Updated January 28, 2013
When was the last time you had trouble sleeping? Too much caffeine, emotional stress, loud neighbors, or the anticipation of leaving on a trip can all interfere with a good night’s rest. But if you frequently have trouble going to sleep or staying asleep, you can count yourself among the one-third of Americans who suffer from insomnia. In the US, insomnia is the third most common health complaint after headaches and colds.
Either acute or chronic, insomnia involves problems with falling asleep, remaining asleep at night, waking early, or a combination of all three. Acute insomnia occurs only occasionally and is generally a response to emotional stress or excitement. Financial worries can keep you awake at night, but so can a positive life experience such as receiving a promotion. Temporary physical discomfort like a cold can cause short-term insomnia, as can jet lag. Even exercise can trigger insomnia if it takes place too close to bedtime. If your insomnia lasts only a night or two (or up to a month), you can rest assured that you're only suffering from temporary sleeplessness.
If your sleeping difficulties persist for more than a month, however, you're slipping into the territory of chronic insomnia. It's not unusual for people with chronic insomnia to suffer from disrupted sleep at least 3 nights a week. According to the National Sleep Foundation, people with chronic insomnia have problems sleeping more than 16 nights out of every month. That's a lot of lost sleep. Chronic sleep deprivation casts a wide net of problems, affecting work, relationships, leisure activities, and physical and emotional well-being.
Although prescription and over-the-counter sleep medications are widely promoted for sleep, I strongly recommend against their use. Even one night of relying on sleep medications can cause you to have more difficulty sleeping the following night, setting in motion a cycle of sleeplessness and drug dependence that can be difficult to break. Sleep medications are addictive, ineffective, and have potentially dangerous side effects, including an increased risk of daytime accidents. We also do not recommend kava; although it is an herb, it carries the risk of serious side effects, including potential liver damage.
Sleep is a natural process, and your body will self-regulate if given the appropriate conditions for rest. We recommend a comprehensive program that includes diet, exercise, relaxation, and a variety of pleasurable suggestions that will help you create an atmosphere conducive to sleep. If necessary, there are also a number of natural supplements we've found helpful for restoring healthy sleep patterns and eliminating insomnia.
What Is Known About Insomnia
There are many possible causes of insomnia, ranging from physical conditions to prolonged emotional distress. Simple environmental or lifestyle factors also commonly contribute to chronic sleep problems or may even be the sole cause of sleeplessness.
Sleeping well is a sign of good health, so it's no surprise that poor sleep is associated with many medical conditions. Acid reflux, sleep apnea, restless legs syndrome, pain caused by arthritis or fibromyalgia, respiratory diseases, an overactive thyroid gland, and an enlarged prostate are all obvious sleep disrupting conditions. Some medications can also cause insomnia-for example, diuretics, thyroid drugs, and antidepressants.
As we age, we become increasingly vulnerable to struggles with sleeplessness. Women are more than twice as likely as men to suffer from insomnia because of hormonal fluctuations associated with menstruation and menopause. One of the most common and unrecognized causes of sleep disturbances is elevated cortisol. The adrenal glands secrete this stimulating hormone in response to both stress and sleep disruption. Given our modern lifestyles of doing too much, staying up too late, being constantly exposed to artificial lighting, and watching television or working on the computer before bedtime, it's easy to see how we can get caught in a vicious cycle of stress and insomnia.
Another cause of insomnia are the "naturally" decreasing levels of melatonin, a hormone produced in the pineal gland of the brain that helps us fall asleep and stay asleep. Our modern lifestyle, as described above, conspires against healthy melatonin production. Sleeping in a dark room, avoiding exposure to any bright lights during late evening and night hours, and regular sleep schedules enhance our melatonin production. If you must use a light at night, red and amber shades of light are less disruptive to our brain's ability to promote sleep.
Not surprisingly, insomnia results in daytime fatigue, but that's the least of the problems caused by insufficient sleep. Insomniacs tend to have difficulty concentrating; are more irritable, anxious, and depressed; and are more likely to suffer illnesses ranging from headaches to heart disease. They're also prone to both driving and work-related accidents. Memory is compromised as we lose time spent in deep or 'slow wave' sleep.
To break the cycle of sleeplessness and restore a pattern of healthful sleep, it's essential to address dietary factors, stress management, and exercise patterns as well as to adopt simple sleep hygiene techniques. Caffeine is near the top of the list of substances that negatively affect sleep, but it is even more important to avoid sugar and refined carbohydrates so blood sugar remains even. Fluctuating blood sugar stimulates the release of cortisol and causes middle-of-the-night awakenings. To ensure blood sugar stability, eat regular, balanced meals throughout the day and have a small snack of healthful protein and fat before bed.
