INSOMNIA
Insomnia is an increasingly common problem and is the most common type of sleep disorder. At least half the population has difficulty falling or staying asleep. Sleep deprivation has a variety of bad effects on health. Industrial and motor vehicle accidents are higher in those with inadequate sleep. Most people need 7 to 8 hours of sleep nightly to function at their best. Primary insomnias are those without apparent cause. Secondary insomnia is due to medical, psychiatric or environmental causes. Conventional treatment is to identify and treat underlying causes, improving sleep habits and using medications. The most commonly used medications are benzodiazepine tranquilizers. They are effective for short-term management and improve quality of sleep as well as shortening time to onset of sleep. The sedative effects often linger and can cause daytime sleepiness and cognitive impairment. They can be habit forming and may cause a rebound worsening of the insomnia when stopped suddenly. Ambien, a newer drug, has a shorter duration of action and has less potential to cause side effects or rebound. If depression is part of the problem, use of the older antidepressants such as Elavil or Desyrel can be used to treat both the insomnia and the depression. Over-the-counter drugs such as antihistamines may help but they tend to have a prolonged effect and cause daytime drowsiness and dry mouth.
Factors which can cause insomnia include older age, alcohol, caffeine, tobacco, decongestants, drugs (thyroid medication, oral contraceptives, beta blockers, marijuana, cocaine, amphetamines), overactive or underactive thyroid function, B vitamin deficiency, sugar, food sensitivity, chemical sensitivity, menopause, hypoglycemia, nocturia (frequent nighttime urination), allergies, pain, noise or other environmental factors, anxiety and worry, depression, grief and manic-depressive illness (bipolar disorder). A significant contributor in our society is overwork and excessive stimulation with continual pressure to accomplish more in less time.
A holistic approach should address all of these issues. Eliminate caffeine in coffee, tea, chocolate, and cola drinks. Stop all use of tobacco products. Check to see if any OTC drugs being used have caffeine or decongestants. Check with your physician about any prescription drugs and whether they can cause insomnia. Foods high in tryptophan can help induce sleep. Tryptophan as a prescription supplement can be helpful. An OTC supplement with similar effects to tryptophan is 5-hydroxytryptophan. A dose of 100-200 mg before bedtime may help by boosting serotonin levels in the brain.
Melantonin is a hormone secreted by the pineal gland of the brain. It has been shown to be helpful for initiating sleep at a dose of 1-4 mg 30 to 60 minutes before bedtime. It is also helpful in treating jet lag. Progesterone, a natural hormone made by the ovaries and adrenal gland, is helpful in women with insomnia due to PMS or menopause.
Sedative herbs that may help include valerian root, hops, passionflower, and skullcap. Valerian root is most likely to help but effectiveness can wane with repeated use. Kava kava is useful in both anxiety and insomnia. St. John’s wort is an effective herbal antidepressant and may improve sleep as well. Chinese herbs and acupuncture are effective for many people.
Regular exercise (not too close to bedtime), especially outdoors in the sunlight, helps sleep. A warm or hot bath an hour before bedtime is relaxing and helpful. Using lavender essential oil in the bath water can relax tense muscles. Sleep hygiene should include a comfortable bed, restricting the bed to sleep and sexual activity only (no reading or TV), avoiding naps, a quiet and dark room, use a room humidifier for dry air, keep the room temperature at a comfortable level and go to bed at the same time each night. The best quality sleep is usually between 10 PM and 6 AM (due to circadian rhythms).
Other techniques to assist sleep include meditation, visualization, listening to audiotapes designed to induce sleep, breathing exercises and journaling. Keeping a dream journal can be helpful if frequent awakening from sleep occurs. The journal may reveal issues that your unconscious mind is working on during sleep.
Daniel Blodgett MD