Annals of Tropical Medicine and Public Health
Home About us Ahead Of Print Instructions Submission Subscribe Advertise Contact e-Alerts Editorial Board Login 
Users Online:104
  Print this page  Email this page Small font sizeDefault font sizeIncrease font size

Table of Contents   
Year : 2017  |  Volume : 10  |  Issue : 4  |  Page : 923-927
Studying the effect of Ginkgo on sleep quality of working midwiferies in hospital

School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran

Click here for correspondence address and email

Date of Web Publication5-Oct-2017


Midwifery is a high-stressed job, and midwiferies are prone to many stresses threatening their health over long working hours; further, it also influences their ability and the quality of patient care. Midwifery is characterized with sleep disorder influenced by stress and working shifts. This research is conducted to study the effect of Ginkgo biloba on midwiferies sleep quality in hospitals. In this random controlled clinical trial, thirty midwiferies working in hospitals were assigned into two groups of receiving treatment and placebo. The participants suffering from sleep disorder received the packs containing G. biloba and/or placebo and a pill every 12 h was prescribed over 30 days. Demographic and Pittsburgh Sleep Quality Index questionnaire were distributed prior and after Ginkgo. Following a 1-week cleaning, Ginkgo group received placebo; while, the placebo received Ginkgo over 30 days. Pittsburgh Sleep Quality Index questionnaire was also completed at the beginning and end of this period. Data were collected and descriptive, and inferential statistics was analyzed by t-test, Anova test through SPSS-20. At significant level P = 0.457, it may be expressed that there is no significant difference seen in the total sleep quality following treatment in experimental and control group. Research results demonstrate that Ginkgo has no effect on sleep quality of working midwiferies. Therefore, it is necessary to conduct longer studies with larger sample volumes.

Keywords: Ginkgo biloba, midwiferies, sleep quality

How to cite this article:
Naimeh AT, Masoomeh DF, Narges AT. Studying the effect of Ginkgo on sleep quality of working midwiferies in hospital. Ann Trop Med Public Health 2017;10:923-7

How to cite this URL:
Naimeh AT, Masoomeh DF, Narges AT. Studying the effect of Ginkgo on sleep quality of working midwiferies in hospital. Ann Trop Med Public Health [serial online] 2017 [cited 2020 Jul 10];10:923-7. Available from:

   Introduction Top

Midwifery is of the medical careers undergone high working pressure; midwiferies are exposed to several stresses influencing health, ability, and quality of patient care in long-term.[1] Working shifts interferes with biologic time such that inadequate sleep of night work may cause increased the individual, family and social problems, as well as cardiovascular, musculoskeletal, digestive and sleep disorders.[2],[3]

Sleep is one of the human basic requirements such that any interference in its natural trend may decrease individual performance in addition to creating mental problems.[4] Sleep may reduce stress and anxiety; further, it helps the individual recovering energy for concentration, compatibility, and enjoying daily activities. Over 30% of people around the world suffer from sleep disorders.[5]

Zamaniyan demonstrated that shift workers experience more sleep disorders and fatigue than control group.[6] Studies show that 60%–70% shift workers suffer from sleep disorders. A study on 635 nurses in Massachusett Hospital, US, revealed that such individuals likely experience twice drowsiness and napping; consequently, two times more likely to make mistakes.[7] Salehi et al., studying nurses of Imam Khomeini Hospital including maternity ward, also showed that 62.5% understudied personnel experience low sleep quality; moreover, working shifts showed statistically significant relationship with sleep quality.[8]

Benzodiazepines and antidepressant are of the drugs used for sleep disorders.[9],[10] In general, insomnia is treated by reducing sleep disturbers and decreasing anxiety through psychological interventions, relaxation training, or medication.[11] Apparently, the most significant effects of pharmacological benzodiazepines include relaxation, antianxiety, muscle relaxant, and antipsychological pressure. It also has many side effects such that the greatest concern on long-term use is drug dependency in a way that most psychological medications may lead to withdrawal syndrome once it is discontinued.[9],[12]

According to mentioned side effects and regarding that complementary medicine may also help in sleep order treatment,[4],[13] scholars were intended to use herbal medicines without side effect. In this regard, Hypericum perforatum, known as perforate St. John's-wort, valerian, and saffron… were investigated. Ginkgo biloba is of the medicinal plants undergone the highest studies and most common medical treatments during the last 100 years.[14] According to studies, Ginkgo effects on anxiety are reported as analog to standard antinxiety drugs such as benzodiazepine, buspirone as well as antidepressants. Ginkgo influences stress, memory, tinnitus, dizziness with unknown origin, sexual dysfunction, cure insomnia, headache, etc.[15]

