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The Effect of Aromatherapy on Patients with

Insomnia
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Background
According to the American Sleep Association, almost 10 percent of Americans suffer
from long term insomnia. For years, the Eastern therapeutic method of aromatherapy has been
used to aid in the difficulties of sleep. The topic of discussion in this research proposal is to
scientifically examine the potential effect of aromatherapy on patients suffering from chronic
insomnia disorder (ASA).

Aromatherapy
Aromatherapy is defined as “the inhalation or bodily application, as by massage, of
fragrant essential oils, as from flowers and fruits, for therapeutic purposes” (Miriam-Webster).
Aromatherapy uses essential oils, which are highly concentrated substances extracted from
flowers, leaves, stalks, fruits, roots, and distilled resins which are viscous liquid from plants.
They are administered in small quantities by inhalation, by massage, on the surface of the skin,
and on rare occasions they are taken internally. While there are many different aromatherapy
practices, such as massage aromatherapy or cosmetic aromatherapy (which is used to rejuvenate
the skin), the focus of this research proposal is on olfactory aromatherapy, namely, inhalation.
(Ali et. al., 2015).
This kind of therapeutic process is rooted in a holistic, Eastern approach to medicine; as
opposed to Western medicine which targets specific symptoms of illnesses (Tseui, 1978). In
recent years, it has become more common to take a more holistic approach to healing in the
Western world, whether physical or psychological. New methods like acupuncture, yoga,
meditation, and herbal medicines are becoming more commonly studied in scientific
environments (Ruggie, 2004).
Aromatherapy has been shown to aid in pain relief, stress relief, improved digestion, and
increased energy levels. In addition, aromatherapy may also speed up the body’s healing process,
strengthen the immune system, and reduce headaches (Hedaoo et. al., 2019). A recent study done
by Pin-Hsuan Lin and Yuan-Ping Lin demonstrated aromatherapy’s ability to regulate the
autonomic nervous system, specifically activating the parasympathetic nervous system which is
responsible for “rest and digest” functions that relieve stress and regulate homeostasis (Lin et.
al., 2021). Another recent study demonstrated the effects of aromatherapy on inhibiting
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neurogenic inflammation, hyperalgesia and balancing vasorelaxation in patients suffering from

migraines (Yuan et. al., 2020).
While Research shows that the inhalation of essential oils can communicate signals to the
olfactory system and cause the brain to exert neurotransmitters such as serotonin and dopamine,
the underlying molecular mechanism of action is still a matter of uncertainty (Nan Lv et. al.,
2013).

Insomnia
Insomnia disorder is defined as “prolonged and usually abnormal inability to get enough
sleep especially due to trouble falling asleep or staying asleep” (Miriam Webster). Insomnia is
considered chronic when symptoms persist for more than one month. Symptoms include not
feeling well rested after sleeping, daytime sleepiness, waking up too early or during the night,
trouble falling asleep at night, difficulty focusing on tasks, increased accidents or errors,
depression, anxiety, or irritability. Insomnia is classified as primary when it is not connected to
any known current disorders, as opposed to secondary insomnia which is connected to external
circumstances (Narindra & Musabiq, 2019).
While there are many potential issues that lead to insomnia, our study puts emphasis on
indicators of the hyperarousal model of insomnia, which relates to increased activation of
cognitive, behavioral, and autonomous processes in patients with insomnia. More specifically,
increased EEG fast frequencies before and during sleep, increased number of arousals during
REM Sleep, increased body temperature, and increased heart rate (Morin et. al., 2015).
Since research suggests that through the use of essential oils, aromatherapy is able to
assist in balancing dysregulation of the autonomic nervous system as well as general stress
symptoms in other scenarios, we saw it fit to measure its effects by testing it on chronic insomnia
patients (Hedaoo & Chandurkar, 2019).

Research Goals
The main goal of our research is to demonstrate whether aromatherapy can affect the
negative symptoms that are experienced by those suffering with insomnia. This specific
population was chosen because the expected effect from aromatherapy would overlap well with
the symptoms of insomnia (more specifically the hyperarousal model).
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Contingent on the prior results, we hope to better understand the mechanism of

aromatherapy and its effects. More specifically, whether there will be a measured physiological
difference in a group that receives aromatherapy. If so, it would be important to examine whether
the results are consistent with previous research on the topic.
While its mood enhancing effects have been well researched, we would like to compare
the essential oils to another synthetic pleasant smell in order to better understand whether its
therapeutic effects are really separate from the potential mood enhancing effect of a good smell.
Finally, beyond just insomnia, we seek to potentially learn new information regarding an
additional treatment option that is readily available, inexpensive, easy, and noninvasive. We
hope it can contribute to the scientific understanding of a popular, but understudied holistic
therapeutic method. If results are significant, further research should be conducted in relation to
similar stress related symptoms found in any population, as well as further research into the
potential underlying effects of aromatherapy.

Hypothesis
Our hypothesis is that patients with chronic insomnia who undergo olfactory
aromatherapy will display a greater change of improvement in symptoms related to hyperarousal
when compared to control groups. More specifically, we expect to see a positive change in
physiological hyperarousal symptoms before and during sleep, as well as self-reported
improvement in sleep quality.

