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Insomnia

Let’s begin with the basics. Insomnia comes from the Latin word “insomnis,” which means “sleepless.” Sleep is necessary for repair and rejuvenation, and those with chronic insomnia must find a solution in order to maintain their quality of life. Most people don’t know that chronic insomnia predisposes people to an early death. Therefore, from the perspective of extending life, restoring good sleeping patterns is essential.

Insomnia can be explained as difficulty either initiating or maintaining sleep—or both. It affects millions of people and is often hard to treat. Those with insomnia feel as though they have not had sufficient sleep upon awakening. Over the long haul, it may result in fatigue, irritability, and decreased concentration, just to name a few symptoms. Keep in mind that elderly people may need less sleep than younger adults, who should be sleeping, on average, between 6 to 8 hours per day. This is a typical change connected to age and should not be considered a sleep disorder in a healthy person.

Insomnia affects one-third of all adults and accompanies many of the disorders discussed elsewhere in this book. People with sleep-onset insomnia have difficulty falling asleep, while those with maintenance insomnia wake frequently throughout the night or very early in the morning. Insomniacs need to be examined for overt or underlying depression, for these conditions frequently cause insomnia. When this is the case, the depression must be treated first.

Let’s briefly examine sleep in greater detail. Sleep is a smooth condition made up of a series of changes that take place during the sleeping phase. Each phase has its own unique brain wave patterns. Of special interest is the rapid eye movement (REM) period, the stage when dreams occur. REM periods are, in turn, subdivided into approximately 5 periods. The deepest levels of sleep occur during the third and fourth phases. As we grow older, the length of sleep during these phases diminishes.

Causes

Insomnia can be caused by a variety of physical, mental, and behavioral conditions. Among the common causes are pain, anxiety, tension, illness, indigestion, caffeine, and drugs. A major cause of insomnia, especially if it’s chronic, is reactive hypoglycemia. This is frequently exacerbated by eating late at night, especially foods with a high glucose level, such as pastries, candy, or even fruit juice. Such foods cause blood-sugar level to go up and then plummet, a fluctuation that can contribute to insomnia. Also, overindulging late at night in highly fatty foods can cause sleeplessness. That’s because foods with a lot of fat take four to five times longer to empty from the stomach and be digested than simple or complex carbohydrates do.

Another important cause of insomnia is intake of stimulants. Most of us are aware of the caffeine in coffee, tea, chocolate, and colas. Alcohol, although generally considered a depressant, can have stimulant effects in some cases. In addition to food and drink, certain medications can be culprits in insomnia. Drugs that interfere with the natural sleep cycle include Prozac, the newer drugs related to it, and Xanax.

Exercising in the late evening is another possible bane for the insomnia-prone in that it can overstimulate adrenal levels and excite the musculoskeletal system, resulting in difficulty getting to sleep. Likewise, stress and overstimulating the mind by thinking about unresolved conflicts can be a problem when the goal is sleep.

Symptoms

There is no ironclad set of symptoms for insomnia. It is as individual as a snowflake, as it depends on the particular person’s need for sleep. It may be classified as primary insomnia, a condition with no apparent relationship to stress or other upset, or secondary insomnia, a condition related to another cause. Treatment will depend on the underlying cause, if any, and the severity of the sleeplessness. The more common reasons for difficulty initiating sleep are anxiety, stress, and depression.

Difficulty maintaining sleep may be caused by the same factors just mentioned. Or it may be the result of a sleep disorder due to obstructive apnea, in which a breathing disturbance wakes up the individual. Nocturnal myoclonus—which makes the individual large muscle groups twitch, thereby waking up the individual—is another common condition.

Often people will complain of being tired and sleeping poorly yet not recall waking up during the night. This is because they are not necessarily fully waking up. In the language of those who study sleep, this refers to full versus partial arousal. A person’s sleep may be grossly disturbed with multiple partial arousals, even in the absence of full arousals.

It is a good idea to ask your bed partner about heavy snoring or periods where you are gasping for air or kicking your legs. Your physician may refer you for a sleep study which monitors your brain waves and limb movements, as well as looks for sleep apnea.

Conventional Treatment

Many people with insomnia often use over-the-counter or prescription drugs to help them sleep. Benzodiazepines and tricyclic antidepressants are among the medications that may be prescribed by a doctor. Potential side effects include daytime sleepiness, loss of muscle coordination, and addiction.

Herbal Remedies

A variety of herbs can be a real help to those challenged by insomnia. Unlike sleeping pills, herbs won’t leave you in a fog in the morning, or feeling like you haven’t really slept. Most of these herbs address the underlying cause of the insomnia, a depleted nervous system that cannot settle itself down.

Terry Willard, president of the Canadian Association of Herbal Practitioners, in an article posted on the HealthWorld Online website (www.healthy.net) offers some recommendations:

 

REISHI MUSHROOM (GANODERMA LUCIDIM) This herb provides daytime calm, decreases anxiety, and adjusts sugar metabolism. It helps to resolve what the Chinese call disturbed shen qi (a disturbed mental spirit). It has also been found to boost the immune system, and reduce cholesterol and hypertension. Take three 1-gram tablets three times daily.

 

HOPS (HUMULUS LUPULUS) This age-old sedative can be taken as a tea or combined with other dried herbs in a sleep pillow. To make the tea, mix 1 teaspoon of whole hops into a cup of boiling water. Some people may have an allergic reaction to hops.

