Insomnia & Sleep-wake Cycle Disorder

tired-woman-first-trimesterWhat is Insomnia?

Insomnia refers to a difficulty in achieving or maintaining normal sleep. There are two basic forms of insomnia. In sleep-onset insomnia a person has a difficult time falling asleep. In sleep-maintenance insomnia a person suffers from frequent or early awakening.

What causes Insomnia?

The most common causes of insomnia are psychological: depression, anxiety, and tension. If psychological factors do not seem to be the cause, various foods, drinks, and medications may be responsible. There are numerous compounds in food and drink (most notably caffeine) that can interfere with normal sleep. There are also over three hundred drugs that interfere with normal sleep.

What dietary factors are important in Insomnia?

Eliminate caffeine. It is essential that the diet be free of natural stimulants such as caffeine and related compounds. Coffee, as well as less obvious caffeine sources such as soft drinks, chocolate, coffee-flavored ice cream, hot cocoa, and tea, must all be eliminated. Even small amounts of caffeine such as those found in decaffeinated coffee or chocolate, may be enough to cause insomnia in some people.

Other food compounds that can act as stimulants include some food colorings. Adverse food reactions such as food sensitivities and allergies can also cause insomnia. Although not considered a stimulant, sugar and refined carbohydrates can interfere with sleep. Eating a diet high in sugar and refined carbohydrate and eating irregularly can cause a reaction in the body that triggers the “fight or flight” part of the nervous system, causing wakefulness.

Eliminate alcohol. Alcohol causes the release of adrenaline and disrupts the production of serotonin (an important brain chemical that initiates sleep).

Avoid nocturnal hypoglycemia. In my clinical experience I have found nocturnal hypoglycemia (low nighttime blood glucose level) is an important cause of sleep-maintenance insomnia. When there is a drop in the blood glucose level, it causes the release of hormones that regulate glucose levels, such as adrenaline, glucagon, cortisol, and growth hormone. These compounds stimulate the brain. They are a natural signal that it is time to eat. Good bedtime snacks to keep blood sugar levels steady throughout the night are oatmeal and other whole grain cereals, whole grain breads and muffins, and other complex carbohydrates. These foods will not only help maintain blood sugar levels, they actually can help promote sleep by increasing the level of serotonin within the brain.

Foods high in the amino acid tryptophan, such as turkey, milk, cottage cheese, chicken, eggs, and nuts, especially almonds, may help to promote sleep. In the brain, tryptophan is converted to serotonin and melatonin, which are natural sleep-inducing compounds.

What nutritional supplements should I take for Insomnia?

Foundation Supplements. There are three products from Natural Factors that I think are critical in supporting good health:

  • MultiStart (age and gender specific multiple vitamin and mineral formulas). Follow label instructions.
  • Enriching Greens – a great tasting “greens drink” containing highly concentrated “greens” like chlorella, spirulina, wheat grass juice, barley grass juice, etc., and herbal extracts. Take one serving (one tablespoon) in 8 ounces of water daily.
  • RxOmega-3 Factors – A true pharmaceutical grade fish oil supplement. Take two capsules daily.

B12 Methylcobalamin from Natural Factors. Methylcobalamin is the body’s active form of vitamin B12. Methylcobalamin has been shown to help some people suffering from what is referred to as sleep-wake disorder. This disorder is characterized by excessive daytime sleepiness, restless nights, and frequent nighttime awakenings. It is very common in shift workers and the elderly. In people with sleep wake disorders, taking methylcobalamin (3 mg daily) has often led to improved sleep quality, increased day time alertness and concentration, and improved mood. Much of the benefit appears to be a result of methylcobalamin influencing melatonin secretion. Low levels of melatonin in the elderly may be a result of low vitamin B12 status – one of the most common nutrient deficiencies, especially in the elderly.

To highlight the superiority of methylcobalamin, let’s take a look at one study specifically evaluating the effects of methylcobalamin versus cyanocobalamin on circadian rhythms, well-being, alertness, and concentration in healthy subjects. The twenty subjects (mean age 36 years) were randomly assigned to treatment for 14 days with 3 mg cyanocobalamin or methylcobalamin after 9 days. The results indicated a significant advantage for methylcobalamin. Methylcobalamin supplementation led to a significantly improved sleep quality, shorter sleep cycles, increased feelings of alertness, better concentration, and a feeling of waking up refreshed in the morning. Some of the interesting findings included the fact that methylcobalamin was significantly more effective even though blood levels of cobalamin increased more significantly in the cyanocobalamin than the methylcobalamin group.

