Insomnia:  Put it to Bed

by Karyn Siegel-Maier

Originally published in Let's Live Magazine

O sleep!  O gentle sleep!
Nature’s soft nurse, how have I frighted thee,
That thou no more wilt weigh my eyelids
Down and steep my senses in forgetfulness?
-- The Merry Wives of Windsor
William Shakespeare

If a good night’s sleep seems to elude you night after night, you can at least take solace in the fact that you are not alone.  About 30% of the general population regularly tunes into the late-late-soon-to-be-tomorrow show because they’ve been awake all, or most of, the night.  Worrying about your insomnia is of little help, and you might as well forget everything you’ve learned about counting sheep. Sleeping pills may provide short-term relief, but they also offer undesirable side effects and fail to address the underlying cause.  What’s an insomniac to do?  If you haven’t had a visit from the Sandman recently, there are several ways to naturally and safely put your insomnia to bed. 

Defining Insomnia 

What kind of insomniac are you?  According to the National Institutes of Health, there are three classifications of insomnia: transient, intermittent and chronic.  Transient insomnia is short-term, occurring for a single night or up to a period of a few weeks. Intermittent insomnia is the term used to describe bouts of transient insomnia experienced periodically.  Chronic insomnia amounts to sleeplessness nearly every night, lasting for a month or more. 

Most people have had a brush with transient and/or intermittent insomnia at some point in their lives.  This kind of sleep problem isn’t necessarily a disorder, but usually the result of anxiety, certain medications, illness or stress associated with an event, such as the loss of a job or spouse.  While both men and women of all ages have occasional insomnia, women witness a 40% higher rate incidence, especially those over 40 years of age.  People of advanced years also statistically evidence a greater rate of occurrence, but this is usually due to difficulty achieving or maintaining sleep due to a medical condition, rather than a decreased need for sleep dictated by popular myth. 

Contrary to another common misconception, insomnia is not necessarily defined by a reduction in the quantity of sleep, but rather sleep quality.  In fact, regardless of how long it takes you to fall asleep or the number of awakenings that you endure, you may actually be getting enough sleep after all.  To fully appreciate this point, it is important to understand your own sleep “architecture,” the term used to illustrate the pattern of alternating between REM (rapid-eye-movement), or dream sleep, and non-REM sleep. 

There are five basic stages of sleep ranging from relaxed wakefulness to a dream state. The entire cycle takes up to three hours to complete and is repeated several times each night, regardless of that time you go to bed.  As the night progresses, the duration of REM phases increase and deep sleep periods grow shorter.  In effect, our sleep becomes lighter in the second half of the night when more frequent awakenings are likely to occur.  Although you may think you never sleep a wink, the fact is that adults spend 50% of their total time asleep engaged in deep sleep early in the evening.  So, even though you may be up with the roosters (or sooner) it is possible to maintain daytime performance and alertness based on what sleep researchers refer to as “core sleep”. 

Gregg D. Jacobs, Ph.D., Assistant Professor of Psychiatry at Harvard Medical School and author of Say Goodnight to Insomnia (Henry Holt), equates the efficiency of core sleep as being akin to surviving on a baseline of adequate food intake.  Just as we often eat more than is necessary to function, we think we need more sleep than we really do.  “In this sense,” says Jacobs, “the impact of losing part or all of a night’s sleep is similar to that of skipping a meal or fasting for a day.  And just as it is possible to go without food for several days without serious consequences, we can endure a few days without sleep.  Yet missing sleep creates anxiety that missing food does not!” 

Even Insomniacs Can Learn New Tricks 

In his book, Dr. Jacobs, outlines a six-week program to reverse insomnia without the use of drugs.  His program includes cognitive restructuring, the aim of which is to identify and replace negative thought patterns with more positive ones.  As Dr. Jacobs points out in his book, “...this is not the same as denying insomnia.  Rather, cognitive restructuring means to think about insomnia in less negative and distorted ways.”  If, for example, you find yourself lying awake in bed thinking, “If I don’t get to sleep, I’ll be a wreck at work tomorrow,” you can replace the thought with something like, “All I really need is my core sleep” or, “I always fall asleep sooner or later.”  With practice, this technique will almost become automatic. 

Another strategy recommended by Dr. Jacobs is stimulus-control modification.  According to Jacobs, it’s a mistake to use the bed for anything other than sex or sleep.  Television viewing, talking with your spouse, or reviewing work-related material in bed will encourage the insomniac to cue the bed to wakefulness.  Similarly, if you awaken during the night and sleep doesn’t return within a few minutes, don’t lie in bed “trying harder” to sleep.  This will only make you anxious and reinforce being in bed with being awake. 

