To sleep: perchance to dream: ay, there’s the rub;
– William Shakespeare
Insomnia is characterized by the inability to fall asleep or by waking up during the night and having difficulty going back to sleep – and it can be maddening. An estimated 10-15% of people suffer from chronic insomnia, which may be associated with difficulty concentrating, memory lapses, fatigue, lethargy, emotional instability, weight gain and low hormone production.
We spend about a third of our lives sleeping and it is not simply some passive thing we do when we are not awake. It is a very active process during which there are numerous hormonal and neurological changes that restore and replenish our system for optimum performance. A good night’s sleep is necessary to rest muscle and brain, solidify memory, reset metabolism, produce hormones, and have a healthy life.
Myth: Cutting just one hour per night out of the sleep cycle won’t make much difference. Nope, adults need about 7-8 hours of sleep per night, on average. Running short just one hour can accumulate into a sleep debt that will have effects on motor and cognitive performance.
Myth: People need less sleep, as they get older. In truth, people tend to sleep less as they age due to health problems that cause pain, more fragile sleep with easier disruptions, and less time in deep restful sleep.
Myth: The body can quickly adjust to different sleep schedules. Not so. The body has a biological clock, our “circadian rhythm” that controls our sleep patterns. External cues are mostly the day / night cycle. Quite simply we are designed to sleep when it is dark and be active when it is light. Internal cues from the brain literally signal time to sleep and time to wake.
After trying drug after drug for insomnia, most people find they either don’t help, cause unpleasant side effects, or they wind up hooked on a sedative-hypnotic tranquilizer. The typical prescription medications never really solve this common problem. By targeting the underlying causes of insomnia we can not only treat it more naturally but also restore the normal sleep cycle.
First off, proper sleep habits or “sleep hygiene” are basics that need addressed. A few tips include setting the alarm for the same time every day, going to sleep at the same time, keeping the bedroom absolutely dark and quiet, and keeping the temperature cool. Avoid stimulating activity late in the evening. Eat dinner at least 2-3 hours prior to bedtime. Cut out caffeine after lunch and avoid too much alcohol.
Many patients have sleep disorders secondary to hormone changes. Melatonin is the sleep-orchestrating hormone and it naturally declines with aging. Taking 1 to 3mg at bedtime, regularly, will help many sleep better. Get a good brand, preferably “micronized” for better absorption. My favorite is a 3mg under-the-tongue tablet from Douglas Labs.
Menopause and female hormone imbalances are very common. Aside from the proverbial night sweats causing poor sleep, many women suffer from low progesterone, which leads to estrogen dominance and an over-stimulated brain causing not just insomnia, but anxiety, agitation, and irritability typical of PMS. Men too, have disrupted sleep associated with falling testosterone levels.
Perhaps the greatest hormonal sleep disturber is the stress hormone called cortisol. While necessary for many positive health functions, chronic elevations of cortisol wreak havoc with sleep cycles. Cortisol is our “daytime” hormone, reaching its peak about 30 minutes after awakening and slowly returning to a low level prior to bedtime, which allows melatonin to rise and orchestrate a healthy sleep cycle.
Cortisol induced insomnia leads to the classic “wired but tired” feeling at bedtime – feeing exhausted but unable to sleep. Mind racing, patients will clean house, read, or watch TV until they finally just drop from sheer exhaustion. They may awaken during the night with a startle or shock, feeling agitated or hyper-vigilant, and have a tough time returning to sleep.
For the high-cortisol insomniacs we must tackle the cortisol problem. Dietary changes include eating protein with every meal, not skipping breakfast, cutting out sugar and high glycemic foods, and increasing adrenal supporting foods such as fresh fruits and veggies. We usually use supplements that nurture and modulate the stress response, including holy basil and magnolia bark. Cortisol lowering nutrients such as phosphatidylserine and whey peptides from milk are both very effective in knocking out high cortisol. Lifestyle changes are often part of the cure and include stress management, mediation, yoga, and bodywork such as acupuncture.
A second type of insomnia is the serotonin / melatonin deficiency. These patients are “night-owls” having a hard time getting to sleep and then having restless sleep with premature awakening. They often have mood disturbances such as depression or anxiety, obsessive thoughts, perfectionism, or emotional mood swings. Winter “blues” may be present as well as a dislike of hot weather. Afternoon or evening cravings for sugar, carbohydrates, alcohol or marijuana are also common.
Tryptophan or its derivative 5-HTP can be taken to support serotonin production, which in turn will increase melatonin. These supplements may be taken during the day for helping mood, or just in the evening. We add melatonin only when the tryptophan alone does not do the job.
The last insomnia type we recognize is GABA deficiency. Calming and balancing to other excitatory neurotransmitters, GABA is the key to a calm and relaxed brain. A patient with GABA deficiency is often stressed and burned out, tense and unable to relax or loosen up. They are the patients who have responded well to drugs such as Xanax or Ambien. For these patients taking GABA prior to bedtime is usually helpful. Taurine is an amino acid that will activate GABA receptors and boost its effects.
While there are many simple, safe, and effective remedies to help with sleep, there is an art to the dosing and timing of supplements. Seek guidance from a practitioner who is well versed in the use of these natural supplements. And again, it is critical to diagnose underlying medical issues that disturb sleep, such as sleep apnea, restless leg syndrome, or hormone imbalances. Sweet dreams!
List of Sleep Supplements and Dosing
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call (970) 245-6911 for an appointment or more information.