep disturbance	Acupuncture and auricular acupressure Not given in the abstract · vs Sham, waiting list, drug therapy, behaviour therapy, usual care	The authors found no evidence of improvement in sleep disturbance from acupuncture or auricular acupressure in the short or long term. Adverse events were minor. The finding disagreed with earlier research. Acupuncture versus sham, long term: MD 1.71; acupuncture subgroup MD 0.54 (-2.38 to 5.81; -1.27 to 2.34) Methods, limits and funding Outcomes: Sleep and insomnia scale scores Limitations: High or unclear risk of bias in most trials. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Wang 2019 The Effect of Mind-Body Therapies on Insomnia: A Systematic Review and Meta-Analysis Evid Based Complement Alternat Med · PMID 30894878 · DOI	Systematic review meta analysis	4506 49 studies of adults with or without disease	Meditation, tai chi, qigong and yoga 4 to 24 weeks · vs Various controls	Mind-body therapies improved sleep quality and lowered insomnia severity, but had no significant effect on sleep quantity measured by diaries or objective tools. Qigong had a slight edge over tai chi. Effects were larger in healthy people than in clinical groups. SMDs pooled by outcome (numbers not in the abstract) (Not given in the abstract) Methods, limits and funding Outcomes: Sleep quality, insomnia severity, sleep quantity Limitations: All study designs were included; authors call for better controlled trials. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Xie 2021 Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Front Psychiatry · PMID 34163383 · DOI	Systematic review meta analysis	22 randomised trials in adults without pathological diseases; exercise lasting at least 2 months	Walking, cycling and mind-body exercise such as yoga At least 2 months · vs Control interventions	Exercise improved self-reported sleep quality, insomnia severity and sleepiness. Physical and mind-body exercise worked to the same extent. Shorter programs (up to 3 months) showed a larger reduction than longer ones. Objective sleep measures changed little except sleep efficiency. PSQI MD -2.19; ISI MD -1.52; ESS MD -2.55 (PSQI -2.96 to -1.41; ISI -2.63 to -0.41; ESS -3.32 to -1.78) Methods, limits and funding Outcomes: Self-reported sleep quality (PSQI), insomnia severity (ISI), sleepiness, actigraphy Limitations: Adults without diseases, so not all had clinical insomnia; mostly self-reported outcomes. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
Yin 2022 Effect of Electroacupuncture on Insomnia in Patients With Depression: A Randomized Clinical Trial JAMA Netw Open · PMID 35797047 · DOI	Randomised controlled trial	270 270 adults aged 18 to 70 with insomnia and depression, 3 hospitals in Shanghai	Electroacupuncture plus standard care 24 sessions over 8 weeks, 24-week follow-up · vs Sham acupuncture plus standard care; standard care only	At 8 weeks, PSQI was lower with electroacupuncture than with sham acupuncture (difference -3.6) and than with standard care alone (difference -5.1). The effect was sustained over the 24-week follow-up. Depression scores also improved. PSQI difference -3.6 versus sham; -5.1 versus standard care (-4.4 to -2.8; -6.0 to -4.2) Methods, limits and funding Outcomes: Sleep quality (PSQI) at 8 weeks; actigraphy, insomnia severity, depression Limitations: Single country; people had both depression and insomnia, so results may not apply to insomnia alone. Funding and conflicts: No funding or conflict statement in the record read. Read: abstract
p30000925 LactMed: Lavender (2006 record) · PMID 30000925	Health agency n/a			Methods, limits and funding Read: abstract
p31643579 LiverTox: Valerian (2012 record) · PMID 31643579	Health agency n/a			Methods, limits and funding Read: abstract
p31643949 LiverTox: Kava Kava (2012 record) · PMID 31643949	Health agency n/a			Methods, limits and funding Read: abstract
s-nccih-sleep NCCIH: Sleep Disorders and Complementary Health Approaches (Last Updated May 2024) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-nhlbi-diagnosis NHLBI: Insomnia diagnosis (last updated 24 March 2022) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-nhlbi-insomnia NHLBI: Insomnia (last updated 24 March 2022) · Source	Health agency n/a			Methods, limits and funding Read: full-text
s-nhs-insomnia NHS: Insomnia (page last reviewed 19 March 2024) · Source	Health agency n/a			Methods, limits and funding Read: full-text

