Sleep Disorders | May 9, 2014 | Author: The Super Pharmacist
A common and distressing condition, insomnia usually arises as a secondary effect of another health related issue, such as an illness, injury or stressful life event, Insomnia also occurs in some individuals as a primary condition with a distinct, though not well understood cause. Healthy sleep habits, such as maintaining consistent sleeping and waking times, avoiding naps, and taking a hot bath in the evening can help treat or prevent insomnia. An array of natural supplements is also available to offer assistance for calming the nervous system and promoting sleep. When using natural remedies, always consult with your doctor for guidance in the correct forms and dosages.
The amino acids tryptophan, tyrosine and phenylalanine, all contribute to the production of the calming neurotransmitter serotonin and may be helpful for insomnia associated with anxiety17. Tryptophan, though not available as a supplement, can be obtained by eating high-protein foods such as turkey, brown rice and cottage cheese. A close substitute for tryptophan that can be found in supplement form is 5-hydroxy-tryptophan, or 5-HTP. In a study on children with sleep terrors, supplementation with 5-HTP for six months eliminated the disruptive sleep disorder in 84% of participants18. Additionally, tyrosine and phenylalanine support production of the brain-activating neurotransmitters dopamine and noradrenaline, deficiencies of which can lead to anxiety and depression17. L-theanine, an amino acid found in green tea leaves, modulates levels of the neurotransmitters gamma aminobutyric acid (GABA), dopamine and serotonin19. L-theanine has been shown to improve sleep quality without causing sedation and does not lead to daytime drowsiness. In a study of children with ADHD-related sleep disturbance, L-theanine supplementation resulted in significantly less awakening during the night19. However, amount of time required to fall asleep was not affected by L-theanine, in this study. A laboratory animal study found that L-theanine may help improve sleep quality by counteracting some of the stimulant effects of caffeine20. While it didn't decrease wakefulness, L-theanine significantly improved duration of slow-wave sleep, a category of non-REM sleep.
An herb in the same family as the opium poppy, California poppy, (Eschscholzia californica), offers nerve-calming benefits without the narcotic effects of the opium poppy. This herb also has mild pain-relieving benefits and has been used to relieve anxiety associated with certain phobias. It is usually combined in low doses with other herbs to improve mood and in higher doses as a sleep aid1. On a precautionary note, California poppy contains an alkaloid compound that activates the hormone oxytocin, which causes uterine contractions and should not be used by pregnant women1.
Apigenin, an active compound in chamomile (Matricaria recutita), binds to the same receptor as benzodiazepines, a category of sedative hypnotic drugs including diazepam and alprazolam, used as sleep aids2. In an animal study, low doses of apigenin reduced anxiety without sedation while higher doses resulted in a mild sedative effect2.
This herb, Humulus lupulus, lends the characteristic bitter flavor to beer and has been used in traditional herbalism for its purported sedative effects. An oil in fresh hops is thought to contribute to its calming benefits, but is mostly lost in the drying processing3. Though research evidence in support of the sedative effects of hops has been inconclusive, it is often included in formulas with other sedative herbs to help boost their effects. A combination of valerian and hops produced superior benefits for reducing time to fall asleep compared to valerian alone, in one study29
A pleasantly scented aromatic herb, lavender (Lavandula angustifolia), is approved for the treatment of restlessness, insomnia, nervous stomach and intestinal conditions1. Supplementation with lavender oil capsules decreased anxiety as effectively as the drug Lorazepam, improved sleep quality in depressed patients and significantly improved symptoms of insomnia and agitation in non-depressed patients, in one study4.Aromatherapy with lavender essential oil reduced blood pressure significantly and improved sleep quality modestly in a group of hospital patients5. Aromatherapy with lavender, chamomile and neroli in 6:2:0.5 ratio lowered anxiety and improved sleep significantly in cardiac intensive care patients6.
