“Sleeplessness is a desert without vegetation or inhabitants” ~ Jessamyn West
You are tossing and turning, muscles tense, mind racing, watching the clock tick the hours by. We all have experienced insomnia. It can be triggered by a test the next day, concerns at work, worries about our beloved children, heat, pain and any number of life’s troubling events. Unfortunately, for some, short term insomnia can become a chronic problem. Insomnia is reported to affect between 30% and 50% of adults in the US
. The degree of this problem is reflected in the fact that sleeping pills have historically been one of two most commonly prescribed medications. In 2004, Americans spent a total of $2.1 billion on sleep medications.
Sleep medications, with their problematic side effects, have distracted us from addressing the issues that lead to sleeplessness. Prescription drugs
, which can cause damaging side effects, and which, with prolonged use become ineffective and potentially psychologically addictive, offer a far less satisfactory approach
to resolving insomnia than other approaches which we will look at in this article. A review of some of the literature of effective treatments for sleeplessness bears the good news that insomnia can frequently be resolved. Peter Hauri and Shirley Linde in No More Sleepless Nights
, and Gregg D. Jacobs in Say Good Night to Insomnia
encourage a variety of behavioral and lifestyle changes and report 80-90% improvement in sleep in their patients. Casey Adams of the Tahoma Clinic also has some interesting observations about nutritional and herbal approaches to sleep issues. Finally, I had the opportunity to interview Gray Graham, founder and director of the Nutritional Therapy Association, about what he has found to be helpful for sound sleep.
First, a little information about sleep. Our circadian rhythms
of sleep and waking are orchestrated in large part by two biochemicals. Melatonin is the primary chemical responsible for relaxation and sleep, while cortisol is a key player in waking us up. Melatonin is triggered by darkness and its levels increase during the night to its highest level at around midnight. With the increase of melatonin, the metabolism slows and the core body temperature cools. As melatonin reaches its lowest level, at around 3:00 AM, the cortisol levels rise. The highest cortisol levels should be at 5:00 to 6:00 AM, just before you wake up. With this rise in cortisol a person will wake up feeling refreshed and rested.
SLEEP RESEARCHERS NOW RECOGNIZE FIVE DISTINCT STAGES TO SLEEP
- The first two stages are shallow sleep.
- The third and fourth stages exhibit the delta brain waves of deeper sleep. According to Peter Hauri and Shirley Linde in No More Sleepless Nights, during delta sleep most of the blood in the body goes to the muscles. It is also during delta sleep that most of a person’s human growth hormone is secreted. If one does not experience delta sleep, one wakes up feeling “off”. One’s body does not function as well the following day.
- In the fifth stage of sleep, characterized as rapid eye movement or REM sleep, we dream. This stage appears to be more restorative to the mind.
Depending on how many hours of sleep you get, the body cycles through four to six cycles of these five stages each night. During the earlier half of the night, the deep sleep stages are longer and during the second half of the night the REM stages longer, so we tend to experience the majority of deep sleep during the first half of the night and the majority of REM sleep during the second half of the night.
In the practical parts of these books I found it interesting that all three traditional doctors have an experiential as well as self-empowering approach to healing, as evident in a quote from No More Sleepless Nights
Be your own best sleep therapist. If you think you have found something useful, double check by going off of it for a while and then reinstate it to see if it as really helping.” Great advice.
HOW TO IMPROVE THE QUALITY OF SLEEP
- First of all: reduce or eliminate caffeine, nicotine and alcohol. Studies indicate that to do so has a significant beneficial effect on sleep. Caffeine can affect the length of time it takes to fall asleep as well as the number of wakings during the night. People can get into a cycle of caffeine consumption in the afternoon followed by insomnia at night, triggering fatigue again in the afternoon. The effects of nicotine are similar to those of caffeine: they speed up the metabolism, raise the heart rate, increase the stress hormones and can last in the system for hours. Alcohol is thought by some to aid sleep, but although it might help one fall asleep, it can cause rebound insomnia and lower the quality of sleep. It often causes waking in the early morning.
- Both books recommend a cognitive retraining in regards to sleep. Fear of not sleeping can become a cause of insomnia. Jacobs encourages training oneself to have “positive sleep thoughts”. Never try to sleep. If not sleeping, it is important to get out of bed to avoid associating the bed with troubled sleep. Find something to look forward to when you cannot sleep. Yoga, a breathing practice, reading, or memorizing poetry can each have a soothing affect and help with positive sleep thoughts. A meditation practice can be a very helpful tool to settle the mind. The gentle rhythms of these activities replace the fast-paced rhythms of an anxious mind.
The concept of sleep efficiency is a useful one. Insomniacs tend to sleep fitfully and take more hours to get their full night’s quota of sleep. To retrain people with insomnia to sleep, researchers suggest reducing sleep time to where one is tired enough to sleep deeply
and then gradually increasing the time in bed. It is useful to know that the amount of sleep needed varies from person to person. While seven and one-half hours is the average amount of sleep needed, some people need as little as three hours and some as many as ten.
USEFUL HABITS FOR SLEEP
- Find rituals before bed that help with relaxation and give yourself time to wind down.
- Get regular exercise while paying attention to what time of day feels best for your exercise.
- Light therapy is a natural way to adjust sleep patterns earlier in the evening. This can be helpful for people experiencing jet lag or those with regular difficulty falling asleep early enough. Bright light early in the day, either from direct sunlight or light boxes can help with sleep cycles as well as with Seasonal Affective Disorder (SAD).
- These lights reset the body clock, and alter the cortisol and melatonin cycles.
