Sleep Disorders | July 25, 2016 | Author: Naturopath
If you suffer from insomnia, then you know how frustrating it can be to find treatments that work and continue to work. You’ve probably tried many techniques, teas, and medications to help you get a restful sleep, and might be fed up with the short-term fixes.
You’re not alone!
A study conducted in 2010 estimated that at least 8.9% of Australians suffer from one or more sleep disorders , and over 18.4% of Australians get fewer than 6 hours of sleep per night.
With such high prevalence, there are plenty of suggestions of how to get to sleep and stay asleep, including lifestyle changes and medications.
Some turn to alcohol and illicit drugs to knock them out in the evening.
All of these techniques work some of the time for some people. So why not all the time, and why not for everyone?
Treating the cause is the only way to end insomnia. Symptomatic relief is important to catch up on sleep, but ultimately the only permanent solution is to find the cause and treat it directly.
Here’s the kick…
The cause is different for everyone. Insomnia is a symptom of many underlying imbalances in the body, from hypothyroid to magnesium deficiency. It can also be a primary disorder, meaning that it can be unrelated to any other disease. In order to treat your insomnia, you first have to identify the underlying imbalances and then alter what is causing them. But to understand insomnia, we first have to understand sleep.
Without getting too technical, there are some key things about the science of sleep that can help us with insomnia.
It is believed that the brain has two major areas relating to sleep-wake cycles: the hypothalamus is in charge of sleep, while wakefulness is taken care of by a network of structures in the brain stem, hypothalamus and forebrain. While these sections of the brain are considered the headquarters, they both influence and are influenced by circadian rhythms and neurotransmitters.
Let’s keep it simple:
Circadian rhythms are internal cycles that (ideally) align with light-dark cycles of day and night. They are mostly disrupted by external factors such as jet- lag or shift-work, but internal factors can throw them out too, such as neurotransmitter imbalances. NOTE: Insomnia can be is a common side effect of many medications. You may need to see your doctor to discuss your dosage or alternative medications.
You have probably heard of melatonin, a neurotransmitter (a type of hormone) that causes drowsiness at the end of the day. There are many other hormones involved in the sleep/wake cycle, but there are five key neurotransmitters that must be in balance to get a good night’s sleep: serotonin, melatonin, adenosine, GABA and histamine. If one is out of balance, sleep will be disturbed; by identifying which one is out, you can target treatment to re- balance the whole system.
Melatonin sets circadian rhythms, causes nighttime drowsiness, and helps us get to sleep. When triggered by the circadian clock and darkness, the pineal gland converts serotonin into melatonin, the most well-known sleep hormone.
The conversion depends on a methylation process that requires vitamin B6, vitamin B12 and folic acid.
Adenosine is the major sleep molecule. It increases the quality and length of deep sleep, keeping us in deep REM by inhibiting activity in the cerebral cortex. An imbalance results in waking at night or suffering from daytime fatigue. Adenosine accumulates during prolonged wakefulness, which is why napping during the day can result in lighter sleep at night. It is created through methylation cycles and when nerve cells use ATP; both of these methods require B vitamins.
GABA reduces nerve transmission in the brain and calms nervous activity. It is created from glutamate, an excitatory neurotransmitter that will keep you awake.
This conversion requires vitamin B6 and magnesium.
Ah-choo. Histamine is a major driving factor in wakefulness (which is why anti-histamine medication can lead to drowsiness). In a healthy sleep cycle, histamine is suppressed during deep-REM and rises again towards morning. Excessive histamine (seen in people prone to allergies) can cause early waking or disrupted sleep. Quercetin, vitamin C and vitamin E help to moderate histamine’s effects.
If you have difficulty falling asleep: melatonin and GABA. If you have difficulty staying asleep: adenosine and histamine.
Affected Neurotransmitter: GABA
When we think of treating insomnia, we often go straight for dietary causes like caffeine. But the core of disturbed sleep may be feelings of danger. Do what you can to change any situation that gives you tension at night, or ask for help. If feelings of danger stem from excessive worrying, mind-body techniques can quiet the mind before bed. Yoga, self-massage, visualisation and binaural beats are great ways to increase calmness and feelings of safety. Consider what kind of media you're consuming, particularly at night –dramas, violence, horror and world news can cause the mind to carry fear to bed.
Affected Neurotransmitter: GABA, Melatonin, Adenosine, Histamine.
Chronic and short-term stress produces hormones that disrupt the sleep/wake cycle. GABA and melatonin are unable to promote relaxation when adrenaline is pumping through your veins. • Reduce the build-up of stress hormones by using mindfulness techniques, or burn them off with moderate exercise during the day. Use yoga and deep breathing in the evenings. • Calm a busy mind before bed with journaling, meditating, and progressive muscle relaxation techniques. • Soothe worrying thoughts by listening to binaural beats or hypnosis tapes.
