INSOMNIA

MANY PEOPLE HAVE experienced insomnia at some point in their lives. Sometimes it’s because of that late cup or two of coffee. Sometimes it’s because of a job interview the next morning. And sometimes you just can’t figure out why you’re having trouble getting to sleep. If insomnia, an inability to fall asleep and stay asleep, troubles you occasionally, you can usually identify the cause and avoid it. But some people suffer so regularly with insomnia that it interferes with their normal functioning.

I believe that one of the real dangers of insomnia is not the ailment itself-most people can perform better than they think with less sleep and eventually the body will catch up. The real problem is with the traditional treatment: sleeping pills. Most sleeping pills are miraculously effective-at first. And then, after several weeks, their effectiveness diminishes. Too often people take one or two extra pills to recapture the deep sleep they enjoyed when they began the medication. Before they know it, they’re taking far too many, reducing any hope they have of getting a good night’s sleep without them.

Sleeping pills interfere with normal sleep. They often increase nightly wakings. They interfere with deep sleep and they continue to interfere with normal sleep for up to five weeks after they’ve been discontinued. So, unless you’re experiencing a temporary, unusual situation and your doctor agrees that a few nights of pill-induced sleep won’t harm you, don’t even think about getting into the sleeping pill habit. Instead rely on the natural treatments I’ve outlined here; many of my patients have enjoyed success.

I’ve found insomniacs are divided into two groups: those who can’t fall asleep and those who can’t stay asleep. Sometimes the causes for the two patterns are the same. People who can’t fall asleep at night often are simply too wired. They have a lot on their minds and their thoughts are racing. Perhaps they do work or get involved in a challenging project before bedtime or even exercise too strenuously late in the evening. They can be suffering from stress and tension, but they can also be ingesting too much sugar and sweets, alcohol, or caffeine, or perhaps they smoke -all stimulants.

The solution for the first group of insomniacs is to limit these stimulants at bedtime. They must develop good sleep habits, which I’ll discuss in a minute. And they should adopt an exercise program if they don’t have one, being careful not to exercise an hour or so before bedtime.

The second group is people who wake in the middle of the night and can’t get back to sleep. They often have problems with low blood sugar, drink alcohol in the evening, consume caffeine late at night, overeat, or suffer from depression.

A common cause of insomnia that many patients fail to identify as the source of their problem is caffeine. Some people aren’t aware of how much caffeine they consume. I had one patient who drank roughly six cups of coffee a day-mostly at the office-and drank two or three cans of (caffeinated) cola in the afternoon. She was exhausted at the end of the day and fell soundly asleep at bedtime but regularly woke in the middle of the night and couldn’t get back to sleep. When she cut down her caffeine to one cup a day and eliminated sodas and diet sodas, her problem disappeared. If you have any problem with insomnia, keep track of exactly how much caffeine you consume. A cup of coffee or tea may be okay, unless you’re unusually sensitive to caffeine, but anything more than that should be eliminated. Don’t be surprised if you have withdrawal symptoms when cutting down-caffeine is an addictive substance. But within a week you should be back to normal and sleeping well.

There are any number of medications that can cause sleepless nights. Many cold remedies that contain phenylpropanolamine (PPA), some blood pressure medications, appetite suppressants, Inderal and other beta blockers, and Dilantin for the prevention of seizures can all cause insomnia. Check with your doctor to see if any medications you are taking could interfere with your sleep. Or check the label on the medicine itself. Obviously, if the drug is causing insomnia, you should discuss it with your doctor.

Many of my patients who wake in the middle of the night suffer from low blood sugar. One man would have dinner each evening with his family at about six-thirty, followed by dessert or sweets later that evening. He would go to bed at 11:00 P.M. and fall soundly asleep, but at 3:00 A.M. he would be wide-awake. He ate his dinner so early that his blood sugar fell as the evening went on and, by the middle of the night, he would wake up. He solved this problem by having a light snack before bed, a piece of fruit or crackers. If you have some fatigue in the morning and also are tired and irritable at about four in the afternoon, you could have a blood-sugar problem that affects your sleep, and a snack should help.

You should know that insomnia is closely associated with depression. Indeed, about half of all cases of insomnia have some psychological cause. If you have had major surgery, have had a major life change like a divorce, death of a loved one, job loss, or recent move, or if you are simply worried about your tax return, you could develop insomnia. If your problem is a major one, you should seek help, but you can still find that the techniques I’ll outline can help.

If none of the above is your problem, then it could be that you don’t have good sleep habits. Sleep really is a habit, and it’s important to set up a pattern that you follow each night to settle your body and mind. It’s amazing how many people will sit down at 10 P.M. to catch up on paperwork, pay bills, or figure out their taxes, and then be surprised when they don’t readily fall asleep an hour later. I advise patients who have trouble with insomnia to avoid any demanding work for two hours before bedtime. Read a novel, watch television, listen to music, or simply arrange your clothes for the next day.

It might seem obvious, but some people are unaware that a nap in midafternoon will probably make it harder for them to sleep at night. Elderly people often have a problem with this. I had a patient who would come home from work exhausted-she was a primary school teacher-and would often take a nap for about forty-five minutes in the early afternoon. She then found that she had trouble sleeping at night. The nap also seemed to set up her body to demand naps every afternoon: She said that even on weekends, she felt the desire to nap. When she began taking a half-hour walk after school instead of a nap, she found that her sleep became restful and satisfying. No matter how tired you may feel during the day-unless you’re sick or have experienced some major disruption of your schedule-don’t nap.