 

VALERIAN (VALERIANA OFFICINALIS) Valerian has been used as a sedative for more than 2,000 years. In Europe it is the most commonly used over-the-counter drug for sleep disorders. Willard recommends that valerian be taken only for short periods or intermittently, when insomnia is at its worst. This is because the herb can become habit-forming, and increased doses may be required if used for a long period. Too much valerian also can make you nauseous. About an hour before going to bed, take a dose of 300 to 400 milligrams of valerian product standardized to 0.5 percent oil.

 

SKULLCAP (SCUTELLARIA LATERIFLORA) This is a powerful nerve tonic and sedative herb. It can be taken as a tincture of 15 to 40 drops two to three times a day; in combination with reishi, hops, and valerian; or as a tea, using 1 to 3 teaspoons of the root for every cup of water.

 

PASSIONFLOWER (PASSIFLOR INCARNATA) This is an important relaxant herb. You can find tinctures and extracts in health-food stores. You can make a cup of tea by pouring 1 cup of boiling water over half a teaspoon of dried passionflower. If you’re being treated for depression, Willard issues a warning: this herb can reduce the effects of monoamine oxidase inhibitors.

 

LEMON BALM (MELISSA OFFICINALIS) Lemon balm is used to relax the body and help with sleep. It can be taken as a tea, by steeping 1 to 2 tablespoons in a cup of hot water.

 

KAVA KAVA (PIPER METHYSTICUM) This powerful anxiolytic (antianxiety agent) and sedative “will probably become one of the most important healing herbs in the next few years,” Willard says. Its active compounds, called kavalactones, apparently work directly on the limbic system, which regulates emotional feelings and behavior. A clinical study in Germany found that patients receiving 100 milligrams of kava extract three times daily experienced a significant reduction in anxiety symptoms after only 1 week of treatment. Willard cautions that you should not take this herb if you are depressed, pregnant, nursing, or operating machinery.

 

CHAMOMILE (MATRICARIA CHAMOMILLA) Chamomile not only relaxes and calms the body, but also strengthens the nervous system. Chamomile tea is a commonly used before-bedtime sedative. You can also take it as a tincture, 10 to 40 drops three times a day; or in capsule form, six 300 to 400 milligram capsules daily.

 

HERBAL SLEEP PILLOW Rosemary Gladstar, former director of the California School of Herbal Studies and author of Herbs for Reducing Stress and Anxiety, tells how to make an herbal pillow that can be placed next to your head while you sleep: Fill a 4 x 4 inch piece of fabric with dried hops, rose petals, lavender blooms, and chamomile flowers. You might want to put a few drops of lavender oil on top of the pillow as well.

Nutrition and Supplements

Foods with naturally occurring tryptophan in high amounts, such as turkey, eggs, fish, and dairy products, may help you sleep. Other options include calcium citrate and magnesium citrate—1,200 milligrams of each taken any time after dinner; 50 milligrams of the B complex; and 200 milligrams of inositol. Also, 200 micrograms of chromium in the evening will help stabilize your blood-sugar level. Melatonin, 1 to 3 milligrams before bed, and niacinamide, 70 to 280 milligrams daily, have been found to help some people.

The late Dr. Robert Atkins pointed out the efficacy of tryptophan—an essential amino acid that is a precursor for serotonin, melatonin, and niacin—in the treatment of insomnia: “Tryptophan is very valuable for sleep disorders because serotonin is the sleep chemical. If you take it right when you are ready to go to bed, when your serotonin level is on the upswing anyway, you are really fitting in physiologically with your body’s chemical rhythms.”

Homeopathy

Homeopathy is based on the principle that “like cures like.” Homeopathic remedies are prescribed in minute doses. The homeopathic remedy chosen should correspond to the symptoms described; only one should be used for best results. Sometimes it’s a matter of trial and error; if one does not work, try another. Judyth Reichenberg-Ullman and Robert Ullman, naturopathic and homeopathic physicians, describe some of the most commonly used remedies for insomnia in an article posted on HealthWorld Online (www.healthy.net):

 

ARSNEICUM ALBUM Recommended for insomnia caused by anxiety, with waking after midnight and restlessness.

 

NUX VOMICA Used for insomnia from overuse of stimulants, stress, worries about work. The person usually wakes up in the middle of the night and stays awake.

 

COFFEA CRUDA Recommended when you find yourself wide awake at 3:00 in the morning. You feel jubilant and excited, and your mind is racing.

Other Natural Therapies

A gentle neck and head massage for 15 minutes may do the trick in conquering insomnia, and 15 minutes in a warm bath may be helpful as well. Along the lines of positive affirmation, writing in a diary shortly before bedtime can be extraordinarily beneficial. It can be a way of really seeing what you’ve done that’s affirmed your mental, spiritual, and physical health, as well as any deeds you’ve done that have had positive effects on others. If a person spends some time at the end of each day reflecting on what they’ve done in the past 24 hours that’s been positive, and on plans for the next day, he or she gains a sense of completeness about the day. In a sense, then, diary-writing legitimizes going to bed; it’s as if you can now see that you really deserve the good night’s sleep you’re about to get.

Judyth Reichenberg-Ullman and Robert Ullman also say it’s important to prepare for sleep. Choose a time for bed and stick with it. Get ready for bed by unwinding slowly. Your bedroom should be “soothing and comfortable, dim and quiet.” Make it a “peaceful sanctuary” used simply as a place for sleeping.