Two natural sleep aids may work better together than either does alone
STUDY: Movva N et al, Clocks & Sleep 2026;8:15
STUDY TYPE: Randomized, double-blind, placebo-controlled trial
FUNDING: Independent
Background
Melatonin regulates circadian rhythms, and ashwagandha, a popular herb for anxiety and stress, modulates the stress response via the hypothalamic-pituitary-adrenal axis. Each has evidence for improving sleep, and this trial is the first to test them together.
The Study
- 200 adults aged 18–50 with sleep disturbance
- Randomized to ashwagandha (300 mg twice daily), melatonin (3 mg nightly), both, or placebo for eight weeks
- Sleep was measured by actigraphy (wrist-worn device) along with the Sleep Quality scale (PSQI) and Anxiety scale (HAM-A)
All three active groups outperformed placebo on every sleep measure.
The combination group showed the largest gains: sleep onset latency fell by about 21 minutes (versus 7 minutes with placebo), total sleep time increased by 56 minutes, and sleep efficiency rose by 10.5 percentage points. Anxiety scores (HAM-A) also improved most in the combination group. Effect sizes were large across the board (partial η² = 0.56–0.61). Adverse events were mild — mostly nausea and headache — and comparable across groups.
The effect sizes here are impressive and the study is large. Use of actigraphy adds credibility over purely subjective measures. But this was a single-center Indian trial of 200 relatively young, otherwise healthy adults, and the study was conducted by a group with prior ashwagandha research.
Practice Implications
- For patients who prefer natural approaches or who want a non-sedating, non-habit-forming option — especially those whose sleep trouble seems tied to stress or anxiety — combining melatonin 3 mg at bedtime with ashwagandha (KSM-66, 300 mg twice daily) is reasonable.
- However, natural doesn’t mean safe, and there are rare reports of liver injury on ashwagandha. Melatonin is much safer, but many products do not contain the right amount on the label.
- Use products tested by independent labs like the ones here.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