G. biloba extract seems totally harmless to Smith. In a study receiving 600 mg Ginkgo extract per day, no significant effect was observed. Mild symptoms, however, such as digestive disorders and headaches were reported. Moreover, no herbal teratogenic and mutagenic effects were also found in animal experiments.[14] Murray et al. in Oxford University studied the effect of G. biloba extract on REM sleep stage in human. This research showed no significant difference between sleep parameters in REM stage for both groups; the participants properly tolerated the medicine.[16] Moreover, Batysheva et al. carried out a study entitled “using Ginus in treatment of advanced chronic brain disorders.” Ginus, which is a product of G. biloba extract was used, in this study, for 100 patients suffering from chronic and advance brain disorders. Neurological and psychiatric state of 90% of the patients improved; however, it was less effective in improving depression and anxiety. Further, the drug was well tolerated in all patients.[17]

Considering the nature of midwifery occupation interwoven with high-stress working shifts and sleep disorder outcome, and as so far, no study specifically investigated sleep quality in midwiferies, this research tried to study the effect of G. biloba on sleep disorders of working midwiferies.

   Materials and Methods Top

Thirty working midwiferies (15 in the treatment group and 15 in the placebo group) participated in this study within sampling from February 2012 to April 2013. Of these, three were excluded due to pregnancy, four due to colds, flu, depression, and forgetting to take medications; and three individuals were excluded due to disinterest. Hence, sample volume was completed by other individuals carrying the same features. Finally, thirty individuals were assigned into two groups of treatment and placebo. Demographic and Pittsburg Sleep Quality index questionnaires were initially filled out. The participants suffering from sleep disorders received G. biloba and or placebo pills; they were prescribed to take one every 12 h over 30 days, with a glass of water. At the end of 30 days, Pittsburg Sleep Quality Index questionnaire was redistributed. After 1 week of clean up, the individuals receiving Ginkgo were treated with placebo; whereas, those receiving placebo were medicated by Ginkgo over 30 days. Sleep quality index questionnaire was also distributed at the beginning and end of this period. Finally, data of 60 questionnaires (30 drug questionnaires and 30 placebo questionnaires) were investigated. Data were analyzed through SPSS 20 using descriptive and inferential statistic like t-test.

   Findings and Results Top

Mean age in experimental group and control group was 27.46 ± 3.85 and 27.6 ± 4.96, respectively, indicating that there was no significant difference seen between experimental and control group at P = 0.908. For education level, 2 testees (6.7%) held associate degree and 28 testess (93.3%) were bachelor in experimental group; whereas in control group, 3 testees (10%) held associate degree and 27 testees (90%) held bachelor degree. On marital status, 7 (23.3%) and 23 (76.7%) of testees in experimental group were single and married, respectively; while, in control group, 3 (10%) were single and 27 (90%) were married.

Comparing post-Ginkgo and placebo sleep total quality between experimental and control groups at P = 0.457, it may be stated that there is no significant difference between postintervention sleep total quality of experimental and control groups. Comparison of sleep delay intervention between experimental and control group at significant level P = 0.706 revealed no significant difference in both groups. According to the result of comparing postintervention sleep length at P = 0.232, no significant difference was seen between experimental and control group.

No significant difference was observed between postintervention sleep adequacy of experimental and control group at P = 0.412. Sleep disorders of experimental and control groups after treatment showed no significant difference at significant level 0.085.

The component of using medication for sleeping after intervention demonstrated a significant difference between experimental and control groups at P = 0.027. Whereas, comparing sleep performance of attendees revealed no significant difference between experimental and control groups at P = 0.816. The results are represented in [Table 1].
Table 1: Comparing pre- and post-intervention indicators between experimental and control groups

Click here to view

   Discussion Top

The results of this research as the first study on midwiferies' sleep quality indicate the nonsignificant effect of Ginkgo on sleep quality; further, components of sleep delay, sleep length, sleep adequacy, sleep disorders, as well as sleep performance also, showed no significant changes. These results are consistent with Murray et al. such that G. biloba did not influence sleep polysomnography referring to sleep quality.[16] Possibly, the results of this study and Murray et al. are justified by studying sleep mechanism.

