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Although one-third of the average person's life is spent sleeping, many of the physical and chemical bases of sleep remain a mystery. Sleep-wake patterns are governed by circadian rhythms, which usually run on 25-hour cycles with two natural daily peak times for sleeping, at night and at mid-day, the traditional siesta time.
There are three main types of insomnia based on the time of difficulty: - sleep onset insomnia
- maintenance insomnia
- early a.m. insomnia (often a symptom of underlying depression).
There is also mixed insomnia, conditioned insomnia (chronic disturbance such as a baby in the house), and dream-interruption insomnia (caused by deep anxiety). Compulsive urination insomnia is often seen in patients suffering from fibromyalgia (FMS) due to hypersensitive nerve endings that cause wakening due to bladder pressure.
Causes & Development
Primary insomnia is not due to any other sleep disorders such as restless legs syndrome, medical conditions, drugs or mental disorders.
A large percentage of chronic insomnia cases have a serious psychological cause. The disorders that most often cause insomnia are chronic anxiety, depression, and bipolar (manic) depression. At least 70% of people with depression complain of insomnia.
Many common medical problems (and some of the drugs that treat them) can cause insomnia, including allergies, arthritis, heart disease, hypertension, asthma, arthritic conditions, Alzheimer's disease, Parkinson's disease, hyperthyroidism, and attention deficit hyperactivity disorder (ADHD).
Signs & Symptoms
Chronic primary insomnia is diagnosed when, for at least a month, a person has difficulty in falling asleep, maintaining sleep, or has non-restorative (ineffective) sleep, and, in addition, the patient is distressed and believes that normal functioning is impaired because of sleep loss.
Transient insomnia lasts for a few days and short-term insomnia for no more than three weeks; if sleep is disturbed for a longer period of time, a person is considered to have chronic insomnia. It can take 4-6 weeks of getting enough sleep to fully recover from prolonged sleep deprivation.
Treatment & Prevention
Some women experience insomnia around menopause and find that hormone evaluation and balancing helps.
There are many natural treatments for insomnia that should be considered before resorting to medications. Tryptophan, melatonin, 5-HTP, Valerian, and St. John's Wort may help with sleep. In difficult cases, use of these in combination have been successful.
Valerian is sometimes used as a treatment for anxiety. However, it is more commonly recommended as an aid for occasional insomnia. Kava is probably better for anxiety but is sometimes recommended at higher doses to treat insomnia as well.
Make sure that something you are currently taking is not causing the problem. Substances such as panax ginseng, hydrocortisone taken late in the day, caffeine, and too much alcohol, cocaine or sedatives can cause insomnia.
Other suggestions:- A 1995 study showed that poor sleepers do not clear caffeine from their systems as rapidly as normal sleepers. Even one cup of coffee at breakfast only was enough to keep them awake at night. A two week trial of no caffeine may be beneficial.
- Sleep in complete darkness. A recent study indicated that even dim artificial light may disrupt sleep and melatonin production.
- Don't nap. Sleep disturbances may encourage napping during the day, which can make it harder to fall asleep at a normal hour. Avoiding naps can promote sleep at an earlier hour.
- Try taking your watch off and any clocks out of the room. This simple technique has worked for a surprising number of people.
- Reading for 45-60 minutes.
- Aerobic exercise 3-5 times per week.
- Many with FMS need a water bed, sometimes even with an egg-crate pad. Some need a hard bed. Find out what works for you. Go to a store and try some.
- If hypoglycemia is a problem, some are helped by a snack before going to bed.
- Go to bed only when you are sleepy but get up at the same time each morning.
- If medication is necessary, find out which works for you. Don't give up - good sleep is worth the search.
- Vitamin B12 can help with fatigue, insomnia, depression, and the anxiety of getting older, especially if low stomach acid is suspected. Shots may be required for large doses.
- Mild acting agents like homeopathic preparations, chamomile tea, a long relaxing bath, or a touch of sea salt on the tongue with a glass of water can be tried.
