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Insomnia, Part 2: Treatments for Insomnia

In our last post, we started examining many of the different facets of insomnia, including its definition, symptoms, and effects. Now, we’ll turn to treatments — what you can actually do to alleviate insomnia and get the restful, restorative sleep your body needs.
There is a wide range of different areas you can address in order to try to tackle insomnia, which is one reason why it’s important to first begin with a proper understanding of what is causing the problem. If it’s something clear-cut and time-specific, like a big family event that’s giving you jitters, that’s pretty easy to pinpoint. But if you’re actually struggling with another physical or psychological concern, you need to work with a professional to be sure that you are treating the root cause and not, by focusing on sleeplessness, just treating the symptoms.
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One way to get a grasp of the problem is to keep a sleep diary. This doesn’t have to be elaborate: Just jot down daily notes of what you did during the day, and the next day, of how you slept. Focus on the basics of your routine, like what time you started trying to go asleep and what time (or times) you woke up, what you ate and drank, and what specific insomnia symptoms you had. You should also note if anything especially stressful or out of the ordinary happened during the day. You may find that some of the things you’ve been doing to try to cope with insomnia are actually exacerbating the problem. Changing these habits can help you get back to a normal sleep schedule — and while that kind of change takes time, it will be worth it in the long run.
Here’s a rundown of the different ways that you can treat insomnia, along with the pros and cons of some of these solutions:
Lifestyle Changes
Taking proper precautions to ensure that you are as primed for sleep as possible is a relatively easy, self-directed way that you can manage insomnia. You can think of it as practicing sleep hygiene. You know how with infants, parents often try to create a nighttime routine to teach the baby, “Okay, it’s time to go to sleep now?” You can do it for yourself, too, by making sure that you’re taking steps that get you ready for bed and avoiding sneaky triggers that may be keeping you awake at night.
During the day…

  • Let light in: The hormone melatonin plays a major role in regulating your sleep schedule, and light exposure controls it. If you don’t get enough natural light during the day, your brain will produce more melatonin, which will make you feel more tired. Open the blinds or curtains when you wake up, so that you get some light exposure first thing in the morning. During the day, take breaks outside when you can so that you are exposed to natural light and not just artificial lighting.
  • Avoid napping: Taking a nap during the day can make you feel better after a restless night, but then it will be even harder for you to go to sleep that night. If you feel like you absolutely must get some rest, set a timer so that you sleep for no more than 20 to 30 minutes, and take your nap before 3 pm.
  • Get in an early workout: You might think that hitting the gym after work would make you more tired for sleep, but exercising pumps up your body in more ways than one. To avoid having excessive energy right when you don’t want it, limit physical activity after 6 pm.
  • Eat to promote sleep: There are a number of ways your that adjustments to your diet can help you get to bed more easily. Sugar can give you a boost, but then it’s followed by a crash — and then craving more sugar. These ups and downs in blood sugar will tire you out during the day, and can interfere with your sleep at night, so it’s a good idea to cut down on sugar. Foods you should add to your plate? Magnesium is a natural sedative, so any magnesium-rich foods can aid with sleep. Your options include legumes and seeds, dark leafy green vegetables (perfect for juicing!), wheat bran, almonds, cashews, blackstrap molasses, and other whole grains (as long as you’re not allergic to gluten). Don’t forget about tryptophan, too: Everyone talks about how turkey makes you tired at Thanksgiving, but it’s good for catching Z’s year-round. Tryptophan is a naturally-occurring amino acid that is a precursor to serotonin, which is then converted to melatonin. Foods with tryptophan (like turkey) can help increase your melatonin, but be sure to also include foods rich in vitamin B6, sunflower seeds, and bananas. These enhance your body’s conversion of tryptophan, so you’re getting more benefit.
  • Limit caffeine, alcohol, and nicotine: That afternoon latte may be a major culprit in your troubles falling asleep. Limit caffeinated beverages — including coffee, tea, and soda — to at least eight hours before you go to bed (an easy rule of thumb is no caffeine after noon). Be on the lookout too for sneaky sources of caffeine like chocolate and medications. Alcohol, which you might think is a way to relax and get drowsy, actually interferes with the quality of your sleep. And as if there aren’t enough reasons already not to smoke: Nicotine is a stimulant, so smoking is going to keep your body in an alert state.
  • Stay out of the bedroom: You don’t want to do anything in the bedroom except sleeping and sex. That means no working, watching TV, or using your laptop or tablet. The idea is to get your brain to make a strong link between the bedroom and sleeping or sex, so that when you head in there, your body is primed to relax.