Cultivating healthy sleep habits is a simple and effective way to immediately improve your quality of sleep. Prior to the invention of electricity, our ancestors lived in harmony with nature. With no artificial light, television, or computers, they went to bed at dark and rose with the sun, sleeping as much as 14 hours a night in the depth of winter. On the surface, our lives may be very different, but our bodies still require the healing sleep of our ancestral genes. Deep rest encourages the production of mood-enhancing endorphins, enhances immune function, and allows the body and mind to perform their restorative, healing tasks.
- Balance your blood sugar. Eat plenty of protein and healthful fats while avoiding sugar and refined carbohydrates, not just at dinner, but at every meal.
- Avoid caffeine. Stay away from excessive caffeine (coffee, black tea, green tea, chocolate) and avoid all sources of caffeine eight hours before bedtime.
- Decrease stimulation. Make your bedroom as dark and quiet as possible to raise melatonin levels and encourage restful sleep.
- Establish a regular routine. A regular bedtime routine is essential; go to bed at the same time every night, dim the lights before bed, and keep the temperature in your bedroom below 70 degrees.
Healthy Steps: Insomnia—Full Program
A comprehensive insomnia treatment program involves many areas in which action steps can be taken, gradually or all at once. Start by following my basic nutrition and healthy lifestyle guidelines, with the following modifications:
Savor Helpful Foods
To keep blood sugar balanced, eat your first meal within one hour of awakening and never go for more than five hours without eating. Emphasize protein and fat for blood sugar control:
- Healthful proteins. Eat protein throughout the day to prevent hypoglycemia. Chicken with skin, fish with skin, beef, lamb, and pork are good choices; turkey contains tryptophan, which encourages relaxation.
- Healthful fats. Organic butter, coconut oil, extra virgin olive oil, and other beneficial fats provide satiety and keep blood sugar balanced.
- A gentle dose of carbs? If you are already on a low carbohydrate eating plan (this may be particularly true for women), sometimes you are a little too low for your adrenals to stay quiet all night. A remedy for insomnia in a low carb eater might be half a sweet potato with butter, eaten in the evening 1-3 hours before bed.
- Organic milk and cheese, preferably raw. These dairy products contain tryptophan, an amino acid necessary for producing the neurotransmitter serotonin, which enhances relaxation.
Avoid Problematic Foods
- Caffeine. If possible, completely eliminate all sources of caffeine, including coffee, black tea, green tea, chocolate, and colas. Also avoid medications containing caffeine such as drugs for colds, migraines, and menstrual cramps.
- Aspartame. This artificial sweetener suppresses the production of the neurotransmitter serotonin, which is essential for relaxation.
- Alcohol. Although alcohol has an initial relaxing effect and can help you fall asleep, it often wakes you up several hours later.
- Allergenic foods. If you suffer from food allergies (symptoms include eczema, chronic sinusitis, and migraines), you must identify and eliminate trigger foods because they can also affect sleep.
- Green Pastures Fermented Cod Liver Oil. Take 5 capsules or 1 teaspoon daily.
- Green Pastures XFactor Gold High Vitamin Butter Oil. Take 2 capsules daily.
- NewMark Synbiotic B. Take 2 with breakfast or lunch.
If you have trouble falling asleep:
- Integrative Therapeutics Phosphatidylserine. Take 1-4 at bedtime or up to 4 hours before bedtime. A natural sleepiness after taking is a good sign of its effectiveness, and select time of dosing by degree of morning wakefulness. If sleepy in the morning, take the capsules earlier in the evening.
- Thorne Research Magnesium Citramate. This mineral supports muscle and nervous system relaxation. Take 300-600 mg daily, to bowel tolerance.
- 5-hydroxytryptophan (50 mg) or L-Tryptophan (500 mg). Tryptophan is an amino acid precursor for the neurotransmitter serotonin and can help with both falling asleep and staying asleep. Take 1 capsule (50 or 500 mg) in the afternoon, followed by 2-4 capsules on a relatively empty stomach before bed for the first week. Then switch to a lower maintenance dosage of 2 capsules at bedtime. It may take three weeks to notice obvious results. If desired, try three days on followed by four days off; studies indicate this can be effective long-term. Thorne's 5-HTP and Pure Encapsulations L-Tryptophan both vitamin B6: if you have troubling or unremembered dreams, you might remedy that with this version of tryptophan.
- Thorne Research Niacinamide. Take 1-2 with the 5-HTP before bed; the combination may be more effective than either alone. Do not take more than 1000 mg (2) of niacinamide without the supervision of your doctor.
- New Chapter Tranquilinite Plus. Take 1-3 softgels half an hour before bed if you're not feeling ready for sleep.
If you have trouble staying asleep:
- Protein/Fat Snacks. To promote and maintain blood sugar balance, snack on small amounts of protein and fat (nuts, olives, turkey, raw cheese) every two hours throughout the day and evening.
