I’ve seen a lot of people talking about sleep issues/insomnia lately and since the Noble Peace Prize winner in medicine this year won for their research on circadian rhythm, (Its fascinating research! Read about it here) and sleep is imperative to optimal health I thought I might share some insights. Also in the news recently is more research on how amyloid beta levels and tau proteins, both which contribute to Alzheimer’s are higher in healthy adults with interrupted stage 3 or deep, slow wave sleep (read the research here) Needless to say sleep is important!
Sleep deprivation leads to weight gain, it also leads to poor food choices during the day. People with poor sleep have reduced leptin levels and increased ghrelin levels (the hormones that regulate our appetite) you also have a higher risk of having increase Hemoglobin A1c levels and diabetes.
There are medical conditions that disrupt sleep, some of these conditions are ones treated with a drug that may be contributing to the insomnia. Finding the root cause of why you have this condition may help improve sleep. Lets review a few.
Insomnia can be caused by psychiatric and medical conditions, unhealthy sleep habits, specific substances, and/or certain biological factors. Insomnia improves when other symptoms improve. Many medications such as ones for cold and nasal allergies, high blood pressure, heart disease, thyroid disease, birth control, asthma and depression can cause insomnia, finding alternatives or fixing the issue you are taking the medication for may help with better sleep.
Keeping a gap of 4 hours between your last meal and bedtime may help. Finding the underlying cause of GERD is a better option (food triggers, low stomach acid, H-pylori, SIBO, lack of digestive enzymes etc.) Remember long-term antacid (PPI) use makes you B12 deficient, see below!
Other GI issues like leaky gut
In functional medicine we view the body as a whole so lets look at an example: You cant’ sleep because you are depressed, you are also on an antacid for heartburn (GERD). Bad sleep contributes to depression, but depression contributes to bad sleep. Low serotonin contributes to depression, low serotonin contributes to low melatonin. Guess where most of your serotonin is made? The gut! If the gut is unhealthy because you are eating foods that are punching holes in it, or you have high levels of stress or an untreated parasite, or are on antibiotics and you are not replacing the good bacteria, or you are over-exercising guess what’s going to be low? Serotonin! Guess what else is low when you have gut issues, B12, you need a functioning gut lining (specifically a protein called intrinsic factor) to absorb B12. Guess what a lot of people who are depressed are low in? B12! You have to connect the dots, not just treat one of these symptoms!
Reactions to food
Can contribute to poor sleep-have you tried an elimination diet to get these offensive foods out of your diet?
Arthritis, headaches, fibromyalgia can make it hard to fall asleep and stay asleep. Addressing these issues with medication short term and nutritional therapies long-term to target and reduce pain can facilitate better sleep.
Anxiety and Depression
This is a biggy! Anxiety makes good sleep very difficult, less sleep increases anxiety. Addressing the root of the anxiety (genes, psychological issues) can help as well as meditation, yoga and other relaxation techniques. Depression improved in sleep apnea patients who used CPAP (the machine to help open airways) Prozac and Wellbutrin may have a negative impact on sleep. Trying natural treatments for depression can be helpful for sleep. These include Vitamin D, Omega 3 fatty acids and neuro-transmitter precursors such as 5HTP (do not take if on an SSRI) Natural treatments for anxiety include most of the same herbs/supplements that are used to treat insomnia! (See the connection?) They are listed below.
Many things can contribute to waking up to urinate, various medications, a UTI, enlarged prostate, overdoing fluids in the evening, caffeinated beverages (if a slow metabolizer). Some misperceive getting up to urinate as the problem when in reality they are waking for another reason.
Sleep problems increase with age in both sexes; women have a drop in estrogen and progesterone, which can reduce sleep quality. Hot flashes may be the issue but falling hormone levels are not the only issue. There is an increase in sleep apnea in postmenopausal women. If you have ongoing daytime fatigue a sleep study may be necessary. If no apnea exists raising levels of hormones with bio-identical therapy or natural products discussed in my hormone article here can help with sleep.
Low levels of melatonin
Melatonin levels drop in postmenopausal women, and older men. Supplementation may be in order but getting some sunlight during the day to start production and avoiding blue light before bed are both helpful rituals to help production. If you can’t get sunlight during the day consider investing in full spectrum light therapy and turn it on first thing in the morning, there is also a light based alarm clock. You can find both on Amazon for under $50. This also stimulates your body to make cortisol in the morning (versus at night), which will give you the appropriate morning energy.
Restless leg syndrome
Is 60% genetic but may be due to abnormal iron metabolism, make sure you have a full iron panel run if you have this, see my article here on which labs to run. Low magnesium may also be a factor.
Abnormal cortisol levels
If an appropriate test shows that you are high or low (I like the Dutch hormone test as it shows free and total cortisol) regulating this can help with sleep. Usually altered coritsol production stems from other problems that also need to be identified but in the short term supplementing to bring levels back to normal can be beneficial. If you have a high nightly cortisol pattern extra vitamin C, B5, B6, zinc and phosphatidyl serine may be beneficial. Low cortisol production suggesting some sort of imbalance in the HPA axis may produce non-restorative sleep and daytime fatigue, in this case it is important to balance blood sugar levels with a higher protein, lower carb diet. Various herbs, glandular formulas or hormone replacement may be beneficial in both cases. You need to work with someone to balance these levels.