One of the most important habits for good sleep is going to bed at the same time every night. Many people who stay up very late one night are surprised to find that the following night, when they thought they’d sleep like a baby, they have insomnia. One of my female patients had this problem at the beginning of every week. She had a mild case of insomnia on Monday and Tuesday nights. It turned out that she stayed up very late on Friday and Saturday nights and sometimes Sunday night as well, and she slept as late as she possibly could on the following mornings. When Monday evening came she was exhausted and fell asleep early but always woke up during the night and had trouble getting back to sleep. When she regulated her hours-getting to bed earlier and getting up earlier on the weekend-the problem disappeared.

One remedy for insomnia that has proved extremely helpful in the past is an amino acid supplement called L-tryptophan. You may have heard about it a few years ago when people using it became ill. It was revealed that a batch of the supplement was contaminated and the problem had nothing to do with toxicity of tryptophan itself. I believe that tryptophan will one day become available again, but until it does you can rely on naturally occurring tryptophan in foods like milk and turkey and tuna fish. The time-honored glass of warm milk before bed really does induce sleep because it’s rich in tryptophan, and it’s worth a try if you have a problem.

I’ve had great success with some of my insomniac patients when they take a calcium supplement at bedtime.

There’s an herb-valerian-that has been used for years as a sedative, and some of my patients have had success with it. Valerian depresses the central nervous system and relaxes smooth muscle tissue. It’s available in natural food stores as a nutritional supplement.

There is another herb that when made into a tea can be helpful in inducing sleep. Passionflower, which is a sedative and an analgesic, is available in natural food stores in various forms.

In addition to taking herbs and supplements and eliminating the sources of bedtime stimulation, there is one more important thing that you can do to encourage restful nights, and that’s exercise. While it’s not a good idea to exercise in the evening as it can be too stimulating, exercise at any other time of the day will help defuse tension and relax your body so that sleep will come more easily at night. Daytime walks can serve this function, as can any other mild regular exercise.

Exercise helps to reduce tension, but some insomniacs need a more specific program of relaxation. There are a number of theories about how best to induce relaxation. You can buy tapes on self-hypnosis, and many books are available on relaxation techniques. Many of these methods are a variation on the simple time-honored trick of counting sheep. One technique that helps my patients is to imagine lying on a warm beach and breathing in and out slowly in time to the rhythm of the waves. You can also think about breathing in through your fingertips, following the path of the breath up into your shoulders, down into your lungs, through your legs and feet, and out your toes. If you concentrate on images like these, you’ll find that your muscles relax, and you’ll begin to feel pleasantly warm and drowsy. Herbert Benson’s Relaxation Response has excellent detailed information on how to develop these techniques.

NATURAL TREATMENTS FOR INSOMNIA:

• Check your medications. Some common medications can cause insomnia.
• Do not overeat at dinner; avoid late meals.
• Eliminate caffeine, including all caffeinated beverages-don’t forget colas and other soft drinks-as well as chocolate. You can try one caffeinated beverage in the morning but nothing more.
• Stop smoking or at least don’t have a cigarette within a few hours of bedtime, as it’s a stimulant.
• Avoid stimulation at bedtime, including any work or reading that is likely to produce anxiety.
• Don’t take naps even if you’re tired at a certain point in the clay. Try to exercise at this time instead.
• Develop regular sleep habits, going to bed and getting up at virtually the same time every day.
• Until and unless the natural supplement L-tryptophan comes onto the market again, rely on natural sources including turkey and tuna or a glass of milk before bed.
• Try the herb valerian: two capsules one hour before bedtime.
• Take a cup of passionflower tea before bedtime.
• Get regular daily exercise, avoiding exercise close to bedtime.
• Try relaxation techniques at bedtime.

IN ADDITION TO YOUR DAILY SUPPLEMENTS, TAKE:

• Calcium: 1,200 mg. at bedtime.

IN ADDITION: Another supplement that can be helpful in promoting sleep is melatonin. The latest research is encouraging. Some researchers have found it to be as effective as tryptophan in promoting sleep. As it’s without side effects, you might give it a try. It’s available in 2-mg. capsules; take one night for two weeks. If no results, discontinue.

Another key theory is an insufficient amount of the calming neurotransmitter serotonin versus the excitatory norephinephrine. 5-HTP is capable of solving this deficiency. 5-HTP is 5-hydroxytryptophan, the substance from which the body makes serotonin. The FDA banned L-Tryptophan, unjustly, because of one contaminated batch from a Japanese manufacturer. Suspicions have arisen that the FDA was rotecting American drug companies which were just then launching SSRI antidepressants like Prozac™. Tryptophan was used successfully for its calming, antidepressant properties. Tryptophan is converted in the body into 5-HTP which is converted into serotonin, so 5-HTP is actually a step closer than tryptophan. 5-HTP has been available and widely used in Europe since the 1970’s

Serotonin is an important initiator of sleep. In numerous studies 5-HTP has been shown to decrease the time required to get to sleep and to decrease the number of awakenings. One of the benefits of 5-HTP is that it increases REM sleep and deep sleep. Total sleep does not change since other stages of sleep are shortened to compensate.