If you have ever suffered from insomnia, you know how frustrating it can be. You go to bed, only to find yourself laying there, watching the clock, or staring at the ceiling. Or perhaps you go to bed, sleep for a few hours and wake up in the middle of the night, only to find yourself tossing and turning and can not get back to sleep. These are two different scenarios that many people experience when suffering from insomnia. According to the National Sleep Foundation, there are multiple different ways to describe insomnia.1 These include (and are not limited to):
- Acute insomnia which is defined as a brief episode of insomnia usually the result of traveling or a stressful life event such as a move.
- Chronic insomnia- which has many causes and is defined as having insomnia 3 or more nights per week for 3 or more months
- Comorbid insomnia- this is insomnia that occurs with another condition such as anxiety or depression, pain from arthritis, or thyroid disorders.1,2(748)
- Sleep onset insomnia- is seen in those who have difficulty falling asleep
- Sleep maintenance insomnia is seen in those who have difficulty staying asleep.
Some people may experience one or more of these types of insomnia. According to the CDC, more than 1/3 of the adults in the United States suffers from insomnia in any given year. 3 This is not surprising considering the role blood sugar regulation, hormones, depression, sleep apnea, nutrients, alcohol, caffeine, neurotransmitters, medications, stress and numerous other factors play in our sleep cycle. Over the next few weeks, this blog will address some of these factors that affect sleep, as well as some of the remedies to help you get a better night’s sleep. In our first week, we will discuss blood sugar regulation
Blood sugar regulation:
One cause of chronic or occasional sleep maintenance insomnia is blood glucose fluctuations. If the blood sugar drops too low, the body responds with a release of cortisol, a stress hormone that can help raise the blood sugar. 4,5 Cortisol, has a “natural cycle in the body and low levels are required prior to sleep.” 4 If you have any interest in the role of cortisol and the sleep cycle, please see source number 5. It is a bit technical if you are not in the medical profession, but I found it to be informative and well written and explains this cycle quite thoroughly. Low blood sugar can cause a person to arise from sleep, but irritability, hunger and anxiety as well. One cause for low blood sugar levels are due to consumption of simple carbohydrates- processed, sugary foods and beverages that cause a sharp raise in blood sugar, causing a release of insulin (commonly called an insulin spike), then a quick and steady drop in blood sugar. This can cause carbohydrate cravings, cortisol release and ultimately issues with insomnia. 4On the other hand high blood sugar levels can also cause sleep on set insomnia, as people often complain of feeling jittery and restless.
This problem can sometimes be resolved by eating a protein rich snack combined with complex carbohydrates before bed (think apple with natural peanut butter – the kind with no added sugar). The best snack also is high in fiber which will help slow the sugar release. Another helpful tip is to cut out sugar and processed foods, as well as eat at regular intervals. 4,5
Many people have heard of tryptophan, which is an amino acid found in turkey, chicken, milk, cheese and eggs that is known to play a role in sleep. I know growing up we would joke about being in a “turkey coma” after thanksgiving, and my parents would often tell my sister and I to have a glass of warm milk to help us get to sleep when we were kids. Tryptophan metabolism can take several pathways in the body, one of them being to synthesize the neurotransmitter serotonin (which is known as the “feel good” neurotransmitter). The intermediate product as tryptophan is made into serotonin is something called 5-hydroxytryptophan, also known as 5HTP for short. 5HTP gets converted into serotonin, which then gets chemically altered in the pineal gland located in the brain, to eventually synthesize melatonin. Melatonin is a hormone that plays a role in the sleep wake cycle. 6 The production of melatonin is affected by light exposure to the eyes, as well as the amount of serotonin available to be converted to Melatonin. It is important to point out that this metabolic pathway requires certain nutrients including iron, vitamin C, folic acid, magnesium, to convert tryptophan to 5HTP, and vitamin B6 is required to convert 5HTP to serotonin, so sometimes just starting on a multivitamin can help. 7(220),8
I do recommend supplementing with 100-300mg of 5HTP about 30-45 minutes prior to bedtime (only if you are NOT taking an antidepressant medication because they do interact), however keep in mind that some people will experience side effects from these supplements. 4,9 If you experience irritability, agitation or GI symptoms such as nausea, or gas, discontinue its use. Melatonin can also be helpful for occasional bouts of insomnia, however I generally don’t recommend taking melatonin every night because as you begin to continuously supplement, the body eventually stops production. Keep in mind this normally occurs in the elderly (production of melatonin diminishes, but you don’t want to have your body stop producing this if you can help it). Treatment with melatonin is most effective in people who have low levels to start with 2(752), so please keep this in mind if it doesn’t work when you take it. If you want to give melatonin a try, a dosage of 1-3gm at bedtime generally does the trick for most people with low levels. 2(756) There are several products that can be recommended that only have a small amount of melatonin and other sleep inducing botanicals.