You Can’t Buy Sleep 

It seems logical – if you can’t sleep long, sleep less.  John Wiedman, author of Desperately Seeking Snoozin’, dealt with his own insomnia, and now helps others, by improving sleep “hygiene” and using sleep restriction techniques.  John, who calls himself a “recovering insomniac,” has struggled with chronic insomnia for most of his life.  He describes his experience has having had “bad nights and real bad nights.”  In fact, on 3-4 nights of the week, John could only get to sleep after reading the morning paper delivered at 5:00 a.m. 

John recalls that he, “followed the same path as many insomniacs.  I would use alcohol.”  John also tried a myriad of over-the-counter and prescription drugs, but to no avail.  Realizing that good sleep doesn’t come in a pill or bottle, John finally tried a different approach. “To break my cycle of chronic insomnia,” he says, “I resorted to sleep restriction where I cut my time in bed back to six hours, regardless of the number of hours I actually slept.”  John established regular retiring and rising times and adheres to them, seven days of the week.  This, he believes, helped to reset his “body clock”. 

John also recommends a pre-sleep routine, an hour or two of activity that helps you to prepare physically and mentally for the evening.  In his own routine, John includes deep breathing and relaxation exercises just before turning out the light.  As with Dr. Jacobs’ program, John advocates leaving the bedroom if there is difficulty getting to sleep or returning to sleep after awakening during the night. 

The Sleeping Herbs 

While you can rest assured that your brain is indeed programmed to make sure that you get at least enough core sleep, stress and anxiety can still form a barrier to quality sleep.  There are several herbs that can help to promote relaxation and ease the effects of stress, paving the way to a good night’s rest.  A word of caution is warranted however - it is not advisable to take any sleeping aid, natural or not, for extended periods of time. Nor should you combine anti-depressant drugs with herbal sleeping aids. If your insomnia is chronic (lasting for more than three weeks running) it may be the result of “poor sleep training.” On the other hand, it could also be brought on by a potentially serious medical condition, such as hypoglycemia, and this possibility should be ruled out before beginning any self-care.  Consult your health care practitioner for the best course of action for you.  

Valerian (Valeriana officinalis) – This herb has been used as a mild tranquilizer and sleep aid for more than 1,000 years.  In England, it was prescribed to help citizens contend with the air raids of World War II.  In terms of its efficacy, valerian has been compared to diazepam (Valium) and L-tryptophan, an amino acid necessary to produce serotonin (a neurotransmitter with sedating action) and once prescribed for sleep disorders but banned from the American market due to an incidence of contamination by a Japanese manufacturer in 1989.  The active constituent is valeric acid, found in the root of valerian.  In a double-blind study involving 128 subjects, valerian root extract provided “poor sleepers” with an improved quality of sleep as measured by their brain wave patterns.  The subjects required less time to fall asleep and experienced fewer awakenings.  Unlike most barbiturates, valerian usually doesn’t produce morning grogginess and is non-addictive.  It should be noted however, that long-term use can sometimes cause depression in some individuals.  Valerian extract is standardized to contain 0.8% valerenic acids, the dose being ½ to 1 tsp. In water 45 minutes before retiring.  The recommended dosage for capsules of the dried root is 150-300 mg. 45 minutes before bedtime.  

Passionflower (Passiflora incarnata) – This herb was first introduced to American medicine for use as a mild sedative in 1867.  The calming properties of P. incarnata should not be transferred to other species of this genus. P. caerulea for instance, a popular ornamental variety, contains toxic cyanogenic glycosides.  The mild tranquilizing effect of passionflower is due to the presence of harmine, found in the dried aerial parts of the plant.  Harmine was once called “telepathine,” so named for its ability to induce a feeling of euphoria.  In Germany, this substance was put to use as “truth serum” during World War II.  Passionflower contains other harma alkaloids that act as monoamine oxidase inhibitors (MAOs), a mechanism that combats depression and triggers the “feel good” response.  The extract or capsules should be standardized to contain 3.54% flavonoids, or isovitexin. The recommended dosage is 1 dropperful of extract in warm water, or 2 capsules of extract up to four times a day as needed.  

Gota kola (Centella asiatica) – In spite of the implication of the species name, gota kola is not related to the caffeine-containing kola nut (Cola spp.).  Gota kola is world renowned for its ability to calm mind and body.  In Ayurvedic medicine, gota kola is considered a “balancing” herb that promotes relaxation and energizes the senses. For this reason, it is often included in the diets of yogis to help achieve meditative states and improve recall.  Indian elephants, who reputedly “never forget,” often graze on the leaves.  Gota kola contains two sedatives, the saponin glycosides brahmoside and brahminoside, and is high in B vitamins, the anti-stress vitamins.  The presence of pyridoxine (vitamin B-6) reportedly has the additional benefit of aiding dream recall.  

