When a study concludes that ashwagandha ‘improves sleep’, the first question is what exactly was measured. Researchers use two types of tools, which do not necessarily produce the same results.
Time to fall asleep, duration, perceived quality: different measures
Objective measures most often rely on actigraphy, using a small sensor worn on the wrist to record movement during the night. It can be used to estimate how long it takes to fall asleep (known as sleep latency), total sleep duration, periods of wakefulness during the night and sleep efficiency, meaning the proportion of time in bed actually spent asleep.
Subjective measures, meanwhile, rely on questionnaires: the Pittsburgh Sleep Quality Index (PSQI), participants’ own ratings of their sleep quality, or how fully alert they feel on waking. Although these measures reflect personal experience, they matter just as much when someone is having difficulty sleeping.
In some trials using KSM-66 root extract [6] [7] [8], both types of measure showed more favourable changes than with a placebo: participants fell asleep faster, spent a greater proportion of their time in bed asleep, rated their sleep quality more highly and felt more alert on waking. A trial in healthy adults using another standardised extract (Shoden) [5], at a different dose and concentration, points in the same direction. This highlights an important distinction: ashwagandha extracts are not interchangeable, and results obtained with one cannot automatically be applied to another!
A more noticeable effect in women who sleep poorly
One trial included two groups [8]: volunteers without sleep difficulties and people with insomnia. Sleep improved in both groups taking ashwagandha, but more markedly among those with insomnia, who fell asleep faster.
A meta-analysis published in 2021 [3], which brought together five randomised trials, points in the same direction. Its authors describe a small but significant effect on sleep overall. In their subgroup analyses, this effect appears greater in adults diagnosed with insomnia and at doses of at least 600 mg per day. They also observed improved alertness on waking and a shorter time to fall asleep.
What the studies do not tell us
The results of studies on ashwagandha and KSM-66 are encouraging:
- The effect is real, but it is not a medicine. No trial has compared ashwagandha with a sleep medicine, and there is no evidence to suggest it is equivalent to one.
- Results vary from person to person. The improvement is more or less clear depending on the measure used. The authors of the meta-analysis therefore consider the quality of the evidence for overall sleep to be moderate.
The question of how it works remains. In several of these trials, anxiety decreased as sleep improved, and researchers hypothesise that part of the effect is linked to this reduction in anxiety. We explore the findings on stress in our article ‘Ashwagandha and stress’.