When you’re ready for bed…

  • Stick to a schedule: Going to bed and getting up at the same time every day (even weekends, if you can manage it) will help support healthy sleep. Your biological clock wants to be in a rhythm, and being consistent with your sleep schedule is one way you can help it get there.
  • Avoid stressful situations: Right before you go to sleep is not the time to bring up a contentious issue with your partner. Even if it’s a short talk, it’ll get the wheels in your head turning, and can make it harder to relax. Focus on soothing, quiet activities in your evening hours.
  • Turn off the technology: Again, light exposure controls melatonin production. Getting artificial light before bed suppresses melatonin production and makes it harder to sleep. Stop watching TV or using the computer at least an hour before bedtime, and don’t bring anything backlit into bed, whether it’s your phone, tablet, or eReader.
  • Set up your bedroom for sleep: Your ideal sleeping space is a room that is quiet, dark, and cool; all conditions that are conducive to sleep. Use a sound machine or earplugs to dampen outside noises, and open the window or use a fan to keep the room cool. Blackout curtains or a sleep mask can help block out light.
  • Don’t watch the clock: Clocks are another key light source to remove. Watching the minutes tick by when you can’t sleep is stressful, so set clocks so that you can’t see them. It’s okay to have an alarm set, you just don’t want to be able to see the time.

When you can’t sleep…

  • Get out of bed: Don’t stay in bed tossing, turning, and growing ever more frustrated at your inability to sleep. Instead, get up and do a low-key activity for a while — maybe read and have a cup of (decaf!) chamomile tea. When you start to feel sleepy, head back to bed.
  • Stay calm: Having trouble with sleep can quickly stress you out. You might be thinking about how tired you’re going to be the next day, or that it feels like you’ll never fall asleep — all of those stressful thoughts only make it more difficult to sleep. Worrying spurs your body to increase adrenaline, making you more awake. If you find yourself agonizing over your insomnia, try to challenge your negative thoughts with more calming ones that can help promote sleep. If you’re thinking, “I’m never going to fall asleep!” counter it by thinking something like, “Insomnia can be cured. I’m working on treating it now, and I can beat it.”

Sleeping Pills
For many people who are experiencing chronic insomnia, taking a sleep aid — whether over-the-counter or prescription — often seems like the best, or at least easiest, solution. However, these are problematic for a number of reasons. The main ingredient in OTC sleeping pills is an antihistamine that is generally taken to alleviate symptoms from colds, allergies, or hay fever. Antihistamines however are not advisable for some people, especially the elderly. Dizziness is a common side effect (increasing the risk of falls), as is constipation and the potential for worsening eye conditions. OTC sleep aids are really just a Band-Aid for insomnia; they aren’t really providing a cure.
On the other hand, prescription sleep medications can provide temporary relief. Still, these are not ideal because prescription meds generally give patients either a light, non-restful sleep or — sometimes worse — a sort of “black out” sleep where you go under but don’t necessarily achieve deep, restorative sleep. Many recent studies have shown that these pills can have dangerous side effects, and the FDA has recently lowered the recommended dosage for some of the most prominent prescription sleep aids as a result of these concerns. These medications also have a high risk for being habit forming. If they are combined with other medications — including those for anxiety disorders, depression, or pain — or with alcohol, they can be deadly.
When you’re tossing and turning at night, it can be tempting to turn to a sleeping pill for relief. However, no sleeping pill will cure the underlying cause of your insomnia, and some can even make the problem worse in the long run. Before taking any sleep aid or medication, talk to Dr. Tang.
At drug stores and in the health aisle at grocery stores, you’ll often see dietary and herbal supplements marketed for their sleep-promoting effects. Some remedies, like chamomile tea, are generally harmless, while others can have side effects and interfere with other medications. Before taking a supplement, it’s important to understand how they work and if they will have an interaction with anything else that you are taking (prescription or otherwise). Two of the most popular supplements for promoting sleep are melatonin and valerian.
Melatonin is, as described above, a naturally-occurring hormone that helps to regulate your sleep cycle. Melatonin is produced from serotonin when exposure to light decreases (in other words, at night). If low levels of melatonin at night are triggering insomnia, it can be taken as a supplement to help with insomnia brought on by aging, depression, or jet lag. Studies have found that low doses of melatonin have helped older adults fall asleep more quickly and get better sleep quality. The tricky thing about supplementing with melatonin is that it must be timed right, so as not to disrupt your body’s sleep-wake cycle. Taking it in the morning delays your natural rhythms, while in the afternoon or early evening it advances them.
Valerian is an herb that has mild sedative affects, and is often taken as a supplement or brewed as tea to reduce anxiety and improve sleep. It has anecdotally received a good amount of support as a sleep aid, but research has not found that it is especially effective. Again, timing is important. Taking valerian during the day can lead to drowsiness, so it’s better to take it an hour or so before bed. It is also important to be sure you are taking a high-quality valerian supplement, as quality varies widely.
There are a range of other natural substances that have been found to help promote sleep. Phosphatidylserine (PS) is an essential component of all neuronal membranes. Research suggests that PS may help support overall brain wellness, but particularly relevant to sleep quality, PS helps maintain healthy cortisol levels. This is beneficial for memory and concentration as well as better sleep. Inositol is a substance that is naturally present in human cells and certain foods. As a supplement, inositol is used to support relaxation, reduce anxiety, and get restful sleep by helping to maintain your body’s proper metabolism of serotonin. An effective natural form of GABA, pharmaGABA is an amino acid in the brain that is a major inhibitory neurotransmitter for the central nervous system (CNS). GABA serves as a calming agent for the body, helping to combat stress and anxiety, which can exacerbate insomnia. German chamomile is an excellent natural alternative to benzodiazepines, as it promotes calmness in a similar way to these medications but without their overt side-effects. German chamomile helps to reduce anxiety, but does so without impairing memory, diminishing motor skills, or causing “day after” drowsiness. Another amino acid, L-theanine, has also been clinically proven to help reduce stress and improve the quality of sleep. Last, 5-HTP is a nutrient that supports the production of serotonin and melatonin during the night, helping you to stay asleep. If you’re curious about whether natural supplements could help with your sleep, come in and talk with Dr. Tang.

