Paper as published in The Lancet (1995) vol.346, p.701.

Replacement of chronic drug treatment for insomnia in psychogeriatric patients by ambient odour

Mark Hardy (Millaton House Nursing Home, Bridestowe, Okehampton, Devon.)

Michael D Kirk-Smith (Reader in Behavioural Sciences, University of Ulster, Newtownabbey, Co. Antrim,
Northern Ireland)

David D Stretch (Greenwood Institute of Child Health, University of Leicester, Westcotes House, Westcotes
Drive, Leicester, LE3 0QU)

Hypnotic drugs are frequently prescribed chronically to relieve insomnia in psychogeriatric, despite recommendations
that they are for short-term use only. They have serious side-effects such as impaired psychomotor function, which has
strong links to serious accidents. The chronic prescription indicates the current difficulty in treating this condition
effectively.

Recent pharmacological and animal studies indicate that the main components of lavender oil have a light sedative
effect (refs 1,2,3,4). In this study, the hours of sleep of each of four psychogeriatric patients three of whom were under
different long-term medication (patient 1: 10mg Temazepan for one year; patient 2: 25mg Promazine hydrochloride for
three years; patient 3: 1 cap hemineverine for 7 months; patient 4: no previous medication) was measured for six
weeks. After two weeks of measurement, medication was withdrawn, and for the final two weeks ambient lavender oil
was introduced into their ward using an odour diffuser.

The results (Table One) suggested that the amount of time spent asleep was significantly reduced after withdrawal of
medication. However, after introduction of ambient lavender oil, sleep returned to the same level as under medication.
Post-hoc comparisons confirmed this pattern in all four patients. Patients were also reported to be less restless during
sleep. Additionally, the lavender oil was reported to have masked the unpleasant odours typically present. This
exposure to odour could potentially be more economic than current medication. The study suggests that ambient
lavender oil, under certain circumstances, might be used as a temporary relief from continued medication for insomnia.
This could be potentially important in lessening side effects. The results are preliminary only, however, being based
on only four patients. But with the other evidence that suggests that there may be understandable mild
pharmacological effects, they indicate that it may be worthwhile to investigate this effect more formally under better-
controlled situations, which is what the last two authors are planning to do. A more complete account of this study is
available on request from the last author.

References

1. Teuscher E, Melzig M, Villmann E, and Moritz K.U. (1990) Phytotherapie, 11, 87-92.

2. Buchbauer G, Jirovetz L, Jager W, Plank C. and Dietrich H. (1993) Fragrance compounds and essential oils
with sedative effects upon inhalation. Journal of Pharmaceutical Sciences. 82(6), 660-664.

3. Buchbauer G, Jirovetz L, Jager W, Dietrich H, Plank C, and Karamat E. (1991) Aromatherapy: Evidence for
sedative effects of the essential oil of lavender after inhalation. Zeitschrift fur naturforschung c-a, Journal of
Biosciences. 46c, 1067-1072.

4. Chen YW, Su KSE, and Chang S. (1989) Nasal systemic drug delivery. NY: Marcel Dekker.

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Table One: Median Sleep Times

Prescribed Two week period

Patient Drug Phase 1 Phase 2 Phase 3 sig.

1 Temazepam 9.50 9.00 10.00 < 0.005

(9.0, 10.0) (7.0, 9.0) (9.0, 10.0)
 2 Promazine 9.25 7.50 8.75 < 0.010
(8.0, 9.5) (6.5, 9.0) (8.0, 9.5)

3 Hemineverine 6.50 5.50 7.25 < 0.005

(6.0, 7.5) (4.0, 6.5) (6.5, 9.0)

4 No Medication 9.00 7.00 8.00 < 0.025

(8.0, 9.5) (6.0, 8.0) (8.0, 9.0)

Times given are median hours (Interquartile ranges) spent asleep per night, and the probability levels give the
probabilities with which such differences between the medians could arise if due only to chance differences between
the three conditions (Kruskall-Wallis Test.)