We all love a restful sleep. Sleep is so important to our health, it's something I ask my patients about at nearly every visit. Though it may appear that we're not doing much, while we sleep our bodies are carrying out a lot of maintenance to keep us healthy. When we don't get enough (high quality) sleep, our bodies don't perform at their best. Few of us realize that our behaviors and what we consume may be adding fuel to the insomnia fire.
This past week I had quite a few patients coming in for trouble getting or staying asleep. Each patient had a unique set of circumstances and slightly different problems. They had all tried a variety of over-the-counter and prescription medications. And each of them had done their best in the vitamin aisle to find a natural remedy. None of them had found satisfactory solutions, so they came to my office to see if we could take a different approach to getting them back to sleep. With my patients, I like to get a bigger picture of what may be going on with them personally. Here are a couple of examples:
One patient was a young guy with a few other symptoms besides the insomnia. He told me he had tried melatonin, Benedryl (diphenhydramine), and finally smoking cannabis (marijuana) to help him get to sleep. Instead of focusing solely on his symptom of insomnia, I got a thorough history including his diet, exercise and other lifestyle habits. A few things really stood out to me. His diet needed some improvements, he needed more exercise, and he needed to improve his sleep hygiene (what we do before we get into bed). I offered him some advice about his behaviors before bed, recommended a multivitamin, and we set some specific goals to change his diet.
Another patient was a woman approaching menopause. Her insomnia was a bit more severe than the previous guy's. She had a higher burden of stress and some anxiety to accompany it. The doctors she'd seen before coming to me had prescribed her Xanax (alprazolam), Valium (diazepam), Ambien (zolpidem), and trazodone. None of these were helping her sleep much, and the side effects/withdrawal symptoms she was experiencing with them were frustrating to her, too. Surprisingly, none of the doctors she'd seen had mentioned her hormonal changes, and how they might be affecting her sleep. This became a key piece in her case and helped explain some of the other symptoms she was having as well. We addressed her hormonal changes and came up with a plan for her to slowly decrease her medications.
With chronic insomnia there is always a lot to the story... which is why over-the-counter and single agent medications don't always do the trick. We need to view insomnia as a symptom and look at what else is going on. Many times patients will tell me things they're doing that are clearly contributing to their poor sleep. Here are a few of the most common obstacles, and what we can do about them:
- Rushing Out the Door -- Remember that saying we learned as kids? "Breakfast is the most important meal of the day." Turns out there was a lot of wisdom there. Eating regular meals helps regulate our body's daily hormonal rhythms . When we skip meals, we can disrupt this rhythm and cause a change in our sleep pattern. Missing breakfast can change our "fight or flight" and "rest and digest" responses (the autonomic nervous system), and negatively affect our cholesterol, too (bummer!). . Skipping meals can be especially stressful on our sleep when it pushes us to eat close to bedtime, as eating late meals can also cause negative changes in our sleep .
- Stress at Night -- By now we all know that stress can cause a surge in cortisol (the so-called "stress hormone") and adrenaline . Some of the more common stress-causing things I hear from patients are watching the news, discussing work or money troubles, and working on the computer. In our house we have a rule (that I struggle to stick to) of not checking email in the hour before bedtime. In many cases, the stress isn't even something "negative," it's exciting, but it can make it hard to sleep nonetheless. An evening meditation can help calm us down, and save the excitement for the morning, when it will help to increase our alertness.
- Unhealthy Food Choices -- We know our diets are important to our overall health, and sleep is no exception. Our bodies use amino acids, vitamins, and minerals to create the calming neurotransmitters that allow us to sleep. When our diet lacks variety, or contains a lot of processed foods, we miss out on some of those beneficial nutrients. Consequently, our bodies struggle to complete the biochemical reactions that help us get to, and stay asleep . When we eat healthy (think fruits, vegetables, whole grains and quality meat, if you're into that), we give our body the best chance of putting us to sleep naturally.
- Inconsistent Sleeping Schedule -- Having a work week is good for us in a lot of ways, but if we operate on a totally different schedule on the weekends we confuse our natural rhythms . Our hormones don't know it's Saturday. It can be tough to pass up the opportunity to sleep in, especially if we've been having trouble sleeping the rest of the week, but setting a consistent pattern is one way to help get back on track.
- Boozing -- While a drink can bring on a relaxed feeling and maybe even make us a little sleepy, drinking can cause us to wake up later in the night . This effect is likely because breaking down alcohol makes it tough for our livers to balance our blood sugar . If we binge, or chronically exceed the recommended drink amounts, it can conversely cause us to sleep longer and throw our schedules off that way [4,5,6]. With most of my patients with insomnia, I tell them to avoid drinking altogether until their sleep schedule has normalized.
Of course, these suggestions can't solve everyone's insomnia, but they're a good place to start. If you've been having a hard time getting or staying asleep for a while, it might be time to schedule an appointment with a health care provider who will take the time to listen to you before reaching for the prescription pad. Sleep issues can be complicated, and tied to other aspects of your health, so it's best to talk it over with your primary care provider if it happens more than occasionally.
Dr. Michael Stanclift
Naturopathic Doctor practicing in Carlsbad, California
1. Bechtold, D.A., Loudon, A.S.. "Hypothalamic clocks and rhythms in feeding behavior." Trends in Neurosciences - 1 February 2013 (Vol. 36, Issue 2, pp. 74-82)
2. Yoshizaki T, Tada Y, Hida A, Sunami A, Yokoyama Y, Yasuda J, Nakai A, Togo F, Kawano Y. "Effects of feeding schedule changes on the circadian phase of the cardiac autonomic nervous system and serum lipid levels." Eur J Appl Physiol. 2013 Oct;113(10): 2603-11.
3. Crispim CA, Zimberg IZ, dos Reis BG, Diniz RM, Tufik S, de Mello MT. "Relationship between food intake and sleep pattern in healthy individuals." J Clin Sleep Med. 2011 Dec 15;7(6): 659-64.
5. Grandner, M., Jackson, N., Gerstner, J.R., Knutson, K.L. "Dietary nutrients associated with short and long sleep duration. Data from a nationally representative sample." Appetite. Volume 64, 1 May 2013, Pages 71-80.
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