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for a Sleepless Night
I can never sleep through the night. Seems like I've tried everything.
What remedies do you recommend?
A: I hear from
at least one patient a day about sleep problems. Either they cannot
fall asleep easily at bedtime, or they awaken in the middle of the
night and can't get back to sleep. Such chronic sleep disturbances
lead to a variety of problems: fatigue, lost motivation, irritability,
depression and immune-system dysfunction. So, assuring good sleep
is a health priority that I emphasize with my patients.
seek the causes of a sleep disturbance, I ask patients whether they
ate or drank something that could interfere with sleep. Most obvious
is caffeine, which can unknowingly be consumed in chocolate, diet
pills and some pain medications. Alcohol, although considered a
nervous-system depressant, also can disturb sleep. So can sugar.
Even natural products, such as the herbs ginseng, ephedra, guarana
and kola nut, can disturb sleep. Adrenal and thyroid-glandular food
supplements can be overstimulating. Although B-complex vitamins
usually help people sleep, an extremely small percentage of the
population is unable to tolerate some B vitamins and will experience
agitation and insomnia. A small percentage of the population will
also respond the same way to dehydroepiandrosterone (DHEA) supplements.
The problem with any of these substances
may be that they are taken too late in the day or that too much
is consumed. For some people, even small amounts or morning dosages
are too much. If the problem is being caused by an otherwise beneficial
medicine or supplement, a substitute treatment needs to be found
that won't erode sleep.
If the problem doesn't lie in that
direction, I suggest that - before turning to external remedies
- my patients try the simple behavior changes that help so many
people to fall asleep and stay asleep.
Since stress and anxiety are extremely
common causes of insomnia, I suggest self-care measures than can
help. Exercise is one. Jogging, biking, dancing, walking and yoga
all give the body some activity that can insulate you from stress
and enhance sleep. (Vigorous exercise is best done earlier in the
Skilled relaxation exercises also
can induce a state that enhances sleep. In visualization, you imagine
a relaxing or loving experience. In progressive muscular relaxation,
you imagine a state of complete relaxation in each part of the body,
in sequence. With relaxation response, you silently say a calming
word or phrase with each outgoing breath. In yet another breathing
technique, you focus on the sensation that each breath makes as
it enters or leaves your nostrils. As simple as these exercises
seem, they can, with the proper focus, bring deep calm and well-being.
Other self-care measures include making
your bedroom more serene, listening to a relaxation tape, taking
a warm bath and planning other relaxing activities in the evening.
If those measures don't work, I recommend
that my patients try one of a number of nonaddictive remedies that
may help them fall asleep more easily and possibly help them sleep
longer. These include supplemental calcium at bedtime (up to 1000
mg with or without magnesium); sedative-like herbs, such as valerian,
passionflower, skullcap or hops (often available in combination
herbal or herbal/vitamin sleep formulas); passion flower tea alone
(brewed strongly-up to 5 teasp in a cup); vitamins B-6 and niacinamide
(as part of a multi or in a combination sleep formula); homeopathic
sleep formulas (available in most health food stores); and the amino-acid
derivative, 5 hydroxytryptophan (5 HTP 100 to 400 mg at bedtime:
avoid 5 HTP if also using SSRI type antidepressant medication such
as prozac, zoloft, paxil, etc). If sleeplessness is related to anxiety,
I suggest to my patients to try inositol, 1000 mg up to 3000 mg
I emphasize to my patients to take
an adequate dose of these remedies to do the job, but to eventually
find the lowest effective dose. Also, it is important to note that
some of these remedies may cause morning drowsiness or have other
minor adverse effects. These effects are rather individual, so it
requires a bit of experimentation to determine which ones are best
tolerated and effective.
The hormone melatonin is often used
successfully for insomnia, but I am uncertain of its long-term safety
when used in doses above the physiologic 0.3 mg. I recommend higher
doses, up to 3 or 4 mg -- if needed, but only for periodic use.
I recommend for those individuals
interested in trying these natural remedies to first consult with
your physician and pharmacist to find out if there are any contraindications
to using them regarding adverse interactions with current medications
or current conditions.
For still-resistant cases, I refer
my patients to an acupuncturist. Sometimes I recommend cranioelectric
stimulation (CES), in which the patient uses a small device to administer
a slight, safe current - one natural to the body - to the ear lobes
that helps normalize electrical currents in the brain.
To people whose efforts to use relaxation
and remedies have failed, I often recommend certain prescription
drugs, a talk with a therapist or evaluation by a sleep clinic.
Before I begin prescribing various
sleep remedies, however, I look very carefully for evidence of common
underlying conditions that frequently disturb brain metabolism and
which can then disturb sleep. Low or rapidly falling blood-sugar
levels can wake you up. Having a small protein-carbohydrate balanced
snack before bed can sometimes prevent this hypoglycemic occurrence.
Food allergy and yeast overgrowth can also disturb brain chemistry
and sleep. Insomnia can also be a manifestation of menopausal-hormonal
changes and of both high and low thyroid function. It can also be
a result, of course, of depression.
Elevated cortisol levels at night
also can make it quite difficult to sleep properly. So measuring
adrenal function can be important. Implementing cortisol-reduction
measures, one of which is to take phosphatidyl serine at bedtime,
Sleep is unquestionably one of the
most vital measures we have for maintaining mental, emotional and
physical health. If your sleep is consistently interrupted or inadequate,
or in any way unrestorative, taking measures to improve the quality
of your sleep is paramount.
is provided for educational purposes only and is not intended as
a substitute for professional advice. Although the material may
help you understand a diagnosis or treatment, it cannot serve as
a replacement for the services of a licensed health care practitioner.
Any application of the material set forth is at the reader's discretion
and sole responsibility.
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