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
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.