Sleep Naturally Plans

Why some people sleep like a baby and others toss and turn for hours often remains a mystery. Americans have constant reminders that without restful sleep, health cannot prevail. The medical and economic consequences of the Nation’s sleeplessness are staggering and statistics imply that 100 million Americans do not sleep well. Up to 40 million Americans may have chronic insomnia with problems related to going to sleep, staying asleep and early morning wakening. About 30 percent of all people with chronic insomnia have no identifiable cause for their problem.

The media is alive with information about the importance of sleep deprivation and quick fixes with drugs. The use of pharmaceuticals for sleep is embroiled in controversy. Recent media reports question the promise that newer forms of sleeping pills are safe. All hypnotic drugs may cause drowsiness, dizziness, memory loss or headache and tolerance is a common problem. Tolerance to sleep drugs requires continued or increased dosage of sleeping pills. While sleep drugs commonly cause dependence, or frank addiction, there are increasing reports of the precipitation of a “zombie-like” state associated with aberrant behavior and eating disorders.

In the calendar year 2005, there were 26.6 million prescriptions for the drug Ambien® (Sanofi-Aventis) with continuing claims by the manufacturers of a well established safety profile for this drug. Lunesta® (Sepracor) is advertised for free trials and it carries a “cloaked” recommendation for continued use, a matter of great concern to many people. All sleep drugs are best used for a couple of weeks or so, but as many as one third of all consumers of hypnotic drugs use them on a chronic or intermittent long term basis.

Amidst a current series of class action law suits against the manufacturers of Ambien® and other hypnotic drugs, patient safety issues have come to the forefront of scientific and public debate. In the late Victorian era, H.C. Woods stated “the treatment of insomnia by drugs is always to be avoided as much as possible” (cited by D.F. Kripke MD “The Dark Side of Sleeping”). The medical wheel has turned!

Sleep 101
Sleep has several basic stages with two characteristic states. These states involve rapid eye movement sleep (REM) and non-rapid eye movement sleep (NREM). In brief, there are 5 stages of sleep:

1. Stage 1: Light, drifting sleep, slow EM, muscle relaxation (cascade of events)
2. Stage 2: EM stop, slow brain wave, burst of sleep spindles (EEG)
3. Stage 3: delta waves, small fast waves (EEG)
4. Stage 4: deep sleep, dominant delate waves, no EM, no muscle contraction
5. Stage 5: REM sleep, rapid breathing, eye jerks, limb paralysis and dreams

Restful sleep involves the passage through all 5 stages in sleep and these cycles have approx. 2 hours of duration. The cycles restart with stage1 sleep and as they become repeated the cycles are shorter with a predominance of REM sleep. A healthy person spends about 50% of their sleep time in stage 2 and about 20% in REM, where dreaming occurs. Infants experience about 50% of their sleep in REM time and this form of sleep declines with age.

Causes and consequences of sleep problems
Common causes of insomnia include stress, irregular schedules, psychological distress, physical illness, drugs, substance abuse and chronic pain. There are several obvious symptoms or signs of sleep deprivation including: drowsiness, poor memory, lack of motivation, general fatigue, poor concentration, behavior problems, mood problems and accidents. Modern research has pointed to several less obtrusive components of sleep deprivation. These occult components of sleep deprivation include: weight gain or obesity associated with eating disorders, the development of insulin resistance and metabolic syndrome X, significant hormonal changes and even premature death. Sleep deprivation promotes premature aging by many mechanisms.

Carefully, controlled, scientific studies imply that sleep deprivation in healthy volunteers precipitates abnormalities in sugar metabolism (glucose intolerance) and carbohydrate craving occurs with sleep loss. Elegant research shows changes in hormones that regulate appetite when sleep is deprived (decreased leptin and increased ghrelin). Restoration of normal sleep patterns is an important and obligatory need for effective weight control. Restoring sleep patterns may do more for some individuals with obesity than any special diet, drug or dietary supplement.

Normal biorhythms are closely linked to hormonal secretion; and unpleasant symptoms associated with premenstrual syndrome (PMS) or menopause are linked to sleeplessness. Sleep deprivation promotes insulin resistance which, in turn, may cause polycystic ovary syndrome (PCOS), a disorder associated with obesity, acne, unwanted body hair and menstrual problems (“Syndrome X of the ovaries). In addition, major changes may occur in chemical messenger systems in the body, such as interleukin production; and sleep deprivation depresses immunity.

Natural ways to healthy sleep
Most simple sleep problems can be self managed with lifestyle changes and the first line option of nutritional support when required. There are several “red flag” signs or symptoms of sleep problems that should precipitate medical consultation by a sleep specialist. Alarming associations of sleep disorders include: disruptive snoring, irregular breathing, co-existing psychiatric disorders, dependence on drugs to sleep, greater than 1 month without sleep, mood disorder with sleep deprivation and inappropriate daytime sleeping. Broad advice for the self-management of sleep problems includes:

• Regular sleep schedules and sleep modification programs e.g. bed deprivation for insomnia
• Regular bedtime routines with attention to sleep hygiene
• Sleep environment controls with “good gadgets”
• Regular exercise, at the right time of day
• Care with drugs, diet, alcohol, caffeine, smoking, illicit drug use, and diet pills
• Where extra help is required nutritional support with dietary supplements is a first line option.