Most of us know if caffeine makes us jittery but there is a good part of the population which are slow metabolizers of caffeine (you can find this out on a genetic test like 23 and me) who still drink coffee or soda or chocolate late in the day and may not realize that the slow metabolism of the caffeine may be contributing to their sleep issues. Snapple ice teas have just as much caffeine as coffee, energy drinks much more and many may choose these as a drink with dinner or later in the evening to finish work. There are also drugs that interfere with the metabolism of caffeine. To check your caffeine gene look at your CYP1A2 gene if you have AA you are a fast metabolizer if you have AC or CC you are slow.
Lack of neurotransmitter precursors
Tryptophan is the precursor to serotonin, which is a precursor to melatonin. Low carb diets can disrupt the transfer of tryptophan across the blood brain barrier as it is competing with bigger proteins. Some carbohydrate with your evening meal can help the tryptophan get to the brain. Supplementing with straight tryptophan requires many conversions (first to 5HTP, than serotonin then melatonin) this is a slow conversion so if looking to help with depression (to make serotonin) I’d take 5HTP, to help with sleep I’d just go straight for the melatonin.
Alcohol is a central nervous system depressant and will make you sleepy but for every drink, the sedation is followed by an equal amount of arousal. Excess alcohol leads to restless sleep, elevated coritsol levels occur, as well as body temperature. Proper melatonin actually decreases body temp.
WHAT CAN I DO?
Before treating a sleep disorder as insomnia, identify the root cause from above of what is creating the sleep disturbance. In the short term using medication or one of the following natural sleep aides can be helpful. But if you find that you are using these long-term, working with someone to fix the root cause may be in order.
The following are natural sleep aides:
Chamomile-may help with insomnia, anxiety, digestive and skin problems. A dose of 300mg helps initiate sleep or a cup of good quality tea. People with asthma or ragweed allergies may want to avoid. Chamomile may have a slight estrogenic effect helping women with low hormone status but should be avoided by those with a history of estrogenic type cancers.
Lemon Balm-Usually used in combination with valerian, hops or chamomile but can be use alone. It is thought to be an inhibitor of GABA catabolism, low levels of GABA are linked to anxiety, depression and sleep disorders. Valium and ativan are benzodiazepine type drugs that bind to the GABA receptors and help calm or slow down the body’s central nervous system. They are used for people with anxiety and sleep disorders. Lemon Balm acts on the same receptors.
Valerian Root-Similar modes of action as lemon balm but does not produce the residual morning sleepiness that a benzodiazepine drug may. Usually in a combination of other sedating herbs such as hops, passion flower, lemon balm, chamomile and lavender. Has been shown to help with restless leg syndrome.
Hops-Yes this what is used to make beer bitter! Hops do contain phytoestrogens and may have an estrogenic effect for women experiencing menopausal sleep problems; it also has a sedating effect on the central nervous system. IPA beers do not have enough of the active phytoestrogen constituent to cause problems in men who drink it regularly. But for men with high estrogen levels malt beer may be a better choice just to be safe.
Kava-Has been used for anxiety, insomnia and fibromyalgia. It induces relaxation and may improve cognitive function. It acts on the amygdala in the limbic system, which controls many emotional processes. Kava does not bind to GABA receptors like many sedatives. It was banned in other countries and now contains a warning label in the US because of fear of liver damage. Uncontrolled ethanol extracts were used in the past, which contained illegal varieties contaminated with bacteria or fungi, this warning stems from these products. If you have a compromised liver do not use this, but for most people using a trusted brand can be very beneficial. When using herbs never buy from an unknown company. My two favorite trusted brands in the U.S. are Gaia and Herb Pharm.
L-Theanine-Is an amino acid it causes relaxation but is not necessarily sedative so can be used during the day for anxiety. But because it can lower anxiety it can promote better sleep. L-theanine is also found in tea. If taking a medicine to lower blood pressure consult with your doctor first.
Taurine. Taurine is an amino acid that reduces cortisol levels and increases the production of GABA. Using magnesium taurate allows you to get both magnesium and taurine with a single pill. In many sleep formulas. Taurine is also used to treat cardiovascular issue and high blood pressure.
Magnesium-Helps to maintain the efficacy of the suprachiasmatic nuclei (the location of the bodies biological clock) and the pineal gland that produces melatonin. Magnesium is also involved in may other pathways which may improve symptoms related to fibromyalgia, migraines, chronic fatigue syndrome, helps improve c-reactive protein marker, may help restless leg syndrome. Anyone with sleep issues should safely supplement with magnesium.
Tryptophan/5HTP-both melatonin precursors. Do involve conversion that is sometimes hindered in people. Zinc and B6 are cofactors to make tryptophan work to make serotonin, make sure you are getting enough of these important nutrients.
