The Ancient Medicinal Herb Ashwagandha for the Treatment of Insomnia
“Even a soul submerged in sleep is hard at work and helps make something of the world.”
― Heraclitus, Fragments
“Innocent sleep. Sleep that soothes away all our worries. Sleep that puts each day to rest. Sleep that relieves the weary labourer and heals hurt minds. Sleep, the main course in life’s feast, and the most nourishing.”
―William Shakespeare, Macbeth
Sleep is still somewhat of a mysterious enigma, but we know it serves many critical and nourishing purposes, as noted by both Heraclitus, an ancient Greek philosopher, and Shakespeare centuries ago. Modern science confirms some of the functions of healthy sleep include waste clearance via the glymphatic system; immune support to facilitate recovery from and prevent illness; a restorative function to replete brain energy stores; a recovery function to reboot cognitive and behavioral performance; and a connectivity function that may erase obsolete memories, consolidate new memories, solidify neuromuscular circuitry, stabilize and preserve neuronal plasticity, optimize glutamatergic synaptic transmission, increase synaptic efficacy, and promote cellular maintenance.1
The glymphatic system, also known as glial-dependent lymphatic transport, was discovered in 2012 and is exceptionally fascinating. The glymphatic system filters toxins from the brain; however, during wakefulness this waste clearance system is mostly inactive. The critical role sleep plays in the function of the glymphatic system has been thoroughly studied and conclusively demonstrated. Impaired glymphatic clearance, which does occur secondary to insomnia, has been linked to several neurodegenerative diseases, including Alzheimer’s disease.2 Insomnia is a condition characterized by an insufficient quality or quantity of sleep, with symptoms including difficulty in initiating sleep, difficulty in maintaining sleep, frequent awakenings, and problems returning to sleep after awakenings.3
Since sleep has an active, complex, and unique function in the body, insomnia can contribute to the development of many systemic diseases. Insomnia causes both functional cognitive impairment and emotional dysregulation and increases the risk of various health concerns such as depression, diabetes, hypertension, cancer, and infection. The prevalence of insomnia is reported to be up to 25.5% of the population in international studies; however, the 1-year incidence rate of simple insomnia symptoms is a staggering 30.7%. Insomnia causes direct and indirect costs of over $100 billion per year in the United States alone.3
One safe and evidence-based treatment option to consider for insomnia is Ashwagandha.
Ashwagandha is a medical herb that has been used for centuries, even before 3000 BCE, for various purposes in Ayurveda, which is the traditional system of medicine in India. 4,5 In Ayurvedic practice and literature, “Nidrajanan” (sleep induction) is one of the traditional clinical indications for which Ashwagandha is prescribed.6 The Latin name for Ashwagandha is Withania somnifera, which means “sleep-inducing.” Ashwagandha is an evergreen, straight, branching shrub, and the roots are especially rich in withanolides and other bioactive molecules. Studies have shown that Ashwagandha offers anti-inflammatory, anti-cancer, anti-stress, antioxidant, immunomodulatory, hemopoietic, and regenerative properties. Furthermore, Ashwagandha is helpful for rheumatic pain, arthritis, cognitive disorders, anxiety and stress disorders, male infertility, and those seeking improved athletic performance. Ashwagandha extract is generally well-tolerated and safe.4,5
Several clinical studies have confirmed the safety of Ashwagandha, and a review of the toxicity studies on Withania somnifera confirms no toxicity or side effects have been reported to date. Therefore, Ashwagandha is considered safe for use in human beings for the treatment of acute and chronic disease states.7
Evidence suggests that Ashwagandha contains sleep-inducing compounds, such as withanolides, that improve sleep in all age groups, and several clinical trials confirm that supplementation with Ashwagandha is effective for the treatment of insomnia.8
In one clinical trial, individuals under chronic stress who took an Ashwagandha extract saw their serum cortisol levels substantially decrease compared to those who received a placebo. The group of subjects that received the Ashwagandha also showed a substantial 69.7% reduction in the “Anxiety and Insomnia” item-subset score of the General Health Questionnaire (GHQ-28), meaning their anxiety level and insomnia improved by nearly 70% while taking the Ashwagandha.9
