Preliminary examination of the efficacy and safety of a standardized chamomile extract for chronic primary insomnia: a randomized placebo-controlled pilot study

Suzanna M Zick, Benjamin D Wright, Ananda Sen, J Todd Arnedt, Suzanna M Zick, Benjamin D Wright, Ananda Sen, J Todd Arnedt

Abstract

Background: Despite being the most commonly used herbal for sleep disorders, chamomile's (Matricaria recutita) efficacy and safety for treating chronic primary insomnia is unknown. We examined the preliminary efficacy and safety of chamomile for improving subjective sleep and daytime symptoms in patients with chronic insomnia.

Methods: We performed a randomized, double-blind, placebo-controlled pilot trial in 34 patients aged 18-65 years with DSM-IV primary insomnia for ≥ 6-months. Patients were randomized to 270 mg of chamomile twice daily or placebo for 28-days. The primary outcomes were sleep diary measures. Secondary outcomes included daytime symptoms, safety assessments, and effect size of these measures.

Results: There were no significant differences between groups in changes in sleep diary measures, including total sleep time (TST), sleep efficiency, sleep latency, wake after sleep onset (WASO), sleep quality, and number of awakenings. Chamomile did show modest advantage on daytime functioning, although these did not reach statistical significance. Effect sizes were generally small to moderate (Cohen's d ≤ 0.20 to < 0.60) with sleep latency, night time awakenings, and Fatigue Severity Scale (FSS), having moderate effect sizes in favor of chamomile. However, TST demonstrated a moderate effect size in favor of placebo. There were no differences in adverse events reported by the chamomile group compared to placebo.

Conclusion: Chamomile could provide modest benefits of daytime functioning and mixed benefits on sleep diary measures relative to placebo in adults with chronic primary insomnia. However, further studies in select insomnia patients would be needed to investigate these conclusions.

Trial registration: ClinicalTrials.gov NCT01286324.

Figures

Figure 1
Figure 1
Participant Flow Through the Study.