Melatonin-Is a hormone secreted by the pineal gland in the brain, it decreases with age. Melatonin does not have a negative feedback loop meaning taking it will not quell the body’s natural production. Lower supplemental levels are just as effective (for sleep) as higher levels. Higher levels work like an antioxidant and should only be used for specific purposes (10-20mg). Melatonin lowers the body temp and helps people fall asleep. In studies though, falling asleep quicker does not always improve sleep. Time release at 2mg has actually been shown to improve sleep quality. One interesting fact is that Alzheimer’s patients have a profound reduction in melatonin and melatonin is an antioxidant and neuroprotector.
Other things to try:
- The circadian rhythm is no joke. If you think you are getting decent sleep while sleeping with the TV on, think again. Noise and light both disrupt this pattern. It is imperative that you sleep in a cool completely dark room for this cycle to work properly. To get started, try a night mask or t-shirt over your eyes. A white noise machine can be helpful if you are use to the noise of the TV. Machines are sold on Amazon or use a free app on your phone.
- If you have a spouse that snores, help them to stop by losing weight, utilizing a mouthpiece like snoreRx, surgery or possibly sleeping separate until your sleep pattern is back on track.
- If you sleep with your pet, try wearing a device to track your sleep, you may be surprised at how many times per night you wake up, try to notice if they pet caused this. It is a hard habit to break, but if you are having any sleep issues you may want to consider moving them to a separate rom.
- Try eating some complex carbs with dinner if you are on a lower carb diet. This may help to facilitate tryptophan across the blood brain barrier.
- If you can, avoid TV and devices before bed. In reality this is sometimes unrealistic so at least set your phone to night mode so the screen is not emitting blue light after 7pm.
- Avoid processed foods during the day; choices of food intake can influence your dream content. Keeping balanced blood sugar can also aid with sleep patterns.
- If you are a wine drinker have your wine while making dinner or with dinner. Having protein with alcohol is very beneficial. Read why here. Avoid a glass of wine before bed as it may help you feel tired, but will make the quality of your sleep low.
- If you are on medications that you cannot come off, work with a practitioner to review any nutrient deficiencies the drug may be causing, this can help pinpoint why the drug may keep you awake and supplementing may help offset some of the negative effects. There is a very complete database that you need a subscription too, but most health practitioners will have access to that gives all herb/drug interactions and nutrient deficiencies caused by drugs. It is called the Natural Medicines Database, ask your practitioner.
- If you are someone that is always congested, which may be disrupting sleep, first try to figure out why (allergy etc) but for the short term trying a natural migraine remedy or a natural anti-histamine may be helpful. A well-studied migraine supplement is called Pentadolex. Natural antihistamines are vitamin C, quercetin or a product called D-Hist, which contains quercetin and a few other things to help clear histamines, which may be causing congestion. Try avoiding dairy and gluten for 21 days.
- Exercise-If you are not making time to do this, try a walk everyday (also a good way to get some sunlight!). If evening is the only time you can fit it in do weight lifting with rest in between or yoga so that your body does not have to work so hard to bring its temperature down, a cold shower or at least some time to cool off is important. Also if possible keep the lights dim and be sure to have the blue light setting on your devices to minimize bright light exposure. Bright lights in a gym are going to tell your body that it’s not time to make melatonin!
Some products to try:
I recommend working with someone to pick the right thing and dosage for you based on symptoms and genes, but I realize not everyone wants to do this. If you decide to try a product and are on any medication please check with your doctor first as some herbs can interact with medications.
Single herb/supplemet varities:
- Organic chamomile extract by Herb Pharm
- Lemon balm extract by Gaia Herbs
- Organic Valerian Root by Gaia
- Time release 1 or 3 mg Melatonin by Natrol
- L-Theanine- by Enzymatic Therapy (Suntheanine)
- Magnesium Glycinate by Metabolic Maintenance
- Magnesium Taurate-Douglas Labs
- 5HTP synergy by Designs for Health
- Kava kava root by Gaia
- Pentadolex (migraine formula)
- Sleep and Relax tea or capsules by Gaia Herbs
- Anxiety soother by Herb Pharm
- Gaba Calm by Source Naturals
- Neurocalm by Designs for health
- Gabatone by Apex Energetics
- Sound sleep by Gaia
- Catecholacalm by Designs for Health
- D-Hist by Ortho Molecular
As a reminder Ambien is a drug that also works on the GABA receptors but with addictive qualities and some very nasty side effects. Read about it here.
Tylenol or Advil PM taken long term will literally punch holes in the lining of your intestines and create “leaky gut” if you have read this far you know that leaky gut causes inflammation, decreased B12 and decreased serotonin which can lead to depression which can lead to poor sleep!
Benadryl is used by some to assist with sleep (basically Tylenol PM is Tylenol with Benadryl) Long term Benadryl use which is an anticholinergic drug blocks the action of acetylcholine. This is an important substance in the body that transmits messages to the nervous system, it is also involved in memory and learning. This study here showed that long-term use was associated with dementia.
Wishing you a restful, restorative sleep tonight!