Material impact in sleep quality and quantity depends on the effect of hormones secretions in the body. Melatonin is one of the critical sleep hormones secreted by pituitary. Therefore, it is referred as sleep hormone. It regulates biological clock, reduces physical activity, exhilaration, and euphoria level. Melatonin production decreases by sunlight. Hence, it is expected that changing sleep time of hospital staffs may disrupt their biologic clocks. On the other side, within day and light hours, more serotonin is produced, which also influences melatonin production. This hormone effectively contributes in regulating neuroendocrinological system, sleep, fatigue, and physiologic activities, as well as cognitive activities such as learning and memory.[18] Studies show that the mice suffering from the lack of Serotonin may experience lower growth; further, they show respiratory, cardiovascular problems, sleep disorder, and intensified aggressive behaviors.[19] Burns et al. reviewed the evidence demonstrating that G. biloba directly and indirectly influences cholinergic systems through regulating serotonergic system.[20]

On the other hand, there are two monoamine oxidase enzymes in neurons and astroglia oxidizing monoamines such as epinephrine, norepinephrine, dopamine, and serotonin. In this way, serotonin impact in melatonin may decrease. Thus, it concluded that improved sleep requires balancing this hormone and its oxidizers. It is recently proved that G. biloba extract may reversibly inhibit serotonin oxidizing enzymes, which consequently leads to reduced melatonin.[21] The results of Shah et al. also exhibited G. biloba mechanism effects on stress, depression, mood changes, and sleep through impacting brain catecholamin and serotonin level.[22] Thus, monoamine oxidase inhibitory effects of G. biloba are proved in many studies and it is expected that it indirectly influences sleep quality and quantity; whereas, the results of this study showed no effect on attendees' sleep performance probably due to decreased melatonin.

Other studies were conducted on a wide range of neurochemical systems, including sleep-related monoamines. Dopamine is one of these monoamines, which is a typical critical chemical substance secreted in the brain; it reduces hormone level in melatonin through connecting to its receptors and sends wake-up signal to the body. Investigations illustrate that dopamine receptors in brain cells may change by changing hours such that the number of the receptors is low at night and high at day. Reduced dopamine receptors at night causes increased secretion of melatonin and consequently higher drowsiness.

Ramassamy et al., in a study, showed that G. biloba leads to increased dopaminergic activity in the brain.[23] Thus, it is probable that using G. biloba by the participants at this study may enhance dopamine and decrease melatonin; and unlike what expected, it shows no contribution in improving sleep quality.

The results of some studies reveal that G. biloba may adjust brain blood flow; therefore, adjusting brain activity by G. biloba may be an effective factor of sleep quality and performance; whereas, findings of the present research showed no Ginkgo effect on sleep quality.[24] The dosage was probably insufficient to change brain flow for improved sleep.

Hechtman also provided positive effects of G. biloba on neurologic performance through cerebrovascular regulations, which consequently reduced anxiety and depression; further, it improves sleep disorder.[25] The results of this study are inconsistent with the present research. However, few studies are conducted on midwiferies' problems, particularly on sleep quality and herbal medicines.

Many studies investigated G. biloba and several contradictory results were obtained on improving cognitive problems, daily activity level, mood, and depression.[26] In addition, some constraints are also mentioned such as a limited number of samples, and weak reporting quality.[27] These studies increasingly demonstrate the necessity of studying sleep improvement factors of nurses and midwiferies.

   Conclusion Top

The results of this research may not support the effect of Ginkgo on sleep disorder of working midwiferies. Therefore, according to the inconsistent results, it is necessary to perform further research. It is suggested to conduct further study on more samples in different individuals by measuring monoamine serum level.


