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by Karyn Siegel-Maier
Originally published in Let's Live Magazine
Defining Insomnia What 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 periodically.
Chronic insomnia amounts to sleeplessness nearly every night,
lasting for a month or more. Most 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 popular myth. Contrary 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. There 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 occur.
Although 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”. Gregg 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!” Even Insomniacs Can Learn New Tricks In 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 automatic. Another strategy recommended by Dr. Jacobs is
stimulus-control modification. According
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 wakefulness.
Similarly, 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 being awake. You Can’t Buy Sleep It 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 techniques. John, 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 a.m. John 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 clock”. John 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. The Sleeping Herbs While 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. Valerian (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. Passionflower (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 plant.
Harmine 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. Gota kola (Centella 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. St. John’s Wort
(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 quality. There
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. Note:
St. John’s Wort can cause photosensitization and sun exposure
should be limited. Discontinue
if a skin rash develops. Kava-Kava (Piper methysticum) – Kava, a member of
the pepper family, has been used as a natural relaxant in the South
Pacific for centuries. The
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 kava. The
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 daily.
Note: 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. Nutritional Considerations In 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 sleeplessness.
Unlike 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. You 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. Resources: The National Center on Sleep Disorders Research Two Rockledge Centre Suite 7024 6701 Rockledge Drive, MSC 7920 Bethesda, MD 20892-7920 (301) 435-0199 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 (301) 251-1222 Fax: (301) 251-1223 InsomniaCure.com Web Site maintained by John Wiedman, author of Desperately Seeking Snoozin’. Includes a message center for “Pillow Talk” The report “Tips for a Better Night’s Sleep” is also available by calling toll-free: (877) 753-3726 References: 1. Gregg D. Jacobs, Ph.D., Say Goodnight to Insomnia, Henry Holt, 1998. 2. Raffa R., “Screen of receptor and uptake-site activity of hypercin component of St. John’s Wort reveals alpha receptor binding. 3. Monograph: Piper methysticum, Alternative Medicine Review, 1998 Dec;3(6):458-60. 4. Herb Research Foundation/BW Health Wire, April 6, 1998, “Clinical Trial shows kava reduces stress.” 5. 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. 6. Kava Root and Anxiety, The Integrative Medicine Consult, Dec. 1998, Vol. 1, No. 1. 7. Voderholzer U., et al, “Impact of experimentally induced serotonin deficiency by tryptophan depletion on sleep EEG in healthy subjects.” Neuropsychopharmacology 1998 Feb;18(2):112-24. 8. Birdsall TC., “5-Hydroxytryptophan: a clinically-effective serotonin precursor.” Alternative Medicine Review 1998 Aug;3(4):271-80. 9. Guilleminault C., et al, “Nondrug treatment trials in psychophysiologic insomnia.” Archives of Internal Medicine 1995 Apr 24;155(8):838-44. 10. Interview
with John Wiedman, author of Desperately Seeking Snoozin’.
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