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Signs, symptoms & indicators of Insomnia:
Risk factors for Insomnia:
Insomnia suggests the following may be present: | | | | | Addictions |  Alcohol-related Problems | Depletion of tryptophan as a result of heavy drinking explains why alcoholics suffer from insomnia. |
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Metabolic |
Tinnitus| | In a double-blind study of people who had difficulty sleeping because of tinnitus, supplementation with 3mg of melatonin per night for one month resulted in improved sleep. |
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Recommendations and treatments for Insomnia: | | | | | Amino Acid / Protein |  Tryptophan / 5HTP| | Due to the fact that the synthesis of serotonin and melatonin within the brain is dependent on the availability of the amino acid tryptophan, supplementing the diet with tryptophan before going to bed may produce good results in relieving insomnia. Tryptophan tends to work better for acute insomnia (sleep-onset insomnia) than for chronic sleep problems since its greatest effect is to shorten the time it takes to fall asleep after going to bed.
Some 1000 to 2000mg of L-tryptophan are needed in order to increase blood levels sufficiently to induce sleep. However, the lowest dose (often as little as 500mg) that works as a sleep aid should be maintained to continue benefits. The dose may be repeated if one wakes during the night. Doctors often recommend starting with 1gm of L-tryptophan 30-45 minutes before bed, which will reduce the time it takes to fall asleep. If 1000mg is insufficient, the dose may be increased by 500mg each night until either the desired effects are achieved or a total of 3000mg is reached. |
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Botanical |
 Hawthorn Berry Extract| | Hawthorn tea is good for nervous tension and sleeplessness. |
Valerian Root| | Historically, the herb valerian was commonly used for the treatment of insomnia. Although we have some studies that appear to indicate that it is effective, more research is needed to tell us how to use valerian appropriately.
Valerian is once again becoming popular in the United States; its reputation is as a gentle sleep aid without side-effects. As one user commented, "Valerian is one of the most gentle and harmless herbal sleeping remedies I've found. It seems to enhance my body's natural process of slipping into sleep and makes the stresses of my day recede. I awaken relaxed and refreshed with no morning hangover."
A 28-day study of 121 people with a history of sleep disturbances compared the effect of 600mg of a valerian extract taken 1 hour before bedtime against placebo. The study concluded that valerian is useful for the long-term treatment of insomnia. Subjects were evaluated by a physician and by self-report at the beginning of the study and at days 14 and 28. At 14 days, only a few significant differences were found between the two groups' outcomes, but by the end of the fourth week, the group taking valerian showed comparative improvements in quality of sleep, mood, and overall evaluation of results. However, it should be pointed out that the results, although mathematically significant, were not dramatic. Valerian is a very mild treatment.
A placebo-controlled study of 19 patients who complained of poor sleep, marked by reports of frequent waking, despite chronic benzodiazepine use, was conducted. Subjects were off benzodiazepine for 2 weeks prior to beginning Valerian or placebo. The fifteen days of treatment with Valerian improved subjective sleep quality, without affecting sleep onset.This study was of relatively short duration, 15 days. [Prog Neuropsychopharmacol Biol Psychiatry 2002;26(3): pp.539-545] |
Kava| | Kava Root Extract has been used by the inhabitants of the Pacific Islands for centuries as an relaxing botanical that also promotes delta-rhythm sleep. Because it potentiates the effectiveness of melatonin, it is the ideal complement in a melatonin complex formula. Kava (piper methysticum) has been proven to be especially effective in treating refractory sleep disorders, including those involving headaches, menstrual cramps, and gastrointestinal disorders.
Kava improves sleep by relaxing the body, reducing mental worry and anxiety, and reducing pain. Although no scientific evidence exists that kava can help insomnia, anecdotal stories tell us that traditional healers have prescribed it for insomnia for centuries. Kava-based products are prescribed as medicines for relaxation in France, Germany, Switzerland, and other European countries.
Although we don't have a definitive study on the effectiveness of kava as a treatment for insomnia, we can look into some studies of kava as an indication that it might be helpful in sleep. A small double-blind placebo-controlled study suggested that synthetic kavain (a kavalactone found in kava) enhances brain activity that favors restorative sleep. At weekly intervals, subjects randomly received placebo; 200, 400, or 600mg of kavain; or 30mg of the benzodiazepine Clobazam. Pulse, blood pressure, EEG, psychometric tests, and side effects were noted at the outset and then at 1, 2, 4, 6, and 8 hours after receiving the medication.
EEG activity showed that kavain increased the alpha-1, theta, and delta brain waves that are associated with sleep while decreasing beta waves, which are a sign of wakefulness. Furthermore, these effects increased with higher dosages. At 600mg, kavain produced sedation comparable to 30mg of Clobazam.