The authors gratefully acknowledge the Research Council of Arak University of Medical Sciences (Grant Number: 807) for the financial support.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Knezevic B, Milosevic M, Golubic R, Belosevic L, Russo A, Mustajbegovic J. Work-related stress and work ability among Croatian university hospital midwives. Midwifery 2011;27:146-53.  Back to cited text no. 1
Sajjadnia Z, Siavashi E, Kavosi Z, Moznebi S, Ravangard R. Shift Work and Related Health Problems among Medical and Diagnostic Staff of the General Teaching Hospitals. Health Man & Info 2015;2:3-94.  Back to cited text no. 2
Santorek-Strumillo E, Zawilska JB, Misiak P, Jablonski S, Kordiak J, Brocki M. Influence of the shift work on circadian-rhythms compare survey on health service employees and policemen. Przegl Lek 2012;69:103-6.  Back to cited text no. 3
Hossein-Abadi R, Nowrouzi K, Pouresmaili R, Karimloo M, Maddah SSB. Acupoint Massage in Improving Sleep Quality of Older Adults. Archives of Rehabilitation. 2008;9:8-14.  Back to cited text no. 4
Ghanei R, Hemmati Maslakpak M, Rezaei K, Baghi V, Makki B. Nursing students quality of sleep in dormitories of Urmia university of medical sciences. J Urmia Nurs Midwifery Fac 2011;9.  Back to cited text no. 5
Paterson JL, Dorrian J, Pincombe J, Grech C, Dawson D. Mood change and perception of workload in Australian midwives. Ind Health 2010;48:381-9.  Back to cited text no. 6
Bagheri M, Valizadehzare N. Night work and its effects on health nurses. Booyeh J Gorgan Fac Nurs Midwifery 2006;3:43-8.  Back to cited text no. 7
Salehi K, Alhani F, Sadegh-Niat KH, Mahmoudifar Y, Rouhi N. Quality of sleep and related factors among Imam Khomeini hospital staff nurses. Iran Univ Med Sci J Fac Nurs Midwifery IJN 2010;23:18-25.  Back to cited text no. 8
Kaplan H, Sadock V. Clinical Psychiatry. In: Rezaee F, Faghani Jadid N, editor. Pocket Handbook of Clinical Psychiatry, 5th ed, Tehran: Arjmand; 2010. p. 431-7.  Back to cited text no. 9
Morin CH. Insomnia. In: Bakhshayesh A, Leshkariyan A, editor. Book of Insomnia. Yazd University; 2002. p. 280-91.  Back to cited text no. 10
Zeraati F, Rabii M, Eraghchiyan M, Saboori T. Sleep quality and use of sleep medications in adults hospitalized in the local hospital Ekbatan. Hamedan Univ Med Sci J 2009;16:31-6.  Back to cited text no. 11
Foral P, Dewan N, Malesker M. Insomnia: A therapeutic review for pharmacists. Consult Pharm 2011;26:332-41.  Back to cited text no. 12
Chernicka EP. The use of alternative medicne for treatment of insomnia in the elderly. Psychogeriatrics 2006;6:21-9.  Back to cited text no. 13
Ghanadi A, Dehdashtinejad KH, Memar R. Ginkgo clinical expenses. Barij Essence Res Q 2010;4:3-4.  Back to cited text no. 14
Faustino TT, Almeida RB, Andreatini R. Medicinal plants for the treatment of generalized anxiety disorder: A review of controlled clinical studies. Rev Bras Psiquiatr 2010;32:429-36.  Back to cited text no. 15
Murray BJ, Cowen PJ, Sharpley AL. The effect of Li 1370, extract of Ginkgo biloba, on REM sleep in humans. Pharmacopsychiatry 2001;34:155-7.  Back to cited text no. 16
Batysheva TT, Bagir' LV, Kostenko EV, Artemova II, Vdovichenko TV, Ganzhula PA, et al. The use of the drug ginos in the treatment of out-patients with chronic progressive brain disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2007;107:55-9.  Back to cited text no. 17
Gutknecht L, Jacob C, Strobel A, Kriegebaum C, Müller J, Zeng Y, et al. Tryptophan hydroxylase-2 gene variation influences personality traits and disorders related to emotional dysregulation. Int J Neuropsychopharmacol 2007;10:309-20.  Back to cited text no. 18
aan het Rot M, Benkelfat C, Boivin DB, Young SN. Bright light exposure during acute tryptophan depletion prevents a lowering of mood in mildly seasonal women. Eur Neuropsychopharmacol 2008;18:14-23.  Back to cited text no. 19
Burns NR, Bryan J, Nettelbeck T. Ginkgo biloba: No robust effect on cognitive abilities or mood in healthy young or older adults. Hum Psychopharmacol 2006;21:27-37.  Back to cited text no. 20
White HL, Scates PW, Cooper BR. Extracts of Ginkgo biloba leaves inhibit monoamine oxidase. Life Sci 1996;58:1315-21.  Back to cited text no. 21
Shah ZA, Sharma P, Vohora SB. Ginkgo biloba normalises stress-elevated alterations in brain catecholamines, serotonin and plasma corticosterone levels. Eur Neuropsychopharmacol 2003;13:321-5.  Back to cited text no. 22
Ramassamy C, Naudin B, Christen Y, Clostre F, Costentin J. Prevention by Ginkgo biloba extract (EGb 761) and trolox C of the decrease in synaptosomal dopamine or serotonin uptake following incubation. Biochem Pharmacol 1992;44:2395-401.  Back to cited text no. 23
Noorbala AA, Akhondzadeh S. Attention-deficit/hyperactivity disorder: Etiology and pharmacotherapy. Arch Iran Med 2006;9:374-80.  Back to cited text no. 24
Hechtman L. Attention deficit/hyperactivity disorder. In: Sadock BJ, Sadock VA, editors. Comprehensive Textbook of Psychiatry. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.  Back to cited text no. 25
Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev 2007;18:CD003120.  Back to cited text no. 26
Beaubrun G, Gray GE. A review of herbal medicines for psychiatric disorders. Psychiatr Serv 2000;51:1130-4.  Back to cited text no. 27

Correspondence Address:
Akbari Torkestani Naimeh
School of Nursing and Midwifery, Arak University of Medical Sciences, Arak
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ATMPH.ATMPH_251_17

Rights and Permissions


  [Table 1]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *

    Materials and Me...
   Findings and Results
    Article Tables

 Article Access Statistics
    PDF Downloaded18    
    Comments [Add]    

Recommend this journal