The effects of caffeine on alertness come from its antagonism of adenosine receptors. No matter how much adenosine you have, adenosine can't do its job if caffeine is around. Caffeine also stimulates fight-or-flight pathways, and causes busy-brain worrying that keeps us up at night. “No caffeine after noon” is a good rule, or you may have to cut it out completely – even a coffee at 9 am will have residual effects in the evening for some people. Sneaky sources of caffeine include chocolate, cacao, macha, iced tea, energy drinks, some soft drinks, diet pills, and certain medications.
Alcohol may make you feel drowsy, but it causes restless sleep and frequent or early waking by blocking adenosine . Likewise, sleeping pills have a “rebound” effect where falling asleep becomes more and more difficult.
Nicotine is stimulatory and can inhibit adenosine and GABA, resulting in sleep onset latency and even marijuana has been shown to have long-term negative effects on sleep .
Affected Neurotransmitter: GABA, Melatonin
This isn’t just about having clean sheets (though that helps!). Sleep hygiene refers to anything that helps you get good quality sleep on a regular basis. • The bedroom should be a sanctuary that is only used for sleep and intimacy. It’s not a hub of activity, so television and telephones should be kept out. • Make sure that the room is dark enough and your mattress is comfortable. • Create a bedtime ritual with herbal tea and soothing music .
Affected Neurotransmitter: Melatonin There are ways to get back into rhythm if you are tired at the wrong times: • Twenty minutes of moderate intensity exercise in sunlight, daily, will reset your circadian rhythms within 3 weeks. • A gentle walk before 10 am and again at dusk will help to regulate melatonin release, keeping you alert during the day and sleepy at night. • Looking at television, phone and computer screens at night stimulates the light sensors in the retina, sending conflicting messages to your circadian regulation system. Turn off all screens and dim overhead lights at least 30 minutes before bedtime.
Affected Neurotransmitter: GABA, Melatonin, Adenosine, Histamine. B vitamins
The B group vitamins are essential for sleep neurotransmitters. In particular, B12 and folate are required for methylation pathways, and vitamin B6 is needed in enzymatic conversions. A good quality B vitamin supplement will support the balance of sleep hormones, but be sure to take it early in the day – vitamin B6 is excitatory, and can keep you awake at night!
Oral supplementation of a good quality magnesium can increase sleep quality. A bath with ¼ cup of magnesium salts (Epsom salts) three times a week is a traditional naturopathic prescription for insomnia. Add a few drops of lavender essential oil to the bath for some bedtime aromatherapy.
Some neurotransmitters like melatonin can be taken in supplement form. It’s advisable to consult a naturopath or nutritionist before taking these formulas in order to target the right neurotransmitters and keep others in balance.
Valerian root, kava and chamomile all have strong evidence showing their effectiveness against insomnia. Brew these into a herbal tea for gentle relief, and consult a naturopath or herbalist for tinctures with more robust effects.
Sleep Health Foundation (2010) The economic cost of sleep disorders.http://www.sleephealthfoundation.org.au/pdfs/news/Reawakening%20Australia.pdf Bartlett, D.J., Marshall, N.S., Williams, A. et al (2008)
Predictors of primary medical care consultation for sleep disorders. Sleep Medicine, 9, 857-864. http://www.ncbi.nlm.nih.gov/pubmed/17980655
Cunnington, D., Junge, M. F. & Fernando, A. T. (2013) Insomnia: prevalence, consequences and effective treatment. Medical Journal of Australia, 199:8, 36 – 40.
https://www.mja.com.au/journal/2013/199/8/insomnia-prevalence-consequences-and-effective-treatment Mahesh M. Thakkar, Rishi Sharma, Pradeep Sahota (2014)
Alcohol disrupts sleep homeostasis. Alcohol, 10.1016/j.alcohol.2014.07.019 Arias-Carrión, O., Huitrón-Reséndiz, S., Arankowsky-Sandoval, G. & Murillo-Rodríguez, E. (2011)
Biochemical modulation of the sleep-wake cycle: endogenous sleep-inducing factors. Journal of Neuroscience Research, 89:8, 1143 – 1149.
http://www.ncbi.nlm.nih.gov/pubmed/21557294 Jespersen, K. V., Koenig, J., Jennum, P. & Vuust, P. (2015) Music for insomnia in adults. Cochrane Database. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010459.pub2/abstract Bent, S. et al. (2006)
Valerian for Sleep: A Systematic Review and Meta-Analysis. American Journal of Medicine, 119:12, 1005 – 1012.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394901/ Brown, R. P. & Gerbarg, P. L. (2001) Herbs and nutrients in the treatment of depression, anxiety, insomnia, migraine, and obesity. Journal of Psychiatric Practice, 7:2, 75 – 91.