Kava: A Holistic Approach to Enhancing Sleep and Reducing Anxiety

by Kyle Perkovich, BS

The pursuit of effective, natural remedies for sleep disturbances and anxiety is increasingly critical. Among various options, kava—a traditional herbal ingredient rooted in Pacific Island cultures—stands out for its potential therapeutic benefits. Known scientifically as Piper methysticum, kava has been celebrated for centuries for its sedative properties¹. Only in recent years has it garnered attention from the scientific community for its potential in enhancing sleep quality and mitigating anxiety. This exploration into kava’s therapeutic capabilities aims to unveil the science behind how this ancient remedy might provide solace for those grappling with sleep challenges and the impacts of stress and anxiety.

The Critical Role of Sleep in Health

Sleep, as we are becoming increasingly aware, is a fundamental component of health, essential for physical, cognitive, and emotional well-being. Insufficient sleep not only leads to those annoying feelings of drowsiness; it is associated with a myriad of health issues, including cardiovascular disease, diabetes, obesity, and mental health disorders.²

The American Academy of Sleep Medicine and the Sleep Research Society advocates for 7 or more hours of sleep nightly for adults to maintain optimal health.³ Despite this, over a third of American adults fall short of these guidelines,⁴ highlighting a pervasive public health issue – but we need to conduct a deeper dive to understand what is causing this issue?

Reasons for insomnia include lifestyle, environment, sleep disorders, and neurologic disorders, but a primary cause that appears to affect people across all demographics is stress and anxiety (bringing the conversation back to kava, a substance known to help with both sleep and anxiety).^1,5 Whether it is part of an anxiety disorder or just a stressful day, most of us have experienced that feeling of lying in bed wishing our thoughts would stop racing, but the stress prevents us from falling asleep.

Unraveling the Sleep-Stress Connection

The complex interplay between sleep and stress is a significant focus of current research. The physiological basis for the relationship involves the hyperactivation of the stress response system, including the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system.⁵ Persistent activation of these systems from stress can lead to elevated cortisol levels and an increased heart rate, both of which hinder sleep initiation and maintenance.⁶

Individuals with chronic insomnia exhibit higher cortisol and anxiety levels, indicating a direct correlation between the stress response and sleep disruption;⁷ moreover, research in Sleep Medicine Reviews discusses the bidirectional nature of the sleep-stress relationship, where stress leads to sleep disturbances, which in turn, amplify stress and anxiety, perpetuating a detrimental cycle.⁸ Because of this, addressing stress and anxiety can be a vital aspect of tackling our issues with getting proper sleep. Research on this subject helps explain why anxiolytic substances, including natural remedies like kava, present potential avenues for breaking this cycle by alleviating anxiety and stress, thereby fostering better sleep quality.

Kava: Bridging Tradition and Science

Kava is more than just a plant; it’s a cornerstone of ancient cultures, revered for centuries for its ability to ease the mind and foster communal bonds.¹ It has been celebrated traditionally for its ability to promote relaxation and a sense of camaraderie during gatherings.¹

Realizing its demonstrable effects, scientists have turned their attention to kava’s traditional uses, particularly its anxiolytic and sedative effects, aiming to unravel the science behind its calming properties. The active compounds, kavalactones, are now known to play a pivotal role in kava’s effects on the human brain, offering a natural remedy for anxiety and stress-related ailments with roots deep in cultural practices.⁹

Kava: Mechanisms of Action Within Our Bodies

Kava’s calming effects are not just folklore; they are grounded in complex biochemical interactions within the brain. The key to kava’s anxiolytic and sedative properties lies in its kavalactones, a group of compounds that modulate neurotransmitter activity.⁹ While the mechanism is still being understood, research has shown that kavalactones interact with the brain’s GABAergic system, enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter responsible for reducing neuronal excitability throughout the nervous system and producing calmness.⁹

This interaction helps to decrease anxiety and promote relaxation without the risk of dependency associated with many pharmaceutical alternatives. Furthermore, kavalactones have been found to inhibit the reuptake of dopamine and norepinephrine, contributing to mood regulation and further enhancing kava’s soothing effects.¹⁰ This multifaceted action on the brain’s neurotransmitter systems explains why kava has been a valued remedy for anxiety and stress.

