Without restful sleep, health cannot prevail. The medical and economic consequences of the Nation’s sleeplessness are staggering and statistics imply that 100 million Americans do not sleep well. Up to 40 million Americans may have chronic insomnia with problems related to going to sleep, staying asleep and early morning wakening.
The use of pharmaceuticals for sleep is embroiled in controversy. Tolerance to sleep drugs requires continued or increased dosage of sleeping pills. While sleep drugs commonly cause dependence, or frank addiction, there are increasing reports of the precipitation of a “zombie-like” state associated with aberrant behavior and eating disorders.
In the calendar year 2005, there were 26.6 million prescriptions for the drug Ambien® (Sanofi-Aventis) with continuing claims by the manufacturers of a well established safety profile for this drug. Lunesta® (Sepracor) is advertised for free trials and it carries a “cloaked” recommendation for continued use, a matter of great concern to many people. All sleep drugs are best used for a couple of weeks or so, but as many as one third of all consumers of hypnotic drugs use them on a chronic or intermittent long term basis. Amidst a current series of class action law suits against the manufacturers of Ambien® and other hypnotic drugs, patient safety issues have come to the forefront of scientific and public debate.
Sleep has several basic stages with two characteristic states. These states involve rapid eye movement sleep (REM) and non-rapid eye movement sleep (NREM). There are 5 stages of sleep. Restful sleep involves the passage through all 5 stages in sleep and these cycles have approx. 2 hours of duration. The cycles restart with stage1 sleep and as they become repeated the cycles are shorter with a predominance of REM sleep.
Common causes of insomnia include stress, irregular schedules, psychological distress, physical illness, drugs, substance abuse and chronic pain. There are several obvious symptoms or signs of sleep deprivation including: drowsiness, poor memory, lack of motivation, general fatigue, poor concentration, behavior problems, mood problems and accidents. Sleeplessness is a major factor in promoting the adverse symptoms of PMS and menopause.
Modern research has pointed to several less obtrusive components of sleep deprivation. These occult components of sleep deprivation include: weight gain or obesity associated with eating disorders, the development of insulin resistance and metabolic syndrome X, significant hormonal changes and even premature death. Sleep deprivation promotes premature aging by many mechanisms.
Natural ways to healthy sleep
Broad advice for the self-management of sleep problems includes:
• Regular sleep schedules and sleep modification programs e.g. bed deprivation for insomnia
• Regular bedtime routines with attention to sleep hygiene
• Sleep environment controls with “good gadgets”
• Regular exercise, at the right time of day
• Care with drugs, diet, alcohol, caffeine, smoking, illicit drug use, and diet pills
• Where extra help is required nutritional support with dietary supplements is a first line option.
Dietary supplements for sleep
Sleep involves a complex cascade of normal body function including muscle relaxation, mental tranquility, complex eye movements etc. It seems logical, that this complex cascade of events would not be managed in an optimal manner by a single agent, be it a drug or a single dietary supplement. It is possible to use combinations of natural substances that will act in a synergistic manner for the nutritional support of sleep. Each component of a synergistic formula adds to the overall desired effect.
There are 3 classes of natural substances that can be used to modify the cascade of sleep in a beneficial manner. These include herbs or botanicals, hormones and nutrients (Table 1).
• HERBS OR BOTANICALS: Valerian, Chamomile, Ashwagandha, Passionflower, Lemon Balm, Catnip, Skullcap, Hops, Green Tea
• HORMONES: Melatonin
• NUTRIENTS: Amino acids, 5-HTP, Magnesium, Niacin (B3), Pyridoxine (B6), Folic Acid
Table 1: Dietary supplement ingredients that can be used in synergistic formulations to benefit the cascade of events that occur during sleep cycles – nutritional support for the normal body function of sleep
Combinations of herbs may be particularly valuable for improving sleep quality, shortening the time of falling asleep and maintaining restful sleep. Green Tea has been found to lull the brain into quality sleep, perhaps as a consequence of the presence of
L-theanine. Table 2 gives a short overview of several herbs that are valuable for sleep management.
• VALERIAN: sedative, anti-myoclonus, GABA breakdown inhibition, carminative, no hangover, adaptogenic
• CHAMOMILE: calming, analgesic, anti-inflammatory, antioxidant, carminative
• ASHWAGANDHA: nervine, adaptogenic, mild sedative, “Indian Ginseng”
• PASSIONFLOWER: nervine tranquilizer
• LEMON BALM: sedative, anti-spasmodic, nervine, value in depression, soothes gastrointestinal tract, anti-spasmodic
• CATNIP: mild sedative, anti-anxiety
• SKULLCAP: anti-anxiety without drowsiness, adaptogenic
• HOPS: sedative-hypnotic, smooth muscle relaxation, close cousin of marijuana
Table 2: Herbs or botanicals that provide nutritional support for the body function of sleep, with a summary of their main effects and specific uses.
Melatonin is a sleep hormone that has been widely used in dietary supplements. Melatonin secretion by the pineal gland occurs with darkness and during sleep, in healthy people. It can be considered to be a “vampire hormone”. Melatonin has a decline in secretion with age. Studies show that Melatonin may shorten sleep induction time and reduce episodes of awakening, without necessarily increasing sleep time.
There are several nutrients that star in the area of sleep management. Magnesium induces muscle relaxation and causes changes in brain waves associated with relaxation. Calcium has similar but more variable effects. Coral calcium carries many anecdotal reports of improving sleeping habits. Aminoacid supplements such as glycine and tryptophan may help sleep, but when used alone very large doses are required, with attendant safety concerns (e.g. at least 3 grams of glycine). 5 hydroxytryptophan is preferred over tryptophan. The role of B-vitamins in sleep management has been underestimated. The classic anti-stress combination of vitamins B3, B6 with folate are necessary for the synthesis of chemical messengers in the brain (e.g. serotonin).
About the author:
Stephen Holt MD is a physician and best-selling author of many books. His book “The Sleep Naturally Plan”, Wellness Publishing Inc., Newark, NJ 2003, is entering its second printing after 50.000 copies in circulation. This article is based in part on a keynote lecture given at the Anti-aging Society, Orlando, FL, April, 2006.
Holt S., The Sleep Naturally Plan, Wellness Publishing, NJ, 2003
Kripke, D.F. www.thedarksideofsleepingpills.com
Library Search: www.ncbi.nlm.nih.gov/Pub/Med/