In another well-designed study, changes in the sleep scale score, mental alertness on rising, and sleep quality were assessed after 12 weeks of supplementation with Ashwagandha. The study was double-blinded, meaning neither the researchers nor the participants knew if they were taking the Ashwagandha. The treatment group received 300 mg of Ashwagandha root extract in capsules twice daily with water, while the control group received an identical dose of placebo capsules. The sleep scale score can range from 0-12, and the sleep scale baseline scores were 7.53 ±1.87 and 7.45 ±3.24 in the treatment and placebo groups, respectively. At the end of the 12-week study, the sleep score in the treatment group had improved to 5.00 ±1.89, while the sleep score in the placebo group was 6.35 ±3.00. A reduction in the sleep score signifies better health status and improved sleep.8
Quality sleep also supports improved alertness and rejuvenated wakefulness after sleep, which is vital for every human being. Thus, mental alertness on rising provides an indirect assessment of sleep quality. In the same 12-week study, mental alertness on rising was assessed on a 3-point scale, and an improved outcome was recorded for the Ashwagandha group (1.05 ± 0.23) compared to the placebo group (1.35 ± 0.587). A lower score represents better alertness and less drowsiness. Lastly, sleep quality was assessed on a scale from 1-7, where the higher the score, the lower the quality of sleep. At baseline, the sleep quality score was 5.76 ± 0.66 for the treatment group and 5.72 ± 0.73 for the placebo group. The final sleep quality score was 2.47 ± 1.07 in the treatment group and 4.3 ± 0.65 in the placebo group. The observed changes between the Ashwagandha treatment group and the placebo group were statistically significant after the 12 weeks of treatment and confirmed the Ashwagandha supplementation improved sleep.8
Another clinical trial evaluated the effects of Ashwagandha extract on sleep quality in healthy adults. In this randomized, double-blind, and placebo-controlled study, the seventy-five participants in the treatment group took two 60 mg capsules of a potent Ashwagandha extract per day, while the seventy-five participants in the placebo group took two placebo capsules with rice powder. Opaque capsules maintained the blindness of the study, so neither the researchers nor the participants knew if they were taking Ashwagandha or rice powder. At the end of the study, the investigators discovered daily supplementation with 120 mg of Ashwagandha extract for 42 days improved the overall quality of sleep in healthy individuals. Specifically, the treatment reduced the onset of sleep latency, waking after sleep onset, and average awakening time; and improved total sleep time, sleep efficiency, and quality of life. The results were statistically significant.6
Clinical trials, traditional use in Ayurvedic medicine, systematic reviews, and meta-analyses have all confirmed Ashwagandha does support healthy sleep, but how does it work?
To date, the exact mechanisms of action are unknown, but many hypothesize Ashwagandha could support healthy sleep by reducing cortisol levels, stimulating GABAergic activity, reducing anxiety, and reducing stress. Research has determined Ashwagandha extract produces a significant attenuation of elevated cortisol levels and other physiologic indicators of stress. For example, in a clinical trial by Choudhary et al., cortisol levels were reduced from their baseline by 16.05% and 22.2%, respectively, after 4 and 8 weeks of treatment with Ashwagandha. The difference between the mean reductions of serum cortisol levels in the treatment and placebo groups after the fourth and eighth week was statistically significant. Additional studies have determined that Ashwagandha has significant anxiolytic properties in humans, as measured by both patient-reported outcomes and quantitative analysis of serum biomarkers. Ashwagandha also has GABAergic activity on ionotropic GABA-A and GABA-ρ receptors, which could be an additional contributing factor to its efficacy for insomnia treatment.10
In summary, according to robust modern analysis and traditional use, Ashwagandha can be considered an evidence-based treatment option to promote all of the nourishing and critical functions of healthy, optimal sleep.
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