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      Insomnia

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Insomnia

Insomnia, difficulty falling asleep or staying asleep through the night are medical conditions that may be episodic, that is, they come and go, or may be chronic, lasting more than four weeks.

Helpful Nutrients & Herbs

  • Vitamin B6 helps production of serotonin which helps regulate sleep patterns.
  • Vitamin B2 deficiency can give rise to insomnia and mood swings.
  • Calcium, combined with magnesium, can be helpful; deficiency is tied to restless leg syndrome.
  • Magnesium deficiencies have been shown to cause depression which is tied to insomnia.
  • Melatonin has a key role in regulating circadian rhythms especially the sleep-wake cycle.
  • Cobalamin (vitamin B12) deficiency contributes to fatigue, nervousness and sleep difficulties.
  • Lemon Balm (Melissa officinalis) is an herb in the mint family which is used for sedative, calming and anti-anxiety effects.
  • Valeriana officinalis' roots are used for their sedative and tranquilizing effects.
  • American skullcap is used as a sedative.

Lifestyle

Behavior therapies are generally considered to be as effective for treating primary insomnia as medications and much more healthful.

While most people have an occasional rough night due to stress, travel or poor lifestyle choices people who chronically have trouble sleeping will awaken unrefreshed and have decreased functionality at work, in relationships, and driving on the highway. Insomnia is most common among the elderly, women, and those with depression, and can be a risk factor for obesity, poor immune function, high blood pressure, heart disease and diabetes.

People vary in their need of sleep but most adults need seven to eight hours a night. Chronic insomnia is defined as three or more nights a week of sleeplessness for four months or more.

Symptoms

Symptoms include difficulty falling asleep, waking up often during the night, trouble going back to sleep, waking up too early in the morning, feeling tired and irritable during the day, difficulty focusing on tasks, tension headaches, gastrointestinal upsets, depression, errors and accidents.

Causes

Primary insomnia is a condition unrelated to other diseases and is often very treatable with simple changes to diet and lifestyle. It is often caused by stress, overuse of nicotine, alcohol and caffeine, travel, poor sleep habits, overeating in the evening, aging, or worries about sleeping, among other possibilities.

Secondary insomnia could be a symptom of other physiological or psychological conditions, the most common of which are depression, restless leg syndrome (tied to iron deficiency), sleep apnea, migraines (tied to B vitamin deficiencies) and the pain of arthritis. It could arise from cancer treatments or drug reactions as well.

Conventional Treatment

After a thorough physical which may include sleep questionnaires, your doctor may assign you to a sleep clinic if he/she suspects your insomnia has physiological causes. Your doctor may prescribe sleep medications or anti-depressants, or advise some form of behavior therapy. Most prescription sleep medications can be used only for short periods of time due to possible side effects that are more severe for the elderly and can be addictive. In addition, there are many have cautions against driving or other normal daily functions due to residual sleepiness. Anti-depressants also have side effects. Over the counter sleep aids have antihistamines which reduce the quality of sleep.

Nutritional Supplements and Complementary Care

Nutritional Supplements

  • Pyridoxine (vitamin B6) helps the metabolic process of digestion and supports the nervous system. B6 converts some of the amino acid tryptophan to serotonin and vitamin B3. Serotonin helps regulate sleep patterns, so without enough B6, your body may not produce enough tryptophan.1, 2
  • Riboflavin (vitamin B2) is essential to how the body metabolizes amino acids, fats, and carbohydrates. It supports availability of vitamin B6 and folic acid. Deficiency can give rise to insomnia and mood swings, in part because vitamin B6 is so important for balanced sleep cycles.
  • Calcium, combined with magnesium, has been found to be effective in combating the problem. Calcium is associated with sleep patterns. Calcium levels are highest in the body during some deep sleep phases. While B6 helps create tryptophan, calcium supports how the brain utilizes tryptophan.3, 4 Calcium deficiency is directly tied to restless leg syndrome.
  • Magnesium deficiencies have been shown to cause depression which is one cause. Supplementation with magnesium has been shown to be helpful.6 Magnesium regulates calcium ion flow in brain neurons, and helps to regulate nitric oxide production. When magnesium is insufficient neuron damage results. Only 16% of the magnesium found in whole wheat remains in refined flour, and magnesium has been removed from most drinking water supplies, making it likely that many people won't get enough magnesium.
  • Melatonin is a hormone naturally produced by the human pineal gland, and has a key role in regulating circadian rhythms especially the sleep-wake cycle. Melatonin's action has led to its being tried as a treatment for a wide range of sleep disorders, such as jet lag, primary insomnia, sleep-wake cycle disruption and sleep problems in children with neuro-developmental disorders. It has been found to be helpful for insomnia.7
  • Cobalamin (vitamin B12) supports a healthy nervous system, among many other important functions. One of the results of a vitamin B12 deficiency is fatigue, nervousness and sleep difficulties. Supplementing with B12 has been found to improve sleep when combined with other therapies.5
  • Lemon Balm (Melissa officinalis) is an herb in the mint family which is used for sedative, calming and anti-anxiety effects. Researchers have found it to be helpful.8 Lemon balm extract was identified as a potent in vitro inhibitor of GABA transaminase, which explains its mood elevating property. Lemon balms also has antiviral, antibiotic, and antioxidant actions and is being considered in treatment of Alzheimer's disease and hyperthyroidism because it improves mental performance and inhibits the stimulation of the thyroid gland.
  • Valeriana officinalis is a flowering perennial whose roots are used for its sedative and tranquilizing effects. Researchers have found it to be helpful.9 It's action in the human body is thought to be mediated through the GABA receptors, which are a class of receptors that respond to the neurotransmitter gamma-aminobutyric acid (GABA), the chief inhibitory neurotransmitter in the central nervous system.
  • American skullcap (Scutellaria lateriflora) is used as a sedative and to treat irritability and other nervous system symptoms.10 It is not the same as Chinese skullcap.

