Insomnia, defined as the inability to fall or stay asleep, can be so debilitating. It affects people to varying degrees with about ten percent of the population suffering from mild or acute insomnia. Short term insomnia, which is the inability to have quality sleep for a duration of 3 months or less, affects 20% of the population. Chronic insomnia occurs in about 10% of the population and is defined as at least 3 episodes a week for longer than 3 months. Sleep is a main pillar of our health and without consistent quality sleep our body and mind can become dysregulated. The impact that sleep has on the body is so significant, that sleep deprivation is used as a form of torture in some countries. In sleep studies on mice (poor little critters), 32 days of sleep deprivation caused death. For a healthy adult, a normal amount of sleep is between 7-9 hours per night.
Insomnia in History
Did you know that medical doctors back in the 1800’s were writing about insomnia? They wrote about the following types:
- Dyspeptic or that related to digestive problems and food
- Toxic type which was related to alcohol consumption
- Neurotic type related to the cerebral cortex and family history
- Insomnia related to circulation, namely heart health
What I found most interesting was that they spoke about how little the pharmaceutical industry could help those with insomnia. The use of drugs did not work long term and they were only being pushed for financial gain. Doctors of that time published in JAMA and The Hospital about how important lifestyle practices were for curing insomnia. They prescribed using warm socks and warm baths for insomnia related to circulation. They wrote about diet, exercise and what to eat before bed for those with dyspeptic insomnia. They issued warnings about consuming alcohol at night and advocated for good sleep hygiene practices including avoiding light exposure right before bed. Remember, this was a time when oil lamps and candles were the source of light! This sure puts our blue light screens and electronic device practices in perspective!
Doctors, then and now, both know the same things. But with the time limitations in conventional medicine and industry of medical care, doctors have forgotten their basic tenants and now go to prescriptions first! Insomnia is not an Ambien deficiency. Insomnia is not a benzodiazepine deficiency. Rather, insomnia develops over time or occurs as a result of another underlying condition. One could say that insomnia is its own condition, however, I disagree. I believe it is a symptom of toxicity or lifestyle disruption, mental or emotional trauma, or an underlying health condition. Insomnia occurs as a result of the circadian rhythm of the brain being disrupted.
What is Our Circadian Rhythm?
Our circadian rhythm regulates the sleep-wake cycle and affects hormones, the brain and the whole body. This internal clock is set by light and dark within a 24 hour cycle. There are seasonal variations on the circadian rhythm, and the same area of the brain keeps track of these cycles. A number of variables can affect our circadian rhythm such as menopause, work schedules, screen time, travel, changes in routine, pregnancy, trauma and mental health issues. When our circadian rhythm is off, we don’t sleep as well, which in turn causes changes in neurotransmitters, hormone levels, cellular regeneration and more.
Insomnia sufferers are desperate for relief and these patients have usually been everywhere, seen every doctor and tried many things. Yet they still suffer. Not only are they contending with insomnia, by the time they come to my office, they now have anxiety that is making the insomnia worse. The more chronic the insomnia, the more health concerns a patient typically has. Therefore, my approach to treating insomnia starts with a thorough patient history and really listening to the issues. I try to treat the individual, treat the whole person and try to use the least invasive measures first if possible. For symptoms such as insomnia, I find this approach is imperative.
The Naturopathic Approach to Treating Insomnia
Insomnia can be related to an endocrine disorder such as menopause, diabetes, hypothyroidism or anemia. Sometimes lab testing is used where appropriate to help diagnose these disorders. Blood testing can also help identify if insomnia is due to toxicity. We may employ the use of food intolerance testing, neurotransmitter testing or environmental toxic exposure. Since lifestyle practices are a huge part of circadian rhythm regulation and sleep, I teach my patients about sleep hygiene, screen time boundaries, and boundaries in our relationships and ourselves. The mind, body and spirit all are affected by poor sleep and each domain of our human existence needs to be addressed.
Supplements Can Help
Many patients wonder about supplements for improving sleep. There are many. However, my favorites are Magnesium, Melatonin and neurotransmitter support such as GABA, 5HTP, Taurine and L theanine.