Unfortunately, this rather theoretical study looked at brain waves rather than true effects on sleep. Also, it used isolated kavain rather than the whole-kava extract as you might purchase it. Much better research needs to be performed before it can be said that scientific evidence exists for using kava in sleep disorders. |
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Diet |
Caffeine/Coffee Avoidance| | People suffering from insomnia often have elevated caffeine levels compared to normal sleepers. They may have as much as 40% of the caffeine they consumed in the morning still in their system at bedtime. [Psychopharmacology 1995; 121: pp.494-502] |
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Drug |
GHB (Gamma-Hydroxybutyrate)| | GHB has been called "almost an ideal sleep inducing substance" [Smart Drugs II, p. 245]. Small doses produce relaxation, tranquility and drowsiness which make it extremely easy to fall asleep naturally. Higher doses increase the drowsiness effect and decrease the time it takes to fall asleep. A sufficiently large dose of GHB will induce sudden sleep within five to ten minutes [Laborit, 1964].
Many other hypnotics interfere with various stages of the sleep cycle thus preventing the body from achieving a complete and balanced session of rest and recuperation. The most remarkable facet of GHB-induced sleep is its physiological resemblance to normal sleep. For instance, GHB sleep is characterized by increased levels of carbon dioxide in the arteries, as in normal sleep [Vickers, 1969].
During both normal and GHB-induced sleep, the central nervous system continues to be responsive to "noxious stimuli" (pain and other irritations), a factor which sets limits on GHB’s uses in anesthesia [Vickers, 1969]. GHB facilitates both REM (rapid eye movement) sleep, and "slow wave" (non-REM) sleep, the stage of sleep featuring increased release of growth hormone [Laborit, 1972]. And - unlike the unconsciousness induced by other anesthetics - that triggered by GHB does not feature a systemic decrease in oxygen consumption [Laborit, 1964].
The primary disadvantage of GHB's use as a sleep aid is its short term influence - some three hours. During GHB's influence, sleep is deeper and more restful, but after the GHB has worn off, people have a tendency to wake up. The higher the dose, the greater is this tendency. Some have called this pattern the "dawn effect" and have speculated that it is related to the release of stored dopamine. Some people minimize this effect by taking minimal doses of GHB. Others take advantage of this effect by getting a couple of hours of work done in the middle of the night. Still others choose to take a second dose of GHB to sleep for another three hours.
It should be noted that not everyone can be put to sleep by GHB. Some people never achieve sleep even with the doses normally used for such purposes. In addition, Takahara (1977) reported in a growth-hormone study that one man remained conscious even though he had received GHB intravenously at a dosage which rendered the rest of the participants unconscious. |
Conventional Drug Avoidance| | Use of benzodiazepine medications for sleep disorders has become more and more common, and is implicated in a long list of side-effects and difficult withdrawal symptoms. Benzodiazepines are often found under the following names, Xanax (Alprazolam), Valium (Diazepam), Ativan, Alzapam (Lorazepam), Halcion (Triazolam), Klonopin (Clonazepam), and Restoril, among others. Patients often find it very difficult to withdraw from these medications, and at the same time long-term medication with these drugs is often discouraged due to the addictive nature of the drugs and the accompanying side-effects. |
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Hormone |
Melatonin| | The body uses the hormone melatonin as part of its normal control of the sleep-wake cycle: melatonin plays an important role in the induction of sleep. The pineal gland - a tiny gland at the base of the brain - makes serotonin and then turns it into melatonin when light decreases. Strong light (such as sunlight) turns off melatonin production. Completely darkened rooms increase melatonin levels more than partially darkened rooms, and weak light doesn't completely shut down melatonin production as does strong light.
Taking melatonin as a supplement seems to stimulate sleep when the natural cycle is disturbed. It is most dramatically effective for jet lag and for those who work night shifts and want to change their hours of sleep on the weekends.
Sustained-release melatonin may provide sleep enhancement for those who have difficulty remaining asleep. Several double-blind trials show melatonin supplementation to be very effective in promoting sleep. However, it appears that the sleep-promoting effects of melatonin supplementation are most apparent if an individual's melatonin levels are low. Melatonin supplementation does not act as a simple sedative like a sleeping pill; only if this sleep-producing hormone is deficient will supplementation be helpful. Furthermore, melatonin acts to regulate or alter sleep rhythms, so its effect may be stronger with problems getting to sleep initially than with sleep disturbances once asleep.
