Natural Ways to Heal

MEMORY DISORDERS, INSOMNIA, AND PAIN

In this chapter I will discuss natural treatments for memory problems and insomnia, two very common causes that impair a magnificent mind. These disorders are increasing at alarming rates. Alzheimer’s disease is expected to triple by 2050, and nearly sixty million Americans have significant sleep problems.

Memory Problems

Memory problems are typically considered an issue for the elderly. In my experience as both a child and adult psychiatrist, however, I have seen memory problems across the life span. They commonly appear in children with learning disorders, in teens who are using marijuana, adults with depression and substance abuse problems, and in the cognitive decline that occurs with aging and many forms of dementia. Memory is housed in a number of different areas of the brain, especially the prefrontal cortex, which is thought to be involved with short-term memory, and the hippocampus in the temporal lobes, which are structures critical to getting memories into long-term storage. In assessing memory problems it is important to consider the following.

• Medical causes, such as low thyroid or B₁₂ deficiencies

• Medications that interfere with memory such as antianxiety medicines like Xanax or painkillers like OxyContin

• Brain illnesses, such as depression or ADD

• Early stages of Alzheimer’s disease

• Excessive stress (stress hormones have been found to kill cells in the hippocampus)

• Lack of sleep, sleep apnea

• Postanesthesia (some people react negative to general anesthesia and complain of subsequent memory problems)

• Environmental toxins, such as finishing furniture or painting your car in a closed garage

• Drug and alcohol abuse

Of course, the first step in enhancing memory is to fix any of the problems listed above if possible. There are a number of important supplements that have been shown to be helpful in enhancing memory, including gingko biloba, phosphatidylserine, vinpocetine, and huperzine A. Medications that have been found to help memory include Namenda, Aricept, Exelon, and Reminyl.

GINGKO BILOBA

The prettiest brains I have seen are those on gingko. Gingko biloba, from the Chinese gingko tree, is a powerful antioxidant that is best known for its ability to enhance circulation, memory, and concentration. The best-studied form of gingko biloba is a special extract called EGB 761. It will be best if this is the form you use. EGB 761 has been studied in blood vessel disease, clotting disorders, depression, and Alzheimer’s disease. A comparison in 2000 of all the published, placebo-controlled studies longer than six months for the gingko biloba extract EGB 761 versus Cognex, Aricept, and Exelon showed they all had similar benefits for mild to moderate Alzheimer’s disease patients.

The most widely publicized study in the United States of gingko biloba was done by Dr. P. L. Le Bars and colleagues from the New York Institute for Medical Research, which appeared in the Journal of the American Medical Association in 1997. EGB 761 was used to assess the efficacy and safety in Alzheimer’s disease and vascular dementia. This fifty-two-week multicenter study was conducted with patients who had mild to severe symptoms. Patients were randomly assigned to treatment with EGB 761 (120 milligrams a day) or placebo. Progress was monitored at twelve, twenty-six, and fifty-two weeks, and 202 patients finished the study. At the end of the study the authors concluded that EGB was safe and appears capable of stabilizing and, in a substantial number of cases, improving the cognitive performance and the social functioning of demented patients for six months to one year. Although modest, the changes induced by EGB were objectively measured and were of sufficient magnitude to be recognized by the caregivers.

Consider taking gingko if you are at risk for memory problems or stroke or suffer from low energy or decreased concentration. The usual effective dose is 60 to 120 milligrams twice a day. There is a small risk of bleeding in the body, and the dosages of other blood thinning agents being taken may sometimes need to be reduced.

PHOSPHATIDYLSERINE

Phosphatidylserine (PS) is a naturally occurring nutrient that is found in foods such as fish, green leafy vegetables, soy products, and rice. PS is a component of cell membranes. There are reports of the potential of PS to help improve age-related declines in memory, learning, verbal skills, and concentration. Positron emission tomography studies of patients who have taken PS show that it produces a general increase in metabolic activity in the brain. In the largest multicenter study to date of phosphatidylserine and Alzheimer’s disease, 142 subjects ages 40–80 were given 200 milligrams of PS per day or placebo over a three-month period. Those treated with PS exhibited improvement on several items on the scales normally used to assess Alzheimer’s status. The differences between placebo and experimental groups were small but statistically significant. Effective doses of PS have been reported to be 300 milligrams per day. The types of symptoms that have improved in placebo-controlled studies of cognitive impairment or dementia include loss of interest, reduced activities, social isolation, anxiety, memory, concentration, and recall. Milder stages of impairment tend to respond to PS better than more severe stages. With regard to depression in elderly individuals, Dr. M. Maggioni and colleagues studied the effects of oral PS (300 milligrams per day) versus placebo and noted significant improvements in mood, memory, and motivation after thirty days of PS treatment.

