Sleep! An informative article

I have been given permission to reproduce this article here.

It is written by Dr. Grisanti (www.YourMedicalDetective.com)


Insomnia refers to a prolonged inability to get adequate sleep. About one out of three people have insomnia sometime in their life. Chronic sleep problems can seriously disrupt your life, taking a heavy toll in both your personal and professional relationships. Failure to get a good night's sleep can affect not only your energy level and mood but your health as well.

While everyone occasionally experiences sleeplessness, chronic insomnia is an ongoing, often debilitating condition. After a night of too little sleep, those with insomnia report impaired mental and physical abilities, diminished memory, reduced alertness, and impaired reaction time.

And although sleep disorders can be debilitating in and of themselves--over time they can spur additional health problems by weakening your immune system and decreasing your natural resistance to infection, depression, cell breakdown, and disease.

How Much Sleep Do We Need

How much sleep is enough varies. Although 7 1/2 hours of sleep is about average, some people do fine on 4 or 5 hours of sleep. Other people need 9 or 10 hours a night.

http://www.yourmedicaldetective.com/...startquote.gifInsufficient sleep can also lead to serious or even fatal accidents. More than 100,000 crashes each year are due to drivers falling asleep at the wheelhttp://www.yourmedicaldetective.com/public/endquote.gif
--National Highway Traffic Safety Administration

Sign and Symptoms

Inability to sleep enough at night
Difficulty falling asleep at night
Waking up during the night
Waking up too early
Awakening not restored, even after a full night's sleep
Daytime fatigue or sleepiness
Daytime irritability

Common Causes of Insomnia To Rule Out

Stress

Anxiety: Everyday anxieties may keep your mind too alert to fall asleep.

Depression: due to chemical imbalances in your brain or because worries that accompany depression may keep you from relaxing enough to fall asleep when you want to.

Stimulants. Prescription drugs, including some antidepressant, high blood pressure and steroid medications, can interfere with sleep. Many over-the-counter (OTC) medications, including some pain medication combinations, decongestants and weight-loss products, contain caffeine and other stimulants.

Change in your environment or work schedule.Travel or working a late or early shift can disrupt your body's normal sleep rhythms, making you unable to get to sleep when you want to.
window.google_render_ad();Medical conditions that cause pain</B> These include arthritis, fibromyalgia and neuropathies, among other conditions.

Eating too much too late in the evening. Having a light snack before bedtime is OK, but eating too much may cause you to feel physically uncomfortable while lying down, making it difficult to get to sleep. Many people also experience heartburn, a backflow of food from the stomach to the esophagus after eating. This uncomfortable feeling may keep you awake.


Clinical Lab Assessments

Some of the following laboratory testing can provide information necessary for diagnosis and treatment. In addition, the tests listed may also give insight to functional metabolism and functional nutrient status in the body.


Amino Acid Profile

The right balance of amino acids can improve the quality of sleep and decrease the time it takes to fall asleep at night.

Several amino acids have impact on healthy sleep patterns. One of these amino acids, tryptophan, has been called a "natural hypnotic" for its important role in the biochemical mechanism of sleep. Research has shown tryptophan improves the quality of sleep and reduces sleep latency--without giving rise to the negative effects on memory and cognitive performance that are often seen in association with benzodiazepine drugs.


Adrenal Function Profiles

High levels of cortisol are associated with stress, restlessness, and the inability to sleep deeply throughout the night.

The adrenal glands release cortisol as a response to stress--in effect prolonging the body's "fight or flight "response. Oversecretion or a disrupted secretion pattern of cortisol can drastically interfere with sleep patterns. Thus cortisol imbalances can result not only in insomnia, but in the tendency to wake often during the night, and to feel "unrefreshed" even after getting a full night's sleep.

Another hormone produced by the adrenals, DHEA, serves to balance some of the effects of cortisol. For example, studies show that DHEA can significantly increase REM (rapid eye movement) time during sleep.


Insulin and Cortisol:

The interactions of these hormones in the sleep-wake cycle have been found to be significant.


Melatonin Profile

Melatonin is known as the body's "biological clock," for its crucial role plays a crucial role in regulating body temperature and the sleep-wake cycle. A Comprehensive Melatonin Profile can reveal abnormal levels of melatonin that may be significantly disrupting healthy sleep patterns.


