PATIENT ENQUIRY

How to Treat Insomnia


Strict Standards: Only variables should be passed by reference in /home/nutrit66/public_html/wp-content/themes/responsive/page-inner_pages.php on line 70
What Is?
What is Insomnia
How to Treat Insomnia
Natural Treatments for Insomnia

What isinsomnia?

A person 75 years of age will have invested approximately 25 of those years sleeping. Not getting enough quality sleep can have detrimental effects on health and so should not be ignored.

Insomnia means a person has difficulty with either falling or staying asleep. Often worries about a personal relationship, or financial difficulties, or even worrying about not being able to get to sleep can prevent a person from falling asleep. Chronic or long-term sleep problems may need professional treatment and management, and a lot of patience.

Insomnia is a symptom, not a disease. The causeof insomnia needs to be accurately identified and corrected.

Dreaming occurs mostly during REM (rapid eye movement) sleep rather than non-REM sleep. A person woken during non-REM stage of sleep may report thought processing but not dreaming.

In the general population, complaints of sleep disturbance tend to increase with age and anxiety level, although there is little change in electroencephalographic patterns. Age-related insomnia is often related to daytime naps or changes in sleep habits.

In some people, sleep disorders such as sleepwalking (somnambulism) and night terrors occur during the third and fourth stages of non-REM sleep, though the causes of these disorders remain undefined.

The two most common insomnia problems are sleep-onset insomnia and sleep maintenance insomnia.

Sleep-onset insomnia is an inability to get to sleep. This appears to be related to a disturbance of serotonin synthesis and is commonly associated with symptoms of anxiousness and excessive stress. Ingesting stimulants (coffee, chocolate, alcohol) and late-night stimulation (exercise, dancing, meetings) all exacerbate insomnia.

Sleep maintenance insomnia is characterised by frequent waking, usually after midnight, with an inability to get back to sleep. This type of sleep problem appears to be related to the nocturnal shift from non-REM to REM sleep, and appears to relate to inadequate maintenance of melatonin production and rising hypothalamus activity in dopamine/catecholamine pathways.

A person with insomnia has one or more of the following symptoms:

  • Difficulty falling asleep
  • Waking up often during the night and having trouble going back to sleep
  • Waking up too early in the morning
  • Feeling tired upon waking
What causes insomnia?

What causes insomnia?

Insomnia can affect anyone at any age, but is more common in adult females compared with adult males. There is evidence of a causal relationship between sleep disorders and other illnesses and injuries, in particular depression and workplace injuries.

Insomnia can reduce performance at school, university, home, and work. Insomnia is also an associated cause in some forms of obesity, anxiety, depression, irritability, concentration problems, memory problems, poor immune system function, chronic disease, and reduced reaction time.

Common causes of acute insomnia:

  • Significant life stress (job loss, death of a loved one, divorce, moving house)
  • Illness (acute or chronic)
  • Emotional or physical discomfort
  • Environmental factors like noise, light, or extreme temperatures
  • Some medications used to treat colds, allergies, depression, high blood pressure, and asthma can interfere with sleep
  • Interferences in normal sleep schedule (jet lag, shift work, new baby)

Common causes of chronic insomnia:

  • Depression or anxiety
  • Chronic stress
  • Pain or discomfort at night

Medications that may cause insomnia:

  • Alpha-blockers
– decrease REM sleep
  • Beta-blockers
– inhibit melatonin secretion
  • Corticosteroids
– stimulate mind
  • SSRI antidepressants-cause mile agitation
  • ARBs
– can cause potassium overload, leads to aching muscles and joints
  • Cholinesterase inhibitors
– blocking acetylcholine can affect involuntary processes including sleep
  • H1 antagonists
 – block acetylcholine to varying degrees, which can affect involuntary processes including sleep
  • Glucosamine/chondroitin
– not well understood why these cause insomnia and drowsiness
  • Statins – can cause muscle pain
How is insomnia diagnosed?

How is insomnia diagnosed?

If you suspect you or someone you know might have insomnia, consult a medical doctor. An evaluation may include a physical exam, taking a medical history, including a sleep history. A doctor might be able to diagnose a sleep disorder by examining your sleep schedule and habits, so you may be asked to keep a sleep diary for a few weeks detailing your sleep patterns and daytime tiredness.

Insomnia disorders are difficult to evaluate, since approximately 30% of a normal population sample will complain of ‘insomnia’. An estimated 50% of sleep problems are due to psychiatric disorders, such as depression and anxiety states.
Sleep studies can help diagnose:

  • Sleep-related breathing disorders, such as sleep apnoea
  • Sleep-related seizure disorders
  • Sleep-related movement disorders, such as periodic limb movement disorder
  • Sleep disorders that cause extreme daytime tiredness, such as narcolepsy

Sleep studies demonstrate that there are two distinct sleep states, as shown by electroencephalographic studies:

  • REM (rapid eye movement) sleep, also called dream sleep, D state sleep, and paradoxic sleep
  • Non-REM sleep,also known as slow (delta) wave sleep or S state sleep, is divided into stages 1, 2, 3 and 4.

