According to a 2012 congressional briefing, 50 to 70 million Americans suffer from insomnia, with women 1.4 times more likely than men to be affected. Thirtyfive to 40 percent of menopausal women report sleep problems, but they can occur at any age. Clearly, insomnia is a common concern, which can accompany 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.
As women get older and their hormones change, it becomes more difficult to have a good night’s sleep. One of the hormones that is particularly important for sleep is progesterone, says Dr. Hyla Cass, a board-certified expert in the fields of integrative medicine, women’s health, and psychiatry, and the author of many books including Eight Weeks to Vibrant Health. Because older women make less progesterone, this can affect their ability to sleep.
Pregnancy is another time in which insomnia may be common. “Pregnant women can’t fall into their usual sleep positions or have their usual contact with their bed mates,” says Dr. Samuel Dunkell, a psychiatrist and sleep clinician working in an insomnia outpatient clinic, and former director of the American Sleep Disorders Association. “There is also an increase in insomnia caused by the pregnancy toward the end of the pregnancy period. Postpartum, women often have difficulty falling asleep for a number of days or weeks.”
Insomnia can be associated with 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 levels 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 can 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.
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.
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.
Herbalist Terry Willard, 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 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 can also make you nauseated. About an hour before going to bed, take a dose of 300 to 400 mg 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 (Passiflora 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 boiling water over 1/2 teaspoon 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 feel-ings and behavior. A clinical study in Germany found that patients receiving 100 mg of kava extract three times daily experienced a significant reduction in anxiety symptoms after only one 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 mg 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-by-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.
Tryptophan has been found to benefit people with insomnia. Foods with high amounts of naturally occurring tryptophan, such as turkey, fish, eggs, and dairy products, may help you sleep. Tryptophan breaks down into serotonin, the brain chemical that regulates sleep, and also enhances the brain’s ability to produce melatonin, the hormone that regulates your body clock. I recommend taking 1,000 milligrams half an hour before bed.
Melatonin, produced in the pineal gland, aids in sleep and setting circadian rhythyms. Low levels can cause interrupted or restless sleep. To prevent insomnia, I recommend taking 300 micrograms to 1 milligram half an hour before bed, two or three nights a week.
Other options include calcium citrate and magnesium citrate, 1,000 milligrams of each taken any time after dinner; up to 30 milligrams of zinc; and 10 to 15 milligrams of iron; 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. Niacinamide, 70 to 280 milligrams daily, has been found to help some people.
Dr. Cass adds the following recommendations: In menopausal women, it may help to enhance progesterone using herb vitex and over-the-counter natural progesterone. To address stress-induced high levels of cortisol in the body, which can cause nighttime wakefulness, use supplements of phosphatidylserine or phosphoralated serine. To address waking due to low blood sugar, you can also keep a small protein snack by your bed.
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):
ARSENICUM 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 three o’clock in the morning, feeling jubilant, excited, with a racing mind.
Other homeopathic remedies include arnica, aconite, cocculus, ignatia, kali phosphoricum, pulsatilla, and sulfur.
A gentle neck and head massage for fifteen minutes may do the trick in conquering insomnia, and fifteen 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 woman spends some time at the end of each day reflecting on what she’s done in the past twenty-four hours that’s been positive, and on plans for the next day, 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.
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,” say Judyth Reichenberg-Ullman and Robert Ullman. Make it a “peaceful sanctuary” used simply as a place for sleeping.
Dr. James Pearl, who is a member of the Sleep Panel at the Presbyterian St. Luke Medical Center in Denver and in private practice as a psychologist, has additional recommendations. “If you are feeling like you are under a lot of stress and a lot of anxiety, it’s important to take a look at that either with a self-help book or with a therapist to see what you can do to minimize the problems. One powerful way to improve your sleep is to maintain a regular sleep-wake schedule. Getting up at the same time every day is helpful, even on weekends. Some sleep experts say you should go to bed at the same time every night and some say go to bed only when you’re sleepy. Do whatever feels right for you. But it is really good to try to get up at the same time every day.
