soft nurse, how have I frighted thee,
thou no more wilt weigh my eyelids
and steep my senses in forgetfulness?
The Merry Wives of Windsor
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.
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
insomnia amounts to sleeplessness nearly every night, lasting
for a month or more.
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
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.
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
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”.
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!”
Insomniacs Can Learn New Tricks
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
strategy recommended by Dr. Jacobs is stimulus-control
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
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
Can’t Buy Sleep
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
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
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
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.
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.
(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.
(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
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.
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.
(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
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.
John’s Wort can cause photosensitization and sun exposure
should be limited. Discontinue
if a skin rash develops.
(Piper methysticum) – Kava, a member of the pepper family,
has been used as a natural relaxant in the South Pacific for
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
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
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.
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
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.
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.
The National Center on Sleep Disorders ResearchTwo Rockledge Centre
6701 Rockledge Drive, MSC 7920
Bethesda, MD 20892-7920
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
Fax: (301) 251-1223
Web Site maintained by John Wiedman, author of Desperately Seeking Snoozin’. Includes a message center for “Pillow Talk
report “Tips for a Better Night’s Sleep” is also available
by calling toll-free: (877) 753-3726
Gregg D. Jacobs, Ph.D., Say Goodnight to Insomnia,
Henry Holt, 1998.
Raffa R., “Screen of receptor and uptake-site activity
of hypercin component of St. John’s Wort reveals alpha
Monograph: Piper methysticum, Alternative Medicine
Review, 1998 Dec;3(6):458-60.
Herb Research Foundation/BW Health Wire, April 6, 1998,
“Clinical Trial shows kava reduces stress.”
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.
Kava Root and Anxiety, The Integrative Medicine Consult,
Dec. 1998, Vol. 1, No. 1.
Voderholzer U., et al, “Impact of experimentally
induced serotonin deficiency by tryptophan depletion on sleep
EEG in healthy subjects.” Neuropsychopharmacology 1998
Birdsall TC., “5-Hydroxytryptophan: a
clinically-effective serotonin precursor.” Alternative
Medicine Review 1998 Aug;3(4):271-80.
Guilleminault C., et al, “Nondrug treatment trials in
psychophysiologic insomnia.” Archives of Internal Medicine
1995 Apr 24;155(8):838-44.
Interview with John Wiedman, author of Desperately