The typical dose of PS is 100–300 milligrams a day.

VINPOCETINE

Vinpocetine has been shown in a number of studies to help memory, especially for people who are at risk for heart disease or stroke. It also helps lower high homocysteine levels, which are also dangerous to your heart and brain. Vinpocetine is derived from an extract of the common periwinkle plant (Vinca minor) and is used in Europe, Japan, and Mexico as a pharmaceutical agent for the treatment of blood vessel disease in the brain and cognitive disorders. In the United States it is available as a dietary supplement. It is sometimes called a nootropic, meaning “cognition enhancer,” from the Greek noos for “mind.” Vinpocetine selectively widens arteries and capillaries, increasing blood flow to the brain. It also combats accumulation of platelets in the blood, improving circulation. Because of these properties, vinpocetine was first used in the treatment of cerebrovascular disorders and acute memory loss owing to late-life dementia. But it also has a beneficial effect upon memory problems associated with normal aging.

There is evidence that vinpocetine may be useful for a wide variety of brain problems. A 1976 study found that vinpocetine immediately increased circulation in fifty people with abnormal blood flow. After one month of taking moderate doses of vinpocetine, patients showed improvement on memorization tests. After a prolonged period of vinpocetine treatment, cognitive impairment diminished significantly or disappeared altogether in many of the patients. A 1987 study of elderly patients with chronic cerebral dysfunction found patients who took vinpocetine performed better on psychological evaluations after the ninety-day trial period than did those who received a placebo. More recent studies have shown that vinpocetine reduces neural damage and protects against oxidative damage from harmful beta-amyloid buildup. In a multicenter, double-blind, placebo-controlled study lasting sixteen weeks, 203 patients described as having mild to moderate memory problems, including primary dementia, were treated with varying doses of vinpocetine or placebo. Significant improvement was achieved in the vinpocetine-treated group as measured by “global improvement” and cognitive performance scales. Three 10-milligram doses daily were as effective or more effective than three 20-milligram doses daily. Similarly good results were found in another double-blind clinical trial testing vinpocetine versus placebo in elderly patients with blood vessel and central nervous system degenerative disorders. Some preliminary research suggests that vinpocetine may also have some protective effects in both sight and hearing.

Reported adverse reactions include nausea, dizziness, insomnia, drowsiness, dry mouth, transient hypotension, transient fast heart rate, pressure headaches, and facial flushing. Slight reductions in both systolic and diastolic blood pressure with prolonged use of vinpocetine have been reported, as well as slight reductions in blood sugar levels.

The usual dosage is 10 milligrams a day.

HUPERZINE A

Huperzine A is a remarkable compound that has been studied in China for nearly twenty years. It appears to work by increasing the availability of acetylcholine, a major memory neurotransmitter in the brain, and preventing cell damage from excitotoxins. It has been shown to be effective in improving patients who suffered with cognitive impairment from several different types of dementia, including Alzheimer’s disease and vascular dementia. Huperzine A has also been shown effective to help learning and memory in teenagers. Researchers divided thirty-four pairs of junior high school students complaining of memory problems into a huperzine A and placebo control group. The huperzine A group was given two 50-microgram capsules of huperzine A twice a day, while the placebo group was given two capsules of placebo (starch and lactose inside) twice a day for four weeks. At the end of trial, the huperzine A group’s memory abilities were significantly superior to that of the placebo group.

The usual dosage is 50–100 micrograms twice a day.

Insomnia

Sleep plays an important role in the formation of memory and normal learning activities. Sleep problems disrupt your energy; interfere with performance at work or school; negatively impact relationships; and compound the symptoms of ADD, anxiety, and depression. People may suffer from trouble falling asleep, frequent awakenings during the night, or waking up too early and having trouble getting back to sleep. Sleep disorders can occur transiently in response to a stress, be a chronic problem, or occur in cycles. These patterns are sometimes helpful in diagnosing the underlying problem. For example, people who have periods where they do not need more than a few hours of sleep at night combined with increased energy levels and mood may indicate the presence of bipolar illness. People who have early morning awakenings and morning fatigue with better energy as the day goes on may have a form of depression.

