by Stephen Holt, M.D.
Without restful sleep, health cannot prevail. Yet, statistics imply that 100 million Americans do not sleep well and that up to 40 million may have chronic insomnia and problems associated with going to sleep, staying asleep, and early morning wakening. The medical and economic consequences of the Nation's sleeplessness are staggering. Its consequences on health are astronomical.
What's the solution? The use of pharmaceuticals for sleep has brought controversy. Most tend to build a tolerance to them, requiring continued or increased dosing, and can commonly lead to dependence, or outright addiction. There are also increasing reports of the precipitation of a "zombie-like" state associated with aberrant behavior and eating disorders.
Amid a current series of class action law suits against the manufacturers of sleep drugs, the patient safety issues with Ambien® (Sanofi-Aventis) and other hypnotic drugs have made it to the forefront of scientific and public debate. In 2005, some 26.6 million prescriptions were written for the drug Ambien® accompanied by continuous claims of a well-established safety profile for this drug from the manufacturers. Lunesta® (Sepracor) is advertised with free trials, while carrying a "cloaked" recommendation for continuous use, a matter of great concern to many people. All sleep drugs are best used for a couple of weeks or so, but as many as one-third of all consumers of hypnotic drugs use them on an intermittent or continual long-term basis.
Sleep has five basic levels with two characteristic states. These states are rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. For sleep to be restful, one must pass through all five levels, with each five-level cycle having roughly a two-hour duration. Each time the cycles restart, they become shorter and consist predominantly of REM sleep.
Sleep can become disjointed and eventually develop into insomnia due to the following common causes: stress, irregular life and sleep schedules, psychological distress, physical illness, drugs, substance abuse, and chronic pain. Several obvious symptoms or signs of sleep deprivation include drowsiness, poor memory, lack of motivation, general fatigue, poor concentration, behavior problems, mood problems, and accidents. Sleeplessness is a major factor in promoting the adverse symptoms of PMS and menopause.
Modern research has pointed to several lesser-known components of sleep deprivation. These obscure components include weight gain or obesity associated with eating disorders, the development of insulin resistance and metabolic syndrome X, significant hormonal changes, and even premature death. Sleep deprivation also promotes premature aging by many mechanisms.
NATURAL SOLUTIONS TO HEALTHY SLEEP
There are some basic dietary and lifestyle modifications you can make to help improve sleep, including:
Regular bedtime routines with attention to sleep hygiene, i.e., don't read, write, eat, watch TV, talk on the phone, or play cards in bed; go to bed at the same time every night; use the bed for only sex and sleep; etc.
Sleep environment controls such as eye masks, ear plugs, air purifiers, etc.
Regular exercise, generally recommended to be completed before 4 pm
Care with drugs, diet, alcohol, caffeine, smoking, illicit drug use, and diet pills
Extra nutritional support from the appropriate dietary supplements
PROPER SUPPLEMENTS FOR SLEEP
Sleep involves a complex cascade of normal body function, including muscle relaxation, mental tranquility, complex eye movements, etc. A single agent, be it a drug or a single dietary supplement, usually isn't able to manage this complex cascade of sleep events. Using combinations of natural substances that act in a synergistic manner work more optimally. Each component of a synergistic formula adds to the overall desired effect.
There are three classes of natural nutritional supplements to support the body's normal function of sleep:
Herbs or botanicals
Several herbs are valuable for sleep management, and combinations of herbs may be particularly valuable for improving sleep quality, falling asleep faster, and maintaining restful sleep. Green tea has been found to lull the brain into quality sleep, perhaps as a consequence of the presence of L-theanine. Other herbs and their respective benefits include:
Valerian: sedative, anti-myoclonus, GABA breakdown inhibition, carminative, no hangover, adaptogenic
Chamomile: calming, analgesic, anti-inflammatory, antioxidant, carminative
Ashwagandha: nervine, adaptogenic, mild sedative, "Indian Ginseng"
Passionflower: nervine tranquilizer
Lemon balm: sedative, anti-spasmodic, nervine, value in depression, soothes gastrointestinal tract, anti-spasmodic
Catnip: mild sedative, anti-anxiety
Skullcap: anti-anxiety without drowsiness, adaptogenic
Hops: sedative-hypnotic, smooth muscle relaxation
Melatonin is a sleep hormone widely used in dietary supplements. In healthy people, melatonin secretion by the pineal gland occurs with darkness and during sleep. The amounts the body secretes tends to decline with age. Studies show melatonin may shorten sleep-induction time and reduce episodes of awakening, without necessarily increasing sleep time.
It is also fortunate that there are several key nutrients that can improve sleep. Magnesium induces muscle relaxation and causes changes in brain waves associated with relaxation. Calcium has similar, though more variable effects. Coral calcium carries many anecdotal reports of improving sleeping habits. Amino acid supplements, such as glycine and tryptophan, may help sleep. When used alone, however, large doses are necessary (e.g., at least 3 g of glycine) and best taken under supervision. 5-hydroxytryptophan (5-HTP) is preferred over tryptophan. The role of B-vitamins in sleep management has been underestimated. The classic anti-stress combination of vitamins B3 and B6 with folate are necessary for the synthesis of chemical messengers in the brain (e.g., serotonin).