Mandana Edalati, ND

Most people are familiar with the occasional tossing and turning in bed, but when this occurs on a chronic basis, it becomes more than just a nuisance. Sleep affects every cell, organ, and system in the body. It affects cognition, energy levels, immunity, appetite and mood, and poor sleep increases the risk of serious conditions such as heart attack and stroke. Insomnia is more than just a discomfort. The widespread and serious consequences of poor sleep on the entire body make prompt, effective treatment of insomnia a priority for healthcare providers. Phytotherapy can be an effective tool in the management of insomnia. Numerous herbs have sedative actions that can greatly enhance the quality of sleep. Passiflora incarnata and Melissa officinalis are 2 herbs that contribute to a restful sleep. One of the mechanisms of actions of these 2 herbs is through their effect on the neurotransmitter, gamma-aminobutyric acid, or GABA.

Passiflora incarnata

Passiflora incarnata, commonly known as passionflower, has its origins in Peru where it was first discovered. With its long, traditional use in herbal medicine, passionflower can act as an effective natural sleep remedy. In 2011, a double-blind, placebo-controlled investigation was conducted on the effects of passionflower herbal tea on subjective sleep quality.¹ The results indicated a significantly higher rating for sleep quality in those consuming passionflower than in placebo. The investigators concluded that having a low dose of passionflower in the form of tea promotes short-term sleep benefits for adults with mild fluctuations in sleep.

Passionflower is known as a sedative with effects on ‬GABA. ‬In vitro investigation has shown that multiple pharmacological effects of Passiflora incarnata are mediated through modulation of the GABA system, including affinity for GABA(A) and GABA(B) receptors, and influences on GABA uptake.²

In another in vitro study, whole Passiflora extract elicited dose-dependent GABA-A currents in mice hippocampal neurons. It also showed that once the amino acid constituent of the passionflower extract was removed, this GABA activity was no longer present.³ Hence, it appears that the amino acid component of passionflower is responsible for enhancing GABA levels.

GABA is the chief inhibitory neurotransmitter in the central nervous system. Inadequate levels of GABA in the brain have been linked to insomnia. GABA helps induce a more relaxed state by reducing the neuronal activity in some brain cells. In particular, GABA(A) receptors are highly expressed in certain regions of the brain involved in sleep processes, including the thalamus.⁴ GABA-A receptor-mediated inhibitory processes is the mechanism by which sedative-hypnotic drugs such as benzodiazepines work on sleep. This mechanism reduces waking and enhances slow-wave sleep, which is deep, restorative sleep.⁵ In this regard, passionflower induces sleep in a similar way as benzodiazepines, minus the grogginess and hangover effects.

Melissa officinalis

Similar to passionflower, Melissa officinalis, commonly known as lemon balm, also acts on GABA. In a 2005 study, 7 different herbal extracts were tested.⁶ The ethanolic extract of lemon balm showed a moderate level of activity at the GABA(A)-benzodiazepine receptor site.

In another study, the effects of various anxiolytic botanicals and their action on enzymes involved with GABA were investigated.⁷ The findings indicated lemon balm as having the most inhibition of GABA transaminase activity, the catabolic enzyme for GABA.And with further investigation in 2009, the rosmarinic acid constituent of lemon balm was found to be the chief component responsible for the inhibition of this enzyme.⁸ The German Commission E has approved Melissa officinalis for insomnia.

In a prospective, open-label 15-day study, the effect of a standardized Melissa officinalis extract on mild-to-moderate anxiety disorders and sleep disturbances was investigated.⁹ Based on clinician-rating criteria, there were improvements in symptoms of anxiety and insomnia, with a 42% lowering of insomnia. In total, 95% of subjects responded to treatment, of which 70% achieved full remission for anxiety, 85% for insomnia, and 70% for both anxiety and insomnia.

Breaking a Vicious Cycle

Sound sleep is one way that the body naturally copes with anxiety and stress. A restful sleep allows the body to relax and rejuvenate, such that it can better handle daily stresses. For many people, however, sleeplessness itself is accompanied by stress and anxiety. So, when restful sleep does not occur, it becomes a vicious cycle: insomnia leads to more worry, stress and anxiety, and these, in turn, contribute to more restlessness and insomnia. Since both passionflower and lemon balm are also anxiolytic herbs, they serve a double benefit for those with insomnia – a direct sedative effect on sleep and an additional benefit of reducing anxiety.

Given the addictive nature of most pharmaceutical sleeping pills, along with many side effects, botanicals are a great, safe alternative. Sometimes going back to the basics and applying simple solutions is what will indeed provide positive results and alleviate the insomnia. Since GABA plays an important role in sleep, and inadequate levels of it affect sleep, both passionflower and lemon balm can serve as an effective treatment of insomnia. Depending on the severity and chronicity of the insomnia, a rich tea made of these herbs may suffice; in other cases, more potent extracts of the herbs may be indicated. As with any other sleep treatments, in order to have the best outcomes, a proper setting, as well as elimination of other contributing factors such as noise, too much light, and a room temperature that is too hot or too cold, is a must. By eliminating these factors, an ambience of serenity and comfort is created, making it a more ideal environment for a restful sleep.

Mandana Edalati, ND is a graduate of Canadian College of Naturopathic Medicine. She holds a degree in psychology and family science from the University of British Columbia, and is also a homeopathic master clinician. Dr Edalati is the founder of Wellness Naturopathic Centre in North Vancouver, British Columbia. Her practice focus lies on women’s health, fertility, digestive disorders, allergies, sports medicine, and chronic fatigue syndrome. She strongly believes in the mind-body connection and incorporates it into her treatment approach. Dr Edalati’s additional trainings include bioidentical hormone therapy, prolotherapy, mesotherapy, cosmetic acupuncture, chelation, homeopathy, and craniosacral therapy. Further information on her clinic can be found on www.wellnessnaturopathic.com.

References

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8. Awad R, Muhammad A, Durst T, et al. Bioassay-guided fractionation of lemon balm (Melissa officinalis L.) using an in vitro measure of GABA transaminase activity. Phytother Res. 2009;23(8):1075-1081.
9. Cases J, Ibarra A, Feuillère N, et al. Pilot trial of Melissa officinalis L. leaf extract in the treatment of volunteers suffering from mild-to-moderate anxiety disorders and sleep disturbances. Med J Nutrition Metab. 2011;4(3):211-218.