References

    1. Alattar M, Harrington JJ, Mitchell CM, Sloane P. Sleep problems in primary care: a North Carolina Family Practice Research Network (NC-FP-RN) study. J Am Board Fam Med. 2007;20(4):365–374. doi: 10.3122/jabfm.2007.04.060153.
    1. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6(2):97–111. doi: 10.1053/smrv.2002.0186.
    1. Breslau N, Roth T, Rosenthal L, Andreski P. Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry. 1996;39(6):411–418. doi: 10.1016/0006-3223(95)00188-3.
    1. Katz DA, McHorney CA. The relationship between insomnia and health-related quality of life in patients with chronic illness. J Fam Pract. 2002;51(3):229–235.
    1. Taylor DJ, Mallory LJ, Lichstein KL, Durrence HH, Riedel BW, Bush AJ. Comorbidity of chronic insomnia with medical problems. Sleep. 2007;30(2):213–218.
    1. Ozminkowski RJ, Wang S, Walsh JK. The direct and indirect costs of untreated insomnia in adults in the United States. Sleep. 2007;30(3):263–273.
    1. Riemann D, Perlis ML. The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Med Rev. 2009;13(3):205–214. doi: 10.1016/j.smrv.2008.06.001.
    1. Pearson NJ, Johnson LL, Nahin RL. Insomnia, trouble sleeping, and complementary and alternative medicine: Analysis of the 2002 national health interview survey data. Arch Intern Med. 2006;166(16):1775–1782. doi: 10.1001/archinte.166.16.1775.
    1. Morin CM, LeBlanc M, Daley M, Gregoire JP, Merette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med. 2006;7(2):123–130. doi: 10.1016/j.sleep.2005.08.008.
    1. Mills S, Bone K. Principles and Practice of Phytotherapy. Oxford: Churchill Livingstone; 2000.
    1. Sanchez-Ortuno MM, Belanger L, Ivers H, LeBlanc M, Morin CM. The use of natural products for sleep: A common practice? Sleep Med. 2009;10(9):982–987. doi: 10.1016/j.sleep.2008.10.009.
    1. Viola H, Wasowski C, Levi de Stein M, Wolfman C, Silveira R, Dajas F, Medina JH, Paladini AC. Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects. Planta Med. 1995;61(3):213–216. doi: 10.1055/s-2006-958058.
    1. Zanoli P, Avallone R, Baraldi M. Behavioral characterisation of the flavonoids apigenin and chrysin. Fitoterapia. 2000;71(Suppl 1):S117–123.
    1. Pereira F, Santos R, Pereira A. Contact dermatitis from chamomile tea. Contact Dermatitis. 1997;36(6):307. doi: 10.1111/j.1600-0536.1997.tb00008.x.
    1. Rodriguez-Serna M, Sanchez-Motilla JM, Ramon R, Aliaga A. Allergic and systemic contact dermatitis from Matricaria chamomilla tea. Contact Dermatitis. 1998;39(4):192–193. doi: 10.1111/j.1600-0536.1998.tb05892.x.
    1. Kupfersztain C, Rotem C, Fagot R, Kaplan B. The immediate effect of natural plant extract, Angelica sinensis and Matricaria chamomilla (Climex) for the treatment of hot flushes during menopause. A preliminary report. Clin Exp Obstet Gynecol. 2003;30(4):203–206.
    1. Kakuta H, Yano-Kakuta E, Moriya K. Psychological and Physiological Effects in Humans of Eating Chamomile Jelly. ISHS Acta Horticulture 749/International Symposium on Chamomile Research, Development and Production. 2007.
    1. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Washington, DC: American Psychiatric Association; 1994.
    1. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485–491.
    1. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Jama. 1999;282(18):1737–1744. doi: 10.1001/jama.282.18.1737.
    1. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121–1123.
    1. Beck A, Steer R, Brown G. Beck Depression Inventory, Second Edition (BDI-II) Second. Harcourt Assessment, Inc.; 1996.
    1. Spielberger C, Gorsuch R, Lushene R. Manual for the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press; 1970.
    1. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297–307. doi: 10.1016/S1389-9457(00)00065-4.
    1. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. NCI Common Toxicity Criteria version 3.0 for Adverse Events.
    1. Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen TP, Witmans M. The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. J Gen Intern Med. 2007;22(9):1335–1350. doi: 10.1007/s11606-007-0251-z.
    1. Krystal AD, Walsh JK, Laska E, Caron J, Amato DA, Wessel TC, Roth T. Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep. 2003;26(7):793–799.
    1. Masago R, Matsuda T, Kikuchi Y, Miyazaki Y, Iwanaga K, Harada H, Katsuura T. Effects of inhalation of essential oils on EEG activity and sensory evaluation. J Physiol Anthropol Appl Human Sci. 2000;19(1):35–42. doi: 10.2114/jpa.19.35.
    1. Roberts A, Williams JM. The effect of olfactory stimulation on fluency, vividness of imagery and associated mood: a preliminary study. Br J Med Psychol. 1992;65(Pt 2):197–199.
    1. Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009;29(4):378–382. doi: 10.1097/JCP.0b013e3181ac935c.
    1. Salgueiro JB, Ardenghi P, Dias M, Ferreira MB, Izquierdo I, Medina JH. Anxiolytic natural and synthetic flavonoid ligands of the central benzodiazepine receptor have no effect on memory tasks in rats. Pharmacol Biochem Behav. 1997;58(4):887–891. doi: 10.1016/S0091-3057(97)00054-3.
    1. Avallone R, Zanoli P, Puia G, Kleinschnitz M, Schreier P, Baraldi M. Pharmacological profile of apigenin, a flavonoid isolated from Matricaria chamomilla. Biochem Pharmacol. 2000;59(11):1387–1394. doi: 10.1016/S0006-2952(00)00264-1.
    1. Della Loggia R, Traversa U, Starcia V, Tubaro A. Depression Effects of Chamomilla recutita (L.) Rasuch, Tubular Flowers, on Central Nervous System in Mice. Pharmacological Research Communications. 1982;14(2):153–162. doi: 10.1016/S0031-6989(82)80096-9.
    1. Meyer H, Bolarinwa A, Wolfram G, Linseisen J. Bioavailability of apigenin from apiin-rich parsley in humans. Ann Nutr Metab. 2006;50(3):167–172. doi: 10.1159/000090736.
    1. Nielsen SE, Young JF, Daneshvar B, Lauridsen ST, Knuthsen P, Sandstrom B, Dragsted LO. Effect of parsley (Petroselinum crispum) intake on urinary apigenin excretion, blood antioxidant enzymes and biomarkers for oxidative stress in human subjects. Br J Nutr. 1999;81(6):447–455.
    1. Cao J, Zhang Y, Chen W, Zhao X. The relationship between fasting plasma concentrations of selected flavonoids and their ordinary dietary intake. Br J Nutr. 2010;103(2):249–255. doi: 10.1017/S000711450999170X.

Source: PubMed

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