Insomnia is one of the most common complaints in medical practices. The number of adults in America affected may exceed sixty million. Patients have many different opinions about what constitutes insomnia and many people who believe they are not sleeping enough are discovered to be sleeping more than the average person when evaluated by a sleep laboratory. Others who complain of insomnia don’t realize that they are unintentionally doing something that disrupts their natural sleep cycle. For example, they may be drinking caffeine, eating sugar late in the day, drinking alcohol or smoking, taking naps during the day, exercising vigorously late in the evening, or staying up very late into the evening, all of which disrupt sleep cycles. Untreated medical and psychiatric illnesses and some medications also disturb sleep.

Transient insomnia is something that we all have experienced. Some of the most common causes of transient insomnia are jet lag, minor stress or excitement, shift work, and trying to sleep in a new environment. This kind of acute insomnia usually goes away on its own or when the stress is resolved. Herbal teas; self-relaxation; and avoiding caffeine, alcohol, evening exercise at least four hours before bedtime also help.

Chronic insomnia is more difficult to diagnose and to treat. By far, the most common reason people develop chronic insomnia is another underlying condition that disturbs their sleep cycle. Doctors have to spend time trying to sort out whether or not a patient has secondary insomnia and, if so, what is causing it. Here is a list of some of the conditions that may cause chronic insomnia:

• Medications. Many medications, including asthma medications, anti-histamines, cough medicines, anticonvulsants, and many others, disturb sleep.

• Caffeine. Coffee, tea, chocolate, and some herbal preparations contain caffeine and will disrupt sleep.

• Alcohol, nicotine, and marijuana. Although these compounds initially promote sleep for some people, as they wear off, they have the reverse effect.

• Restless legs syndrome. This jerking motion of the legs or pedaling motion can drive a person’s bed partner crazy (as well as the person who has it).

• Pregnancy, PMS, menopause, and perimenopause. During many of these hormonal transition times, a woman’s sleep cycle may be disrupted every few minutes.

• Thyroid conditions. Too much thyroid activity can cause people to feel revved too high.

• Congestive heart failure. This can cause trouble breathing.

• Chronic pain conditions. Pain can keep a person awake.

• Untreated or undertreated psychiatric conditions. Conditions such as obsessive-compulsive disorder, depression, or anxiety will disrupt sleep patterns if left untreated.

• Alzheimer’s disease. Dementia patients often “sundown” or rev up at night and wander.

• Chronic gastrointestinal problems. Reflux causes pain and discomfort.

• Benign prostatic hypertrophy. This condition causes many trips to the bathroom at night, disrupting a full night’s sleep.

• Snoring and sleep apnea, which are more common in men than in women, can adversely affect both bed partners’ sleep.

After all other reasons for insomnia have been ruled out or excluded a patient can be diagnosed with primary insomnia. A doctor may also decide to send her patient to a sleep disorders laboratory for observation of their sleep cycle. Sleep labs are able to monitor patients with overnight polysomnography and other tests that provide information about a patient’s heart rate, breathing rate, oxygen levels, leg movements, brain waves, and eye movements during their sleep cycle. The results of these tests help make the diagnosis of sleep apnea, insomnia, and restless legs syndrome.

TREATMENT

Acute or transient insomnia usually responds to the practice of good sleep habits (see the section Steps to Get a Good Night’s Sleep Naturally on Chapter 8). Sometimes the practice of good sleep habits is not enough, as may be the case for some shift workers who are unable to reset their sleep cycles on demand or for people experiencing grief reactions and who may suffer from insomnia for a few weeks to a few months during the acute grief phase. People who are hospitalized are another example of those for whom the practice of good sleep habits is not enough. In these and other cases, I prescribe supplements, such as valerian, kava kava, melatonin, or medication, such as Ambien, Lunesta, or Desyrel on a short-term basis. Chronic insomnia requires a complex approach to treatment. Any underlying cause of chronic insomnia must be identified and treated. It is most often caused by other underlying conditions, and of these, depression and anxiety, substance abuse, psychological stress, and medication side effects top the list.

