Should I take ashwagandha for sleep? Here’s what the science says

Dr. Trisha Pasricha. PHOTO:

Q: I’ve been struggling with sleep. My friends told me about ashwagandha, which seems like a natural solution. Should I try it?

A: Before trying ashwagandha, I’d recommend seeing your health-care provider to understand what’s causing your sleep issues. There are many reasons for insomnia, such as depression and sleep apnea, for which ashwagandha is not the first choice of treatment.

Ashwagandha has become popular among high-profile celebrities and TikTok scrollers for many reasons – they claim it improves sleep, anxiety, memory and even muscle mass.

Though it may be an unfamiliar term to many (the name is derived from Sanskrit), ashwagandha is far from a new therapy. It’s been used for a variety of ailments for thousands of years in countries like India, where Ayurvedic medicine – a traditional South Asian healing system is practiced.

Those who use ashwagandha to help with sleep are probably availing themselves of its known sedating qualities (its Latin name, Withania somnifera, references this). Studies in mice have identified that a chemical compound in ashwagandha, triethylene glycol, may be responsible for promoting sleep as well as its effect on GABA receptors – the same receptors targeted by many prescription sedatives and anti-seizure medications.

A meta-analysis of five randomized controlled trials in humans found ashwagandha led to a modest improvement in total sleep time – up to about 25 minutes – compared with a placebo. It also led to a notable improvement in sleep efficiency (the ratio of how long you were actually sleeping to lying in bed) and sleep quality, as assessed by participants.

The question for me remains: Is a sedative the best answer to your sleep troubles?

Prescription sedatives, which are known to have long-term risks, are not typically prescribed indefinitely. So while ashwagandha may adequately induce sleep, it shouldn’t be viewed as a long-term solution.

Here’s what else we do and don’t know about the ancient herb.

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How has ashwagandha been used traditionally?

Ayurvedic medicine has a long history behind it – medicinal use of ashwagandha is described in an Ayurvedic textbook, the Charaka Samhita, that dates back to at least around 100 B.C.

There are certainly differences in how ashwagandha has been traditionally used versus in recent studies (or on TikTok, for that matter). For instance, in Ayurvedic medicine, herbs like ashwagandha are usually recommended in low doses for a short period of time, such as for two weeks. It’s also traditionally prepared into juices, teas or pastes along with other ingredients and recommendations – as opposed to taking it as a gummy or in a capsule.

“In Ayurvedic philosophies, it’s never like, ‘Oh, this is the one thing you need to take to be cured,’” said Darshan Mehta, medical and education director for the Osher Center for Integrative Health at Brigham and Women’s Hospital and Harvard Medical School. “It’s always part of a comprehensive plan which might include yoga and other healthy lifestyle changes. It’s a very United States and Eurocentric perspective to take out this one thing, thinking that’s the solution, and then market it.”

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Does ashwagandha help with stress and anxiety?

Some of the most popular reasons people are interested in ashwagandha are stress and anxiety. But studies looking at this tend to be small and have mixed results.

A recent randomized controlled trial from Australia of 120 people found no significant differences between ashwagandha and a placebo in improving high stress and fatigue among middle-aged users. But another study of 60 participants found it improved anxiety scores by around 40 percent compared with about 24 percent in the placebo group after about two months. Both studies were funded by the company making the product used in the trials.

It’s hard to pinpoint exactly why ashwagandha may or may not have an effect on mental health. Mehta thinks it may be due to a synergy of multiple compounds found within the plant.

“A plant is not like some prescription medication with one active ingredient and one specific target,” Mehta said. “It becomes a much more complex mathematical equation.”

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Does ashwagandha boost testosterone?

A few studies have found that ashwagandha increases testosterone levels. That alone isn’t exactly helpful – boosting testosterone in people who may have normal levels is associated with known risks, including acne, sleep apnea and prostate growth, with unclear benefit.

But many take ashwagandha to bulk up because a handful of small studies suggest it could be helpful. For instance, a randomized study analyzing 38 men found that ashwagandha supplementation improved strength-training performance after 12 weeks (the research was funded by the company selling the product being studied).

But given how limited these studies are and what little we do know about its effects on testosterone levels, I would instead talk to your provider or a trainer for other options to achieve your fitness goals.

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Can I take ashwagandha daily?

“My advice is to use the herb for a limited time and then check in again,” said Chiti Parikh, co-director of Integrative Health at Weill Cornell Medicine.

Patients on higher doses often report worse gastrointestinal side effects, like nausea or diarrhea, and cases of serious liver injury are associated with increased doses.

“Remember, when it comes to ashwagandha, more isn’t always better. The key is figuring out the right amount for each person,” she said.

In general, Mehta said, ashwagandha is safe. But he said adulteration or impurities in ashwagandha products are a real concern: Heavy metals have been found in some products in the past, and there have been several reports of liver injury associated with ashwagandha, sometimes ending in hospitalization and acute liver failure, that may have been related to these issues.

Both Mehta and Parikh reference third-party platforms that vet and test the chemical properties of supplements, such as “Opt for products from reputable companies, and prioritize organic options whenever feasible,” Parikh advised.

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Who should avoid ashwagandha?

The following groups should avoid ashwagandha:

— Pregnant or nursing: There is concern that high doses of ashwagandha may induce an abortion.

— On other sedatives: Don’t mix ashwagandha with medications that can be sedating (such as gabapentin or benzodiazepines). Check with your provider if you’re not sure about possible interactions.

— Have nightshade intolerance: Ashwagandha belongs to the nightshade family, which some people do not tolerate well (other nightshade examples include eggplants, bell peppers and tomatoes). If you experience symptoms like stomach upset and nausea after taking ashwagandha, it’s probably better to avoid it.

The National Institutes of Health also recommends avoiding ashwagandha if you have autoimmune or thyroid disorders (it’s also thought to potentially interact with thyroid hormone medications) and if you have prostate cancer, given its potential effects on testosterone levels.

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What I want my patients to know

There’s always tension in any discussion about complementary and alternative medical therapies: Is it appropriate – or even feasible – to hold ancient Eastern treatments to Western clinical standards?

Herbal supplements like ashwagandha are not regulated by the Food and Drug Administration the same way as medications. So they won’t go through the same set of experiments as a prescription drug. There’s simply no incentive or funding to take them through the same 10- to 15-year-long process of clinical trials that pharmaceuticals fund for their drugs.

The end result for patients is confusing. Marketing teams for supplements can tout a swath of benefits compared with the highly specific indications given for FDA-approved medications.

A pragmatic approach would be to make the best decision possible with what we know. Ashwagandha has been studied for decades, albeit not along the same pathway as drugs seeking FDA approval. This doesn’t mean it doesn’t work. It just means we need to consider the potential benefits and risks in our decisions to take it.



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