Disease, Illness and Condition Library
Insomnia
In many ways it is the pause that refreshes. It refreshes us both mentally and physically. All of use have has a day when things didn’t go well and just decided to get some sleep, upon waking we had a completely different outlook. Perhaps we able solve a nagging problem or just have a better outlook on life itself. Simply Amazing! Some recent estimates have found that there are over 55 million adults in North America that have sleep problems with insomnia. This condition is one of the leading sleep disorders of which people seek out professional help. Some seek help from their local pharmacy while others feel more comfortable visiting their doctor for a medical opinion. A staggering 6 million prescriptions are written annually for sleeping pills. For the vast majority (ages 20-65) insomnia is closely linked to life style changes and emotional stress, for the rest insomnia is commonly caused by sleep disorders such as sleep apnea. Their have been conflicting reports as to whether sleep loss will lead to serious long term medical problems but we do know that lack of sleep combined with driving causes 80,000 care accident injuries annually. How Much Sleep Do I Need? Most medical professionals agree that there is no normal amount of sleep for adults since we are unique individuals but the average amount of sleep required by adults is 8 hours. We have all had friends or business associates that could function on little or no sleep for long periods of time and show no ill effects and others that need every second of those 8 hours to be effective. The medical community advises people to seek help if they are having trouble falling asleep, have broken sleep patterns or haven’t slept through the night in a while. Insomnia Causes While we have chosen to list insomnia under diseases it is not. Insomnia is a symptom, not a disease with a series of underlying causes. Common causes of Insomnia: *Physical conditions *Anxiety *Stress *Poor sleep surroundings *Noise *Fear *Depression *Uncomfortable sleep temperatures *Bedtime habits (coffee with dessert) *Medications & Supplements Did you know that there are over 300 medications that can contribute to sleep problems? The list is amazingly long but a few common culprits are oral contraceptives, decongestants, certain asthma inhalers and beta blockers prescribed for heart disease and hypertension. Diuretics contribute by increasing the need to urinate during sleep hours. 5 Types of Insomnia There are 5 major categories of chronic insomnia: stress conditioned insomnia, psychiatric insomnia, physiological insomnia, physiological insomnia, insomnia predicated by poor sleep habits and pseudo-insomnia. Stress Conditioned Insomnia In this particular type of insomnia patients don’t have any underlying psychiatric disorder. Their sleep patterns tend to vary in conjunction with stressful events. Once their sleep pattern has been broken a snowball affects starts to take place. They now worry about sleeping well and the anxiety about insomnia itself creates a difficult sleep environment. Psychiatric Insomnia This type of insomnia is linked directly to depression and anxiety, and most studies suggest that this is the most common category of insomnia. Has anyone heard of REM? Some of you want to tell me about how much you love their music and want to know when their next album will be releases. Actually REM stands for rapid eye movement. During REM sleep, a group of brain cells block signals to skeletal and voluntary muscles to prevent the body from reacting to images during dreams. Only tiny twitches of the fingers and face and the constant darting of eyeballs beneath the lids are visible. If you are a pet owner you may have observed you pet in this state of sleep. REM sleep is the essential for good mental and physical health and being deprived of REM sleep for a period of time will make even the mildest mannered person irritable, paranoid and irritable. Physiologic Insomnia This type of insomnia includes sleep problems caused by sleep apnea, periodic leg movements, and medical disorders. It is estimated that about 30 percent of people with chronic insomnia have a physiological cause for their sleep problem. Sleep Apnea Sleep apnea is the major cause of daytime sleeplessness. People with sleep apnea may have certain anatomical abnormalities that create a narrow airway when they are asleep. They may also tend to be overweight. Sleep apnea suffers tend to snore loudly and experience pauses in breathing that may last 30 seconds to a full minute. Their heart may slow down or skip a few beats, and the amount of oxygen in their bloodstream drops to a low level. At this point the brain awakens the person for 5 to 10 seconds, the sleeper takes a deep breath, and goes back to sleep. The apnea can repeat up to 500 times a night. Severe sleep apnea is common in senior citizens and is estimated