Patients who have difficulty getting to sleep frequently complain that thoughts keep them up at night. Sometimes they are anxious and therefore worry at night or obsess about problems. Other times, people say they feel fine but just can’t turn off their mind and quit thinking. Nighttime thinkers often benefit from a technique called imagery distraction. Imagery distraction is an elaborate and interesting mental image developed and focused on at bedtime in order to distract the insomniac from the other thoughts that keep them awake. Patients who practice this technique fall asleep more quickly and easily than those who don’t. Self-hypnosis and other relaxation techniques such as progressive relaxation, deep breathing, and meditation also help.

Natural interventions may be helpful for either acute or chronic insomnia. For some people, 400–900 milligrams of valerian root improves sleep. It also has mild anxiety-reducing and muscle-relaxing effects. Results of several double-blind, placebo-controlled trials involving valerian for the treatment of insomnia showed that patients report improvement in the quality of their sleep and a decrease in the length of time it took for them to fall asleep when they used valerian. The benefits appeared to increase after several days of use. Higher doses of valerian were associated with reports of morning sedation.

MELATONIN

Melatonin is a hormone made in the brain that helps regulate other hormones and maintains the body’s sleep cycle. Darkness stimulates the production of melatonin while light decreases its activity. Exposure to too much light in the evening or too little light during the day can disrupt the production of melatonin. Jet lag, shift work, and poor vision are some of the conditions that can disrupt melatonin production. Some researchers think that being exposed to low-frequency electromagnetic fields (from common household appliances) may disrupt melatonin levels. Melatonin is involved in the production of female hormones and influences menstrual cycles. Researchers also consider melatonin levels to be involved in aging. Children have the highest levels of melatonin, which diminish with age. The lower levels of melatonin may help explain why older adults generally need less sleep. Melatonin is a strong antioxidant, and there is some evidence that it may help strengthen the immune system.

Research suggests that taking melatonin may help sleep patterns in shift workers or those with poor vision. One study found that melatonin helps prevent jet lag, particularly in people who cross five or more time zones. Melatonin is more effective than placebo in decreasing the time required to fall asleep, increasing the number of hours sleeping and improving alertness. Melatonin may be helpful for children with learning disabilities who suffer from insomnia. One study of postmenopausal women found that melatonin improved depression and anxiety. Studies of people with depression and panic disorder have shown low levels of melatonin. People who suffer winter blues or seasonal affective disorder also have lower than normal melatonin levels. Melatonin causes a surge in the neurotransmitter serotonin, which may help explain why it is helpful in both sleep and depression. Although taking melatonin does not help the primary symptoms of ADD, it does seem to help the sleep disturbances common in these children.

The best approach for dosing melatonin is to begin with very low doses. In children start with 0.3 milligrams per day, always at bedtime, and raise it slowly. In adults start with 1 milligram an hour before bedtime. You can increase it to 6 milligrams.

Steps to Get a Good Night’s Sleep Naturally

• Get stimulants out of your system well before bedtime. If you take a stimulant for ADD or any other condition, try to take your last dose by early afternoon so it wears off before bedtime. Sometimes people with hyperactivity actually benefit from a stimulant before bedtime to calm them down so they can sleep. Stimulating antidepressants like Wellbutrin may need to be taken before 4 P.M. as well. Nicotine should be eliminated and caffeine should not be consumed for six to eight hours before bedtime. Caffeine is found in many foods including teas, coffee, and chocolate.

• Don’t take naps! This is one of the biggest mistakes people with insomnia make. They feel tired during the day, take naps, and thereby compound their nighttime sleep cycle disruption.

• Exercise during the day is very beneficial for insomnia. However, it should be at least four hours before bedtime. Vigorous exercise late in the evening often energizes people and keeps them awake.

• Alcohol, pain medication, and marijuana also disrupt sleep. These compounds may cause initial drowsiness, but as the body metabolizes them, they interrupt sleep. Avoid trying to fall asleep using these drugs.

• Plan for transition time. Almost everyone needs time to relax and unwind before going to sleep. Put aside busy or intense work and focus on calming activities before lying down.

• Don’t use your bed for anything other than sexual activity or sleeping. If you can’t sleep and are not engaged in sexual or sensual contact with your partner, get out of bed. Do not work, watch TV, read, write, or lie around awake in bed.

• Move the clock. Clock watching and trying too hard to go to sleep will cause more anxiety and aggravate your problem.

• Establish a regular sleeping schedule and stay on it, even on weekends. Changing sleep patterns by staying up too late or oversleeping on weekends is enough to trigger cycle disruptions in sensitive people.