I have found having people take 3 sublingual tablets of B12 Methylcobalamin (3 mg total) the first thing upon arising is very important in helping people with a history of insomnia.

Melatonin is an important hormone secreted by the pineal gland, a small gland in the center of the brain. Melatonin is one of the best aids for sleep. In several studies, supplementation with melatonin has been found helpful in inducing and maintaining sleep in both children and adults, for both people with normal sleep patterns and those suffering from insomnia. However, it appears that the sleep-promoting effects of melatonin are most apparent only if a person’s melatonin levels are low. In other words, taking melatonin is not like taking a sleeping pill or even 5-HTP. It will only produce a sedative effect when melatonin levels are low. A dosage of 3 mg at bedtime is more than enough. I prefer products that provide sublingual (under the tongue) tablets.

5-Hydroxytryptophan (5-HTP) is converted in the brain to serotonin – an important initiator of sleep. 5-HTP has also been reported, in numerous double-blind clinical studies, to decrease the time required to get to sleep and to decrease the number of awakenings.6 Because tryptophan is currently available only by prescription, 5-HTP is an obvious substitute. The sedative effects of 5-HTP can be enhanced by taking it near bedtime with a carbohydrate source such as fruit or fruit juice. The recommended dosage is 50 to 100 mg.

L-theanine is a relaxing amino acid found in green tea available as a supplement. Clinical studies have shown L-theanine to induce a sense of calm in patients with anxiety. At typical dosages, e.g., 100-200 mg L-theanine does not act as a sedative, but it does significantly improve sleep quality. Hence it is a good support agent to melatonin and 5-HTP. At higher single dosages, e.g., 400 mg L-theanine does exert sedative action.

Valerian (Valeriana officinalis) is the most popular herbal sedative. Several double-blind clinical studies have substantiated valerian’s ability to improve sleep quality and relieve insomnia. In fact, it has shown effectiveness equal to benzodiazepines. The advantage of valerian is that it does not cause daytime sleepiness, diminished concentration or impairment of physical performance. The dosage for the standardized valerian extract (0.8% valerenic acid content) is 150-300 mg 45 minutes before bedtime. I would reserve use of valerian after giving melatonin, then 5-HTP a try.

Comment:

I think that it is very important for people to utilize natural measures to treat insomnia as there are such major problems with sleeping pills. The two primary classes of drugs used in the treatment of insomnia are antihistamines and benzodiazepines. Antihistamines, like Benadryl and Nytol, are available over the counter, while benzodiazepines, like Valium and Halcion, are available by prescription. While both antihistamines and benzodiazepines are effective in the short term, they cause significant problems in the long term. Benzodiazepines, in particular, are not designed to be used for the long term, as they are addictive, have numerous side effects, and cause abnormal sleep patterns. Antihistamines also interfere with normal sleep patterns. As a result, people who take sleeping pills enter a vicious cycle. They take the drug to induce sleep, but the drug causes further disruption of normal sleep. In the morning, in an attempt to “get going,” they will typically drink large quantities of coffee, which further worsens insomnia. Like in most other health conditions, the natural approach just makes better sense.

WARNING: If you have taken a prescription sleeping pill regularly for more than four weeks, do not stop taking the drug suddenly. It is important to work with your physician to taper off the drug gradually to avoid potentially dangerous withdrawal symptoms. Symptoms of withdrawal can include: anxiety, irritability, panic, insomnia, nausea, headache, impaired concentration, memory loss, depression, extreme sensitivity to the environment, seizures, hallucinations, and paranoia.

How do I know if the recommendations are working?

Again, I would definitely start with the B12 Methylcobalamin in the morning (3 mg) and 3 mg of melatonin at night. In many cases, just this little nudge to a good night’s sleep is all that is needed. If after 4 or 5 nights, no significant improvement has been noted, I would recommend adding 5-HTP and L-theanine to the mix. If after another 4 or 5 nights no significant improvement is noted, add valerian. The real key factor on how the program is working is daytime energy levels.