What we do not know yet

No large, long placebo-controlled trial of any herb or supplement for diagnosed insomnia was read.
Most non-drug trials other than CBT-I are small, with unmatched control groups and mostly self-rated sleep.
Long-term follow-up beyond a few months was not read for exercise, yoga, tai chi or mindfulness.
Interaction studies between sleep supplements and medicines were not read.
Kava and L-theanine have no insomnia trial among the sources read.
Online (digital) CBT-I trial abstracts were not read; only the NHS statement that it may be offered.

How new research is added

New studies are found by a saved PubMed search and placed in a review queue before the page changes.

Lab markers

What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".

Other 4

●

Time to fall asleep (sleep onset latency)

Shorter is better in trials

How long it takes to fall asleep, from a sleep diary or sensor.

Moderate certainty

Results and what it means

Why it was measured

To see whether an approach helps people who lie awake.

Statistical vs. clinical meaning

A clinically meaningful change in diary measures in the 2015 review.

Study	Result	People	Product
²²	About 19 minutes sooner after CBT-I.	1,162 adults in 20 trials	Face-to-face CBT-I

²²

●

Time awake after sleep onset

Shorter is better in trials

Minutes awake during the night after first falling asleep.

Moderate certainty

Results and what it means

Why it was measured

To see whether an approach helps people who wake in the night.

Statistical vs. clinical meaning

The largest pooled change for CBT-I.

Study	Result	People	Product
²²	About 26 minutes less after CBT-I.	1,162 adults in 20 trials	Face-to-face CBT-I

²²

●

Self-rated sleep quality (PSQI)

Lower is better in trials

A questionnaire score where lower means better sleep.

Low certainty

Results and what it means

Why it was measured

To see how people rate their sleep.

Statistical vs. clinical meaning

Self-rated, with no blinding.

Study	Result	People	Product
³	Mindfulness group improved more than a sleep hygiene class (difference 1.8 points).	49 older adults	Six-week mindful awareness program
²⁶	Sleep-quality score lower by 2.19 points after exercise.	22 trials in adults without disease	Regular exercise

^{3 26}

●

Insomnia severity (ISI score)

Lower is better in trials

A questionnaire score where lower means less severe insomnia.

Low certainty

Results and what it means

Why it was measured

To see whether insomnia is easing, not just sleep length.

Statistical vs. clinical meaning

Self-rated; small trials.

Study	Result	People	Product
⁴	Walking or jogging may lower ISI scores by about 9.6 points (low certainty).	22 trials in adults with insomnia	Exercise
¹⁶	Lower insomnia severity with tart cherry juice than placebo.	15 older adults	Tart cherry juice blend

^{4 16}

Safety

What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.

Main points to know 3

See a doctor if sleep problems last, or other signs appear. The NHS says to see a doctor if changing sleep habits has not helped, if trouble sleeping has lasted months, or if it makes daily life hard. The NHS and NHLBI both describe checking for other causes, such as sleep apnea, thyroid problems, medicines, pain, anxiety or depression. Self-treating with supplements can delay finding those causes. Health agency guidance ^{34 32}
Natural does not mean risk-free. NCCIH says natural does not always mean safe and standardised does not guarantee quality. A 2023 study it cites found most melatonin gummies mislabelled. Kava has been linked to severe, sometimes fatal liver injury. Health agency guidance ^{31 30}
This page does not replace care. Guidelines list CBT-I first for chronic insomnia. The natural options on this page are add-ons to discuss with a clinician, and most have weak evidence. Guideline ^{17 7}

