--- topic: "Chamomile" title: "Sleep, Anxiety, and Digestive Calm" order: 1 description: "What the research says about chamomile for sleep, anxiety relief and gut comfort, and what is known about its flavonoid apigenin" question: "Does chamomile help with anxiety and sleep?" answer: "Chamomile extract likely reduces symptoms of generalized anxiety and improves sleep quality, though trials are small and modest in effect." actions: - "Try chamomile tea: 2–3 g dried flowers in 150 ml hot water for 5–10 minutes; for sleep, drink it 30–45 minutes before bed." - "For anxiety, trials used extract standardized to 1.2% apigenin (220–1500 mg daily), with benefits building over weeks [1][2]." cautions: - "People allergic to ragweed, chrysanthemum or other Asteraceae plants may react to chamomile." - "At high doses it may add to anticoagulants and sedative medications; it is not recommended during pregnancy." - "Digestive benefits have only cell and animal support so far; no human trials of gut outcomes are cited [4]." confidence: 3 confidenceNote: "Two small RCTs from one group and a meta-analysis of 12 trials agree, but effects are modest and sleep trials were short." evidenceSummary: rctCount: 2 observationalCount: 0 metaAnalysisCount: 1 totalParticipants: "150+" replicated: true newestStudyYear: 2022 references: - id: "1" pmid: "19593179" title: "A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder" authors: "Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J" year: 2009 journal: "Journal of Clinical Psychopharmacology" - id: "2" pmid: "27912875" title: "Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial" authors: "Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD" year: 2016 journal: "Phytomedicine" - id: "3" pmid: "31006899" title: "Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials" authors: "Hieu TH, Dibas M, Surya Dila KA, Sherif NA, Hashmi MU, Mahmoud M, et al." year: 2019 journal: "Phytotherapy Research" - id: "4" pmid: "27237110" title: "An Hydroalcoholic Chamomile Extract Modulates Inflammatory and Immune Response in HT29 Cells and Isolated Rat Colon" authors: "Menghini L, Ferrante C, Leporini L, Recinella L, Chiavaroli A, Leone S, Pintore G, Vacca M, Orlando G, Brunetti L" year: 2016 journal: "Phytotherapy Research" - id: "5" pmid: "36297396" title: "A Comprehensive Study of Therapeutic Applications of Chamomile" authors: "Sah A, Naseef PP, Kuruniyan MS, Jain GK, Zakir F, Aggarwal G" year: 2022 journal: "Pharmaceuticals" - id: "6" pmid: "35454969" title: "Chamomile (Matricaria chamomilla L.): A Review of Ethnomedicinal Use, Phytochemistry and Pharmacological Uses" authors: "El Mihyaoui A, Esteves da Silva JCG, Charfi S, Candela Castillo ME, Lamarti A, Arnao MB" year: 2022 journal: "Life (Basel)" - id: "7" pmid: "7617761" title: "Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects" authors: "Viola H, Wasowski C, Levi de Stein M, et al." year: 1995 journal: "Planta Medica" - id: "8" pmid: "10751547" title: "Pharmacological profile of apigenin, a flavonoid isolated from Matricaria chamomilla" authors: "Avallone R, Zanoli P, Puia G, Kleinschnitz M, Schreier P, Baraldi M" year: 2000 journal: "Biochemical Pharmacology" --- Chamomile (Matricaria chamomilla) is one of the world's most widely consumed medicinal plants — a gentle, daisy-like flower with a decades-long research record behind its traditional uses. It contains apigenin, a flavonoid that binds to the central benzodiazepine receptor targeted by prescription anti-anxiety medications; in mice it was anxiolytic without sedation at the doses tested [7]. Clinical trials report measurable benefits for generalized anxiety disorder [2] and sleep quality [3], and cell and tissue studies suggest an anti-inflammatory action in the gut [4]. ## How Chamomile Works Apigenin (5,7,4'-trihydroxyflavone) is the chamomile flavonoid studied most for calming effects. In one study it competed for the central benzodiazepine receptor and was anxiolytic in mice, without sedation or muscle relaxation at doses similar to those of classical benzodiazepines, while a ten-fold higher dose was mildly sedative [7]. A second study also found that apigenin displaced a benzodiazepine-site ligand, but in rats it reduced locomotor activity without anxiolytic effects, so how apigenin acts is not settled [8]. Neither study tested chamomile tea or a standardized extract in people; the human trials are described below. Beyond apigenin, chamomile contains **bisabolol** and **bisabolol oxides** (sesquiterpenes with anti-inflammatory activity), **chamazulene** (formed during steam distillation), and multiple flavonoids including luteolin, quercetin, and patuletin that contribute to antioxidant and immune-modulating effects [6]. ### Anxiety and Mood Three clinical trials have specifically examined chamomile for generalized anxiety disorder (GAD). The 2009 double-blind RCT by Amsterdam et al. used 1.2% apigenin standardized extract (220 mg/day) and found significantly greater symptom reduction compared to placebo over 8 weeks [1]. The 2016 follow-up by Mao et al. tracked patients for 26 additional weeks and found chamomile significantly delayed symptom relapse when continued long-term, with a hazard ratio for relapse of 2.5 — meaning patients on placebo relapsed two and a half times faster [2]. ### Sleep Quality A 2019 meta-analysis of 12 randomized trials found statistically significant improvements in sleep quality scores (standardized mean difference −0.97, 95% CI −1.87 to −0.06), particularly for subjective sleep ratings, daytime functioning, and mood upon waking [3]. ### Digestive Support Chamomile is traditionally used as an antispasmodic and for gastrointestinal disorders [6]. Cell and tissue studies show chamomile extract reduces the production of pro-inflammatory cytokines (TNF-α, IL-6) in gut epithelial cells and isolated colon tissue, suggesting a direct anti-inflammatory action on the gut lining [4]. ## Practical Use **Tea:** The most traditional and widely available form. Use 2–3 g of dried flowers steeped in 150 ml of hot water for 5–10 minutes. For sleep, drink 30–45 minutes before bed. For anxiety, 2–3 cups daily provides consistent apigenin exposure. **Standardized extract:** For clinical-level effects seen in trials, look for extracts standardized to 1.2% apigenin. Doses used in RCTs were 220–1500 mg daily. **Duration:** The anxiety trials suggest chamomile's benefits build over weeks of consistent use rather than occurring immediately. **Safety:** Chamomile is well-tolerated. The main caution is allergy — those with ragweed, chrysanthemum, or other Asteraceae family allergies may cross-react. It may potentiate the effects of anticoagulants (coumarin constituents) and sedative medications at high doses. Not recommended during pregnancy due to potential uterine stimulation. See our [valerian page](/valerian/sleep-and-anxiety) for another herb with sleep evidence, or our [lemon balm page](/lemon-balm) for a complementary calming herb often combined with chamomile. ## Evidence Review ### Randomized Controlled Trials for Anxiety The earliest high-quality trial, Amsterdam et al. (2009), enrolled 57 adults with DSM-IV-defined mild-to-moderate GAD in a double-blind, placebo-controlled design [1]. Participants received either pharmaceutical-grade chamomile extract standardized to 1.2% apigenin (220 mg/day, titrated to 1100 mg/day) or matching placebo for 8 weeks. The primary outcome was the Hamilton Anxiety Rating Scale (HAM-A). Results showed a significantly greater mean reduction in HAM-A total scores for the chamomile group compared to placebo (−2.15 points difference, P = 0.047). Secondary outcomes including the Hospital Anxiety and Depression Scale and Clinical Global Impression also favored chamomile. The effect size was modest but clinically meaningful for a well-tolerated herbal intervention. The follow-up trial, Mao et al. (2016), addressed a key question the 2009 study left open: does chamomile prevent relapse when continued long-term? [2] This study enrolled 93 patients with moderate-to-severe GAD who first received 12 weeks of open-label chamomile (1500 mg/day), then randomized treatment responders to either continue chamomile or switch to placebo for 26 additional weeks. The primary finding was time to relapse: 15 of 47 patients on placebo relapsed vs. 9 of 42 on chamomile, and Cox regression showed a hazard ratio of 2.5 (95% CI 1.08–5.77, P = 0.03) for relapse on placebo. Crucially, GAD symptom scores continued to decrease during the continuation phase in the chamomile group but rose in the placebo group, confirming sustained efficacy rather than mere symptom suppression. ### Meta-Analyses Hieu et al. (2019) conducted a systematic review and meta-analysis of 12 randomized and quasi-randomized trials covering state anxiety, GAD, insomnia, and sleep quality [3]. For GAD specifically, pooled analysis of two RCTs (totaling 153 patients) confirmed a significant reduction in HAM-A scores (WMD −5.0, 95% CI −9.03 to −0.98). For sleep quality, a meta-analysis of six studies showed a significant improvement in Pittsburgh Sleep Quality Index (PSQI) scores (SMD −0.97, 95% CI −1.87 to −0.06). The authors rated the overall evidence as moderate quality, noting that trials were methodologically heterogeneous in dosing and patient populations but consistent in direction of effect. ### Gut and Anti-Inflammatory Evidence Menghini et al. (2016) applied a hydroalcoholic chamomile extract to human colorectal adenocarcinoma HT29 cells and to rat colon specimens treated with lipopolysaccharide (LPS) to induce an inflammatory stimulus, a well established model of acute ulcerative colitis [4]. Key findings: - The extract was as effective as sulfasalazine (2 mg/ml) in reducing the production of myeloperoxidase (MPO), serotonin (5-HT), IL-6, NF-κB, TNF-α, prostaglandin E2 (PGE2) and 8-iso-prostaglandin F2α after the inflammatory stimulus - The study measured biomarkers of inflammation and lipid peroxidation, including reactive oxygen species (ROS) - The authors concluded that the observed effects support a rationale for chamomile supplementation as a promising pharmacological tool for the prevention and management of ulcerative colitis in humans These findings come from cell and isolated-tissue models, not human trials, but they suggest an anti-inflammatory action in the gut that may help explain chamomile's use for digestive complaints. ### Phytochemical Basis The 2022 comprehensive review by Sah et al. gathers the literature on chamomile's therapeutic applications, the chemical components responsible for them and their mechanisms of action [5]. The authors report that the plant contains many components, namely flavonoids, terpenoids and coumarins, which are responsible for its medicinal properties, and they discuss its role as an anti-inflammatory, antioxidant, analgesic, antimicrobial, hepatoprotective, anti-allergic, anticancer and anti-hypertensive agent [5]. They also note that not much is known about its role in the treatment of CNS disorders and metabolic syndromes [5]. ### Strength of Evidence - **Anxiety (GAD):** Moderate. Two dedicated RCTs with consistent positive findings, meta-analysis confirmation. Effect sizes modest but meaningful. Limitations: relatively small sample sizes, both trials by the same research group. - **Sleep quality:** Moderate. Meta-analysis of six trials finds consistent improvement in subjective sleep quality. Limitations: most trials used subjective measures rather than polysomnography; trials short (≤4 weeks). - **Digestive support:** Preclinical (cell and animal models). Consistent with traditional use and mechanism, but dedicated human RCTs for GI endpoints are lacking. - **Safety:** High. Consistent across all trials, with adverse events no different from placebo. Long-term safety established up to 38 weeks in the Mao et al. trial.