about a third of healthy senior citizens have sleep apnea. An amazingly high 40 percent of sleeping pill prescriptions are written for people over 60, although people in that age group make up 15 percents of the overall population. Overall sleep apnea affects 1 percent of the total population. Periodic Leg Movements Do you have a friend or a spouse that kicks during sleep? They could be suffering from a form of insomnia. The medical name for periodic involuntary leg movements is nocturnal myoclonus. A person with this condition will experience leg jerks frequently throughout the night often resulting in brief arousals or total awakenings. Others, in addition to having periodic leg movements when asleep have restless leg syndrome. Some with RLS report the sensation of bugs crawling in the calf area. Those suffering with type of insomnia will kick so violently as to awaken themselves not to mention anyone attempting to sleep in the same bed. Medical Disorders If you are experiencing pain during sleep periods you could be suffering from insomnia. Low blood sugar levels can cause insomnia in the middle of the night, because a drop in blood sugar because a drop in blood sugar causes the release of stimulant hormones such as adrenaline and cortisol. The hormonal changes that accompany menopause can also contribute to sleep problems. Poor Sleep Habits This type of insomnia includes such things as addiction to sleeping pills, addiction to other drugs, alcoholism, excessive caffeine use and irregular sleep patterns. For those of you whose jobs require a rotating shift probably can relate to irregular sleep patterns. Perhaps some of you have even experienced this type of insomnia. Pseudo-Insomnia This type of insomnia accounts for about 10 percent of chronic insomniacs. People suffering from this form of insomnia get a full night sleep with normal brain tracings, but say they had no sleep at all- or a few hours of sleep at best. They may be experiencing brain activity that cannot be picked up by measuring devices or have underlying psychological problems.
Identifying and addressing the cause is the best approach to dealing with most health concerns, including insomnia. The most frequent causes of insomnia are psychological: depression, anxiety, and tension. If psychological factors do not seem to be the cause, certain foods, drinks, and medications may be the cause. There are a myriad of compounds in food and drink and in well over three hundred drugs that can interfere with normal sleep patterns. Dietary and Lifestyle Factors There are several dietary and lifestyle factors to consider in relieving insomnia, including: doing away with food and drink compounds that impair sleep processes: avoiding nocturnal hypoglycemia; learning to relax; and getting an adequate amount of exercise. These possible causes of insomnia should be addressed before resorting to the use of any sedative, even if the sedative is a natural compound. Eliminating Inhibitors of Sleep It is of importance that the diet be free from 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 sacrificed. The sensitivity to the stimulant effects of caffeine varies greatly from one person to the next. This is largely a reflection of how rapidly the body can eliminate caffeine. In other words some people are more susceptible to the effects of caffeine than others, due to a slower elimination of these substances from the body. Even tiny amounts of caffeine such as those found in decaffeinated coffee or chocolate, may be enough to trigger insomnia in some people. Another substance that must be avoided is alcohol, which produces a number of sleep impairing effects. In addition to causing the release of adrenaline, alcohol impairs the transport of tryptophan as the source for serotonin, alcohol interferes with serotonin levels. Nocturnal Hypoglycemia Avoidance Many health experts believe nocturnal hypoglycemia (low nighttime blood glucose level) is one of the main causes of sleep maintenance insomnia. When there is a drop in 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. A great many people in the United States suffer from faulty glucose metabolism, either hypoglycemia or diabetes, because of overeating refined carbohydrates. 