Side effects 7

Effect	How often	Severity and recovery	Evidence
Daytime drowsiness from sleep aids sold in pharmacies The NHS says pharmacy sleep aids with valerian, lavender or an antihistamine can cause drowsiness and may help for 1 to 2 weeks at most. Do not drive while drowsy.	Not given	Mild to moderate Not stated	Health agency guidance ³⁴
Liver injury LiverTox lists rare cases of clinically apparent liver injury with valerian, and acute liver injury, sometimes severe and fatal, with products labelled kava.	Rare	Can be severe Not stated in the abstract	Case reports and agency record ^{29 30}
Stomach upset from magnesium NCCIH says higher magnesium intakes can cause diarrhoea, nausea and cramping; extremely high intakes can disturb the heart rhythm.	Not given	Mild Not stated	Health agency guidance ³¹
Allergy or skin irritation Chamomile can cause reactions in people allergic to ragweed or related plants. Lavender essential oil on skin can cause allergy or irritation.	Not given	Mild Not stated	Health agency guidance ³¹
Needle-related problems with acupuncture NCCIH says serious complications can come from non-sterile needles or poor technique, including infection and punctured organs.	Uncommon	Rarely serious Not stated	Health agency guidance ³¹
Muscle aches or sprains with exercise, yoga or tai chi Sprains and strains are the commonest yoga injuries; tai chi may cause minor muscle aches.	Not given	Mild Not stated	Health agency guidance ³¹
More anxiety with relaxation practices Some people report more anxiety with relaxation techniques, with rare reports of worsened symptoms in epilepsy or certain psychiatric conditions.	Not given	Mild to moderate Not stated	Health agency guidance ³¹

Medicines and supplements 4

With	Why it matters	Importance	Evidence	What to do
Other sedating products (sleep aids, alcohol, antihistamines) general	Could add to drowsiness	Not studied in the sources read.	Absence of evidence Not enough evidence ³⁴	No interaction study was read. Drowsiness is listed for pharmacy sleep aids by the NHS; mixing sedating products is a reasonable thing to raise with a pharmacist.
Medicines that raise serotonin (for example some antidepressants) with L-tryptophan prescription	Excess serotonin	NCCIH says L-tryptophan supplements can cause life-threatening serotonin toxicity when used with medicines that affect serotonin.	Health agency statement Not enough evidence ³¹	If you take such medicines, ask a doctor or pharmacist before any tryptophan product.
Liver-affecting medicines with kava or valerian prescription	Possible added liver strain	No interaction study was read; the concern comes from case reports of liver injury with each herb alone.	Case reports Not enough evidence ^{30 29}	People with liver disease or who take liver-affecting medicines can ask a clinician before using these herbs.
Medicines in general with any supplement general	Unknown	NCCIH advises telling all your health care providers about any complementary approach you use.	Health agency guidance Not enough evidence ³¹	Bring supplement bottles to a pharmacist or doctor.

Who should check first 4

Situation	Advice	Evidence
Pregnancy and breastfeeding	NCCIH advises talking to a health care provider before using supplements if you are pregnant or nursing, and gives no approach-specific pregnancy data. LactMed says no data exist on lavender in nursing mothers or infants and that lavender oil should not be applied to the breast area.	Health agency guidance ^{31 28}
Children	NCCIH reports rising melatonin overdoses and emergency visits in children, many involving gummies, and cases of breast tissue swelling in children using topical lavender products. Ask a paediatric clinician before giving any sleep supplement.	Health agency guidance ³¹
Liver disease, or kava use	NCCIH calls kava a serious safety concern because of liver damage. LiverTox lists rare liver injury with valerian.	Health agency record ^{31 30 29}
Suspected sleep apnea, restless legs, depression, anxiety or pain driving the insomnia	The NHS and NHLBI list these as causes of poor sleep that need their own assessment. A clinician can look for them, and a sleep study is used when another sleep disorder such as apnea is suspected.	Health agency guidance ^{34 32}

Overdose, product quality and regulators

Body	Action	Date
National Center for Complementary and Integrative Health (NCCIH, US NIH) (United States)	Says CBT-I is the most strongly recommended insomnia treatment; evidence is low-quality for relaxation, insufficient for mindfulness alone, limited for acupuncture, inconsistent for valerian, not conclusive for chamomile and very limited for magnesium; 2017 and 2019 guidelines recommend against melatonin for chronic insomnia; kava is a serious safety concern. source	2024-05
NHS (UK) (United Kingdom)	Says GPs now rarely prescribe sleeping pills for insomnia because of serious side effects and dependence; pharmacy sleep aids cannot cure insomnia and may help for 1 to 2 weeks at most. source	2024-03
American Academy of Sleep Medicine and American College of Physicians (guidelines) (United States)	CBT-I first for chronic insomnia; weak suggestions against melatonin and valerian as insomnia treatments; suggests against sleep hygiene as the only treatment. source	2017-02, 2021-02