Treatment Options

Conventional

Conventional treatment of insomnia includes the use of antihistamines, sedative hypnotic drugs (benzodiazepines), antidepressants, or a combination of the above. The prescription medications most commonly used to treat insomnia include zolpidem (Ambien®), zaleplon (Sonata®), estazolam (ProSom®), flurazepam (Dalmane®), temazepam (Restoril®), and triazolam (Halcion®). Though these agents are beneficial, they often become less effective over time.


Nutritional Medicine


Melatonin
Melatonin reportedly is effective in improving sleeping patterns in phase shift workers and people who have trouble sleeping due to what is called delayed sleep phase syndrome.

Melatonin products are available as regular tablets (or capsules), sublingual tablets, and timed-release tablets. Sublingual tablets, which are fast acting, work best for people who have difficulty falling asleep. Timed-release products work better for people who wake up during the night. Some take both, a sublingual to get to sleep and a timed-released tablet to help them have a better chance of sleeping through the night.


5-Hydroxytryptophan (5-HTP)

5-HTP (5-Hydroxytryptophan) is the immediate precursor to serotonin, which is converted into melatonin in the brain. Thus, 5-HTP is a product that can be used to improve sleep patterns. Animal studies report that 5-HTP is significantly more effective than tryptophan at inducing dose-dependent changes in sleep-wake activity.


Herbal Medicine

Passionflower

Passionflower has been reported to have sedative, hypnotic, antispasmodic, and anodyne properties. Passionflower has been reported effective when used in combination with other sedative and anti-anxiety herbs such as valerian.


Valerian

Valerian has long been used as an agent to soothe the nervous system in response to stress. Valerian root makes getting to sleep easier and increases deep sleep and dreaming. It has been reported that valerian helps improve sleep quality. Valerian does not seem to produce the morning drug hangover effect as seen with some benzodiazepines.

http://www.yourmedicaldetective.com/...startquote.gifA double-blind trial found that valerian extract(600 mg 30 minutes before bedtime for 28 days) is comparable in efficacy to oxazepam (Serax®), a commonly prescribed drug for insomnia.http://www.yourmedicaldetective.com/public/endquote.gif
--Institute fur Psychomatische Forschung, Stuttgart, Germany. 2002

Hops

Hops was reported to improve sleep disturbances when given in combination with other sedative herbs such as valerian root and passionflower.


Tips for Better Sleep

Try one or two of the following tips or a combination until you have enough quality sleep to feel alert and well rested. If these tips don't work, see your doctor. You could have a sleep disorder, such as obstructive sleep apnea, that requires medical attention.

1) Avoid caffeine and alcohol in the afternoon and evening. Some people report that small amounts of caffeine can keep them awake, even 8-10 hours after consumption

2) Maintain a consistent bedtime routine. Go to bed and wake up at the same time every day, even on weekends

3) Avoid trying to sleep. The harder you try, the more awake you'll become. Read in bed until you become very drowsy and fall asleep naturally. In the morning, get up at the same time as usual even if you read for a large part of your time in bed.

4) Exercise during the day can improve sleep at night.

5) Increase your body temperature slightly before bed in a warm bath or shower. The subsequent decline can help induce and maintain sleep.

6) A slightly cool room is ideal for sleeping

7) Try to stop work or doing tasks that keep the mind active earlier in the evening.

8) Avoid watching television before bed. The lights and sounds can over-stimulate the nervous system.

9) Hide the bedroom clocks. Set your alarm so that you know when to get up, but then hide all clocks in your bedroom. The less you know what time it is at night, the better you'll sleep.

10) A naturopathic therapy for insomnia is take a 15- to 20-minute hot Epsom-salts bath before bedtime. One or two cups of Epsom salts (magnesium sulfate) in a hot bath are thought to act as a muscle relaxant.

11) Avoid or limit naps. Naps can make it harder to fall asleep at night. If you can't get by without one, try to limit a nap to 45 minutes in bed and to 30 minutes asleep.

12) Check your medications. If you take medications regularly, check with your doctor to see if they may be contributing to your insomnia. Also check the labels of OTC products to see if they contain caffeine or other stimulants, such as pseudoephedrine.

13) Learn stress reduction techniques. This is different for many, but exercise, yoga, tai chi, or any activity that will bring joy and calmness is a big step in the right direction.

14) People who wake up during the middle of the night do so because of hypoglycemia. Consuming a small snack just before bedtime helps to stabilize blood sugar levels throughout the night. Ideally, snacks should consist of complex carbohydrates, along with a little fat and protein. This allows for more of a timed-release breakdown and release of energy into the body.

