Dr. Cheré Edgar, ND
Naturopathic Doctor
(707) 840-0556
1727 Central Ave, McKinleyville, CA 95519
Dreaming of Sleep
by Daniel I Newman, M.D., N.D., M.S.O.M.
Many years of working nights in hospital emergency rooms have taught me that there is no
substitute for sleep. You cannot eat, exercise, or supplement your way to optimal health if you
are not sleeping well.
Most adults need 7-9 hours of sleep. (Yes, there are people like my stepson who only need 5,
but they are the relatively rare exception). And it's not just adults who have issues with sleep
deficiency. Children need 10-12 hours sleep, and adolescents generally at least 9 hours. With
today's (unreasonably) early school schedules, caffeinated soda use, and late nights on the
internet, many kids are lacking; and we all know how gracious sleep deprived teenagers can be!
Insomnia is rampant, and is no trivial matter. Studies suggest that 10-30% of Americans have
problems sleeping. Aside from obvious consequences such as daytime drowsiness, fatigue,
impaired mental function, caffeine dependence, and an increased likelihood of accidents,
health consequences associated with loss of sleep include an increased risk of infections,
cancer, heart attacks, pain problems, depression, anxiety, and an overall doubling of
mortality rate. My point here is not to scare you into sleepless nights. Rather, it is to encourage
you to get your sleep problem handled.
Sleep occurs through a complex interplay of at least a dozen areas of the brain involving many
different neurotransmitters (chemical messengers), that must either be released to promote sleep,
or diminished to tamp down wakefulness. Promoting sleep is therefore a bit like orchestrating a
symphony: you want to create the circumstances that make sleep possible by finesse rather than
by force.
Drugs are generally not the answer. While sleep medications often induce sleep, they can
come with side effects, including physical dependence, impaired thinking and balance,
dizziness, dry mouth, and daytime drowsiness. Also, they frequently interfere with the
deeper, more restorative stages of sleep. Though you may sleep longer, your body is not
necessarily adequately replenished. Rather than resorting to medications, the key to tackling
your sleep problem is to identify why you aren't sleeping, and specifically remedy the
issue(s).
One of the most common problem areas is called 'sleep hygiene.' This is a somewhat misleading
term. (It sounds like you need to take a bath before going to bed - although that might not be a
bad idea!) It refers to creating the conditions before bed that allow sleep to happen. A good
recipe for sleep is: tired, quiet, dark, and calm.
If you're having trouble sleeping, then 'tired' may be a given. However, if you are so weary that
you're sleeping during the day, then you have set up a vicious cycle. If you must rest, try to limit
naps to no more than 30 minutes. Exercise can be a great boon to fostering drowsiness.
However, avoid aerobic exercise within 3 hours of bedtime, as it can wire you. (Strength
training may be done closer to retiring).
Noise, whether from raucous neighbors or a snoring bed partner, can also disrupt sleep.
Closing windows to shut out street sounds, using a fan or white noise generator, or wearing
earplugs may be a solution. Separate bedrooms may even be necessary for some couples.
(A recent British survey found that 40% of couples over age 70 sleep separately).
Many bedrooms have too much light for restful sleep. Light can decrease melatonin
secretion, along with other important hormone cycles. (Melatonin, either alone or combined
with herbs in a product called Sleep Blend by Vitanica, can be a very effective sleep aid).
Good blinds, heavy window drapes, or an eye mask may solve the problem. It is also a good
idea to move towards lower light before going to bed. Use dimmer switches in the bedroom,
bathroom, and for reading lamps and turn down lights a half hour before bed.
Stress, anxiety, and even positive excitement are enemies of sleep. Avoid television, the
internet, or other computer use for 1 hour before desired sleep time. Read a nondisturbing, non-violent, even boringly technical book before going to bed. Other relaxation
strategies helpful for include: hot baths with Epsom salt, medical grade peat, or essential oils
of lavender or jasmine; Castor oil packs (instructions and supplies available at Dr. Edgar’s
office and on her website: www.drchereedgar.com); gentle yoga, Qi gong, or stretching
exercises; meditation; progressive relaxation exercises; relaxation tapes; and relaxing
music. Natural calming agents such as Zen by Allergy Research Group or Theanine Serine
by Source Naturals, available over the counter at most health food stores (a combination of the
amino acids GABA and theanine), chamomile tea, lemon balm, catnip (not just for cats),
hops, passion flower, scutellaria, valerian, and Chinese date seed (Suan Zao Ren), among
other herbs, can be taken either alone or in combination for a calming effect. Even supplemental
calcium and magnesium at bedtime can promote relaxation.
