I'm a doctor - these are the most effective sleep supplements you can take

As one of the UK’s leading research doctors for nutritional supplements, I am in a fortunate position to be able to explain which supplements can help us sleep, which should be avoided in the longer term and which are just a ploy to extract your hard-earned cash.

Sleep deprivation is a big problem - A third of the UK get less than the recommended 7 hours sleep a night and 12 per cent less than five hours. That’s why a colossal 10 million people, or more, look for help from their GPs or turn to over-the-counter remedies. The trouble is, the choice of pills, tinctures and potions in health food shops or in online websites is now truly overwhelming.

More and more manufacturers are trying to tap into the unmet needs of this wide section of society but it’s difficult for consumers to know whether they are worth trying or which could even make matters worse. Many, which claim effectiveness, have limited evidence of benefit or have based their claims on poor quality research. What’s more, the ones which can work in the short term tend to cause sedation, like sleeping tablets, so are contraindicated for long-term use.

That said, supplements can be a convenient way to boost elements of food and can certainly help some people. Here is my summary of the pros and cons of the more commonly used over-the-counter (OTC) varieties:

Magnesium supplements are one of the most popular OTC sleeping aids. Studies show that magnesium can help some people get to sleep and improve overall sleep quality, but here’s the rub. It only helps sleep if a person has deficient levels but not if their magnesium levels are normal in the first place.

Overall it would be better to adopt a diet which incorporates more magnesium, and other essential minerals in the diet. Foods such as pumpkin and chia seeds, nuts, beans, oysters, clams, seaweed, shell fish and even dark chocolate can be rich in magnesium. If you are someone who does not eat these foods regularly, a multiple mineral supplement would be sensible rather than just a magnesium supplement alone.

Vitamin D: There is growing evidence that vitamin D deficiency is linked to sleep disorders in children and adults. Recent studies are beginning to show that vitamin D supplementation can improve sleep patterns but the best results are for insomniacs who have low levels to start with. It is, therefore, unlikely that people with good vitamin D levels will benefit but it’s difficult to know whether you are deficient or not. Most GPs will not request a blood test, if asked, but it is possible - albeit expensive - to get a private analysis. It’s a fair bet, however, if you live in the UK, that unless you sunbathe regularly, take a winter sunny holiday or take a supplement your levels will be low.

Vitamin D tables are safe, so taking a regular supplement, especially in the darker months is certainly worth a try. The best supplements for sleep would combine the vitamin D with a prebiotic and probiotic which enchases absorption and utilisation.

Probiotic supplements: Boosting the diet with capsules containing healthy lactobacillus bacteria has been shown to improve sleep patterns in a number of studies. It is not clear, however, whether these benefits were seen only in people with poor gut health or whether they helped everyone.

In addition to a probiotic capsule, it is worth adopting dietary and lifestyle strategies to improve gut health. When choosing one the hundreds of brands available OTC, those mainly containing lactobacillus seem have the most benefit and, as mentioned above, blends combining a prebiotic and vitamin D with lactobacillus are better.

One such combination, called yourgutplus, significantly improved sleep quality in people suffering from long covid and because it was evaluated in a clinical trial is known to be safe.

Melatonin tablets are available over the counter in some countries, and can be prescribed in the UK. Multiple trials have reported significant benefits for the short term only such as jet lag. The trouble is, taking extra melatonin, over time, suppresses the natural release of melatonin from our own pituitary glands. Many researchers agree that that dietary strategies which naturally improve intrinsic melatonin levels would be better.

Chamomile and ginger have been a well-recognised traditionally sleep remedy for years. The active phytochemical in chamomile is called apigenin which weakly interacts with the GABA neurotransmitter system that regulates sleep and can natural encourage melatonin production.

The amount in a cup of chamomile tea is usually too small to sufficiently cross into the brain and induce sleep. Studies using concentrated chamomile show more convincing benefits especially among the elderly who particularly should avoid mainstream sleeping tablets.

Ginger is also rich in phytomelatonins which enhances melatonin production. Ginger is also a natural bioenhancer, meaning it improves the absorption of phytochemicals from other plants. So adding some grated ginger to your chamomile tea would add to the benefits, as well as the taste.

Phytonightplus+ is a new phytochemical rich food supplement that has been shown to improve sleep and reduce day time fatigue, in a recent major scientific study involving participants suffering from long covid. This OTC supplement contains a blend of melatonin-enhancing phytochemical-rich foods including pomegranate, chamomile, citrus bioflavonoids, turmeric and resveratrol. In the trial, participants were also given a lactobacillus probiotic.

Although some of these foods can influence GABA levels, they don’t directly cause sedation so have no hangover or additive effects. Instead they work in synergy to prepare the body for sleep by naturally increasing melatonin levels, improving mood, helping to relaxing the mind and body and promoting a regular circadian rhythm.

Antihistamines such diphenhydramine in Benadryl and Nytol and Doxylamine in Unisom can be bought OTC as a sleeping aids or to help hay fever and other allergies. They can induce drowsiness which can aid sleep. Side effects include daytime drowsiness, dry mouth, constipation and urinary retention. There is evidence that they can help for two to three nights so can help some people with jet lag but tolerance to the sedative effects can develop quickly. As a result, the longer you take them, the less likely they help.

CBD oil: Many people swear by CBD oil or gummies and if it works for them that’s a bonus. The medical evidence, however, is not so convincing. One of the most robust scientific trials found that the was no difference in sleep quality between 150mg of CBD oil before bed or a dummy oil. That said, both groups of people in the trial had some improvement in sleep quality compared to pre-study, revealing a significant placebo effect in both groups.

There was some improvement in psychological well-being in the day in the CBD group which is being investigated further.

Medical cannabis oil: Surprisingly this remains illegal in the UK, as unlike CBD oil it still contains the tetrahydrocannabinol (THC) component which is responsible for the “high” in recreational use. One well-conducted study, albeit with only 29 insomniacs, found that cannabis oil before bed was well tolerated and improved sleep in 60 per cent of the participants who had a history of anxiety and severe adults insomnia. They also found that night time, natural melatonin levels, measured in the saliva, significantly improved in the cannabis group.

Medical cannabis is available for some conditions but, although this trial was interesting, larger trials would have to be conduction to convince UK medical agencies to change the law.

Valerian is one of the most frequently studied plant extracts, and its use has been associated with some calming effects and improvements in quality and duration of sleep. Valerian, added to products such as Kalms, is believed to aid sleep through its interaction with the GABA neurotransmitter system in the brain leading to a calming and sedative impact.

Individual responses to valerian can vary, and some people complain of a hangover effect. About half of the available studies have reported a statistically significant short-term benefit and the other half did not, so the results are conflicting.

Ashwagandha (Indian ginseng) is a medicinal plant that has been used for centuries to treat insomnia. A recent systematic review of seven randomised trials concluded that ashwagandha reduced stress and anxiety levels, reduced sleeplessness and fatigue, and reduced serum cortisol (a stress hormone) levels, compared with placebo. Like valerian, however, it can cause sedating and hangover effects so is best to avoid for the long term.

In conclusion

Although it’s completely normal to have the odd sleepless night, several factors conspire against us getting the optimal amount we need to avoid day-time fatigue. Before resorting to medication, it would be worth adopting lifestyle strategies which have be shown to enhance natural sleep patterns.

Although melatonin, antihistamines and other sedating remedies can help in the short term, extended use is discouraged by many sleep experts. Plant-based, nutritional strategies which improve mood, naturally enhance melatonin production, support the circadian rhythm, correct vitamin D, mineral deficiencies and improve gut health reap more benefits for the long term.