Scientific Research on Kava and Sleep

In the broad realm of natural remedies for sleep disturbances, kava emerges as a clear leader of the pack. Among the myriad of studies, one 2004 pivotal study shined  light on kava’s ability to promote sleep for those wrestling with stress-induced insomnia, concluding that sleep disturbances associated with anxiety can be effectively and safely treated with kava, without the dependency brought on by many sleep aids.¹¹ This randomized controlled trial found statistically significant differences in favor of kava for quality of sleep and recuperative effect after sleep, with good safety and tolerability.

Other studies echo positive results showcasing the sedative powers of kava, such as a pilot study with results demonstrating its ability to significantly reduce total stress and insomnia.¹² A 2021 review article found evidence that kava can affect the sleep-wake cycle and increase the duration of sleep,¹³ while another 2021 review paper similarly attributed a hypnotic effect to kava, pointing to results of reduced sleep latency, reduced awake time, and increased non-rapid eye movement (NREM) sleep time.¹⁴  

Kava’s interactions with our internal mechanisms, particularly with its soothing effects on our GABA system and promotion of soothing neurotransmitters, has clear demonstrable effects on the quality of our sleep.

Kava’s Anxiolytic Effects: A Closer Examination 

Working synergistically with its sedative properties, kava also has strong research pointing to anxiolytic activities, effectively contributing to the reduction of anxiety. As discussed previously, stress and anxiety play a key role in the insomnia many people suffer from today; kava’s scientific results benefitting both anxiety and sleep helps to demonstrate the close connection they have with each other.

In a groundbreaking double-blind, placebo-controlled study conducted in 2009, statistically significant results were demonstrated, showing a  reduction in anxiety.¹⁴ Aqueous kava extract reduced participants’ Hamilton Anxiety Scale scores with highly significant and substantial results, while also reducing depression scores and showing no serious adverse effects.¹⁵ The discovery of anxiety reduction is consistently reflected across numerous clinical trials. These studies indicate a significant correlation between kava and anxiety reduction in patients with generalized anxiety,¹⁶ a notable decrease in anxiety compared to placebo in perimenopausal women,¹⁷ and a significant reduction in anxiety scores among postmenopausal women.¹⁸

The list of studies demonstrating kava’s anxiolytic effects goes on; one 2020 review article in Frontiers of Psychology, examining available natural remedies for anxiety, noted that “the agent with the strongest evidence for use is kava.”¹⁹ The paper also recognized kava as the “most widely studied herbal compound”, noting how multiple meta-analyses have shown large-scale results of kava reducing anxiety scores. Overall, the evidence for kava’s effect on anxiety is increasingly substantial and provides another key benefit for those suffering from stress or anxiety that prevents proper sleep.

Expanding the Therapeutic Scope

While kava’s primary benefits affect sleep and anxiety, emerging research suggests that kava may have other exciting potential therapeutic benefits. One previously mentioned study on sleep also found results indicating that kava has properties that might protect against Alzheimer’s disease and stroke, although further research is needed.¹³ Another systematic review, while not conclusive, found hints at kava’s ability to improve cognitive performance, visual attention, and working memory.²⁰ This expanding scope of applications underscores kava’s versatility as a natural remedy, inviting further exploration into its full spectrum of benefits.

Addressing Safety

The conversation around kava is incomplete without addressing concerns regarding its safety. Previous concern stemmed from early clinical reports, in which accounts of hepatic failure due to kava were alleged and warnings were issued.²¹ However, subsequent research on liver toxicity has proven that these concerns were overblown, and risk of liver toxicity is much smaller than originally thought.

While it cannot be stated that there is no risk of kava toxicity, it is generally understood that no compound or supplement taken orally can be considered absolutely safe. Whether it is vitamins, minerals, protein, fats or carbohydrates, the possibility of toxicity increases with increasing dose;²² in fact, even water can become toxic with excess consumption, causing hyponatremia.²³

Subsequent meta-analyses going in-depth with larger amounts of data have also confirmed the safety of kava. One 2018 systematic review found that kava had the same statistical rate of adverse events as placebos, as well as no overall increase in hepatoxicity.²⁴ A 2013 randomized controlled trial displayed similar results, with aqueous kava doses of up to 240 mg kavalactones daily showing no changes to liver enzyme levels or adverse effects.¹⁶ Early cases showing the allegedly high complications were not well documented, did not account for traditionally high dosing levels (often >750mg/day), and failed to acknowledge the difference in safety between types and sources of kava.⁹ Despite this, researchers estimate the worst case risk from these reports would be less than 0.3 cases per one million daily doses, which is in fact superior to many commonly used anxiolytic agents.⁹

The best way to ensure safety with kava is to make sure it comes from a safe and high-quality source and take it as recommended. While the FDA does regulate supplements, they note that some companies may enter the marketplace without notifying the FDA.²⁵ Therefore, it is vital to buy from a company with quality sourcing of ingredients.