When to get medical help

Thoughts of harming yourself, or feeling unable to keep yourself safe: contact your local emergency number or a crisis line in your country now, or go to the nearest emergency department.
Loud snoring, gasping or pauses in breathing at night, or falling asleep during the day without warning: see a doctor, because sleep apnea or another sleep disorder may be the cause.
Sleep problems that last months, or that make work, driving or daily life hard to manage: book a doctor visit, as the NHS advises.
Yellow skin or eyes, dark urine, or severe stomach pain after using valerian, kava or any herbal product: stop it and seek medical care promptly.
Sleepwalking, eating or driving while asleep after taking a sleep product: stop and speak to a doctor or pharmacist.

Stop using the product and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.

General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.

Frequently asked questions

What is insomnia?

Insomnia is a common sleep disorder in which you have trouble falling asleep, staying asleep or getting good-quality sleep even with enough time and a suitable place to sleep. Only a clinician can say whether you have it.

^{33 34}

What are the symptoms of insomnia?

Lying awake before sleep, waking often or too early, waking unrefreshed, daytime tiredness, trouble concentrating and irritability.

³⁴

What causes insomnia?

Common contributors include stress, anxiety or depression, noise, alcohol, caffeine, nicotine, shift work and jet lag, plus conditions such as sleep apnea, pain, an overactive thyroid and menopause, and some medicines.

³⁴

When does insomnia count as chronic?

NHLBI says 3 or more nights a week for more than 3 months. The NHS calls insomnia of 3 months or longer long-term.

^{33 34}

How do doctors check for insomnia?

A clinician asks about sleep habits, health and medicines, may ask for a 1 to 2 week sleep diary, and may check for other causes. A sleep study is used when another sleep disorder is suspected.

^{32 34}

What is the first-line care for chronic insomnia?

Guidelines from the American College of Physicians and the American Academy of Sleep Medicine list CBT-I first.

^{17 7}

Do sleeping pills solve insomnia?

The NHS says GPs now rarely prescribe them because of serious side effects and dependence, and when used it is only for a short time. Talk to a clinician before taking or stopping any medicine.

³⁴

Does valerian work for insomnia?

Reviews disagree. A 2024 review of reviews found no evidence it treats insomnia, though it may improve self-rated sleep quality. A sleep medicine guideline weakly suggests not using it.

^{23 20}

Does melatonin help insomnia?

It shortened time to fall asleep by a few minutes in pooled trials, but a 2022 review found no benefit in adults with chronic insomnia. Two guidelines suggest not using it for chronic insomnia.

^{8 6 31}

Does magnesium help with sleep?

Three small trials in older adults suggested quicker sleep onset, but the evidence is low to very-low quality.

^{15 31}

Do exercise, yoga or tai chi help?

Reviews found gains in sleep scores, mostly with low certainty. In older adults with insomnia, CBT did better than tai chi at clearing insomnia.

^{19 4 11}

When should I see a doctor about insomnia?

If changing habits has not helped, if it has lasted months, or if it affects daily life. Also if you snore loudly and gasp, or feel very low or unsafe.

^{34 32}

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Editorial transparency

Written by: AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
Medical review: None. This page has not been reviewed by a physician or pharmacist.
First published: 2026-10-31
Last substantive update: 2026-10-31
How we research: We searched PubMed, re-read the abstract of every review and trial cited, and read the NHS, NHLBI and NCCIH pages through a tool that summarises pages. Full texts were not read. Certainty ratings are the compiler's own reading, except where a guideline gives its own grade (stated in the text). Funding is not stated in most abstracts, and this is noted where relevant.
How we rate evidence: See "How we rate evidence" in the Evidence tab.
Independence: No product is promoted on this page. No affiliate links are shown.

