After decades of research, the case can be confidently made that sleep loss and sleep disorders have profound and widespread effects on human health.
~ Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem
Institute of Medicine (US) Committee on Sleep Medicine and Research
2006
Insomnia is one of the most common complaints seen by physicians. . . . Approximately 12.5% of the adult population uses a prescribed anxiolytic or sedative hypnotic in the course of a year . . . Nearly 100 million prescriptions are written each year for these drugs. . . .All of these drugs are associated with significant risks. Most of them are highly addictive and very poor candidates for long-term use.
~ Michael Murray, ND, & Joseph Pizzorno, ND
The Encyclopedia of Natural Medicine 3rd Edition (2012)
Are you one of the estimated 50-to-70 million Americans who suffer from a chronic sleep problem? Does your inability to get restorative sleep, or your ongoing difficulty falling asleep (sleep-onset insomnia) or staying asleep (sleep-maintenance insomnia), interfere with your daily functioning? If you have one of the 90 distinct sleep disorders, including insomnia, it quite possibly has already negatively impacted your health and longevity, or will in the future if ignored or addressed only with high-risk prescription drugs.
Sleep Disorders Defined
The body’s genetically controlled biological clock regulates its circadian rhythms (physical, mental, and behavioral changes that follow a daily cycle in response primarily to light and darkness). Circadian rhythms manage multiple important bodily functions, including natural sleep cycles, hormone release, body temperature, and eating habits and digestion. As detailed below, chronic disruption of regular rhythms resulting from sleep deprivation is cause for great concern.
In 2015, the National Sleep Foundation recommended these numbers of daily sleep hours: (1) newborns/14-17; (2) infants/12-15; (3) toddlers/11-14; (4) pre-schoolers/ 10-13; (5) school-aged children/ 9-11; (6) teenagers/8-10; (7) adults & young adults/ 7-9; (8) older adults/7-8. Most sleep disorders are characterized by at least one of these symptoms: (1) excessive daytime sleepiness; (2) difficulty initiating or maintaining sleep; or (3) sleep-time abnormal movements, behaviors, and/or sensations. The most common harmful sleep conditions include sleep apnea (causes brief breathing interruptions and brain oxygen deprivation during sleep; obesity is its biggest risk factor), chronic insomnia (sleeplessness occurs most nights and lasts at least one month), narcolepsy, restless legs syndrome (RLS), parasomnias (involve abnormal movements, behaviors, emotions, perceptions, or dreams that occur before or during sleep, or upon arousal from sleep), sleep-related psychiatric, neurological, and medical disorders, and circadian rhythm sleep disorders.
Causes of Sleep Loss
The causes of sleep deprivation fall into multiple categories. Physical causes include: the conditions noted above, candidiasis (systemic overgrowth of yeast), hormonal imbalances (such as estrogen and progesterone in menopausal women, testosterone in andropausal men, and excess cortisol), hyperthyroidism, heart, lung and digestive disorders, allergies, arthritis, cancer, fibromyalgia, prostate problems, and nocturnal fast-onset hypoglycemia.
The psychological issues that can underlie chronic sleep deprivation include stress, depression (including seasonal affective disorder), anxiety, bipolar disorder, and ADHD.
The drugs that may cause sleep problems include those prescribed for depression, hypertension, birth control, water retention, hypothyroidism (if overprescribed), and asthma, allergies and other upper-respiratory conditions. Recreational substances and stimulants, including alcohol, marijuana, cigarettes, and excess caffeine (coffee, tea, chocolate, colas, energy drinks), also can disrupt sleep.
Finally, numerous environmental factors can underlie sleep disorders, including toxic overload, EMFs (electromagnetic frequencies, often referred to as radiation, which emanate from any electrical or wireless device), extreme temperature fluctuations, and environmental noise or changes. The contributory lifestyle factors are addressed below.
Health Risks of Chronic Sleep Deprivation
According to Michael Murray, ND, “adequate sleep is absolutely necessary for long-term health and regeneration.” Sleep influences the function of the immune, hormonal, and nervous systems. A growing number of studies have thus linked inadequate sleep, or even sleeping at odd hours, with increased risk of obesity, diabetes, high blood pressure/heart disease, and cancer. Sleep deprivation has also been linked to neuronal damage and accelerated brain aging, prevalence of emotional and psychological problems, and increased hospitalizations and mortality.
The combination of sleep deprivation with chronic stress sets the stage for disease. The resulting adrenal gland production of excess cortisol can cause functional deterioration of various organ systems as they constantly attempt to rebalance. For example, stress from sleep deprivation may slow down thyroid function by inhibiting thyroid hormone production (TSH) or metabolism (conversion of T4 to T3).
