Like other health conditions, the most effective ways to improve sleep quality are based upon identifying and addressing factors that impair sleep.
For example, let’s take a look at the most common form of insomnia – sleep maintenance insomnia. In this form, people are able to get to sleep, but awaken 3, 4 or 5 hours later and have a really tough time getting back to sleep. What I have found is that most people with sleep maintenance insomnia suffer from faulty blood sugar control. Basically, these people are on what I refer to as the “blood sugar roller coaster.” New techniques in blood sugar monitoring have shown quite clearly that nighttime fluctuations in blood sugar levels are the major cause of sleep maintenance insomnia.
One of the first steps to improving sleep quality in many people is eliminating caffeine. The average American consumes 150–225 mg of caffeine daily, or roughly the amount of caffeine in 1–2 cups of coffee. Although most people can handle this amount, there is a huge – 15-fold – variation in the rate at which people detoxify stimulants such as caffeine. Genetic variation in the liver enzyme that breaks down caffeine means that some people can eliminate caffeine while others have a form that works so slowly it may take them as much as 12–24 hours to fully eliminate the caffeine from a single cup of coffee. Anyone who has trouble sleeping should simply try caffeine avoidance for 7–10 days. This avoidance has to be strict, so all sources, not just coffee, but tea, chocolate, drugs with caffeine, energy drinks, etc. must be avoided.
Alcohol must also be eliminated in people with regular insomnia. Alcohol causes the release of adrenaline and disrupts the production of serotonin (an important brain chemical that initiates sleep). Although not considered a stimulant, sugar and refined carbohydrates can interfere with sleep. Eating a diet high in sugar and refined carbohydrates, and eating irregularly, can cause a reaction in the body that triggers the fight or flight response, causing wakefulness.
Natural Sleep Aids
The most popular natural aid for sleep is melatonin. Supplementation with melatonin has been shown in several studies to be very effective in helping induce and maintain sleep in both children and adults, and in both people with normal sleep patterns and those with insomnia. However, the sleep-promoting effects of melatonin are most apparent if melatonin levels in the body are low. In other words, using melatonin is not like taking a sleeping pill. It has a sedative effect only when melatonin levels are low.
When melatonin is taken just before going to bed in normal subjects or in patients with insomnia who have normal melatonin levels, it produces no sedative effect. This is because there is normally a rise in melatonin secretion just before going to bed. Melatonin supplementation appears to be most effective in treating insomnia in the elderly, in whom low melatonin levels are quite common.11, 12
A dose of 3 mg at bedtime is usually enough, because doses as low as 0.1–0.3 mg have been shown to produce a sedative effect when melatonin levels are low.13 Although melatonin appears to have no serious side effects at recommended doses, melatonin supplementation could conceivably disrupt the normal daily hormonal rhythm (the circadian rhythm). In one study, a dosage of 8 mg/day for only four days resulted in significant alterations in hormone secretions.14
5-HTP is converted in the brain to serotonin – an important initiator of sleep. It is one step closer to serotonin than L-tryptophan and has shown more consistent results in promoting and maintaining sleep, even though used at lower dosages.15-18 One of the key benefits of 5-HTP is its ability to increase REM sleep (typically by about 25%), while increasing deep sleep stages 3 and 4 without lengthening total sleep time.19, 20 The sleep stages that are reduced to compensate for the increases are non-REM stages 1 and 2 –the least important stages. To take advantage of the sleep-promoting effects of 5-HTP, the recommended dosage is 50–150 mg, 30–45 minutes before retiring. Start with the lower dose for at least three days before increasing it if necessary.
L-theanine is a unique amino acid found almost exclusively in tea plants (Camellia sinensis). Clinical studies have demonstrated that L-theanine reduces stress, improves the quality of sleep, diminishes the symptoms of PMS (premenstrual syndrome), heightens mental acuity and reduces the negative side effects of caffeine.
At typical dosages, e.g., 100–200 mg, L-theanine does not act as a sedative, but it does significantly improve sleep quality.21 It is an excellent support agent to melatonin and 5-HTP. As described above, these ingredients exert synergistic effects to promote restful sleep. NOTE: At higher single dosages, e.g., 600 mg, L-theanine does exert a sedative effect.
In terms of herbal medicine, there is no question that valerian (Valeriana othcinalis) is the most popular remedy for insomnia. Recent scientific studies have substantiated valerian’s ability to improve sleep quality and relieve insomnia. In a large double-blind study involving 128 subjects, it was shown that an aqueous extract of valerian root improved the subjective ratings for sleep quality and sleep latency (the time required to get to sleep), but left no “hangover” the next morning.22
In a follow-up study, valerian extract was shown to significantly reduce sleep latency and improve sleep quality in sufferers of insomnia and was suggested to be as effective in reducing sleep latency as small doses of benzodiazepines (Valium).22 The difference, however, arises from the fact that these drugs also result in increased morning sleepiness. Valerian, on the other hand, actually reduces morning sleepiness.
As a mild sedative, valerian may be taken at the following dose 30–45 minutes before retiring:
Dried root (or as tea) – 1–2 g
Tincture (1:5) – 4–6 ml (1–1.5 tsp)
Fluid extract (1:1) – 1–2 ml (0.5–1 tsp)
Valerian extract (0.8% valeric acid) – 150–300 mg
Michael T. Murray, N.D. is widely regarded as one of the world’s leading authorities in the field of natural medicine. He is a graduate, former faculty member and serves on the Board of Regents of Bastyr University in Seattle, WA and is the author of over 30 books including co-author of the best-selling, How to Prevent and Treat Diabetes with Natural Medicine, Hunger Free Forever and his latest book, What the Drug Companies Won’t Tell You and Your Doctor Doesn’t Know.
This text was excerpted with permission from Stress, Anxiety, and Insomnia: What the Drug Companies Won’t Tell You and Your Doctor Doesn’t Know (Mind Publishing, 2012), by Michael T. Murray, M.D.
Posted on WholeFoods Magazine Online, 10/5/12