- Decide how many and what specific hours would be best for you to sleep and then get up at a consistent time in the morning even if you have not slept well. This offers three benefits: it compresses sleep time, it is evidence of a positive sleep thought (because it is based on the belief that you have and will get enough sleep during your chosen hours), and it can allow you to have sun or bright light exposure early in the morning to reset your sleep clock.
One interesting observation was made by Dr. Peter Hauri. While he was working at Dartmouth, he had so many clients mentioning to him that aspirin helped their sleep that he decided to test it. He ran an experiment with eight people who had had significant insomnia and found that six of the eight had better sleep with aspirin
. None of the sleep patterns were disturbed and they woke up with no feeling of hangover the next morning. He observed a four-hour delay in the effect, so, if he gave the aspirin when someone was falling asleep, it helped him sleep through the night. One would advise only very short-term use of aspirin because of the adverse effects on the stomach lining.
NUTRITIONAL SUPPORT FOR SLEEP
There are many ways that diet can affect sleep: eating a large meal late in the evening causes your digestive system to work hard during the night and can foster poor sleep. It is better to eat a large breakfast, moderate lunch and light dinner. Eating slow-burning protein and fats at dinner can prevent the wakeful effects of dipping blood sugar levels. The Mayo Clinic doctors report that removal of a food which causes sensitivities can often result in immediate improvement of sleep.
In a phone interview with Gray Graham, he (as well as many of the sleep researchers) divides sleep difficulties into two categories: not being able to fall asleep and not being able to stay asleep
. According to Graham, staying asleep is largely an issue of blood sugar regulation. If we have proper blood sugar regulation, the liver produces glucagon for a gentle message to increase glucose levels. In a situation of blood sugar dysregulation where the liver is overwhelmed and insulin resistance has developed, the adrenals are called into play to raise the blood sugar. They do this by secreting glucocorticoids which, in addition to causing the release of glucose into the blood stream, also cause a rise in energy and wakefulness. Often people think that they have been woken by intense dreams but Gray’s interpretation is that the glucocorticoids trigger stress which is then incorporated into the dream.
Supplements which address blood sugar regulation and liver function can help with sleeping through the night. Work with your clients to see what is appropriate. Nutritional support to the adrenal glands can help reestablish normal cortisol cycles. Often a casein concentrate can help a person settle down for sleep at night.
Specific nutrients can be particularly helpful for sleep. Studies show the effectiveness of calcium and magnesium
as natural relaxants and aids to sleep, and that magnesium aids in reducing tiredness, fatigue and anxiety during the day. B vitamins
regulate the body’s use of tryptophan. A significant number of studies show tryptophan
to be an effective sleep aid. Tryptophan is a precursor to serotonin, a hormone which both contributes to relaxation and is also a precursor to melatonin. One study indicates that taking tryptophan in the evening helps half of all insomniacs. Dr. Casey Adams from the Tahoma Clinic suggests that foods containing tryptophan eaten mid-morning contribute to greater ease in both falling and staying asleep. He also indicates that melatonin levels can also be increased by consumption of phytomelatonin
, a plant based melatonin. Foods with high levels of phytomelatonin are: Montmorency tart cherries (with some of the highest levels), oats, sweet corn, rice, ginger, tomatoes, bananas and barley. Dopamine and GABA, neurotransmitters, also play a significant role in sleep. For all of these nutrients, a healthy digestive system is necessary to help the body ingest and utilize them.
Herbs can be beneficial to sleep. Valerian, Passiflora, and Hops have been used for thousands of years and have been shown in numerous studies to be effective in increasing sleep quality.
Passiflora and Hops can elevate mood and reduce sleeplessness caused by anxiety and an overactive mind. “Research has shown subjective sleep quality improvements [with these herbs] and quality of life improvements comparable to pharmaceutical benzodiazepines, without their side effects and dependency issues”, says Dr Casey Adams of the Tahoma Clinic. Gray Graham has observed that some people report feeling groggy in the morning after these herbs. Have your client give them a try and see how they work for them.
We are fortunate to have this extensive array of behavioral and nutritional suggestions to support our clients with their sleep issues. A sound sleep is the body’s age-old way of repairing and restoring health.
In the words of Thomas Dekker, an Elizabethan poet: “Sleep is the golden chain that ties health and our bodies together.”
- Peter Hauri PhD, director Mayo Insomnia Research and Treatment Program and Shirley Linde, PhD (1991) No More Sleepless Nights
- Gregg D. Jacobs, PhD, (1999) Say Good Night to Insomnia
- NTA, (2009) Clinical Reference Guide and Clinician’s View
- Casey Adams, PhD, DSc @ Tahoma Clinic http://www.healthiertalk.com/natural-solutions-insomnia-0201
- Gray Graham, BA, NTP, Director of Public Policy for the Nutritional Therapy Association SPC. Phone interview 7/2009
- Angela Clow, Frank H. Hucklebridge, Neurobiology of the Immune System p96 Beatriz Duarte Palma; Paula Ayako Tiba; Ricardo Borges Machado; Sergio Tufik; Deborah Suchecki,
- Immune outcomes of sleep disorders: the hypothalamic-pituitary-adrenal axis as a modulatory factor Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil
ABOUT THE AUTHOR
After twenty five years of designing custom furniture, Judith Ames embarked on a new career in nutrition. She graduated in the 2009 Olympia class and in the first months of practice already saw gratifying results working with clients with insomnia. Judith holds certifications as Wellness Coach (2013) and Mental Health Nutrition Coach (2014) allowing her to deepen her practice offerings. She now runs a thriving practice and you can reach her and learn more on her website revivinghealth.com.http://www.revivinghealth.com