Risks of Prescription Sleep Aids
Most sleeping pills (including Xanax®, Librium®, Valium®, Ambien®, Lunesta®, and Halcion®) are actually “sedative hypnotics” that are widely prescribed to treat stress and anxiety. These conventional drugs commonly cause dizziness, drowsiness, and impaired brain function (significantly decreased coordination and memory).
In October 2015, Daniel F. Kripke, MD, an internationally recognized sleep researcher and professor of psychiatry emeritus at the University of California, San Diego, petitioned the FDA to consider mandating a new black box warning for sleeping pills. His petition was based on an analysis of 50 sleeping pill studies published from 2012 to 2015, and his assertion of a growing United States overdose epidemic. Dr. Kripke maintained that the most important risks of hypnotics include excess mortality (those who use them die sooner than those who do not), infections, cancer, depression and suicide, automobile crashes, falls and other accidents, and hypnotic-withdrawal insomnia. He emphasized that: (1) short-term use of these prescriptions is associated with greater risk per dose than long-term use; (2) they are usually prescribed without approved indication and most often with specific contraindications; and (3) even when indicated, there is little or no benefit (recommended doses increase sleep little if at all, and daytime performance is often made worse, contrary to advertising misrepresentations).
Natural Sleep Aids
Effective management of any sleep disorder should be directed at its underlying cause. However, certain dietary supplements and lifestyle changes can be used safely, often with quick results. The impact of nutritional sleep aids and their doses is individualized, and professional guidance may be indicated in more serious cases.
Amino Acids: Tryptophan, 5-HTP & L-Taurine
The central nervous system’s creation of serotonin, a critical sleep initiator, requires L-tryptophan (with cofactors magnesium, vitamin B6, and niacin). The administration of large doses also yields high levels of plasma melatonin, the sleep-inducing hormone (see below). Although all sleep patients have not obtained results from L-tryptophan in clinical trials, many who have responded have experienced dramatic relief following several nights’ use, without experiencing impaired daytime performance. Based on studies, experts recommend that chronic insomniacs take 2-3 grams per night with a carbohydrate (but not a protein) for a minimum of one week.
5-HTP and L-taurine can be highly effective sleep aids, especially when taken together. The body manufactures 5-HTP from L-tryptophan and is one step closer to serotonin production. Although it stays in the system for a shorter time period than L-tryptophan, studies have shown 5-HTP to produce dramatically better results in promoting and maintaining sleep, even at lower dosages. Experts recommend 100 mg 30-45 minutes before bed for at least three days, after which the dose can be increased to 200-300mg as needed.
L-taurine is a soothing, inhibitory neurotransmitter that plays a major role in stabilizing the heartbeat, blood pressure, and electrical activity of the nerves. As a nootropic, it can thus reduce anxiety and promote relaxation and sleep.
Herbs: Lavender, Passionflower & Valerian Root
Lavender can be taken internally (as Silexan®, clinically proven to relieve tension and stress), or used in massage or aromatherapy. According to the University of Maryland Medical Center, scientific studies suggests that massage or aromatherapy with lavender can slow down the nervous system, improve sleep quality, and reduce anxiety in sleep disorder sufferers.
Passionflower, most frequently studied with other calming herbs, is known for its ability to manage anxiety. Scientists believe it increases levels of the neurotransmitter GABA, which reduces the activity of brain cells and promotes relaxation.
Valerian root makes falling asleep easier and takes the body into deeper sleep cycles. One double-blind trial found that valerian extract (600mg 30 minutes before bedtime) is as effective as the insomnia drug Serax (oxazepam). Formulas that can also provide relief combine valerian with lemon balm (a blend shown in a small trial to be similar to Halcion, without any hangover effect), chamomile, hops, skullcap, catnip, melatonin, and/or 5HTP.
Hormone: Melatonin
Derived from serotonin, melatonin is the hormone that the brain’s pineal gland secretes to regulate the body’s circadian rhythms. Studies show that melatonin deficiency may be one underlying cause of insomnia in the elderly, most likely because pineal tissue calcification reduces melatonin production during normal aging.
