Insomnia

Newsletter #2 - February 2009

What is insomnia?

The inability to get a good night's sleep can result from waking up in the middle of the night and having trouble getting back to sleep. It also occurs when people have a hard time getting to sleep in the first place. Insomnia can be a temporary, occasional, or chronic problem.

What are the symptoms of insomnia?

Sleep-onset insomnia refers to the inability to fall asleep initially. Sleep-maintenance insomnia refers to the inability to stay asleep, with one or more awakenings during the night.

Conventional treatment options

Behavioral or psychological counseling may be recommended for people whose insomnia is due to poor sleep habits or emotional disorders. People with insomnia are typically advised to avoid stimulants such as caffeine (found in coffee, tea, and soda), diet pills, and certain over-the-counter medications. Sleeping pills may be prescribed, but these often become less effective over time and require higher doses.

Nutritional supplements that may be helpful

5-HTP (5-Hydroxytryptophan)*:
5-HTP is converted into serotonin, a neurotransmitter that helps regulate sleep; 5-HTP may thus be helpful for improving insomnia. In a double-blind study of individuals without insomnia, supplementation with 5-HTP increased rapid-eye-movement (REM) sleep, presumably indicating improved sleep quality. Additional research is needed to determine whether 5-HTP is safe and effective for people with insomnia.

Melatonin (0.5 to 3 mg, one and a half to two hours before bedtime):
Melatonin is a natural hormone that regulates the human biological clock. It is most helpful for elderly people with insomnia, less so for middle-aged people, and probably ineffective for young people with insomnia.
Caution : Melatonin is a potent hormone, and its long-term safety is not established. It should therefore be taken only with the supervision of a healthcare provider.

Key herbs

Valerian (Valeriana officinalis) (a concentrated [4–5:1]
Valerian root supplement in the amount of 300–400 mg can be taken 30 minutes before bedtime; or, 2 to 3 grams of the dried root in a capsule or 5 ml tincture can be taken 30 minutes before bedtime): Herbal remedies have been used safely for centuries for insomnia. In modern herbal medicine, the leading herb for insomnia is valerian. Valerian root makes getting to sleep easier and increases deep sleep and dreaming. Valerian does not cause a morning “hangover,” a side effect that occurs in some individuals who take prescription sleep drugs.
Other herbs that may be helpful

Corydalis (Corydalis yanhusuo)
(Ideally, standardized to provide 100–200 mg of dl-THP at bedtime): Corydalis contains several alkaloids; tetrahydropalmatine (THP) is considered to be the most potent. Clinical trials on a form of THP have shown that the ability to get to sleep was improved in persons suffering with insomnia after taking 100–200 mg of THP at bedtime. No drug hangover symptoms were reported by individuals taking the alkaloid extract.

Lifestyle changes that may be helpful

Behavior :
A steady sleeping and eating schedule combined with caffeine avoidance and counseling sessions using behavioral therapy has reduced insomnia for some people, as has listening to relaxation tapes.

Exercise :
The effect of exercise on sleep has not been well studied; however, some doctors recommend daily exercise as a way to reduce stress, which in turn can help with insomnia.

Epsom-salts bath :
Take a 15- to 20-minute hot Epsom-salts (magnesium sulfate) bath before bedtime. One or two cups of Epsom salts in a hot bath may act as a muscle relaxant.

Quit Smoking :
Smokers are more likely to have insomnia than are non-smokers.

Dietary changes that may be helpful

Avoid caffeine :
The effects of caffeine (a stimulant) can last up to 20 hours, so some people will have disturbed sleep patterns even when their last cup of coffee was in the morning. Black and green tea, cocoa, chocolate, some soft drinks, and many over-the-counter pharmaceuticals also contain caffeine.

High-carbohydrate food :
Eating a slice of bread or some crackers before bedtime can significantly increase levels of serotonin, which is known to reduce anxiety and promote sleep.

Avoid food allergens :
Food allergy may also contribute to insomnia. In a study of eight infants, chronic insomnia was traced to an allergy to cow's milk; avoidance of milk resulted in normalized sleep patterns.

Other integrative approaches that may be helpful

Counseling and behavioral therapy :
A combined program of counseling, sleep restriction methods (i.e., the only time spent in bed is when sleeping), and control of stimuli that might interfere with sleep may help with insomnia.



* Although evidence suggests that this supplement/herb may be beneficial, an effective dose has not been clearly established. Consult with your healthcare practitioner. 

All health-related material and links contained in this document are provided for information purposes only. The information in this document does not replace medical advice. Advice on treatment or care of an individual patient should be obtained through consultation with a physician or trained health care practitioner who has examined that patient or is familiar with that patient's medical history.