A polysomnogram (PSG) is a multi-parameter diagnostic test used in sleep labs to measure physical and neurological activities, such as heart rhythm (ECG), blood pressure, neural activity (EEG), skeletal muscle activation (EMG), respiratory airflow, eye movement and peripheral pulse oximetry.

If a doctor suspects sleep apnoea or restless legs syndrome, you may be referred to specialist for a sleep study, which will measure how well you sleep and how your body responds to sleep problems. A sleep study is important because untreated sleep disorders can raise your risk for heart disease, high blood pressure, stroke and other medical conditions. A sleep study will determine breathing patterns, stages of sleep, and movements while sleeping.

Restless legs syndromeusually is diagnosed based on signs and symptoms, medical history, and a physical exam, but your doctor might use sleep studies to help diagnose or rule out this neurological condition.

Types of insomnia

Types of insomnia

Insomnia is called acute or chronic depending on how long sleeping difficulties last and how often they recur. Short-term episodes are called acute insomnia and last for a few weeks, while insomnia that occurs more than three nights a week or lasts more than one month is called chronic insomnia.

The types of chronic insomnia:

  • Secondary insomnia – due to a range of medical and psychiatric problems and the chronic use of drugs and alcohol
  • Primary sleep disorders – include circadian rhythm disorders, central sleep apnoea-insomnia syndrome, inadequate sleep syndromes or restless legs syndrome
  • Idiopathic insomnia – sleeplessness without a known cause, formerly called childhood onset insomnia.
Neurotransmitters involved in sleep

Neurotransmitters involved in sleep

Several neurotransmitters and neuroactive chemicals are involved in sleep onset, sleep depth, and sleep maintenance, but their role in normalising sleep in patients with insomnia remains confused.

Serotonin synthesis from tryptophan requires the nutrient cofactors Vitamin B6 and magnesium and may be compromised by Vitamin B3 insufficiency, which wastefully diverts tryptophan metabolism into niacin production.

Melatonin is a chemical made from serotonin released by the pineal gland. The decrease in light intensity with nightfall triggers melatonin release, which peaks around midnight, but rises and falls periodically until daybreak, when the increase in light intensity triggers the final decline.

Melatonin production usually declines from about 45 years of age, falling well below young adult production levels by 65 years of age. Reduced melatonin production alters the circadian sleep-wake cycle, which contributes to increased insomnia and sleep-disturbance.

Dopamine and catecholamine production islowest around midnight and increases as melatonin levels fall with the approaching dawn. The interaction between catecholamine-mediated brain activation and serotonin and melatonin mediated inhibitory effects may influence sleep onset and maintenance. However, a confounding factor in this hypothesis is the finding that pineal gland melatonin release is activated by a sympathetic nervous system mediated neuronal locus in the suprachiasmic nucleus of the hypothalamus. B-adrenergic blockade apparently increases melatonin production and improves sleep onset, especially when melatonin supplements are taken before sleep.

Adenosine levels increase during waking brain activity and also induce sleepiness by producing slow rhythmic EEG pulses in lower brain centres. Adenosine administration rapidly induces sleep onset, but the adverse effects on the peripheral cardiovascular system means that adenosine cannot be used to treat insomnia.

Self-help suggestions for short-term insomnia

Self-help suggestions for short-term insomnia

A person who suffers with insomnia will often become frustrated or annoyed by the problem and in turn these feelings contribute further to the problem and a vicious cycle begins.

Having less sleep than usual doesn’t cause any harm in the short term. However, chronic sleep deprivation can affect quality of life considerably. Reducing anxiety and sticking to a day–night routine can improve sleep quality.

Suggestions for improving sleep:

  • Wean yourself off daytime naps and avoid napping during the day
  • Exercise regularly, early in the day
  • Quit smoking and cut down on drinking alcohol
  • Avoid tea, coffee and other caffeinated drinks four hours before bed
  • Don’t exercise strenuously during the four hours before bedtime
  • Eat your evening meal at least four hours before bedtime
  • Do something to relax, such as read, meditate or have a warm bath, just before you go to bed
  • Make the room you sleep in a peaceful retreat – not too hot, cold, noisy, or bright
  • Stop worrying or watching television in bed
  • Limit your activities in the bedroom to sleeping and sex
  • If you can’t sleep, get up, go to another room and do something else until you feel sleepy again
  • Establish a routine – try to go to bed and get out of the bed at the same time every day
  • Avoid analysing the quality of sleep on a day-to-day basis
  • Place your alarm clock where you can’t reach of see it, to avoid watching or checking the clock throughout the night
  • Make a to-do list to get the things that worry you out of your mind.

