Herbal medicine for cancer patients: An evidence based review

Abstract

Insomnia is a common disorder in both clinical and general populations. Treatment is complicated various methods of classification and confounding co-morbidity. Conventional pharmaceutical managements tends to focus on short term relief of symptoms rather than managing the underlying cause of insomnia. Moreover, conventional pharmaceuticals have unwanted side effects, tolerance and dependence. Herbal medicine provides safe, effective and reliable treatment strategies aimed at addressing both symptoms and aetiology of insomnia. Herbal treatments for insomnia tend to offer a cost effective alternative with no associated issues relating to tolerance and dependence. This article provides a summary of herbal treatment options in insomnia, and a brief analysis of supporting evidence. INTRODUCTION It is important to distinguish insomnia from other sleeping disorders. Indeed, a patient may themselves not know sufficient information about their sleep disorder and history to differentiate. Often it is information from parents or a bed partner that provides the clues to differentiate insomnia from, for example, hypersomnia and parasomnia. Moreover, one must differentiate insomnia symptoms from clinical insomnia (genuine dissatisfaction with sleep) highlighted perhaps by a recent study that indicated 36% of people reported insomnia but only 25% of those (9% overall) experienced genuine dissatisfaction with sleep (1). Insomnia relates to problem initiating or maintaining sleep (2,3) and tends to result in day time fatigue (3). Hypersomnia is excessive day time sleepiness with a tendency to fall asleep during the day and is generally associated with respiratory disorders (sleep apnea, narcolepsy) (3). Parasomnia are sleep aberrations like sleep walking, night tremors, nightmares and sleep paralysis (3). Other sleep disorders include restless leg syndrome and circadian rhythm disorder (3). Insomnia can be classified in terms of either its duration (acute or chronic) or its aetiology (primary or secondary) (4). Acute insomnia (also known as transient insomnia) generally results from a significant event in ones daily life (eg. trauma, long distance travel, change in sleep/awake pattern) and can be treated directly or preventative measures might be adopted (4). Chronic insomnia tends to be longer lasting with an association with medical aetiology and requires a more rigorous assessment to determine treatment options (4). Primary insomnia are those where there is no mental or physical cause requiring more direct treatment while secondary insomnia results as co-morbidity associated with other mental or physical illness requiring a more considered treatment approach (4). It must be noted, however, that any classification of insomnia can be confounded by the presence of a multitude of contributory factors (2). In general practice, the prevalence of clinical insomnia (causing day time dysfunction) range from 10% to 34% and is typically higher in older persons, women, those with less education, the unemployed and in those separated or divorced (1,5). Prevalence of insomnia is also higher in clinical populations than the general population (5) which reflects both secondary insomnia and the skewed age distribution in the clinical population. Ebert, Wafford and Deacon (2) report that 25% of adults experience insomnia at some point while 10% of the population consider insomnia to be a chronic problem. PATIENT HISTORY The goal of the patient history is to elicit sufficient information to classify the sleep disorder; to confirm indeed that the patient is suffering insomnia and not another sleep disorder. If insomnia is the correct sleep disorder, the information will also provide some scope to classify the type of insomnia; chronic versus acute, primary versus secondary, and an insight into the cause, although one recognises that Insomnia: An Overview Of Herbal Treatments 2 of 5 causal relationships are extraordinarily difficult to establish. Only after establishing this history can an intervention be considered; the correct treatment will depend on accurate classification and reatments should reflect the aetiology of insomnia and, thus, be individualised for each patient. HISTORY (,): Onset of insomnia Severity of insomnia Duration of insomnia Progression of insomnia Impact on awake activities Family history of sleep disorders Sleeping habits (sleep hygiene) and perhaps a ‘sleep diary'.