Clinical Observations:

Food allergy may also contribute to insomnia. In a trial involving eight infants, chronic insomnia was traced to an allergy to cow’s milk. Avoidance of milk resulted in a normalization of sleep patterns.

References

Born J, et al. Night-time plasma cortisol secretion is associated with specific sleep stages. Bio Psychiat 1986;21:1415-1424.

Born J, et al. Gluco- and antimineralocorticoid effects on human sleep: a role of central corticosteroid receptors. Amer J Physiol 1991;260(2 Pt 1):E183-E188.

Dahlitz M, Alvarez B, Vignau J, English J, Arendt J, Parkes JD. Delayed sleep phase syndrome response to melatonin. Lancet 1991;337: 1121-1124.

Dollins AB, Zhdanova IV, Wurtman RJ, Lynch HJ, Deng MH. Effect of inducing nocturnal serum melatonin concentrations in daytime on sleep, mood, body temperature, and performance. Proc Natl Acad Sci USA 1994;91:1824-1828.

Petrie K, Dawson AG, Thompson L, Brook R. A double-blind trial of melatonin as a treatment for jet lag in international cabin crew. Biol Psychiatry 1993;33: 526-53.

Jan EJ, O'Donnell ME. Use of melatonin in the treatment of paediatric sleep disorders. J Pineal Res 1996;21(4):193-9.

Onen SH, Onen F, Bailly D, Parquet P. Prevention and treatment of sleep disorders through regulation of sleeping habits. Presse Med 1994;23(10):485-9.

Spinweber CL. L-tryptophan administered to chronic sleep-onset insomniacs: late-appearing reduction of sleep latency. Psychopharmacology 1986;90(2):151-5.

Schneider-Helmert D, Spinweber CL. Evaluation of L-tryptophan for treatment of insomnia: a review. Psychopharmacology 1986;89(1):1-7.

Williams DC. Periodic limb movements of sleep and the restless legs syndrome. Va Med Q 1996;123(4):260-5.

Fitten LJ, et al. L-tryptophan as a hypnotic in special patients. J Am Geriat Soc. 1985;33:294.

Van Cauter E, Blackman JD, Roland D, Spire JP, Refetoff S, Polonsky KS. Modulation of glucose regulation and insulin secretion by circadian rhythmicity and sleep. J Clin Invest. Sep1991;88(3):934-42.

Beyer CE, Steketee JD, Saphier D. Antioxidant properties of melatonin - an emerging mystery. Biochem Pharmacol. Nov1998;56(10):1265-72.

Kayumov L, et al. Melatonin, sleep, and circadian rhythm disorders. Semin Clin Neuropsychiatry. Jan2000;5(1):44-55.

Skene DJ, et al. Use of melatonin in the treatment of phase shift and sleep disorders. Adv Exp Med Biol. 1999;467:79-84.

Dagan Y, et al. Evaluating the role of melatonin in the long-term treatment of delayed sleep phase syndrome (DSPS). Chronobiol Int. Mar1998;15(2):181-90.

Imeri L, et al. 5-Hydroxytryptophan, but not L-tryptophan, alters sleep and brain temperature in rats. Neuroscience. 2000;95(2):445-52.

Soulimani R, et al. Behavioural Effects of Passiflora incarnata L. and Its Indole Alkaloid and Flavonoid Derivatives and Maltol in the Mouse. J Ethnopharmacol. Jun1997;57(1):11-20.

Bourin M, et al. A Combination of Plant Extracts in the Treatment of Outpatients with Adjustment Disorder with Anxious Mood: Controlled Study Versus Placebo. Fundam Clin Pharmacol. 1997;11(2):127-132.

Speroni E, et al.Neuropharmacological Activity of Extracts from Passiflora incarnata. Planta Med. Dec1988;54(6):488-491.

Lindahl O, Lindwall L. Double Blind Study of Valerian Preparations. Pharmacol Biochem Behav. 1989;32(4):1065-66.

Leathwood PD, et al. Aqueous Extract of Valerian Root (Valeriana officinalis L.) Improves Sleep Quality in Man. Pharmacol Biochem Behav. 1982;17:65-71.

Balderer G, et al. Effect of Valerian on Human Sleep. Psvchopharmacology. 1985;87:406-09.