Approved by the German Commission E for insomnia related to nervousness, lemon balm (Melissa officinalis), relieves anxiety and improves mood. Lemonbalm is effective at low doses of 300 mg/day1. It has been found to reduce agitation in Alzheimer's patients1. Lemon balm has an excellent safety profile, though it should be used with some caution for people with thyroid conditions as it has been shown to suppress thyroid function and used to treat hyperactive thyroid conditions itself1. It is thought that certain components of the plant neutralize its thyroid-inhibiting activity in general use1. Single doses of lemon balm increased calmness in healthy volunteers, in one study8. Lemon balm has been found to activate acetylcholine, a brain-stimulating neurotransmitter that regulates sensory processing and attention. Deficits or inhibition of acetylcholine often lead to depression8. A combination of lemon balm and valerian root, in 600 mg/day doses, decreased anxiety in a group of healthy volunteers. However, a 1,800 mg dose resulted in increased anxiety9.
Flowers of the linden tree, Tilia americana, have historically been used for their sedative, tranquilizing effects. Linden helps lower blood pressure and has been used for its calming effects in elderly patients with nervousness1. Preliminary studies show that linden reduces stress and increases physical indurance1. Flavonoid compounds in linden have shown sedative and anti-anxiety effects in laboratory animals7.
The minerals calcium and magnesium work in concert with each other to control muscle contraction and relaxation. Calcium acts as the chemical messenger that tells muscles to contract while magnesium exerts a calming, relaxing effect. In elderly patients with insomnia, magnesium supplementation has been shown to decrease the amount of time it takes to fall asleep and prevent awakening too early11. Magnesium also increases total sleep time and sleep efficiency – the percentage of time spent in bed asleep11. Additionally, magnesium supplementation leads to a rise in melatonin levels and a drop in cortisol levels11. In one study, Magnesium supplementation was found to reduce the frequency of nocturnal leg cramps, a chronic and painful condition that leads to insomnia in those affected, by almost half. Severity and duration of cramps was not affected, however10.
Supplementation with melatonin, a brain hormone that control sleep/wake cycles, improved sleep quality in a study of breast cancer survivors, for whom sleep disturbances are a common problem12. No adverse effects were noted. Declining melatonin production, a normal part of the aging process, contributes to poor sleep quality and impaired ability to function during the day in many elderly people. In one study, melatonin supplementation for three weeks significantly improved sleep quality and morning alertness13. Discontinuing the supplement did not result in withdrawal symptoms or rebound insomnia. Melatonin combined with the minerals magnesium and zinc improved ability to fall asleep, quality of sleep and next morning alertness in a study of elderly long-term care facility residents14.
A compound in oats, called methylbutenol, which develops during drying, is known to have sedative effects3. In one study, brainwave recordings were made after participants consumed a lozenge containing lavender oil, hops extract, lemon balm and oats35. Results showed increases in alpha1, which contribute to a relaxed state of attention, alpha 2, which facilitate working memory and beta 1, which are associated with low anxiety states. Oats are highly safe, with no reported adverse effects or interactions1.
Omega 3 fatty acids offer anti-inflammatory benefits that may improve sleep for patients with a sleep disorder known as obstructive sleep apnea, OSA15. These fats have been shown to lower levels of an inflammation-promoting molecule called TNF-alpha, which is commonly elevated in OSA patients and leads to inflammation in the sinuses and nasal passages that contributes to airway obstruction and sleep disruption in OSA15. Omega-3 fatty acids also alleviate symptoms of depression and depression-related insomnia, in part by contributing to healthy brain growth and development16. As an important structural component of nerve cell membranes, the communication interface between nerves, omega-3 fatty acids help the brain function more efficiently16. Additionally, omega-3 fatty acids reduce inflammation in a part of the brain that helps control the body's stress response and sleep reflex16.