The way a kava supplement is processed may have a significant effect on its potential safety. For example, possible toxicity likely arises from the ariel part of the kava plant (the stems and leaves above ground), as these contain higher concentrations of alkaloids.^9,24 Because of this, kava supplements prepared from the root of the plant are generally safer and have less risk of toxicity.^9,26 Research has also noted that kava products made through water-based extractions, as opposed to extractions with ethanol or acetone, generally decrease risk.²⁶ Extracting with water is generally preferred as it creates a product rich in liver-protective glutathione compounds.²⁶

Other research suggests that the choice of kava cultivar plays a significant role in both safety and efficacy, with varying levels of kavalactones and flavokavains.⁹ Noble kava cultivars, often exported from areas with a tradition of kava use like Hawaii, Vanuatu, and Fiji, are broadly regarded as the superior option for daily intake; these strains provide a more desirable and safer experience with enhanced anxiolytic properties.⁹

Reviews of clinical studies have shown that correct dosing of kava is also a key component of ensuring safety, noting an absence of severe side effects if the dose remains below 400 mg of kavalactones per day. ²⁴  Multiple studies note that risk of liver toxicity is reduced and safety increased at lower doses (less than 240-250 mg per day)^9,16. To properly ensure a safe dose, it is best to always take as recommended by the product label and/or your doctor.

The research has proven that kava, despite possible misconceptions, has strong data in favor of its safety, especially when taken correctly. To ensure both safety and the best effects on stress and sleep, it is advised to research before you buy your kava, looking for safe doses (generally below 240 mg per day), excellent cultivars (noble kava), safe extraction (preferably water-based), and proper sourcing of the plant (ideally kava root for decreased alkaloids).^9,16,24,26

A Natural, Traditional Sleep Solution

Pharmacy counters are filled with various sleeping aids and remedies, and there are prescription options as well for those who need them. However, these can often lead to dependency and side effects, so many people prefer to turn to a natural option to help with issues falling asleep.

Kava is a blend of cultural tradition and scientific research and a promising natural remedy for those grappling with sleep disturbances. The evidence demonstrates kava’s efficacy in reducing anxiety, a common cause of insomnia, thereby improving sleep quality without the side effects typical of conventional sleep aids.¹⁶ It is clinically non-addictive and has been shown to have very low risk of toxicity, especially when taken at the right dose and from the best sources.⁹ For healthcare practitioners or everyday consumers seeking evidence-based, holistic solutions, kava appears to be a significant addition to the arsenal against sleep disturbances and anxiety.

Citations

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17. Cagnacci A et al. Kava-Kava administration reduces anxiety in perimenopausal women. 2003;44(2):103-109.
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23. Joo MA et al. Hyponatremia caused by excessive intake of water as a form of child abuse. Ann Pediatr Endocrinol Metab. 2013;18(2):95-8.
24. Smith K et al. The effectiveness and safety of Kava Kava for treating anxiety symptoms: A systematic review and analysis of randomized clinical trials. Complement Ther Clin Pract. 2018;33:107-117.
25. S. Food and Drug Administration. https://www.fda.gov/news-events/rumor-control/facts-about-dietary-supplements.  Accessed on February 29^th 2024.
26. Teschke R et al. Kava, the anxiolytic herb: back to basics to prevent liver injury? Br J Clin Pharmacol. 2011;71(3):445-448.

Kyle Perkovich is a medical writer with a background in clinical research and leading medical writing teams in the completion of clinical reports to get products approved for global sale. He graduated from the University of California, Santa Barbara with a degree in microbiology and a minor in professional science writing, while writing for the university newspaper and completing a technical writing internship with the Vandenberg Air Force Base. Kyle has helped manage documentation for large-scale clinical studies of medical devices and has been involved in various clinical and scientific research studies. He hopes to educate healthcare practitioners and consumers on the science behind the world of supplements and vitamins to help people better understand the complexities of nutrition and live healther lives.