One week of supplementation with melatonin (0.1mg, 0.3mg or 3mg before bedtime) in 30 patients with insomnia over 50 years old with reduced melatonin levels, improved sleep in a double-blind, placebo-controlled, cross-over study. The 3mg per day dose induced hypothermia and caused plasma melatonin to remain elevated into the daylight hours. [ J Clin Endocrinol Metab 2001;86(10): pp.4727-4730]
One double-blind study enrolled 320 people who were given 5mg of standard melatonin, 5mg of slow-release melatonin, 0.5mg of standard melatonin, or a placebo for 4 nights following plane travel. The results showed improvements only with 5mg of standard melatonin. Benefits were noted in time to fall asleep, quality of sleep, and daytime drowsiness and fatigue. Positive results were seen in several other studies but at least one study failed to find a significant sleep-inducing effect for melatonin. On balance, the evidence is strongly positive that melatonin can help sleep.
According to one review of the literature, treatment is most effective for those with significant jet lag, such as those who have crossed more than 8 time zones. However, melatonin also seems to be help induce sleep for other people, including those with no sleep problems to begin with. |
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Mineral |
Magnesium| | Because of its nerve and muscle support, magnesium may also be helpful for insomnia. |
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Nutrient |
DMAE| | DMAE has been shown to increase daytime motivation and physical energy in persons afflicted with insomnia. As well as reducing the amount of sleep required by about 1 hour per night, users experience sounder sleep. |
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Physical Medicine |
Hydrotherapy| | Various forms of hydrotherapy have to been used to treat insomnia. The neutral bath tends to sedate disturbed people. |
Calming / Stretching Exercises| | It is claimed that the practice of yoga will benefit your sleep in three ways:- The quality of your sleep will improve because of yoga's beneficial effect on the nervous system, in particular the brain. This results from certain yoga postures increasing the blood supply to the sleep center in the brain.
- You will need less sleep because of the improved quality of your sleep, and because yoga increases the elimination of toxins from the body. On average, for every minute you put into yoga you will need one minute less sleep.
- You will fall asleep in a shorter time. This is because your body and mind are more relaxed.
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link | | | Likely to help | | | Highly recommended |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Aerobic (Aerobically)
Using oxygen. For example, aerobic exercises such as running, swimming, bicycling or playing tennis use up lots of oxygen and burn up lots of calories and fat.
Allergy (Allergies)
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Alzheimer's Disease (Alzheimer's)
A progressive disease of the middle-aged and elderly, characterized by loss of function and death of nerve cells in several areas of the brain, leading to loss of mental functions such as memory and learning. Alzheimer's disease is the most common cause of dementia.
Amino Acid (Amino Acids)
An organic acid containing nitrogen chemical building blocks that aid in the production of protein in the body. Eight of the twenty-two known amino acids are considered "essential," and must be obtained from dietary sources because the body can not synthesize them.
Anesthesia
Loss of sensation caused by neurological dysfunction or a pharmacological depression of nerve function.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Arterial (Arteries, Artery)
Blood that leaves the heart. When it leaves the right ventricle, it is venous blood; and when it leaves the left ventricle, through the aorta, it is fresh and oxygenated. After it has passed out to the capillaries and started to return, it is venous blood.
Arthritis (Arthritic)
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Asthma (Asthmatic)
A lung disorder marked by attacks of breathing difficulty, wheezing, coughing, and thick mucus coming from the lungs. The episodes may be triggered by breathing foreign substances (allergens) or pollutants, infection, vigorous exercise, or emotional stress. Extrinsic Asthma is triggered by pollen, chemicals or some other external agent; Intrinsic Asthma is triggered by boggy membranes, congested tissues, or other native causes… even adrenalin stress or exertion.
Central Nervous System (CNS)
A collective term for the brain, spinal cord, their nerves, and the sensory end organs. More broadly, this can even include the
neurotransmitting hormones instigated by the CNS that control the chemical nervous system, the endocrine glands.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Cobalamin (B12, B-12, Cobalamine, Vitamin B12)
Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Cramp (Cramping, Cramps)
A sudden, involuntary, painful muscular contraction.