“Sunday night insomnia is a common problem, especially for people under forty. Let’s say you normally go to bed at 11:00 and get up at 7:00. On Saturday, if you sleep in an extra hour, your body rhythms are one hour behind. If you sleep an extra hour on Sunday, until 9:00, then your internal sleep-wake rhythm is two hours behind. Sunday night, if you try to go to bed at 11:00, you are not sleepy because your body clock is two hours behind. If it is really important for you to sleep in on weekends, don’t go to bed that Sunday night until you feel sleepy. You might sleep one or two hours less than usual but that won’t hurt you.”
Light therapy can be useful. Dr. Pearl explains, “Studies show that people who spend a lot of time indoors away from windows, away from sunlight, have a disproportionate amount of insomnia. They have difficulty sleeping for the same reason that blind people do. Nine out of ten blind people have severe sleep problems because they are not getting sunlight into the retina of their eyes, into the brain to tell the brain that it is time to be awake during the day. The more light stimuli you can give your body during the day, the stronger your sleep-wake rhythm will be. I am talking about sunlight in particular. Indoor light is not going to make any difference. You need to expose yourself to bright sunlight—just your eyes. There are artificial sun boxes that are commercially available. But if you have insomnia, get outside as much as you can, during your lunch hour, during your breaks. Don’t wear sunglasses, unless you’ve got an eye condition that requires it.”
Exercising in the late afternoon or early evening may help some people with insomnia. “When you do aerobic exercise for half an hour, you raise your body temperature,” Dr. Pearl says. “Five or six hours later, your body temperature drops. So working out after work or before dinner is an ideal way to get your body ready for bed. A lazy way to get that same benefit is soaking in a hot bath. It has to be really hot, at least 102 degrees. When you use passive body heating, the drop in body temperature occurs just about three hours later.
“A lot of people intuitively know that stressful experiences during the evening can disturb nighttime sleep and research has confirmed that. So it is important to think of the evening as a transition period between the day’s troubles and the night’s rest. Get ready to wind down. Try to leave your work at the office. If you have to bring it home, get it done early in the evening. Do stressful things like planning your schedule early in the evening or else wait until the morning.”
Physical stress can interfere with sleep. “If your muscles are tense and tight or your breathing fast and shallow, try abdominal breathing,” says Dr. Pearl. “Take breaths that are increasingly deep and slow, so deep that it makes your abdomen push out. Hold it for a few seconds and let it out slowly, breathing away the tension.
“Finally, if you can’t sleep despite everything you have tried, do something else. Switch on the light and read; watch a tape or clean out a drawer. A lot of people think that missing sleep is going to hurt their health, but losing sleep has very few effects. Many studies show that when people sleep less than normal, their performance the next day in most cases is just as good as when they had a good night’s sleep. Highly creative tasks do sometimes become more difficult when you have lost sleep, but, for most of us, even if we go a whole night without sleep, we can get along fine the next day. Don’t be afraid of insomnia. Don’t lie in bed trying to sleep. Some people like to imagine sleep as a wave in the ocean and themselves as a surfer. Position yourself in this warm ocean and wait. The wave will overtake you and sweep you away.”
The following chart summarizes the supplements I recommend adding to the protocol for overall brain health found in chapter 16. This protocol is designed for individuals who suffer from, or are specifically concerned about, insomnia. If you are concerned about conditions discussed in other chapters, consult with a health professional about how you can safely impact multiple conditions.
If you are taking medications—whether prescription or over-the-counter—or have any food restrictions, consult with your doctor before beginning any supplement program. Your health care provider should always be up-to-date on all vitamins, supplements, and herbal or homeopathic remedies you are taking. Supplement overdoses are rare, but possible, and certain combinations may affect individuals adversely.
| SUPPLEMENT | DOSAGE | CAUTIONS |
|---|---|---|
| calcium (from citrate) | 1,200 mg from citrate taken in four equal doses. | |
| iron | 15 mg daily for menstruating women; 10 mg daily for men and nonmenstruating women. | |
| L-tryptophan | 100 mg taken a half hour before bed. May take an additional 200 mg if awakened during the night. | |
| magnesium | 900 mg taken in four equal doses along with calcium. | May take up to six weeks or more for effects to be felt. |
| melatonin | 300 mcg–1 mg taken a half hour before bed. | Tolerance may develop with regular use. Long-term effects of nightly use are unknown. |