- Pure Encapsulations L-Tryptophan. For difficulty staying asleep, start by taking 500 mg at 3 pm and at bedtime for three days. If necessary, increase the dosage to 1000 mg twice daily for three days. Although 5-hydroxy tryptophan (5HTP) works better for some people, it should be avoided in people with chronic sleep problems or when excess middle of the night cortisol is suspected. For occasional use, take the 50 mg capsules by the same pattern described here for L-Tryptophan 500 mg capsules.
- Thorne Research Melaton-1. This is best supplement for elder insomnia, severe sleep disorders in children, people suffering from major depression or schizophrenia, and insomnia associated with withdrawal from benzodiazepines. Take 1-5 mg 30 minutes before bed; increase the dosage as necessary, using the lowest possible effective dosage. Ideally, your body will resume a normal sleep rhythm within two to three weeks, at which time you can stop supplementation. If necessary, you can continue taking melatonin, as there are no known significant side effects at low dosages. In case of grogginess, decrease the dosage. Do not take melatonin if you are pregnant or breast-feeding or if you are taking birth control pills, Luvox, or anti-diabetes medication.
- Biotics Research DeStress. De-Stress contains a derivative of milk protein (lactose free and almost always non-allergenic) that can help cause middle of the night wakening caused by high levels of cortisol. Take two capsules at bedtime and 1-2 if you wake in the night.
- Integrative Therapeutics Phosphatidylserine. Take 1-3 at bedtime or up to 4 hours before bedtime as an additional cortisol tamer for middle of the night wakening. Take 1-2 on waking, up to a maximum of 4 tablets a day: your middle of the night dose will likely disappear as healthy sleep habits are restored.
- Source Naturals GABA Powder. Source Naturals' well-absorbed form of GABA can be taken in tiny amounts, 1/8 tsp, in water at bedtime or in the event of night time waking, particularly when you are anxious or worried. Theoretically, GABA does not enter the brain easily, so if this supplement really helps you it should be considered a short term solution while you evaluate what might be opening the doorway to your brain: consider some source of systemic inflammation.
- Source Naturals Glycine. The amino acid glycine can help with achieving and sustaining deeper levels of restful sleep. Take 2000-3000 mg at bedtime. Glycine is thought to work by lowering core body temperature, akin to sleeping in a cooler room and yielding greater sleep satisfaction (Yamadera W, et al. Sleep and Biological Rhythms. 2007; 5: 126-131).
The long list of suggestions here reflects human variability: read through the list and pick the suggestions that could make the biggest change in your life. Start with those.
- Exercise. Engage in one hour of exercise daily but avoid exercising just before bed to prevent overstimulation. It is said that morning exercise helps you fall asleep and late afternoon exercise helps you stay asleep.
- Regulate temperature. Keep your bedroom at a cool 68 degrees or less but don't let it get too cold. When sleeping with a partner, use separate blankets to regulate temperature for individual comfort if necessary.
- Increase air circulation. Open windows or use a fan to keep air moving.
- Warm your feet. In winter, use a hot water bottle to warm your feet.
- Use natural bedding. If possible, sleep on organic bedding, including an organic mattress to avoid exposure to the toxic chemicals used as fire retardants in conventional mattresses. Wool blankets are best for temperature regulation; cover with silk or cotton duvet covers. Wool pillows (especially a rectangular supportive neck pillow) are excellent for sleeping. Reserve electric blankets or pads for warming the bed before you get in, and then turn them off.
- Increase darkness. Dim lights in the evening several hours before bedtime to raise prolactin levels. Use blackout curtains to raise melatonin levels; if necessary, use an eye mask with shaped eye pockets so lids can move easily in REM sleep. If you need a night-light, use one with a red bulb.
- Create quiet. Create a peaceful, quiet space by unplugging all equipment and removing alarm clocks and phones. If necessary, use earplugs. A white noise machine is useful when sleeping with a snorer or if there is unavoidable neighborhood noise.
- Cultivate relaxation. Avoid overly stimulating movies, television shows, or books at least one hour before bedtime. Stop using the computer at least two hours before bedtime. Take a shower and wash away the stress of the day.
- Massage with magnesium oil. If you have muscle tension or soreness, apply a few sprays of magnesium oil (may sting briefly on some skin) and rub it in. It is a long-acting form of magnesium that is well-absorbed and can have an immediate as well as a cumulative effect.
- Take a bath. A warm bath with lavender oil relaxes body and mind. Add 5-10 drops of lavender essential oil to the bathwater and breathe deeply. You can also put a drop of lavender oil on your pillow or spray your face lightly with lavender mist.
- Establish a bedtime. Try to go to bed at the same time every night and to rise at the same time each morning. Ideally, go to bed by 10 pm and rise before 7 am.