Dietary supplements for sleep
Sleep involves a complex cascade of normal body function including muscle relaxation, mental tranquility, complex eye movements etc. It seems logical, that this complex cascade of events would not be managed in an optimal manner by a single agent, be it a drug or a single dietary supplement. The brain is not easily fooled by single molecules that focus on distinct tissue receptors and tolerance rapidly develops to single chemicals. Using the long standing precedent of the safety and effectiveness of several herbs and nutrients, it is possible to use combinations of natural substances that will act in a synergistic manner for the nutritional support of sleep. The use of synergy in formulations takes balanced dosages of natural substances to achieve a desired effect in sleep promotion. Each component of a synergistic formula adds to the overall desired effect.

Government and leading bodies of conventional medical opinion have not acknowledged the value of natural substances for sleep promotion, but few people can argue with the long history of the safe use of herbs for sleep (e.g. approx. 1000 years of documented use of Valerian). There are 3 classes of natural substances that can be used to modify the cascade of sleep in a beneficial manner. These include herbs or botanicals, hormones and nutrients (Table 1).

• HERBS OR BOTANICALS: Valerian, Chamomile, Ashwagandha, Passionflower, Lemon Balm, Catnip, Skullcap, Hops, Green Tea
• HORMONES: Melatonin
• NUTRIENTS: Amino acids, 5-HTP, Magnesium, Niacin (B3), Pyridoxine (B6), Folic Acid

Table 1: Dietary supplement ingredients that can be used in synergistic formulations to benefit the cascade of events that occur during sleep cycles – nutritional support for the normal body function of sleep

Combinations of herbs may be particularly valuable for improving sleep quality, shortening the time of falling asleep and maintaining restful sleep. Green Tea has been found to lull the brain into quality sleep, perhaps as a consequence of the presence of
L-theanine. Table 2 gives a short overview of several herbs that are valuable for sleep management.

• VALERIAN: sedative, anti-myoclonus, GABA breakdown inhibition, carminative, no hangover, adaptogenic
• CHAMOMILE: calming, analgesic, anti-inflammatory, antioxidant, carminative
• ASHWAGANDHA: nervine, adaptogenic, mild sedative, “Indian Ginseng”
• PASSIONFLOWER: nervine tranquilizer
• LEMON BALM: sedative, anti-spasmodic, nervine, value in depression, soothes gastrointestinal tract, anti-spasmodic
• CATNIP: mild sedative, anti-anxiety
• SKULLCAP: anti-anxiety without drowsiness, adaptogenic
• HOPS: sedative-hypnotic, smooth muscle relaxation, close cousin of marijuana

Table 2: Herbs or botanicals that provide nutritional support for the body function of sleep, with a summary of their main effects and specific uses.

Melatonin is a sleep hormone that has been widely used in dietary supplements. Melatonin secretion by the pineal gland occurs with darkness and during sleep, in healthy people. It can be considered to be a “vampire hormone”. Melatonin has a decline in secretion with age. Studies show that Melatonin may shorten sleep induction time and reduce episodes of awakening, without necessarily increasing sleep time.

Clinical research indicates that Melatonin is valuable for individuals with irregular schedules or in the presence of jet lag. Tolerance develops and I do not recommend the use of this hormone as a single agent for sleep. The safety of Melatonin remains uncertain in high dosage. Documented problems with Melatonin use include fatigue, depression, elevation of blood pressure and interference with fertility. I do not recommend a daily dosage of Melatonin of greater than 2mg per day and smaller doses are effective when used in synergistic combinations with nutrients and herbs. Delaying the release of Melatonin in some formulations does not make sense because of the effectiveness of a small pulse dose in sleep induction.

There are several nutrients that star in the area of sleep management. Magnesium induces muscle relaxation and causes changes in brain waves associated with relaxation. Calcium has similar but more variable effects. Coral calcium carries many anecdotal reports of improving sleeping habits. Aminoacid supplements such as glycine and tryptophan may help sleep, but when used alone very large doses are required, with attendant safety concerns (e.g. at least 3 grams of glycine). 5 hydroxytryptophan is preferred over tryptophan. The role of B-vitamins in sleep management has been underestimated. The classic anti-stress combination of vitamins B3, B6 with folate are necessary for the synthesis of chemical messengers in the brain (e.g. serotonin).

Sleep problems are often overlooked in medical practice. Sleep problems cause many social, mental and physical disorders and drugs for sleep cause their own series of medical disabilities. Any ways of reducing the use of hypnotic drugs is emerging as an important public health initiative. The first line options for the management of simple sleep problems must involve lifestyle change and nutritional support, preferably with a good diet and synergistic supplements that can modulate the complex body functions of restful sleep.

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