You also want to try to establish regular times for going to bed and awakening. Also, don't
use your bed for anything other than sleep or sex: read, watch T.V., and use your computer
somewhere else. If you're in bed and can't fall asleep, get up and leave the room after half
an hour. You want to make an association in your brain between bedroom and sleep.
If you've addressed the issues above and still can't sleep, we need to look at the 3-D's: diet,
drugs, and disease. You may need to be checked for food allergies. Diets too low in protein,
B vitamins, or minerals such as calcium or magnesium may need to be supplemented to
facilitate sleep. Specific amino acids, such as Tryptophan and 5-HTP, can be very safe and
effective sleep aids.
Food additives such as MSG and aspartame (Nutrasweet or Aminosweet) should be
eliminated, as they are excitatory neurotoxins, and can over stimulate and even kill nerve cells.
Blood sugar problems, either hypoglycemia or insulin resistance (diabetes) can interfere with
sleep, and should be addressed (primarily) through appropriate dietary interventions (generally
a low carbohydrate, whole foods diet).
There is a long list of drugs that can potentially interfere with sleep, including: asthma
medications (? agonists); blood pressure medications (? blockers); stimulants (like
decongestants or drugs for ADD); antidepressants; corticosteroids; pain medications (opiates
and NSAIDS); diuretics; and cholesterol drugs (statins). If you are on any of these, consider
alternatives.
Caffeine and alcohol are probably the two most commonly used substances that can
interfere with sleep. I have seen patients whose insomnia was cured by eliminating their one
cup of morning coffee. And don't forget about caffeine water, soda pop, tea, and even
chocolate as being problematic for some people.
If you've seen people passed out drunk you might wonder how alcohol can cause sleep
problems. However, alcohol inhibits the deeper stages of sleep (Stage 3, Stage 4, and REM
sleep), so sleep is less restorative. Also, there can be a rebound insomnia effect when the
alcohol wears off.
Dysfunction of practically every organ system in the body can result in sleep disturbance,
and a full discussion of insomnia and disease is well beyond the scope of this article. Truth is,
you may need professional help to address your underlying illness, if that is the cause of your
sleep problems. Nevertheless, may I offer a few pearls.
If you are not sleeping well due to pain issues, look at your bed. A mattress that is too hard
(or soft) may need to be replaced, or cushioned with a mattress pad. Special pillows, such
as cervical pillows, side sleeper pillows, or whole body pillows can allow for more
comfortable positions. Natural anti-inflammatory supplements, such as Pain X,
Inflammazyme, Bromezyme 2400, and Meriva, can be, in my experience, helpful in decreasing
night time pain as well.
Sleep disturbance due to breathing problems, like nasal obstruction or sleep apnea, is very
common. Nasal obstruction due to allergies can be addressed by specific allergy treatment (see
my article 'The Nose Knows' in the Publications section of the website), along with those funny
looking nasal strips that football players wear.
Sleep apnea (periods of breathing cessation during sleep) is generally diagnosed through a sleep
study. However, a good screening test is a nocturnal oxygen saturation study, which can be
done at home at much less expense. Several companies will provide you with a recording
device attached to a sensor that clips to your ear. Your oxygen levels will be recorded while you
sleep, and a report sent to you when you return the device.
Hormonal issues including menopause, thyroid disease, and adrenal imbalances are common
causes for sleep disturbance. Diagnosis is confirmed through lab work, and abnormalities best
addressed by supporting glandular function, or, in some circumstances, bio-identical
hormone replacement.
Restlessness, such as restless leg syndrome, can keep people from sleeping well. This may be
caused by nutrient deficiencies (such as iron, folate, or Vitamin E), or neurological diseases
(which require specific treatment).
Finally, insomnia may be caused by frequent nocturnal urination, most commonly due to
prostate problems (in men), bladder irritation, muscular weakness, or hormonal
deficiencies (in women). Herbs like saw palmetto and ProstatPlus may help with prostate
issues. Dietary changes can often alleviate irritation, and topical hormone treatments, I have
found, can help with hormonal deficiency problems. Also, avoiding caffeine or water intake
too late in the day can be essential.
In summary, sleep is a critical health commodity. Insomnia should be specifically diagnosed,
and targeted treatments implemented. Drugs can generally be avoided by following good sleep
hygiene, with the addition of well selected herbs, vitamins, amino acids and / or hormone
replacement therapy when necessary.
Well, I've been working on this for a while, and I'm getting sleepy. Maybe I'll take a nap - but
just a short one! Sweet dreams.
Yours in health,
D.N.
**This article has been reproduced with the permission of Dr. Newman. I have made a few
supplement changes to his recommendations due to regional differences in available
supplements.
Chere Edgar, ND
www.drchereedgar.com