• Pay attention to your environment. Your bedroom should be comfortable. Control the temperature and light.

• Reading might help you fall asleep but don’t read anything too exciting, scary, or anxiety provoking. This applies to TV watching as well.

• A mixture of warm milk, a tablespoon of vanilla (not imitation vanilla, the real stuff), and a tablespoon of sugar can be very helpful. This increases serotonin to your brain and helps you sleep.

• If sugar makes you jittery, gives you an energy boost, or if you have ADD, you need to avoid it beginning in the afternoon. You should avoid starches as well, as they turn to sugar after you eat them.

• Sound therapy can induce a very peaceful mood and help relaxation. Some people like nature sounds; others prefer soft music, wind chimes, or even fans. Our clinic makes a sleep tape with a special sound machine that produces sound waves at the same frequency as a sleeping brain. The tape is played at bedtime and helps the brain “tune in” to a brain wave sleep state, which encourages a peaceful sleep.

• Sexual activity releases many natural hormones, releases muscle tension, and boosts people’s sense of well-being. People with healthy sex lives usually sleep better.

• Meditation, massage, and warm baths are also very relaxing.

I also help my patients using hypnosis and teaching them self-hypnosis. When I was an intern at the Walter Reed Army Medical Center in Washington, D.C., many of my patients wanted sleeping pills. As you can imagine, it was hard to sleep in a busy, noisy medical center. Before I gave them sleeping pills, however, I asked if I could hypnotize them first to see if that would help. Almost all of them agreed. My first professional papers came from using hypnosis for sleep. One of my patients, a decorated World War II hero, had advanced Parkinson’s disease, and in a hypnotic trance his tremor went away. When I told my attending neurologist about it the next morning, he thought I was crazy. So I repeated the exercise in front of him and it became my first professional paper. When I did this for an army chaplain who was in the hospital with a heart arrhythmia, his heart rhythm normalized. When I told my attending cardiologist about what happened the next morning, he thought I was nuts, so I repeated the exercise in front of him and it became my second professional paper. Hypnosis and self-hypnosis are very powerful tools to help gain mastery over your own mind and can be helpful for sleep and other things as well. You can obtain a hypnotic audiotape from the Amen Clinics’ website or go to a trained hypnotherapist.

         

Sleep is critical. Use the techniques listed here to help. Be persistent. If one technique doesn’t work for you, don’t give up. Try others.

Pain

Pain is one of the most difficult and debilitating symptoms that people suffer. Chronic pain affects everything in a negative way, such as sleep, mood, memory, and concentration. Our scans have taught me that the use of chronic pain medications, such as Vicodin or OxyContin, is harmful to brain function. Long-term use of these medications makes the brain look like people who drink too much.

Looking at these scans caused me to develop an interest in alternative treatments for pain that did not leave a toxic effect, such as fish oil, acupuncture, music therapy, and hypnosis.

From a psychiatrist’s standpoint, I have also learned that pain and depression tend to go hand in hand. And that using some antidepressant medications, such as Cymbalta, or antidepressant natural supplements, such as SAMe, can be very helpful for some pain syndromes.

Another issue that came up through looking at scans is that sometimes a person’s brain can get stuck on the pain.

Sam was admitted to the hospital after a suicide attempt. He was a police officer who had been in a car accident chasing a criminal. He had six back surgeries and was tired of living in pain. When I scanned his brain I found too much activity in the front part of his brain. This is the same pattern we often see with people who have obsessive-compulsive disorder or people who get stuck on negative thoughts or negative behaviors. Based on the scan I put him on the supplement 5-HTP that boosts serotonin to calm down this part of the brain, in addition to fish oil. A month later he told me that he felt much better. “I still hurt,” he said, “but I don’t think about the pain all the time.”

Again, there are many natural ways to help the brain. Of course, you should talk to your doctor. If he or she does not know much about natural supplements, as many of us were never taught about them in school, sometimes a naturopath, a nutritionist, or a chiropractor may have information to help you.

One other thought on pain: try getting rid of all of the artificial sweeteners in your diet. When I was thirty-seven I had arthritis. My knees, hands, and fingers hurt a lot. I had trouble getting up off the floor after sitting for a while. As part of developing a brain-healthy life, I got rid of the diet sodas. Within a month, my pain went away. I don’t think artificial sweeteners do that to everyone, but if you hurt, it might be something to consider.