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 sustain blood sugar levels, they actually can help encourage sleep by increasing the level of serotonin within the brain. Progressive Relaxation There are a wide range of techniques designed to promote relaxation and prepare the body and mind for sleep. One of the most popular and easy to use techniques is progressive relaxation. The technique is based on a simple procedure of comparing tension to relaxation, which teaches the person what it feels like to relax. Many people are not aware of the sensation of relaxation. To apply progressive relaxation, you will first vigorously contract one muscle group for a period of one to two seconds; this gives way to a feeling of relaxation. Since the procedure goes progressively through all the muscles of the body, eventually a deep state of relaxation will result. Begin by contracting the muscles of the face and neck; hold the contraction for at least one to two seconds; then relax the muscles. After that, contract and relax the upper arms, and chest, followed by the lower arms and hands. Repeat the process progressively down your body (i.e., the abdomen, the buttocks, the thighs, the calves, and the feet). Repeat this whole practice two or three times, or until you fall asleep. Exercise Exercising is widely known to improve general well being in addition to promoting an improvement in sleep quality. Exercise should be performed in the morning or early evening, not before bedtime, and should be of reasonable intensity. Usually twenty minutes of aerobic exercise at a heart rate between sixty and seventy five percent of maximum (approximately 220 minus age in years) is adequate. Natural Sedatives Often times simple steps are all that is required to relieve insomnia. When additional support is necessary there are several natural sedatives that can be helpful without the problems linked to prescription and over the counter sedative. The following topics are covered briefly as they relate to promoting sleep: serotonin precursor and cofactor therapy, melatonin, restless legs syndrome, and botanicals with sedative properties. Serotonin Precursor and Cofactor Therapy: Serotonin is an important initiator of sleep. Serotonin is made from the amino acid tryptophan. Taking tryptophan will elevate serotonin levels and promote sleep. Tryptophan is more useful for cases of sleep onset insomnia, since its greatest effect is to shorten the time necessary to get to sleep (referred to as sleep latency). More effective than tryptophan is 5-hydroxytryptophan (5-HTP), a form of tryptophan that is one step closer to serotonin administration. 5-HTP has also been reported, in various double blind clinical studies, to decrease the time necessary to get to sleep and to decrease the number of awakenings. Because tryptophan is currently available only by prescription, 5-HTP is an obvious substitute. The sedative effects of 5-HTP can be improved by taking it near bedtime with a carbohydrate source such as fruit or fruit juice. One of the primary benefits of using 5-HTP to treat insomnia is its ability to increase REM sleep (generally by about 25%) while concurrently increasing deep sleep Stages 3 and 4, without increasing total sleep time. The sleep stages that are reduced to compensate for the increases are non REM Stages 1 and 2, the least important stages of sleep. It is essential to maintain adequate levels of vitamin B6, niacin, and magnesium when using 5-HTP, as these nutrients serve as essential cofactors in the conversion of 5-HTP. Melatonin: It is commonly thought that melatonin may be one of the best aids for achieving quality sleep. Melatonin is an important hormone secreted by the pineal gland, a small gland in the center of the brain. 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 evident only if a persons 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. When melatonin is taken by normal subjects just before going to bed, or by insomnia patients who have normal melatonin levels, it produces no sedative effects. That is because, just prior to going to bed, there is normally a rise in melatonin secretion. Melatonin supplementation is only effective as a sedative when the pineal gland’s own production of melatonin is very low. Melatonin appears to be most effective in treating insomnia in the elderly, as low melatonin levels are common in this age demographic. In a quite fascinating study, twenty six elderly insomniacs with lower than normal melatonin levels were given 1 to 2 mg of melatonin two hours prior to their preferred bedtime for a period of one week, Both rapid and slow release melatonin preparations were used. Both sleep latency and sleep quality were evaluated. While there was no noticeable difference in sleep onset and sleep efficiency (percent of time asleep to total time in bed) between the two forms, the timed release form produced better results on sleep maintenance. Restless Legs Syndrome and Nocturnal Myoclonus: The restless legs syndrome is characterized during waking by an overwhelming urge to move the legs. Almost all patients with restless legs syndrome have nocturnal Myoclonus. Nocturnal Myoclonus is a neuromuscular disorder characterized by repeated contraction of one or more muscle groups, generally of the leg, during sleep. Each jerk usually lasts fewer than ten seconds. The patient is normally unaware of the Myoclonus, and only complains of either frequent nocturnal awakenings or excessive daytime sleepiness. On the other hand, questioning the sleep partner often reveals the myoclonus. These disorders