St. John’s Wort (Hypericum perforatum) – Studies since the mid-1980’s have shown that this herb also contains MAOs and can provide significant relief from anxiety and stress, improving sleep quality.  There are at least 10 pharmacologically active constituents found in the extract, but researchers are most interested in hypericin and pseudohypericin.  The exact mechanism of the herb’s ability to alleviate depression and anxiety remain largely unknown, but a recent study may provide some clues.  The action of hypericins at alpha receptor sites, known to be involved in the role of MAOs and 5-HTP reuptake inhibitors (a metabolite of L-tryptophan in the synthesis of seratonin) lends support to the herb’s universal reputation as a mood elevator and sedative.  Preparations of St. John’s Wort are standardized to contain 0.2% hypericin acid and the usual dosage is 500 mg. per day taken with meals.  Note:  St. John’s Wort can cause photosensitization and sun exposure should be limited.  Discontinue if a skin rash develops.  

Kava-Kava (Piper methysticum) – Kava, a member of the pepper family, has been used as a natural relaxant in the South Pacific for centuries.  The four active agents of this herb, known collectively as kavalactones, have received considerable attention for their ability to relieve stress and anxiety in recent years.  Several studies have shown that kava effects a GABA-receptor-binding capacity and an ability to block norepinephrine uptake.  In a 1997 German study, 101 subjects suffering from non-psychotic anxiety took part in a 25 week placebo-controlled, double-blind trial with an extract of kava.  The researchers concluded that kava is comparable to treatment with benzodiazepines but without unwanted side effects.  The therapeutic dosage is up to 120 mg. kava lactones daily.  Note:  It is recommended that supplementation of this herb be limited to three months.  Some individuals may develop “kava dermopathy” characterized by a scaly skin rash.  

Nutritional Considerations  

In recent years, it has come to light that some sleep disorders may be caused by a deficiency of certain neurotransmitters, spawning the birth of monoamine precursor therapy.  L-tryptophan is the metabolic precursor of serotonin and melatonin, neurotransmitters with sedative qualities.  You may recall however, that L-tryptophan was banned due to contamination and the Food and Drug Administration isn’t likely to allow it back on the market any time soon.  But, a newly available supplement, 5-hydroxytryptamine (5-HTP), may be even more effective in relieving sleeplessness.  Unlike L-tryptophan, 5-HTP is readily bioavailable since it does not require a transport molecule or compete with other amino acids in the system.  While it was necessary to take L-tryptophan on an empty stomach, 5-HTP can be taken with meals.  In addition, 5-HTP is biochemically closer to serotonin, chemically known as 5-hydroxy tryptamine.  Studies have also shown that 5-HTP elevates beta-endorphins, the “feel good” hormones.  The usual dosage is 200 mg. per day.  

You can also get tryptophan from eating a carbohydrate 45 minutes before bed, such as a slice of bread or a small potato.  If you choose this method, make sure to take vitamin B-6 (50 mg.) and niacin (100 mg.) at the same time to ensure the synthesis of tryptophan to serotonin.

 

Resources: 

The National Center on Sleep Disorders ResearchTwo Rockledge Centre
Suite 7024
6701 Rockledge Drive, MSC 7920
Bethesda, MD 20892-7920
(301) 435-0199
Fax: (301) 480-3451

 

National Heart, Lung and Blood Institute Information Center - Provides a list of publications related to sleep disorders:

NHLBI Information Center
P.O. Box 30105
Bethesda, MD 30105
(301) 251-1222
Fax: (301) 251-1223
 

InsomniaCure.com
Web Site maintained by John Wiedman, author of Desperately Seeking Snoozin’. Includes a message center for “Pillow Talk

The report “Tips for a Better Night’s Sleep” is also available by calling toll-free: (877) 753-3726 

 

References: 

1.      Gregg D. Jacobs, Ph.D., Say Goodnight to Insomnia, Henry Holt, 1998.

2.      Raffa R., “Screen of receptor and uptake-site activity of hypercin component of St. John’s Wort reveals alpha receptor binding.

3.      Monograph: Piper methysticum, Alternative Medicine Review, 1998 Dec;3(6):458-60.

4.      Herb Research Foundation/BW Health Wire, April 6, 1998, “Clinical Trial shows kava reduces stress.”

5.      Volz HP, “Kava-kava extract WS 1490 versus placebo in anxiety disorders – a randomized placebo-controlled 25 week outpatient trial.” Pharmacopsychiatry 1997 Jan;30(1):1-5.

6.      Kava Root and Anxiety, The Integrative Medicine Consult, Dec. 1998, Vol. 1, No. 1.

7.      Voderholzer U., et al, “Impact of experimentally induced serotonin deficiency by tryptophan depletion on sleep EEG in healthy subjects.” Neuropsychopharmacology 1998 Feb;18(2):112-24.

8.      Birdsall TC., “5-Hydroxytryptophan: a clinically-effective serotonin precursor.” Alternative Medicine Review 1998 Aug;3(4):271-80.

9.      Guilleminault C., et al, “Nondrug treatment trials in psychophysiologic insomnia.” Archives of Internal Medicine 1995 Apr 24;155(8):838-44.

10. Interview with John Wiedman, author of Desperately Seeking Snoozin’.

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