Hormonal balance
We don’t usually think of hormones when we are considering causes for insomnia, but the changes in our hormonal balance that take place as we age can take a major toll on our ability to fall asleep and stay asleep. Restoring proper hormone balance can often help women who are perimenopausal or menopausal, and men who are experiencing symptoms of andropause.
When the sex hormones are out of balance, the result can be disrupted sleep — maybe you can fall asleep, but you have trouble staying asleep. For women, hot flashes caused by low estrogen can encourage waking up at night. When we’re young, oral progesterone forms an active metabolite, 5 Allo-pregnenolone, which binds to GABA receptors in the brain. These provide a calming effect, allowing your brain to relax and you to fall asleep more easily and deeply. Progesterone levels decrease as we age, and this can contribute to insomnia, anxiety, and sleep apnea. For men, low testosterone levels negatively affect sleep. When testosterone is too low, the body does not stay in deep sleep cycles long enough for sleep to have a restorative affect. Growth hormone is also important for men and women: When levels are too low, even a full night’s sleep won’t feel restful, and waking up early in the morning and being unable to fall back to sleep can become common.
There can also be issues with cortisol, which is another hormone that can have a big impact on sleep. Often thought as a stress hormone, elevated cortisol at nighttime can make it hard to fall asleep. Supplements such as Rhodiola, Ashwagandha, and Phosphatadylserine can help to lower cortisol. Those with especially low levels of cortisol often have trouble falling asleep as well, because the body will compensate with adrenaline. Supplements can help here too: Adrenal support with adaptogens and/or glandular support with ingredients like American ginseng, Ashwagandha, licorice root, and N-acetyl tyrosine plus the support of B vitamins can bring back cortisol to a normal level. Some patients who experience severe adrenal burnout may need hydrocortisone because they are not able to produce enough functional cortisol.
Low cortisol is also often the culprit behind waking up early (hours before you need to be up in the morning). Low cortisol causes low blood sugar, which again pushes up your adrenaline. In addition to taking supplements at bedtime, eating a light snack that includes complex carbohydrates (like whole wheat crackers with peanut butter, or berries and cream cheese) can help alleviate that blood sugar dip.
If you are concerned about hormonal balance, we strongly recommend that you come in to Rejuvé for hormone testing. Dr. Tang can check your levels with a blood test, and with repeated visits establish a regimen that will help get your hormone levels back in balance.
When to consider seeking professional insomnia treatment
If your insomnia does not respond to lifestyle changes like we listed above; if it is causing problems at home, work, or school; if you’re experiencing accompanying symptoms like chest pain or shortness of breath; or if your insomnia is persistent and worsening, you need to consider turning to a professional for help.
Dr. Tang can help you unravel the root cause of the sleep disorder. Remember that taking the typical OTC sleep aid or routine prescription does not address the fundamental problems of sleep deprivation, which can be indicative of other medical issues such as hormonal imbalance, nutritional deficiency, or gut issues. A detailed history and often a blood evaluation will be needed to establish the underlying problems. Don’t wait through another sleepless night! Call Rejuvé today at 408-740-5320 to make an appointment.