Santos MS, et al. Synaptosomal GABA Release as Influenced by Valerian Root Extract--Involvement of the GABA Carrier. Arch Int Pharmacodyn Ther. 1994;327(2):220-31.

Haimov I, Laudon M, Zisapel N, et al. Sleep disorders and melatonin rhythms in elderly people. BMJ 1994;309:167.

Singer C, McArthur A, Hughes R, et al. Melatonin and sleep in the elderly. J Am Geriatr Soc 1996;44:51 [abstr #A1].

:yesyes: I would have thought that insomniacs would have been falling over themselves to thank you for such an informative piece of information:yesyes:
ANd also for your kindness in finding and posting it:yesyes:
It is not a problem that I have but it is there for when needed.
Thank you
:hugs: :hugs:
Best wishes
June

thanks for that it has given me something to think about

Debbie

Hi Nic :D :hugs:

What a GREAT informative thread :yesyes:

I have had, (NOTE the word HAD) sleep problem all my life, but the oppiset of this thread, hehe, far to much sleep, tierdness, Zaps of tiredness, it was only when I joined this great site I came to understand that it was all due to anxiety AND I COULD do something about it.:yesyes: To have something all your life and to think you cannot do anything about it, being tierd of being tierd, so to speak, it wieghted very heavy on my life, BUT NOT ANYMORE...

STILL doing great NO MORE PANIC, NO high anxiety and my sleep issue is almost gone, just happens now when I have issuse in life which need to be addressed, which is GREAT :yesyes:

I have had the isomia, but again when something in my life was going horrible wrong, I read this thread and was nodding my head with all the good advice in it, IT DOES WORK.

THANK you Nic for such informative info, HAY, AS ALWAYS :yesyes: :hugs:

YOU TAKE CARE

LOVE JILL XXX

nice one sticky...top bit of info....Cheers

Thanks for that... i'm sure it will keep me awake trying to remember all of those tips! :D

Suppose i'd better go to bed now...:blush:

thanks alot for this i havent slept a full nite in about 2 years.

Thank you for this Nicola,

over the past two months i just cant sleep more than 2/3 hours and was so desperate for some help, this helps a lot, I think I will try the Kalms I bought and see as they contain all the natural products stated above.

Just hope no side effects, got enough of those already lol



Thank you

Wow Nicola,
Thats a great selection of info on sleep.
Thank you

thank you

Thanks Nic, an interesting article to read :)

Unfortunately I have already done most of what is suggested on there, I switched to decaffeinated drinks last year following the advice from my psychiatrist.

I've tried to go to bed at the same time every night and get up at the same time every morning, but I just couldn't cope, some nights I was getting less than 2 hours sleep and it was leaving me feeling really out of sorts and having real problems functioning :wacko:

I know that it's already having a bad effect on my physical health too, I keep breaking out in cold sores and the like because I'm becoming run down.

I think I'm going to ring my doctor tomorrow and seek further advice as to what I can do without the need for any more medication :)

Quote:

---

Originally Posted by AuntieMoosie

Thanks Nic, an interesting article to read :)

Unfortunately I have already done most of what is suggested on there, I switched to decaffeinated drinks last year following the advice from my psychiatrist.

I've tried to go to bed at the same time every night and get up at the same time every morning, but I just couldn't cope, some nights I was getting less than 2 hours sleep and it was leaving me feeling really out of sorts and having real problems functioning :wacko:

I know that it's already having a bad effect on my physical health too, I keep breaking out in cold sores and the like because I'm becoming run down.

I think I'm going to ring my doctor tomorrow and seek further advice as to what I can do without the need for any more medication :)

---

Auntie Moosie, hello. Did you suss out your sleep pattern or are you still having problems? Like you I see the small hours with increasing regularity and have tried sleep hygiene tactics without success. Have forgotten what it's like to sleep until 7 or 8am :-(

Oh, dear, this is really so informative. Most of the people in our society are not so well known about sleep. They take it as an easy matter. But your article gives me the new way to know more about sleep.

I do not believe in anything whatsoever. The only medicine works for me is Mirtazapine, it is a magic soltab, take it, after 30 minutes sleeping like a dead creature, wake up on time like you have never slept, even with no dreams at all. :D

In these moments I go through this

Great article I’ve currently dipped do from 7-9 hours down to 4-5 so this is great to remind me I can function on a small amount I know mine is down to a bit of stress and anxiety and hopefully I can tackle both as much as I can I I know with time and patience it does get better 😋