are noteworthy causes of insomnia. If there is a family history of restless legs syndrome (approximately 33% of all patients with this syndrome have a family history), high dosage folic acid (35 to 60 mg daily) therapy can be beneficial. Dosages in this range will require a prescription, as the FDA limits the amount available per capsule to 800 mcg. In cases of familial restless legs syndrome, there seems to be a higher need for folic acid. If there is no family history of restless legs syndrome, ask your physician or health care professional to eliminate low iron levels from the list of possible culprits. The best method is to measure the levels of the iron-storage protein ferritin in the blood; the level of ferritin indicates the level of stored iron. The connection between low iron levels and the restless legs syndrome was documented in clinical studies more than thirty years ago. In a study conducted in 1994 at the Department of Geriatric Medicine of the Royal Liverpool University in Liverpool, U.K. Levels of ferritin in the blood were found to be lower in the eighteen patients who had restless legs syndrome than in the eighteen control subjects. Ferritin levels were inversely correlated with the severity of restless legs syndrome symptoms, meaning that the lower the ferritin levels, the more severe the restless legs. Blood levels of iron, vitamin B12, folic acid, and hemoglobin did not differ between the two groups. Fifteen of the patients who had restless legs syndrome were treated with iron (ferrous sulfate) at a dosage of 200 mg three times daily for two months, with excellent results. The conclusion of the study was that “Iron deficiency, with or without anemia, is an important contributor to the development of RLS (restless legs syndrome) in elderly patients, and iron supplements can produce a significant reduction in symptoms.” If you have nocturnal myoclonus, or muscle cramps that occur at night, try taking magnesium (250 mg at night) and vitamin E (400 to 800 IU per day). If you are over the age of fifty, Ginkgo biloba extract (80 mg three times per day) may also prove to be helpful. Botanicals Many plants have sedative properties. Plant commonly prescribed as aids in promoting sleep include: passionflower (Passiflora incarnate), hops (Humulus lupuslus), valerian (Valeriana officinalis), skullcap (Scutellaria lateriflora), and chamomile (Matricaria chamomilla). Passionflower and valerian, which have research backing their use, are briefly discussed below. Passionflower (Passiflora incarnata): Passionflower was widely used by the Aztec Indians as a sedative and analgesic. It constituents include harmine. Harmine was initially known as telepathine because of its odd ability to induce a contemplative state and mild euphoria. It was later used by the Germans in World War 2 as “truth serum.” Harmine and related compounds can inhibit the breakdown of serotonin, therefore their use with 5-HTP would have an additive effect. Valerian (Valeriana officinalis): This plant has also been widely used in folk medicine as a sedative and antihypertensive. An early study involving 128 test subjects demonstrated that an aqueous extract of valerian root significantly improved sleep quality. This double blind study compared the effects of the aqueous extract to a placebo and an over the counter preparation of valerian from Switzerland, in both good and poor sleepers. The study measured sleep latency, night awakening, subjective sleep quality, and sleepiness the next morning. From the results, the following conclusions can be made: the aqueous extract of valerian had its most significant effect among people who considered themselves poor or irregular sleepers (especially women), smokers, and those with long sleep latencies; the over the counter valerian produced little sedative effect compared to the placebo; and the use of the commercially available product produced a significant increase in the degree of sleepiness the next morning compared with the aqueous extract or the placebo. Several other clinical studies have supported valerian’s ability to improve sleep quality and relieve insomnia. In one study, valerian showed a considerable positive effect compared to the placebo, with 44% of subjects reporting perfect sleep, and 89% reporting improved sleep. In another double blind study of insomniacs, twenty test subjects received either a combination of valerian root extract (160 mg) and Melissa officinalis extract (80 mg), or a placebo. In the insomniac group, the valerian/Melissa preparation showed an effect comparable to that of the benzodiazepines, as well as an ability to boost deep sleep Stages 3 and 4. The valerian/Melissa preparation did not, however, cause daytime sleepiness, and there was no evidence of diminished concentration or impairment of physical performance.
Encyclopedia of Natural Health
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