Magnesium is a no-brainer. The number of studies on magnesium for relaxation is in the thousands. IV magnesium is given in hospitals or IV clinics for high blood pressure and PMS due to its muscle relaxing effects. It is also used in labor and delivery for preeclampsia which speaks to its safety and efficacy. Magnesium is a water-soluble vitamin and we lose a lot through sweat and daily life. It is a remedy for constipation and a key cofactor in making many neurotransmitters in the brain. It is safe to use and very affordable. There are many types of magnesium and each one has its purpose. My favorite is magnesium glycinate as it supports many metabolic pathways and it is easier on the GI in terms of loose stool and cramping. In naturopathic medicine we dose magnesium ‘to bowel tolerance’. This means that you can take as much magnesium at bedtime as you tolerate until you get loose stool. Typically this is around the dose of 500mg, but I have many patients who can tolerate up to 2,000 mg without loose stool. Again, we are all individuals, and you need to find the right dose for your system.
Melatonin is the most well researched nutrient that affects circadian rhythms. Patients often have many questions when it comes to using melatonin. I believe this is because there is so much fear on Dr Google about this simple nutrient. However, when you really look at the literature, there are over 12,000 human studies in PubMed on Melatonin and not a single one is negative.
Common Questions About Melatonin
- If I take it will my body stop making it?
This has never been shown in studies to occur despite a lot of speculation on the internet.
- Is it safe long term?
There have been studies testing safety and efficacy for up to 1 year. There are still no long term studies.
- Is time release melatonin better?
Time release products have been tested and show no appreciable benefit to non-sustained release products.
- Will it reset my circadian rhythm?
Yes, melatonin sets the circadian rhythm. It is produced in the pineal gland which is regulated by light and dark. The pineal gland also influences reproductive hormones.
- Can children take melatonin?
In 2017, studies showed that children ages 2-17.5 years of age benefited from an oral chewable melatonin and there were no side effects.
- Is melatonin use in cancer therapy?
There are over 2600 studies dating back to the 1960’s on the benefits of melatonin and cancer. Need I say more? It is the most well researched, non-prescription nutrient in cancer research.
- What is the relationship between melatonin, fertility and anti-aging?
A study done on mice showed that melatonin supplementation indicates that melatonin delays ovarian aging by multiple mechanisms including antioxidant action, maintaining telomeres, stimulating SIRT expression and ribosome function, and by reducing autophagy.
- Can melatonin be used in post menopause for sleep?
A Study done in 2018 showed that melatonin did improve sleep in post menopausal females at a daily dose of 8mg, however, not through the pathway of increasing estrogen levels or FSH appreciably.
- Will Melatonin make me gain weight?
A study done in 2015 looked at the effects of weight gain in postmenopausal females and melatonin supplementation. The outcomes showed that melatonin plays a role in weight loss post menopausally, but not by increasing estrogen levels.
- Is melatonin safe to use with prescription medications?
A study done in 2001 showed that those with sleep disturbances who were on Benzos had an improved quality of sleep and were able to either get off of the rx or reduce dose.
- Will melatonin affect my athletic performance?
There are many studies that demonstrate melatonin use in athletics can improve performance and reduce oxidative stress and recovery. For general sleep support, a dose of 3 mg is well tolerated for most people. Again, everyone is unique and there are those people who can handle 40 mg and those that can only handle 1mg. In general for more chronic insomnia, starting doses of 3mg and increasing by 3mg every 3 days is how I work on getting these patients up to 9mg or so.
In terms of neurotransmitter support for insomnia with the use of GABA, 5HTP, taurine and L theanine, this is something that is very individualized and patient specific. It is also very clinic specific. There are urine tests that can be used to get a general idea of a person’s neurotransmitter status. Although these are very controversial, the general take home from all of the studies to date is that each bodily fluid has its own set of parameters. A provider should be consistent with their testing methodology. For example, if the clinic chooses to use serum, then they will always use that. If the provider wants to use urine, then that will always be the go-to when managing a patient. Some doctors use questionnaires and then that becomes the guide for how effective treatment is. Problems can arise when a doctor uses various methods as it is clear from the literature that different values do exist between different bodily fluids.
Sleep is one of the 3 main pillars of health and without it our bodies suffer on the emotional, mental and physical level. Insomnia is a symptom rather than a disease state. It is my goal with each patient to find the underlying cause. Sometimes this is simple and straightforward, sometimes it is complicated and multi-dimensional. Working closely with a trusted provider who thinks outside of the box is the key to finding a solution to insomnia.