Insomnia

Sleep is a necessary and integral state that permits mental and physical restoration.  Adequate restful sleep, proper nutrition, exercise and supplement habits are critical to good health and longevity.  Insufficient sleep can result in a variety of mental and physical health problems.  Yet getting to sleep, staying asleep and waking refreshed can be difficult, especially as we age (The New Anti-Aging Revolution, Ronald Klatz & Robert Goldman, Basic Health Publications, Inc. 2003).

The National Sleep Foundation reported in 2002 that America is on the verge of a poor sleep epidemic.  Recent polls report that 63% of adult Americans get less than the 8 hours of sleep recommended to maintain optimal physical, mental and emotional health.  Getting enough sleep can have a wide range of benefits.  Clinical trials suggest that a good night’s sleep can boost immune function, reduce the risk of heart disease, heart attacks, type 2 diabetes and breast cancer.  There is also evidence that good quality sleep may increase longevity!

A person’s need for sleep does not decline with age but sleep needs remain constant throughout adulthood. However, changes in the stages of sleep directly alter the deepness of sleep that is achieved.  Middle-aged and older people tend to spend less time in deeper sleep than younger people. When it comes to poor sleep, women tend to suffer from insomnia in greater numbers than men. Insomnia may be associated with a wide variety of prescription drugs and other conditions, such as Parkinson’s disease, Alzheimer’s disease, coronary artery disease, cancer, dementia and breathing difficulties (e.g., sleep apnea)

Normally, one cycles through 5 phases of sleep.  Normal sleep is composed of both REM (rapid eye movement) and NREM (non-REM) phases.  NREM sleep is divided into stages 1-4 where sleep deepens until stages 3 &4 (delta sleep).  REM sleep is, also known as stage 5, is where dreaming occurs.  There is little change throughout life in the amount of REM (rapid eye movement) sleep.  REM sleep is the active phase of sleep where the brain is still very active.  Unfortunately, delta sleep declines in the elderly (Kales A et al 1974). This age-related change in delta sleep may explain why sleep tends to be fragmentary in the elderly.  Although they get less sleep and may waken exceptionally early, the elderly often suffer from daytime drowsiness because of this altered sleep architecture.  

Achieving better sleep is critical to achieving optimum health and longevity.  The first step to ensuring adequate sleep is to implement good sleep hygiene.  Sleep hygiene refers to a set of behaviors designed to encourage routine, restful sleep. These behaviors include some obvious elements, such as choosing a dark, quiet sleeping environment, avoiding caffeine or other stimulants (including nicotine) in the hours preceding bedtime, and keeping an unchanging bedtime-wake schedule.  It should be noted that chronic alcohol intake in and of itself is a major cause of poor sleep patterns.  It is especially important to set a schedule and stick to it. Doctors recommend going to bed and rising at the same times every day, even on weekends. They also recommend reserving the bedroom for sleep; do not bring work to bed or watch television, for example.  Regular exercise is known to improve sleep (King AC et al 1997), but it should not be done immediately before retiring, when it may have a stimulating rather than a sedating effect. Experts also recommend finding ways to manage stress and reduce worries so that bedtime is a more relaxing experience (American Academy of Family Physicians 2005).

Many supplements, herbs and other natural sleep aids can be used with varying degrees of success.  Some of the more commonly used compounds are:

Melatonin, Vallerian Root, Magnesium, Lemon Balm, Tryptophan, Chamomile

We prefer to avoid prescription sleep aid since they are often not necessary and carry a risk of tolerance (decreasing effect over time) and dependence.  Daytime drowsiness often occurs caused by lingering effects from the previous night’s dose.  The worst problem is addiction in the sense that you can lose the ability to sleep without them.

However, if natural remedies fail to bring about refreshing sleep, it is our position that people should use whatever means are available to them, including prescription medications, to get good sleep.

Valerian—300 to 600 milligrams (mg) valerian root 30 minutes to two hours before bedtime. If taking liquid valerian, take 30 to 40 drops of extract in a small amount of warm water within the hour before bedtime. Long-term valerian therapy is not recommended. Valerian is sometimes used with lemon balm.

Melatonin—300 micrograms (mcg) to 10 mg about 30 minutes before bedtime. Sometimes lower doses work better than higher doses.  Low-dose melatonin may help any of these prescription drugs work more effectively.  I recommend sublingual melatonin since it bypasses the liver and seems to work more effectively at smaller doses.

GABA—350 to 700 mg before bedtime (taken sublingually).

L-tryptophan—1500 to 2000 mg before bedtime.

DHEA (dehydroepiandrosterone) replacement therapy may be recommended. Almost all aging humans are deficient in DHEA, and DHEA may help reduce cortisol levels and produce a feeling of well-being. Although DHEA has not been studied in insomnia, a suggested starting dose of 15 to 75 mg, followed by blood testing after three to six weeks, is recommended to promote peace of mind. It is important to take DHEA in the morning as taking it at night can be stimulatory.  Only take DHEA under the supervision of a physician familiar with DHEA supplementation

Insomnia Safety Caveats

An aggressive program of dietary supplementation should not be launched without the supervision of a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects. These include:

• L-Tryptophan
• Do not take L-tryptophan if you have carcinoid tumors.
  
• Do not take L-tryptophan while taking monoamine oxidase inhibitors (MAOIs) (type A) or within 2 weeks of discontinuing MAOIs.
  
• Do not take L-tryptophan with any antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants or MAOIs.
  
• Do not take L-tryptophan with serotonin 5-HT receptor agonists, including naratriptan, sumatriptan and zolmitriptan.
  
• Do not take L-tryptophan if you have ischemic heart disease (e.g., a history of myocardial infarction, angina pectoris or documented silent ischemia), coronary artery spasm (e.g., Prinzmetals angina), uncontrolled hypertension or any other significant cardiovascular disease.
  
• L-tryptophan can trigger excess serotonin formation in tissues other than the target organ and cause significant adverse reactions.
  
• L-tryptophan can cause nausea, diarrhea, loss of appetite, vomiting, difficulty breathing, pupil dilation, abnormally sensitive reflexes, loss of muscle coordination, blurry vision and cardiac dysrhythmia.
  

Melatonin

• Do not take melatonin if you are depressed.
  
• Do not take high doses of melatonin if you are trying to conceive. High doses of melatonin have been shown to inhibit ovulation.
  
• Melatonin can cause morning grogginess, a feeling of having a hangover or a “heavy head,” or gastrointestinal symptoms such as nausea and diarrhea.

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