The need for sleep
Researchers now pretty much agree you need around seven to nine hours of largely uninterrupted sleep a night. Insomnia is defined as difficulty falling asleep (on average taking more than 30 minutes to fall asleep); waking up frequently during the night and having difficulty getting back to sleep; waking up too early in the morning and being unable to return to sleep; waking up tired or exhausted which can persist through the day making you feel irritable, anxious or depressed. If this sounds like you, you have a sleeping problem. So what can you do about it?
Why not sleeping pills?
If you can’t sleep and you go to your doctor, the chances are that you will be prescribed sleeping pills, also known as hypnotics. Despite having a long charge sheet of side-effects1, these drugs still regularly feature in the top 20 most-prescribed drugs both in the UK and the USA. Not only that, but they aren’t actually very useful, according to a report in the British Medical Journal.2 Just how marginally effective they are was vividly illustrated by a 2007 study by the American National Institutes of Health, which found that the newer drugs like Ambien (zolpidem) made you fall asleep only 12.8 minutes faster than with a fake pill and sleep for just 11 minutes longer.3
Cognitive Behavioural Therapy
Long-term sleep problems can be the result of an illness like diabetes or a painful condition such as arthritis. Otherwise the most likely root is psychological – stress, anxiety or depression. Therapy such as CBT is able to help by encouraging patients to acknowledge the stress that is preventing them from sleeping and then helping them to deal with it. This might be by identifying negative or unhelpful thoughts – “I just can’t sleep without my pills”, for example – and changing them.
A 2006 review in The Lancet found that various forms of counselling and psychological help are not only the most effective but also the safest way to tackle chronic insomnia.4
A more recent study compared CBT with one of the new sleeping pills called Zopiclone. While CBT improved the percentage of time spent asleep from 81.4 per cent to 90.1 per cent after six months, Zopiclone actually reduced it from 82.3 per cent to 81.9 per cent.5 In a proper evidence-based medical system, we’d have most people being referred to counsellors and few getting drugs, instead of the other way round.
The hygiene approach
Essentially common-sense advice, sleep hygiene forms part of most good sleep regimes. The idea is to create regular sleep-promoting habits on the grounds that the less successful you are at getting to sleep, the more you are going to worry about it. So you are advised to keep the bedroom quiet and dark, to have comfortable clothing, not to have a big meal before bed, to avoid coffee and alcohol and to exercise regularly but not within three hours of bedtime.
Although sleep hygiene is widely recommended, there have been very few studies of it as an individual treatment, and what ones there are, have only found a limited improvement. Good results have been reported, however, for something similar known as ‘stimulus control therapy’ which essentially involves ensuring that the bed is only associated with sleeping. Patients are advised against having naps (although there may be some health benefits to napping – see below), to go to bed when sleepy, to get up within 20 minutes if they haven’t fallen asleep, to do something relaxing till they feel drowsy and to try again but to get up again if it fails. Keep artificial light to a minimum in the bedroom because being exposed to bright light can turn off production of the sleep hormone melatonin, which peaks at around 1am. If you need to get up in the night, only use low wattage bulbs.
Having a nap in the day may also reduce some of the health risks of poor sleep. Scientists from the University of Athens and the Harvard School of Public Health studied 23,681 healthy adults aged between 20 and 86 for an average period of six years. They found that those who nap at least 30 minutes three times a week or more, have a 37 per cent lower risk of coronary mortality than those who did not sleep during the day.6
Nutritional solutions to sleep problems
Nutrients play a key role in producing the hormones that aid sleep, and also ensuring the body is able to calm down.
The main sleep hormone is melatonin, which your body makes from another hormone called serotonin. Natural sources of melatonin include porridge oats, sour cherries (eg as the juice concentrate Cherry Active), bananas, peanuts, grape skins, walnuts and liquorice. It is also concentrated in herbs such as St John’s wort, sage and feverfew. Avoiding caffeine, at least after midday, is a no brainer because caffeine suppresses melatonin for up to ten hours.7 We recommend none after midday, and that includes green tea, if you have difficulty getting to sleep.