MEL is four hours appropriate for these?
Insomnia means difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning, even though a person has had enough opportunity to sleep.

Related sleep problems

Related sleep problems

Sleep apnoea occurs when the walls of the throat come together and block the airway in the throat, while a person is asleep. Generally breathing stops for a few seconds until the brain registers oxygen levels are low and stimulates the person to wake up and breathe. The person usually snorts and gasps to breathe in additional oxygen and then drifts back to sleep without any awareness of what has happened.

Fragmented sleep results when this pattern is repeated, in some cases hundreds of times every night. This lack of deep sleep leaves the person feeling tired in the morning andsleepy during the day. Daily activities and work are affected by an inability to concentration and perform tasks, and daytime fatigue.

A person with sleep apnoea might need a continuous positive airway pressure (CPAP) machine, which creates a positive pressure in the upper respiratory tract and prevents airway blockage.

Restless legs syndrome is characterised by a strong urge to move one or both legs, along with a strange, unpleasant feeling in the legs, which goes away when the legs are moved. The urge gets worse when a person is sleeping or resting.

Restless legs syndromes can make it hard to get to sleep and stay asleep, and make a person very tired during the night because sleep has been interrupted. The condition usually starts after 45 years of age and doesn’t ten to run in families. The exact cause isn’t well understood but could be due to an imbalance in the neurotransmitter dopamine.

  • More than 1.5 million Australian adults, 9% of the adult population, now suffer from sleep disorders
  • Sleep disorders cost the Australian economy more than $5.1 billion a year in health care and indirect costs
  • The reduction in life quality caused by sleep disorders has a further cost equivalent of $31.4 billion a year


Insomnia key facts and statistics

Insomnia key facts and statistics

More than one third of people experience insomnia at some time during their lifetime, but only 5% require medical treatment.

Short-term insomnia can result from a stressful event, jet lag, changes to sleep patterns or environment, some acute medical illnesses, and stimulant medications. Normal sleeping habits usually return once a person deals with the stress or adjusts to the changein circumstance.

Sleep disorders are a large and under-recognised problem in Australia.
Primary insomnia affects 3% of the Australian population. Approximately 5% of Australians suffer from sleep apnoea, with roughly one in four men more than 30 years of age affected.

In Australia during 2010, the total health care cost of sleep disorders was estimated to be $818 million and the indirect financial costs associated with sleep disorders and conditions attributable to them was $4.3 billion.

Conventional medical treatment for insomnia

Acute insomnia may not require medical treatment because often it can be prevented or cured by developing good sleep habits. A doctor might treat acute insomnia that interferes with a person’s ability to function during the day with sleeping pills, for a limited time.

Treatment for chronic insomnia involves first treating any underlying condition or health problem that might be causing the insomnia. If insomnia continues, a doctor might suggest behaviour therapy, which aims to change the behaviours that are causing insomnia. Techniques such as relaxation exercises, sleep restriction therapy, and reconditioning may be useful in dealing with insomnia.

Insomnia that has persisted for years needs professional support and a lot of patience. It might take some time to re-establish normal sleeping patterns.

Some of the techniques used by a sleep disorder clinic might include:

  • Keeping a sleep diary, to help pinpoint the pattern of insomnia
  • A program of mild sleep deprivation
  • Medication to help set up a new sleeping routine
  • Exposure to bright light in the morning
  • Cognitive behavioural therapy.

Though commonly prescribed, pharmacotherapy for insomnia is generally inadvisable except on a short-term basis. Other non-drug therapies are preferable in the long-term.

Drugs prescribed to treat insomnia:

Barbiturates and non-barbiturate sedative-hypnotics such as glutethimide are undesirable sedatives as, though initially effective, they reduce REM sleep and quickly induce tolerance. Chronic drug use produces even more marked decrease of REM and slow wave sleep, with a rebound increase of both types when the drug is withdrawn.

Benzodiazepines do not significantly alter REM sleep but do suppress stage 4 sleep and rapidly induce tolerance that results in drug dependence with continued use. In elderly people, benzodiazepine use is causally associated with impaired cognition and balance, leading to increased memory deficits and a higher rate of falls.

The first step in treating insomnia is to identify and treat any underlying health condition, such as anxiety, that may be causing a person’s sleep problems.

Nutritional medicine treatment for insomnia

Full assessment of the individual patient is required to evaluate the operative factors that may be contributing to insomnia.