Sources 34

Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.

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Kasper S, Anghelescu I, Dienel A. Efficacy of orally administered Silexan in patients with anxiety-related restlessness and disturbed sleep--A randomized, placebo-controlled trial. Eur Neuropsychopharmacol. 2015. PMID 26293583. DOI 10.1016/j.euroneuro.2015.07.024. (abstract)
Kim SA, Lee SH, Kim JH et al.. Efficacy of Acupuncture for Insomnia: A Systematic Review and Meta-Analysis. Am J Chin Med. 2021. PMID 34049475. DOI 10.1142/S0192415X21500543. (abstract)
Losso JN, Finley JW, Karki N et al.. Pilot Study of the Tart Cherry Juice for the Treatment of Insomnia and Investigation of Mechanisms. Am J Ther. 2018. PMID 28901958. DOI 10.1097/MJT.0000000000000584. (abstract)
Mah J, Pitre T. Oral magnesium supplementation for insomnia in older adults: a Systematic Review & Meta-Analysis. BMC Complement Med Ther. 2021. PMID 33865376. DOI 10.1186/s12906-021-03297-z. (abstract)
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Qaseem A, Kansagara D, Forciea MA et al.. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016. PMID 27136449. DOI 10.7326/M15-2175. (abstract)
Rawji A, Peltier MR, Mourtzanakis K et al.. Examining the Effects of Supplemental Magnesium on Self-Reported Anxiety and Sleep Quality: A Systematic Review. Cureus. 2024. PMID 38817505. DOI 10.7759/cureus.59317. (abstract)
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Sateia MJ, Buysse DJ, Krystal AD et al.. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017. PMID 27998379. DOI 10.5664/jcsm.6470. (abstract)
Shinjyo N, Waddell G, Green J. Valerian Root in Treating Sleep Problems and Associated Disorders-A Systematic Review and Meta-Analysis. J Evid Based Integr Med. 2020. PMID 33086877. DOI 10.1177/2515690X20967323. (abstract)
Trauer JM, Qian MY, Doyle JS et al.. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. 2015. PMID 26054060. DOI 10.7326/M14-2841. (abstract)
Valente V, Machado D, Jorge S et al.. Does valerian work for insomnia? An umbrella review of the evidence. Eur Neuropsychopharmacol. 2024. PMID 38359657. DOI 10.1016/j.euroneuro.2024.01.008. (abstract)
Wan Q, Luo S, Wang X et al.. Association of Acupuncture and Auricular Acupressure With the Improvement of Sleep Disturbances in Cancer Survivors: A Systematic Review and Meta-Analysis. Front Oncol. 2022. PMID 35664757. DOI 10.3389/fonc.2022.856093. (abstract)
Wang X, Li P, Pan C et al.. The Effect of Mind-Body Therapies on Insomnia: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2019. PMID 30894878. DOI 10.1155/2019/9359807. (abstract)
Xie Y, Liu S, Chen XJ et al.. Effects of Exercise on Sleep Quality and Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Psychiatry. 2021. PMID 34163383. DOI 10.3389/fpsyt.2021.664499. (abstract)
Yin X, Li W, Liang T et al.. Effect of Electroacupuncture on Insomnia in Patients With Depression: A Randomized Clinical Trial. JAMA Netw Open. 2022. PMID 35797047. DOI 10.1001/jamanetworkopen.2022.20563. (abstract)
. LactMed: Lavender (2006 record). . . PMID 30000925. (abstract)
. LiverTox: Valerian (2012 record). . . PMID 31643579. (abstract)
. LiverTox: Kava Kava (2012 record). . . PMID 31643949. (abstract)
. NCCIH: Sleep Disorders and Complementary Health Approaches (Last Updated May 2024). . . (full-text)
. NHLBI: Insomnia diagnosis (last updated 24 March 2022). . . (full-text)
. NHLBI: Insomnia (last updated 24 March 2022). . . (full-text)
. NHS: Insomnia (page last reviewed 19 March 2024). . . (full-text)

Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.