According to the National Center for Complementary and Integrative Health, melatonin supplementation may help some with certain sleep disorders, including insomnia, jet lag, and those related to shift work. However, the safety of its long-term use is not established, and study reviewers generally cite the need for larger and longer-duration randomized controlled trials. The highly individualized effective dose can vary from 300 mcg to 5mg. Ideally, because an excessive amount can cause morning grogginess, start with a lower dose and build gradually. Time-released products are available for sleep maintenance insomnia. Melatonin is indicated for any patient taking drugs for high blood pressure (which block its production in the body), but is contraindicated in patients taking SSRIs, and those who have adequate levels of serotonin.
Minerals: Calcium & Magnesium Glycinate
Calcium transmits nerve impulses and helps the brain use L- tryptophan to manufacture melatonin (see below). Nerve cells in the brain’s thalamus have calcium channels that act like gates in their membranes to regulate calcium flow in and out and trigger cells to function. When these channels do not operate properly due to calcium deficiency, sleep is disrupted. Since the body will pull calcium from the bones to support this process, it is ideal to consume ample amounts of green leafy vegetables and legumes (NOT dairy products!) and to take calcium supplements to block bone deterioration.
Stress and magnesium deficiency are interrelated in that either can cause the other. Magnesium deficiency can also cause insomnia, muscle spasms/tension, abnormal heart rhythms, headaches, and constipation. Any type of magnesium can promote relaxation and thus restful sleep. Well-absorbed, gentle magnesium glycinate (bound to L-glycine, a non-essential amino acid that studies show alone enhances sleep quality) particularly supports a deep REM sleep when a 400mg dose is taken at bedtime.
Vitamins: Niacinamide + Inositol
Niacinamide and inositol can help induce deep sleep, especially when combined. The generally effective sleep dose of each nutrient ranges from 500-2000mg.
The active form of niacinamide in the body is NAD, a coenzyme found in every cell that is critical for cell function and energy production. The body creates niacinamide from L-tryptophan, and can also convert this form of vitamin B3 back to L-tryptophan, the raw material used to create sleep-inducing 5-HTP, serotonin and melatonin. Short-acting niacinamide penetrates the brain easily, is non-addictive, and does not produce a flush effect. In 1979, Hoffman La Roche, the Swiss drug company that manufactured Valium, described niacinamide as “a brain constituent that has benzodiazepine-like actions.” Dosages above 500mg can cause high liver enzymes and nausea in rare cases.
Inositol, a vitamin-like substance often referred to as vitamin B8, is a key component of cellular membranes and a vital co-factor for the communication capacity of the brain’s major neurotransmitters (acetylcholine, serotonin, dopamine, norepinephrine, and GABA). With few known side effects other than intestinal discomfort from overuse (preventable with gradual dosing increase and dividing doses), it can especially support anxiety- and depression-induced sleep disorders.
Sleep-Supportive Lifestyle Choices & Healing Modalities
Space restriction necessarily limits the scope of discussion regarding sleep-supportive lifestyle choices and healing modalities, but they are no less valuable than the dietary supplements discussed above. Lifestyle choices should include: (1) morning or early evening exercise for 20-60 minutes at a 60-75% maximum heart rate (max = 220 – patient’s age in years); (2) at least two hours before bedtime, eliminating all food/drink (especially large amounts, or those that are fatty or spicy), caffeine, alcohol, and nicotine; (3) sleeping on a set schedule, in a cool, dark, cozy, quiet room, following a relaxing bedtime routine (e.g., drink relaxing tea, take a mineral bath, stop using computer devices and unplug Wifi 1-2 hours before bedtime (NOTE: Ample and growing evidence indicates EMFs may cause numerous health conditions, including insomnia, ADD/concentration problems, tinnitus, migraines, back pain, arrhythmia, Parkinson’s, and cancer.); (4) skipping naps (unless needed to get through the day and if they don’t interfere with night rest); and (5) using sleep-promoting tools (e.g., eye mask, ear plugs, chiropractic pillow, supportive and non-lumpy mattress, and/or a knee pillow).
Sleep-promoting healing modalities include: (1) hypnosis; (2) acupuncture; (3) stress management techniques (deep breathing, yoga, meditation, prayer); (4) osteopathic manipulative therapy (OMT); and (5) cognitive behavioral and bright light treatments.
The statements in this article have not been evaluated by the Food and Drug Administration and are not intended to take the place of a physician’s advice.
Submitted by J. Erika Dworkin, Certified Lifestyle Educator, and Nutrition Consultant and owner of the Manchester Parkade Health Shoppe, trusted since 1956 (860.646.8178, 378 Middle Turnpike West, Manchester, CT, www.cthealthshop.com), trusted since 1956. Erika is available to speak to groups.
All statements in this article are evidence-based and references are available upon request.