- Create a soothing environment. Decorate your bedroom in calming colors of blue, green, and lavender and clear out clutter to make a peaceful haven for sleep. Use your bed only for sleep or sex-not for activities such as work or watching television.
- Wear rose-colored glasses. Spend part of every day outdoors without sunglasses to increase absorption of vitamin D. Wearing rose-colored lenses will enhance melatonin production by up to 60 percent.
- Try yoga for relaxation. Yoga calms the body and mind; forward-bending yoga poses are particularly helpful when preparing for sleep. Soothing music is another good option for cultivating relaxation.
- Avoid heavy evening meals. Eat dinner by 7 pm to allow plenty of time for digestion before sleep.
- Have a snack. A light bedtime snack of protein and fruit will keep blood sugar balanced and prevent hypoglycemia during the night. Protein sources that contain tryptophan are best for encouraging serotonin production (turkey, raw cheese, and raw milk). Low carb eaters, already well satisfied with protein over the day, might actually do well with a complex carbohydrate - not a grain but half a sweet potato, with butter - taken with or just after dinner.
- Curb fluid intake. To prevent getting up in the night to use the bathroom, limit your fluid intake during the hour before bedtime.
- Stop screen time at least an hour before bed. The lights coming from television and computer screens, as well as the content, can be particularly stimulating to the wake-up part of our brains. If possible, eliminate any screen time from the hour or two before bed. Install a software program on your computer to change your computer light in the evening to a warmer and more restful tones.
Homeopathic Treatment for Insomnia
In general, homeopathic treatment of insomnia requires professional consultation. However, if you find you have occasional “excitement” insomnia, or are unable to sleep because of something exciting, good or bad, yesterday or tomorrow: take Coffea 30C two pellets and see how quickly sleep returns. May repeat once more in the night.
The best way to encourage sleep is to adopt good “sleep hygiene” habits. Cultivate a regular routine at bedtime: Go to bed at the same time every night and take a warm shower or bath shortly beforehand. Find a way to gradually wind down from the stresses of the day, and try to avoid “brain work” such as reading emails or working on projects in the late evening. Avoid anything that raises body temperature or speeds up the heart-such as vigorous exercise-at least 2 hours before bed. If you read or watch television to unwind, be sure to avoid violent reading material or television programs.
Lowering the lights in your home a couple of hours before bedtime triggers your body to increase levels of melatonin, a hormone that prepares you for sleep. Sleeping in a completely darkened room keeps melatonin at a high level throughout the night and facilitates deep and restful sleep. If possible, go to sleep before 10 pm and allow yourself to awaken naturally with the sunrise.
Maintain good blood sugar control throughout the day by emphasizing proteins, healthful fats, and vegetables and minimizing sugars and processed carbohydrates. Avoid caffeine, particularly in the afternoon and evening, and excessive alcohol. A small snack of protein and fruit before bed can help maintain blood sugar at a healthy level throughout the night.
If you need to take something to help you sleep, avoid prescription drugs; instead try the natural supplements suggested above. Most of all don't fret if you can't sleep. Lying in bed and worrying about not sleeping will only increase your anxiety, stimulate the production of cortisol, and make it impossible to sleep. If you go to bed and find that you aren't asleep within 30 minutes, get up and do something relaxing like reading a book (choose something boring) or listening to soothing music. Avoid turning on bright lights, though, which will decrease melatonin and cue your body to awaken. Follow the program we've outlined above, and you'll once again be sleeping like a baby.
From Dr. Deborah's Desk:
Many people take a sleeping pill one time or another, but no one really likes taking sleeping pills. The sleep isn't quite the same when it's medicated, nor is the following day. The two most important lifestyle points I would highlight are keeping the same rising time every day and dimming the lights and avoiding the computer through the evening hours. Logical and effective both, our bodies seem to relax better when we unwind from the day gradually over the evening hours. Dimmer lights in the evening offer a closer parallel to truly living with the sun.
I had been advising John for years - 20 to be exact - that his nightly Clonazepam might be a small amount, but as a drug it was highly addictive, meaning it could reasonably be exerting some effect on him the subsequent day. He finally decided he'd switch, with great trepidation. I sent him home with 5-HTP, Melaton-5 and Tranquilinite Plus, suggesting he start them one at a time and change his clonazepam to an alternate night strategy. Urgent telephone call the next weekend, because he was sleeping so well with two of the 5-HTP, one Melaton-5 and one of the Tranquilinite Plus, he was sure they were addictive, too, and he wanted to know if he had to worry about getting off of them in the future. I assured him he could even take extra if he ever needed to, with no worry of ill effects. I asked him about a year later if he saw any difference. He says that even though his finances are as bad if not worse than ever, he doesn't fall into the pit of anxiety he used to, and for that he credits the change in sleep regimens.