Lifestyle Changes

Behavior therapies are generally considered to be as effective for treating primary insomnia as medications and much more healthful. These include:

  • Education about good sleeping habits. Some effective insomnia reducing sleeping habits include:
    • go to bed at the same time each night
    • use your bed only for sleeping
    • avoid naps
    • get out of bed when not sleeping
    • reduce intake of caffeine, alcohol and nicotine
    • eat smaller evening meals
    • get exercise every day
  • Cognitive therapy. Many people believe they can't function if anything happens to disturb their sleep, or if they get less than their normal eight hours. Since sleeplessness can be caused by anxiety due to stress or worrying about not being able to fall asleep, this can cause a reduction in functionality during activity. Therapists work with patients to attain a more balanced perspective and show how to replace worry with positive thoughts.
  • Light Therapy. For patients who fall asleep too early in the evening and then awaken too early sometimes getting more light can help to push back the internal clock.
  • Relaxation Techniques. Meditation, progressive relaxation, bio-feedback and breathing exercises have all been shown to reduce overall stress and anxiety and produce a more relaxed body and mind at bedtime.

Discussion

Many cases of insomnia can be resolved by learning and implementing the recommendations for good sleeping habits. Getting regular exercise, cutting down on caffeine and going to bed at the same time every night are common sense habits that produce only good side effects because they improve general health as well as help the insomnia. Compared to the poor quality of sleep induced by prescription and over-the counter drugs and their side effects, good sleeping habits should always be the first resource for insomniacs.

Persistent insomnia that does not respond to good sleeping habits could be a symptom of some other condition and calls for a medical check-up. Treating the underlying cause can resolve the insomnia. Persistent insomnia, whether primary or secondary, does respond to the herbal supplements and these also have a better track record regarding side effects and quality of sleep than do prescription and over-the-counter medications.

Patients who use food supplements and herbal remedies should pay the same attention to dosage instructions for these as they would for prescription medicines. Also, it is important to be informed about the variety of the herbs, noting and learning the botanical names as many varieties of the plant exists, some versions not having the same efficacy or effect. A supplier of herbal supplements who is trusted always uses the botanical name and gives clear dosage instructions.

Choose supplements with whole naturally occurring ingredients. Pharmaceutical companies in the U.S. have a paradigm in which the active ingredient of an herb is determined and then only that (either extracted or synthesized) is marketed under a brand name, or the name of the herb. Distinguishing these partial and synthetic products from the real, whole herb or nutrient is the responsibility of an informed consumer.

Footnotes & Research

Read summaries of research on vitamins & supplements for insomnia.

1. National Institutes of Health, Office of Dietary Supplements, Vitamin B6 Fact Sheet
2. Indices of Pyridoxine Levels on Symptoms Associated with Toxicity; Aliya N. Chaudary, Adam Porter-Blake, Patrick Holford; Journal of Orthomolecular Medicine"; Indices of Pyridoxine Levels on Symptoms Associated with Toxicity: A Retrospective Study; Aliya N. Chaudary, et al.; 2003 2003
3. Insomnia: Studies Confirm Calcium And Magnesium Effective, Medical News Today; 2009
4. Bookman Press 1998; 2000-02-08; Vitamins: Calcium
5. A multicenter study of sleep-wake rhythm disorders: therapeutic effects of vitamin B12, bright light therapy, chronotherapy and hypnotics., Yamadera H., et al.; Psychiatry Clin Neurosci. 1996 Aug;50(4):203-9.
6. Rapid recovery from major depression using magnesium treatment, Eby GA, Et al, Med Hypotheses. 2006;67(2):362-70
7. The effect of melatonin, magnesium, and zinc on primary insomnia in long-term care facility residents in Italy: a double-blind, placebo-controlled clinical trial, Rondanelli M, Et al. Faculty of Medicine, University of Pavia, Italy, 2011 Jan;59(1):82-90
8. Pilot trial of Melissa Officinalis L. leaf extract in the treatment of volunteers suffering from mild-to-moderate anxiety disorders and sleep disturbances, Cases J, et al, Med J Nutrition Metab. 2011 Dec;4(3):211-218.
9. A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children, M\FCller SF, et al, Phytomedicine. 2006 Jun;13(6):383-7.
10. Wolfson P, Hoffmann DL. Altern Ther Health Med. 2003;9:74-8.