Magnesium is a mineral most known for its involvement in several hundred enzymatic reactions in the body as well as its role in the structure and function of our body. 60% of the magnesium in the body is found in the skeleton10 and this mineral plays a role in energy production, muscle relaxation, and helps regulate other minerals in the body including calcium, copper and zinc. 11 In addition, magnesium is important in muscle relaxation, and can have a calming effect on people, as their muscles become more relaxed. According to the University of Maryland Medical Center, a magnesium deficiency can cause restless leg syndrome, irritability, and sleep disorders including insomnia. 11 I often recommend taking a magnesium supplement at night- about 200-400mg. Rich food sources of magnesium include tofu, wheat bran, nuts, legumes and green leafy vegetables.
Sleep apnea is another common cause of insomnia and must be ruled out in anyone who suffers from insomnia. This article’s primary goal is to discuss nutrients and in the role of sleep, however being that this affects so many people (according to the National Sleep Foundation over 18 million Americans are affected by it),12 I felt the need to mention it. Sleep apnea was first recognized in 1965 and is a breathing disorder “characterized by brief interruptions of breathing during sleep.”2(748) Breathing actually stops as often as several hundred times per night and is almost always accompanied by snoring. When people stop breathing, their brain becomes oxygen deprived and the lack of oxygen causes the person to awake just enough to begin breathing again. Often the person does not fully wake and is unaware of the problem, however these frequent interruptions ultimately result in the person getting less of the deep, restorative sleep that is so important. The condition is associated with irregular heartbeat, hypertension, heart attack and stroke, so it is imperative to be evaluated by a sleep center or physician if your partner notices periods of apnea, or if you are excessively drowsy during the day. This is not a condition that can simply be corrected by nutrients. Medical evaluation and intervention is necessary here.
Other factors including stimulants, medications, and other causes
Another cause of insomnia is the use of stimulants or depressants. Think about how a cup of coffee late in the day can have you staring at the ceiling later that night. Caffeine is associated with sleep onset insomnia, as well as sleep maintenance insomnia. Caffeine is not only in coffee, but tea, chocolate, medications, and energy drinks as well. Please be sure to read the label of whatever you are consuming.
Alcohol is a depressant, and one would think it would help combat insomnia, but it actually can be one reason for sleep maintenance insomnia. Many people use alcohol as a sleep aid, but it’s important to know that there is peer reviewed evidence that discusses the detrimental effects of alcohol on the sleep cycle.13 In addition to alcohol, other prescription and street drugs can also affect sleep patterns, and therefore must be considered when experiencing insomnia.
Other causes of waking up in the middle of the night include restless leg syndrome, benign prostatic enlargement, menopause symptoms including hot flashes, and the need to urinate, which are just too numerous to discuss.
There are several botanical products that have been found to be effective sleep aids.
Valerian, lemon balm, hops, passionflower, skullcap and chamomile are all plants that have sedative effects and can promote sleep. Of all these aforementioned botanicals, valerian is the most studied and has the strongest evidence of its efficacy. Please know though, if you choose to take any of these, it’s always best to check with someone who is a nutritional professional as there are certain compounds in many of these botanicals that are the active ingredient. Because they are supplements, and not medications, there is no strict government regulation and dosages, as well as the amounts of the active ingredients can vary from product to product. There are several products that I can recommend that contain either some or all of these botanicals. L- theonine is a substance found in green tea that can also help with sleep, but if you choose to drink the green tea, make sure it is decaffeinated; otherwise you can take 200-600mg of this as a supplement.2(756) I also need to mention, if you choose to take Valerian on its own, it does have a very strong, offensive odor and I know some people have said it smells like sweaty feet!
Multivitamins/multimineral supplements- We know that various vitamins and minerals all help to maintain homeostasis in the body. Certain vitamin and mineral cofactors are required for biochemical reactions that occur in the body. If you are deficient in any one of these nutrients, chemical pathways can slow down tremendously causing an effect not only in sleep, but general health. If is ALWAYS best to obtain your nutrients from food (especially fruits and vegetables) as there are not only vitamins and minerals, but often other antioxidants, phytochemicals, water and fiber, but if this is not possible, then other multivitamin/multiminerals can be supplemented and may help improve sleep.
2 Murray & Pizzorno. The Encyclopedia of Natural Medicine- 3rd edition. New York: Atria; 2012.
7 Bralley J & Lord R. Laboratory Evaluations for Integrative and Functional Medicine- revised 2nd edition. Metametrix Institute: Duluth, Georgia; 2012.