I was listening to an interview on Natural Medicine Journal's website about insomnia recently and wanted to share some tips that I learned from John Neustadt, ND. I've written about how menopause affects your sleep and how to get better sleep in general, but he brought up some tips that I haven't covered and I thought might be helpful to you all.
Risk of Sleep Aids
Many people with insomnia may be prescribed medications like benzodiazepines or drugs like Lunesta, but both can have some scary side effects and may not even improve the quality of your sleep that much. Benzodiazepines can cause lightheadedness and increase the risk of falling injuries especially in the elderly. Lunesta can cause impairment during the day, amnesia, worsening depression and cause you to do things like drive or eat food while you are asleep. It provides about an extra 30 minutes of sleep per night but doesn't allow you to get into the restorative deep sleep cycles that you need.
Check Your Medications
These medications can interfere with your sleep through different mechanisms. Even if your medication isn't on this list, it's a good idea to look them up to see if insomnia is a known side effect.
Prednisone or other steroids (ie. prednisolone, hydrocortisone, dexamethasone) - these are very good at reducing inflammation but side effects can include insomnia, anxiety and depression.
Beta blockers (ie. atenolol, metoprolol, propranolol) - these are used for cardiovascular conditions like high blood pressure and congestive heart failure, but they can reduce melatonin production. Melatonin is a hormone that our bodies produce at night to help us fall and stay asleep.
Anti-depressants (ie. citalopram, bupropion, paroxetine, fluoxetine) - these can cause you to either not sleep enough or want to sleep too much
Melatonin
This is something that many people start with when they use natural products to treat insomnia. Melatonin's natural rhythm is to rise around 10pm, peak around 2am and then decline around 6am so that we wake up naturally. Melatonin can be helpful if you are having trouble falling asleep because it stays in your system for about 1-2 hours before your body metabolizes it. If your issue is staying asleep, melatonin may not be the answer for you, however, there is a timed-release form of melatonin that can help you both fall asleep and stay asleep. If you take too much you may feel groggy the next morning so use the lowest dose that's effective.
Nutritional and Herbal Therapy
There are many different reasons why sleep can be difficult so it's hard to give a one-size fits all answer. Here are some other nutrients to consider.
Magnesium if your sleep is disturbed by pain or anxiety. This can decrease your threshold for pain and relax muscles.
Neurotransmitters like glycine, GABA and L-theanine are calming to the nervous system. L-theanine is great if anxiety and worry are keeping you up and can be used during the day because it has a calming effect without making you feel sedated.
Herbs like hops, skullcap and adaptogens like ashwagandha and magnolia can be used to relieve nervous tension and support the adrenals if stress is a factor
Diet and Lifestyle
Nutrients are great and can be useful while you work on other possible causes for insomnia, but don't forget to address them too. Naturopathic medicine's goal is always to get to the root cause of disease and resolve the issue for good.
Acid reflux or GERD - if you experience a burning sensation in your chest or throat at night or a cough when you lay down consider talking with your doctor about acid reflux. The pain of heartburn can be enough to wake you up and interrupt your sleep. There are many natural ways that you can treat heartburn without using acid blocking medications. If you're on acid blockers and want to get off them, check out this blog post.
Poor blood sugar control - drops in blood sugar at night can increase the stress hormone cortisol and wake you up. If you tend to have an afternoon slump around 2-3pm or are waking up at the same time every night this may be an indication you're having blood sugar issues. Try eating 8-10 g of protein before bed to regulate blood sugar during the night. If this works well you may want to look into ways to better control your blood sugar during the day too.
ChiliPAD - keeping your bedroom at a cool temperature is one way to improve sleep because your body naturally lowers your internal temperature while you sleep. A temperature controlled mattress pad like this one can help to regulate temperature on either side of the bed, making it easy to adjust it to your needs. I have no affiliation with this company but think this type of product could be really great especially if you and your partner disagree on what a comfortable temperature is for the bedroom.
Stress - When our bodies are under a lot of stress it elevates cortisol and adrenaline. These two make you feel "wired but tired" in what Dr. Neustadt calls the "hyperarousal hypothesis" and can lead to difficulty falling asleep because you can't turn off your mind or relax your body. All the more reason to manage and decrease stress in your life! The goal is not to eliminate stress from your life, it's to decrease it or better learn to deal with it. The way we view a stressful event is more important than the event itself. We all have different ideas of what is stressful and what isn't. Mindset is important and techniques like journaling, setting boundaries, counseling, EFT (emotional freedom technique) can all change the way you view and react to stressful events.
Go to bed at the same time every night - Dr. Neustadt stressed the importance of going to bed at the same time every night. Many people wear Fitbits or other technology that tracks things like exercise, heart rate and sleep. When Fitbit looked at their user data they found that the best predictor of getting enough sleep was going to bed at the same time each night. This routine can train your body to get ready for sleep.
If you'd like to listen to the talk by Dr. Neustadt check it out at Natural Medicine Journal.
Summary
Dr. John Neustadt, ND, gave a talk about an integrative approach to insomnia for the Natural Medicine Journal and this post talks about the topics and tips that he discussed. Commonly prescribed sleep aids like benzodiazepines and Lunesta can have serious side effects and don't improve sleep quality very much. Certain medications may interfere with sleep such as steroids, beta blockers and anti-depressants. Because of its short half-life in the body, melatonin may not be a good option for people who have trouble staying asleep. Nutrients and herbs like magnesium, GABA, L-theanine, hops, skullcap and ashwagandha can be used for calming the nervous system and reducing stress if this is contributing to insomnia. It's important to get to the root cause of insomnia so make sure to address other health issues like GERD, acid reflux and blood sugar issues. Other tips include stress management, using a temperature controlled mattress pad like a ChiliPAD and getting to sleep at the same time every night.
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In health,
Dr. Jamie
Resources
Gazella, Karolyn, and John Neustadt. “Insomnia: An Integrative Approach.” Natural Medicine Journal, vol. 11, no. 2, Feb. 2019. https://www.naturalmedicinejournal.com/ journal/2019-02/insomnia-integrative-approach
This website is not intended for the purpose of providing medical advice. All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.