You can buy melatonin as an over-the-counter medicine in the US, or on prescription from a doctor in the UK. You can alternatively supplement 5-HTP, an amino acid which your body uses to make melatonin. There’s evidence that supplementing 200mg of 5-HTP half an hour before bed improves sleep.8
Several minerals and vitamins are also involved in good sleep. Calcium and particularly magnesium are calming and aid muscle relaxation. Being highly stressed or eating a lot of sugar lowers magnesium levels. Magnesium is found in seeds, nuts, green vegetables and seafood; calcium is in these foods and also in dairy produce. Most supplements contain both. Try supplementing 600mg of calcium and 400mg of magnesium before bed. This is especially helpful if you wake in the night with stiff muscles.
A 2014 study from Oxford University has also found that higher levels of omega 3 (an essential fat found in oily fish) in the diet are associated with better sleep, at least in children.9 Those with higher levels of the omega 3 fat DHA experienced less resistance to going to sleep, fewer parasomnias (eg disorders such as night terrors, sleep walking or restless leg syndrome) and total sleep disturbance. This correlation increased where the DHA ratios where higher in relation to Arachidonic Acid – a fat found in meat and dairy products. While studies have yet to explore if a similar pattern can be identified in adults, there is a significant body of research on the benefits of omega 3 fats on reducing anxiety and improving mood, memory and brain health.
The better alternative to alcohol
Many people use alcohol to relax, which promotes release of the neurotransmitter GABA, switching off adrenalin. But alcohol only works for an hour or so. When the effect wears off, you want another drink. If you go to sleep under the influence of alcohol it disturbs the normal sleep cycle which can promote low moods. The net consequence of regular alcohol consumption is GABA depletion, which leads to more adrenalin, anxiety and emotional oversensitivity and less good quality of sleep. One study found that men who drank more increased their risk of sleeping problems by 25 per cent.9 The less sleep you get, the more potent and dangerous are the effects of alcohol; not only does it suppress dreaming REM sleep, but it also decreases deep sleep.10
In the US and outside the UK you can buy GABA in 500mg capsules. Taking one to three an hour before bed helps promote a good night’s sleep. The combination of GABA and 5-HTP is even better. In a placebo-controlled trial, supplementing GABA and 5-HTP cut the time taken to fall asleep from 32 minutes to 19 minutes and extended sleep from five to almost seven hours.11 Taking 1,000mg of GABA, plus 100mg of 5-HTP is a recipe for a good night’s sleep. GABA is made from two amino acids – taurine and glutamine. Some sleep formulas include these helpful nutrients.
L-theanine, an amino acid found in tea, can help to make you feel more relaxed and less ‘edgy’. Research suggests that 50mg naturally stimulates alpha-wave activity in the brain, which is associated with a relaxed but alertmental state.18
Sounds of sleep
New York psychiatrist Dr Galina Mindlin uses ‘brain music’ – rhythmic patterns of sounds derived from recordings of patients’ own brain waves – to help them overcome insomnia, anxiety and depression. The recordings sound something like classical piano music and appear to have a calming effect similar to yoga or meditation. A small double-blind study from 1998, conducted at Toronto University in Canada, found that 80 per cent of those undergoing this treatment reported benefits.12
Another study found that especially composed music induced a shift in brain wave patterns to alpha waves, associated with the deep relaxation before you go to sleep, and that this induced less anxiety in a group of patients going to the dentist.13 Many of our clients have also reported excellent results with John Levine’s Silence of Peace CD (available from Amazon). It induces alpha brain waves, which help to quiet the mind and induce restful sleep.
Insomniacs may be hotter. Scientists at the University of South Australia have reported that the core temperature of normal sleepers dropped about a degree 1.5 hours before sleep, unlike that of insomniacs. One possibility is that biofeedback might help improve temperature control. However, naturopaths claim poor sleepers may benefit from a bit of heat before bed, citing improved relaxation after a 15 to 20 minute hot bath, containing one to two cups of Epsom salts (magnesium sulphate).
A trial has found that acupuncture can be effective. Daily treatment for seven to ten days led to the complete recovery of sleep in 50 per cent of subjects and an improvement in 21 per cent.
UK sleep expert Professor Jim Horne claims that at least 50 per cent of any insomnia treatment works because of the placebo effect, but trials comparing sham with real acupuncture for sleep showed a difference.