Common causes of insomnia:

  • Inadequate exercise – regular daytime exercise is reported to improve sleep and improve diurnal regulation
  • Impaired brain serotonin production – may be related to cofactor insufficiency (Vitamin B6 and zinc) or magnesium deficiency (magnesium is required for phosphorylation of pyridoxine into its active form pyridoxal-5-phosphate). Impaired ability to relax – often related to chronic stress, which is associated with increased need for Vitamin B3 and Vitamin B6.
  • Impaired melatonin production – due to inadequate exposure to sunlight, long periods of artificial light, shift work, travel across time zones, a bedroom that’s too light, or aging
  • Nocturnal hypoglycaemia – falling blood glucose levels throughout the night may trigger sympatho-adrenal responses causing restless sleep and frequent waking.
  • Excessive stimulation – coffee, cocoa and chocolate all contain the stimulant caffeine, excess alcohol, evening exercise, certain medications

In people with sleep onset insomnia, marked sugar-cravings, or poor dream recall, tryptophan hydroxylase cofactor insufficiency is commonly present and responds to appropriate supplementation.Insufficient vitamin B3 diverts tryptophanmetabolism away from serotonin production, whilea vitamin B6 insufficiency reduces serotonin synthesis.

Food allergy reactions are also known to trigger sympatho-adrenal responses, as well as causing insomnia.

Additional Mel to check

Treatment consists of an integrated dietary and nutrient program to correct for any operative factors identified. In the short-term, phytonutrient extracts may be more beneficial for treating insomnia than pharmacological agents. Effective results have been achieved with Passiflora incarnata(purple passion flower),Valeriana officinalis (valerian)Aizyphus spinosa (red date), chamomile, and Humulus lupulus (hops).

Purple passionflower is a calming herbal remedy used to control nervous anxiety and treat insomnia. Studies suggest that the fresh or dried whole plant is effective in increasing sleep quality, by relieving nerve pain and anxiety.

The herb valerian has been used as a sedative for hundreds of years. Valerian enhances the action of the neurotransmitter GABA (gamma amino butyric acid), the chief inhibitory neurotransmitter in humans that calms us down and enables sleep.

Chamomile has been used to treat anxiety for centuries, but chamomile is also a great sleep remedy. Chamomile soothing tea promotes relaxation and drowsiness at bedtime, probably due to mildly sedative action, and indirectly reduces the impact of depression. The effects of chamomile are much longer lasting than other herbal sleep remedies.

Melatonin is a neurohormone produced by the pineal gland as part of the human biological clock or circadian rhythm and enables sleep. A person with insomnia may have low levels and melatonin supplements taken at bedtime may help a person get to sleep and stay asleep.

Hops ire used to treat anxierty, insomnia, restlessness and irritability.

Red date or jujube dates have long been used in Chinese medicine to sedate and calm the nerves and mind, in particular for women with night-time menopause symptoms.

Lactium is a protein derived from cow’s milk shown to alleviate stress and anxiety, through its ability to modulate sympatho-adrenal responses, commonly called the ‘fight or flight’ response.

The mineral magnesium phosphate down regulates muscle nerves, which in turn relaxes skeletal muscles. Feeling physically relaxed enables a person to get to sleep more easily.

Calcium phosphate taken at night before bedtime improves sleep quality by dealing with any leg discomfort.

Glossary

Glossary

Apnoea – an episode of not breathing during sleep, usually associated with temporary airway blockage.

Benzodiazepines – drugs used to treat anxiety, stress, depression and insomnia Biological clock – the body’s circadian rhythm that runs according to a 24-hour cycle synchronised with sunlight and determines when we sleep and wake up

Circadian rhythm – nature’s 24-hour cycle that synchronises with light and dark, or wake and sleep and a range of carefully timed cyclic biological processes

CPAPis a machine that uses mild air pressure to keep the airways open

Diurnal regulation – daily cyclic changes, similar to circadian rhythm in response to light conditions

GABA – a neurotransmitter in the brain that acts as gatekeeper for melatonin, as it relates to the natural sleep-wake cycle

Insomnia – disturbed sleep or a set of symptoms related to not getting enough sleep

Melatonina neurohormone released by the pineal gland triggered by daily changes natural light.

Narcolepsy – a dangerous sleep disorder characterised by falling asleep inexplicably at any time without warning

NREM – non-REM or non-rapid-eye-movement sleep is a primary part of the sleep cycle. Deep sleep characterized by lack of dreams, lack of eye movement.

Polysomnogram – a diagnostic test used during sleep studies to measure physical and biological changes

REM – rapid-eye-movement sleep is a stage of sleep characterised by brain activity and dreaming – a light form of sleep.
Restless Legs Syndrome a sleep disorder characterised by an uncontrollable urge to move one or both due to an pleasant feeling, which stops when the legs are moved

Sleep apnoea – when a person stops breathing while sleeping at night

Sleep hygiene – changing sleep and bedtime behaviours and habits in order to achieve a more restful sleep