People who get into bed, close their eyes and drift off into a blissful eight hours sleep are unlikely to understand what the fuss is about but for the rest of us insomnia is a complex and frustrating problem.
There are many different types of sleep problems: falling asleep (sleep onset), staying asleep (sleep maintenance), waking too early. Insomnia can also be acute, transient or chronic (depending how long the sleeping problem lasts) but the most common sleep problem I currently see in practice is that people are simply not getting enough hours in bed to sleep.
Having enough hours in bed
While there is conflicting information on how much sleep people need the eight hour benchmark is a good one to aim for. For an adult between 7-9 hours is the optimum range. But whether it’s our expanding work hours, family pressures, a late netball game or a busy social life – many of us just simply are not giving ourselves enough time in bed to sleep any more.
Sleep deprivation is a well documented cause of accidents, including vehicular accidents. It also disrupts the hormones that regulate our hunger/satiety causing us to eat more when we are tired. If you need to lose weight, creating a good sleep pattern is equally important as working with your diet and exercise routine. Getting too little sleep can also negatively impact on moods (can both be caused by and trigger depression), immune strength and cardiovascular health. In extreme cases insomnia causes hallucinations.
There are times when sleep deprivation may be inevitable, such as parenting a baby, jet lag and shift work. However for most of us getting enough sleep is the easiest sleep-related problem to remedy with a bit of planning. Take control of your diary for a week, banish the television and make a date with yourself in bed each night by 10 pm. Set the alarm for the same time each morning as it is the time we get up rather than our bed time alone, that establishes our sleep patterns.
So you’ve given yourself ample time to sleep but you lie awake all night, or fall asleep easily only to wake in the middle of the night or earlier than you need to. Insomnia is not all in the mind, however stress and the entire spectrum of mood disorders including anxiety and depression is a common cause. Even the fear of not being able to sleep is a known trigger. Medical conditions such as sleep apnoea, chronic pain, thyroid dysfunction, restless legs syndrome and side effects of pharmaceutical drugs also need to be ruled out as a cause.
Many sleep problems can be traced back to our hormones, in particular the regulation of cortisol (also known as “the stress hormone”). When all is going well, our cortisol levels are lowest around midnight promoting deep, blissful sleep. When stress or other factors upset our natural cortisol production, peaking when they should be falling, it can over ride other hormones (such as melatonin) that would usually help maintain our sleep.
In other words, our primitive brain thinks it is not safe for us to sleep and keeps us awake by sending out hormones that keep us alert. Naturopathy treats insomnia by treating the underlying cause, which in most cases means supporting the nervous system so we can turn the panic button off.
The naturopathic approach
Good sleep hygiene. That is not about having a bath before bed, rather it is creating a good environment and sleep pattern. The time you wake up affects the time your body will naturally want to go to sleep. As painful as it may seem to set the alarm for the same time every morning, it is the best way to reset a late sleeping pattern. Avoid computers, games and television for at least half an hour before bedtime. Try reading or listening to music in a comfortable bed until you feel sleepy and get into bed and make your bedroom as dark and quiet as possible. If you are prone to waking up in the night feeling hot or thirsty, swap your feather doona for a cotton or wool one (which is not as insulating so won’t build up heat as you sleep).
Avoid caffeine, alcohol and sugar. Caffeine (including chocolate, hot chocolates, green tea and coke) is a stimulant. Both alcohol and sugar can cause a drop in your blood glucose levels and wake you up a few hours after falling asleep. Caffeine, alcohol and apples/apple juice are diuretics and can also cause you to wake up to urinate.
Other stimulants that may interfere with sleep include nicotine, not just in cigarettes but also patches and gum. Some herbs also contain caffeine – the most common include green tea, ephedra and yerba mate. Ephedra, sometimes sold as “natural speed” or “herbal ecstasy”, though not legally available over the counter in Australia is commonly available in other countries.
Other drugs. Almost every recreational drug available will disturb your sleeping patterns and alter your moods. Whether you have become dependent on marijuana to help you sleep or moderate your stress, or use amphetamines/ecstasy to party on the weekends even after the short term drug effects have warn off, your sleep routine can be deeply effected.
Relaxing herbs. There are many herbs that help encourage the muscles to relax and calmsthe mind. The most commonly available over-the-counter are chamomile, skullcap, passionflower, hops and valerian.
Though valerian works well for most people a few will find it has the opposite effect, so if you have not tried valerian before try it on a weekend or less crucial night first.
St John’s Wort is an effective herb for stress, anxiety, depression and insomnia. But check your health care practitioner first if you are taking any pharmaceutical drugs, including the contraceptive pill or implant.
Further aids to relaxation
Consider trying the following:
· learn meditation and practice regularly
· listen to a relaxation cd
· write a to do list to signify the end of your working day
· try journal writing in the morning
· exercise regularly
Magnesium – helps you de-stress and relieve muscle tension. The therapeutic dose range is 500-1500 mg a day. High doses should be considered for anyone with restless legs syndrome. (Caution: if taking tetracycline, quinolone antibiotics or bisphosphonates separate doses by at least two hours.)
Calcium – a deficiency can also cause spasms and twitches. If magnesium alone doesn’t work try a supplement with 2 parts calcium to 1 part magnesium.
B vitamins help the body regulate stress. Take a B group supplement that includes at least 50 mg of B6 but take it during the day, at least two hours away from caffeine (which hopefully you don’t drink any more!). As B vitamins can stimulate some people avoid taking this supplement at night.
Food – other than avoiding stimulants and sugar, try to make sure you evening meal includes good quality, complex carbohydrates. These are unrefined plant foods that release sugar more slowly such as beans, lentils, brown rice, oats, nuts and seeds.
Include lots of magnesium rich foods in your daily diet including: nuts, barley, buckwheat, beans, pumpkin seeds and artichokes.
A note on hormones
Synthetic and natural hormones are often sold as “natural” products. Melatonin in particular has been used to help re-set your sleep clock. However in Australia only homoeopathic melatonin is available for sale over the counter. In other countries synthetic and bovine melatonin products can be sourced. The synthetic form is less effective, however the other “natural” source is made from animal brains. Despite it’s effectiveness, I’d argue that this product is not natural or entirely safe.