Cup (Cups)
A unit of volume measurement equal to 8 fluid oz, or roughly 250ml. It also equals 1/2 pint, 1/4 quart and 1/16 gallon.
Dopamine
A neurohormone; precursor to norepinephrine which acts as a stimulant to the nervous system. Carries signals between neurons and controls feelings of satisfaction, arousal, reward and mood.
Fibromyalgia (FMS)
Originally named fibrositis, it is a mysteriously debilitating syndrome that attacks women more often than men. It is not physically damaging to the body in any way, but is characterized by the constant presence of widespread pain that often moves about the body. Fibromyalgia can be so severe that it is often incapacitating.
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Gland (Glands)
The glandular system is one of the most important and complicated systems of the body. Gland tissue can be either an organ or general tissue that secretes chemicals and there are two types of gland: exocrine and endocrine. Those glands which secrete chemicals through tubules or ducts are called exocrine and include sweat, tear and salivary glands. Ductless glands - part of the endocrine system - secrete special chemicals (hormones) directly into the blood.
Hangover (Hangovers)
A commonly used nonmedical term for the disagreeable physical effects following excessive consumption of alcohol (or the use of other drugs).
Herbs (Herb, Herbal)
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Homeopathy (Homeopathic)
A system of medicine based on the belief that the cure of disease can be effected by minute doses of substances that, if given to a healthy person in large doses, would produce the same symptoms as are present in the disease being treated. Homeopathy employs natural substances in small doses to stimulate the body's reactive process to remove toxic waste and bring the body back into balance.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hypertension
High blood pressure. Hypertension increases the risk of heart attack, stroke, and kidney failure because it adds to the workload of the heart, causing it to enlarge and, over time, to weaken; in addition, it may damage the walls of the arteries.
Hyperthyroidism (Hyperthyroid)
An abnormal condition of the thyroid gland resulting in excessive secretion of thyroid hormones characterized by an increased metabolism and weight loss.
Hypoglycemia
A condition characterized by an abnormally low blood glucose level. Severe hypoglycemia is rare and dangerous. It can be caused by medications such as insulin (diabetics are prone to hypoglycemia), severe physical exhaustion, and some illnesses.
Hypothermia
Abnormally low body temperature.
Melatonin
The only hormone secreted into the bloodstream by the pineal gland. The hormone appears to inhibit numerous endocrine functions, including the gonadotropic hormones. Research exists on the efficacy of melatonin in treating jet lag and certain sleep disorders. Dosages greater than l milligram have been associated with drowsiness, headaches, disturbances in sleep/wake cycles and is contraindicated in those who are on antidepressive medication. It also negatively influences insulin utilization.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Parkinson's Disease (Parkinson's)
A chronic, slowly-progressing disease of the nervous system characterized clinically by the combination of tremor, rigidity, extreme slowness of movement, and stooped posture. It is characterized pathologically by loss of dopamine in the substantia nigra.
Pineal (Pineal Gland)
The pineal gland is a pea-sized organ at the center of the brain that is highly sensitive to light. Until recently, almost nothing was known about this gland. Darkness signals the pineal gland to release melatonin. This important hormone has been found to play a role in sexual function and energy levels in general. It is also a powerful antioxidant protecting the body from age-causing free radicals.
Placebo (Placebos)
A pharmacologically inactive substance. Often used to compare clinical responses against the effects of pharmacologically active substances in experiments.
Restless Legs Syndrome
This condition involves "creepy-crawly" sensations, mainly in the legs but occasionally in the arms and trunk. The sensations have the following features:
- Occur during periods of inactivity
- Become more severe at night
- Are tied to an overwhelming urge to move the limb
- Are sometimes relieved by movement of the limb
- Often cause difficulty staying or falling asleep, leading to fatigue.
Serotonin
A phenolic amine neurotransmitter (C10H12N2O) that is a powerful vasoconstrictor and is found especially in the brain, blood serum and gastric membranes of mammals. Considered essential for relaxation, sleep, and concentration.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Tinnitus (Tinnitis)
A sensation of noise (ringing or roaring) that is caused by a bodily condition and can usually only be heard by the person affected.
Tryptophan
Essential amino acid. Natural relaxant and sleep aid due to its precursor role in serotonin (a neurotransmitter) synthesis. Along with tyrosine, it is used in the treatment of addictions.
Last updated: Jun 28, 2008
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