Approved by the German Commission E for treating nervous restlessness, passionflower (Passiflora incarnata) has been shown to be as effective as the drug oxazepam for alleviating insomnia without impairing job performance1. Passionflower binds to the samereceptorsite as benzodiazepine drugs and reduces anxiety without impairing memory, a common side effect of benzodiazepines21. Higher doses of passionflower had a sedative, sleep-inducing effect in a preliminary animal study21. Sleep quality improved significantly for a group of adults without insomnia who consumed passionflower tea. Passionflower has sedative and anti-anxiety effects22. This herb has a high safety profile with few reported adverse effects1.
Often used as a natural alternative to prescription antidepressants, St. John's Wort (Hypericum perforatum) demonstrated improved sleep quality in addition to alleviating symptoms of depression, in one study31. St. John's Wort exhibited sedative effects and was found to act on the GABA receptor in a similar manner to benzodiazepine drugs, but without having narcotic-like activity, in a preliminary animal study32.
A compound called baicalin, an active constituent of skullcap (Scutellaria baicalensis) is known to decrease inflammation and activate GABA receptors33. Baicalin has also been found to help regulate the sleep-wake cycle and balance REM and non-REM sleep phases33. A laboratory animal experiment found that baicalin produced sedative and anti-anxiety effects by activating GABA receptors in a manner similar to that of non-benzodiazepine drugs, such as Ambien and Lunesta34.
Widely used for its reputed nerve-calming, muscle-relaxing benefits valerian root (Valeriana officinalis) contains a compound called valerenic acid, that stimulates GABA receptors23. Valerian root also reduces alertness and induces sleep by activating adenosine, a compound that inhibits activity of the frontal lobes, the area of the brain that controls planning and reasoning24. One study found supportive evidence for the use of valerian for insomnia but not for anxiety25. Valerian root produced marked improvement in sleep quality in a study of adults with chronic primary insomnia 25 to 65 years of age25, though researchers note that the placebo, olive oil, worked nearly as well. In another study, menopausal women, 50% of whom experience sleep problems, reported improved sleep quality when they supplemented with valerian for four weeks26. A combination of valerian and lemon balm improved sleep patterns in menopausal women, in one study27. Valerian together with hops may be effective for promoting sleep as a single, one-night dose28. A mixture of valerian, passionflower and hops reduced time to fall asleep and number of times participants woke up during the night and increased total sleep time in a two-week study of patients with primary insomnia30. The herbal combination produced comparable results to the prescription sleep aid zolpidem. Minor side effects, predominently drowsiness, occurred in both groups30.
The seeds of this spiny, semi-tropical shrub are used in Asian traditional medicine for their sedative and sleep-inducing effects. Flavonoid antioxidant36 and saponin37 compounds have been identified as the active components in zizyphus. These constituents activate GABA-A receptors, the same attachment site used by most prescription sedative-hypnotic drugs, and may function in a similar manner to diazepam36. They have also been found to suppress central nervous system activity without impairing motor coordination39. In a laboratory animal study, zizyphus phenolic and flavonoid extracts significantly increased sleeping time in mice36. Zizyphus may also influence serotonin pathways that help decrease amount of time needed to fall asleep and increase amount of time spent in REM sleep and slow-wave non-REM sleep38.
The long-honoredtradition of drinking a glass of warm milk at night to promote sleep has received the backing of modern science. The secret to milk's soporific effects is contained in a peptide known as alphaS1-casein, a portion of the milk protein casein. Preliminary research found that supplementation with alphaS1-casein reduced the detrimental effects of chronic stress on sleep by helping maintain sufficient amounts of REM and slow-wave sleep – a form of deep, non-REM sleep40. In a human trial, the milk peptide decreased blood pressure and cortisol levels41. Additionally, alpaS1-casein may exert similar anti-anxiety effects to diazepam without the impaired judgment and risk taking behaviour that can occur as a side effect of that drug42. AlphaS1-casein is available commercially in the form of a supplement called Lactium.