Study Method
Sample
In order to perform our clinical trial we would recruit a random sample of 60 people,
using convenience sampling, that suffer from chronic primary insomnia. We would then
randomly divide them into 3 groups, one being the experimental group, control group A, and
control group B. We would then perform the same trial on all the them, with the only differences
being the substance used in the olfactory therapy. The experimental group would use lavender
essential oil, control group A would use water and control group B would use a synthetic
imitation lavender spray.
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Treatment
Lavender is one the most common essential oils used in aromatherapy. Due to its long
history, as well as frequency of use in modern research studies, we decided it would be best to
use (Hedaoo, 2019).

Administration of therapy
Subjects would be given bottles with their respective substances and would be instructed
on administering 4 drops on a towel that would be placed around their pillow each night before
sleep (as per common aromatherapy practice).

Measurement tools
Pittsburgh Sleep Quality Index (PSQI)
A widely used measure of self-reported sleep quality. Questionnaire asking questions
regarding all different facets of sleep in the last month (Buysse et. al., 1989).
Actigraphy
A validated method of measuring sleep parameters and average motor activity over a
period of days to weeks using a noninvasive accelerometer worn on the wrist, like a watch
Polysomnography
The PSG monitors many body functions, including brain activity (EEG), eye movements
(EOG), muscle activity or skeletal muscle activation (EMG), and heart rhythm (ECG), skin
conductance response (SCR) during sleep.

All of the measurement tools used have been proven to have high test reliability and validity.

Method
We are conducting a pretest posttest control group design. We would start the clinical
trial by having all the participants fill out a PSQI questionnaire. We would then conduct a
preliminary sleep study at a sleep clinic, attached to polysomnography in order to receive
baseline measurements.
The participants would then continue to live their lives as normal, and each night they
would perform the treatment with their respective bottles of substance, as well as wear the
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Actigraphy. This would go on for 30 days until a final PSQI would be filled out and another
sleep study at a clinic would be performed under polysomnography.

Expected Results
We would expect to see changes in both the subjective and objective measures of our
experimental group. More specifically with regard to the hyperarousal model of insomnia, we
would expect slower brainwave frequencies before and during sleep, a decreased number of
arousals throughout the night as the experiment would progress, decreased arousal during REM
sleep, cooler body temperatures, and lower heart rate. We would not expect to see changes in the
control groups.
We would compare the changes with those of the control groups and measure
significance. If they all changed equally, the difference can be attributed to other factors such as
general placebo on all 3 groups. If there is a similar change between the experimental group and
control group B (synthetic smell), it can possibly be concluded that the changes were due to
pleasant smell and not to the unique qualities found in essential oils.
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References:

Ali, B., Al-Wabel, N. A., Shams, S., Ahamad, A., Khan, S. A., & Anwar, F. (2015).
Essential oils used in aromatherapy: A systemic review. Asian Pacific Journal of Tropical
Biomedicine, 5(8), 601-611.)

ASA Authors & ReviewersSleep Physician at American Sleep Association Reviewers

and WritersBoard-certified sleep M.D. physicians. (n.d.). Sleep Statistics: Data About
Sleep Disorders. Retrieved from https://www.sleepassociation.org/about-sleep/sleep-
statistics/

Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989).
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research. Psychiatry research, 28(2), 193-213.

Hedaoo, S. A., & Chandurkar, P. A. (2019). A Review on Aromatherapy. World Journal

of Pharmaceutical Research, 8(7), 635-651.

Insomnia. (2016, October 15). Retrieved from https://www.mayoclinic.org/diseases-

conditions/insomnia/symptoms-causes/syc-20355167

Lin, P. H., Lin, Y. P., Chen, K. L., Yang, S. Y., Shih, Y. H., & Wang, P. Y. (2021).
Effect of aromatherapy on autonomic nervous system regulation with treadmill exercise-
induced stress among adolescents. PloS one, 16(4), e0249795.

Merriam-Webster. (n.d.). Aromatherapy. In Merriam-Webster.com dictionary. Retrieved

July 26, 2021, from https://www.merriam-webster.com/dictionary/aromatherapy

Merriam-Webster. (n.d.). Insomnia. In Merriam-Webster.com dictionary. Retrieved July

27, 2021, from https://www.merriam-webster.com/dictionary/insomnia

Morin, C. M., Drake, C. L., Harvey, A. G., Krystal, A. D., Manber, R., Riemann, D., &
Spiegelhalder, K. (2015). Insomnia disorder. Nature reviews Disease primers, 1(1), 1-18.

Nan Lv, X., Jun Liu, Z., Jing Zhang, H., & Tzeng, C. M. (2013). Aromatherapy and the
central nerve system (CNS): therapeutic mechanism and its associated genes. Current
Drug Targets, 14(8), 872-879.
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Narindra, S. K., & Musabiq, S. (2019, August). Combining Methods of CBT and
Progressive Relaxation for Treating Primary Insomnia: A Case Study. In 2nd
International Conference on Intervention and Applied Psychology (ICIAP 2018) (pp.
464-474). Atlantis Press.)

Ruggie, M. (2004). Marginal to mainstream: alternative medicine in America. Cambridge

university press.

Tseui J. J. (1978). Eastern and western approaches to medicine. The Western journal of
medicine, 128(6), 551–557.

Yuan, R., Zhang, D., Yang, J., Wu, Z., Luo, C., Han, L., ... & Yang, M. (2020). Review
of aromatherapy essential oils and their mechanism of action against migraines. Journal
of Ethnopharmacology, 113326.