These and various other treatments may work because long-term insomnia may be due to ‘hyper-arousal’. Insomniacs often have a faster heart rate, higher levels of the stress hormone cortisol and more of the alert beta brain waves before sleep. However, one study which attempted to treat hyper-aroused insomniacs with tranquillisers has been described as “not robustly positive”.14
Avoid your second wind
If you feel very stressed and fatigued but find your exhaustion lifts around 10 or 11pm in the evening, as you get a second wind, don’t be tempted to start doing all those chores you felt too tired to do earlier in the evening. The extra energy is usually the result of a burst of cortisol, as your body struggles to function and regulate energy to keep you going in what it perceives is an emergency situation. However if this continues long term, you are fast-tracking yourself to burn-out and exhaustion. So go to bed before this hits and save your adrenal glands from extra work they really don’t need.
Once in bed, spending a few minutes doing a simple meditation or relaxation technique (see my report ‘Meditation Techniques for Letting Go of Negative Emotions’ or HeartMath’s Quick Coherence exercise (see my report on ‘HeartMath’) can help to bring your body into a calm state where a good night’s sleep is more likely to follow.
If you find you frequently wake between 2 and 3am with a pounding heart or in a sweat, you may be experiencing a blood sugar low. Try having a small protein-rich snack (eg an oatcake spread with nut butter) before you retire to see if this alleviates the problem.
Good Sleep Tips
Keep your bedroom quiet and dark, wear comfortable night clothes, don’t have a big meal before bed, avoid coffee and alcohol and exercise regularly but not within three hours of bedtime. It’s worth knowing too that certain prescription medications can cause insomnia, such as steroids, bronchodilators (used for asthma) and diuretics. And if you do drink caffeinated drinks, research shows that consumption within six hours of bedtime can have significant disruptive effects on sleep.15
Keep artificial light to a minimum in the bedroom because being exposed to bright light can turn off production of the sleep hormone melatonin, which peaks at around 1am. If you need to get up in the night, only use low wattage bulbs.
There is also a growing body of evidence that suggests electro-magnetic radiation from mobile phones and wireless internet connections can interfere with melatonin production. For example, in one small study, melatonin levels were 44% lower at 2am in those exposed to mobile phone signals, compared to those who weren’t.16 So it may be worth experimenting to see if turning off your mobile and any wi-fi modems at night aids your sleep quality.
If all else fails, having a nap in the day may help to reduce some of the health risks of poor sleep. Scientists from the University of Athens and the Harvard School of Public Health studied 23,681 healthy adults aged between 20 and 86 for an average period of six years. They found that those who nap at least 30 minutes three times a week or more have a 37 per cent lower risk of coronary mortality than those who did not sleep during the day.17
To help yourself get a good night’s sleep:
- Prioritise relaxing activities in the few hours before you go to bed, so you reduce your stress levels and get your body into a calm state ready for sleeping.
- Avoid alcohol before bed, and limit any caffeine intake after midday (and preferably avoid completely).
- Aim to follow a soothing bedtime routine, such as having a warm bath with Epsom Salts and lavender or listening to soothing music.
- Once in bed, do some simple relaxation exercises to get yourself ready for sleep.
- If you have difficulty sleeping, supplement 400mg of magnesium before bed, or experiment with 200mg of the amino acid 5-HTP half an hour before bed or a sleep formula containing both of these, plus GABA or GABA precursors (taurine and glutamine) and theanine.
- Follow good sleep hygiene, ensuring your bedroom is quiet and dark and you are comfortable. Also turn off mobile phones and wi-fi connections at night.
For more information of how to sleep well, and reduce stress and anxiety read The Stress Cure
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- Common side effects include “daytime sedation, motor incoordination, cognitive impairments (anterograde amnesia), and related concerns about increases in the risk of motor vehicle accidents and injuries from falls”, according to The Lancet, 2004, vol 364, pp. 9449
- Editorial: Treating Insomnia – use of drugs is rising despite evidence of harm and little meaningful benefit, BMJ (2004), vol. 329, pp. 1198 – 1199
- S. Saul, ‘Sleep drugs found only mildly effective but wildly popular’, New York Times, 23 October 2007
- J Michael Sateia and Peter D Nowell, Insomnia, The Lancet (2004), vol. 364 (9449).
- B Sivertsen et al, Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial, Journal of the American Medical Association (2006), vol. 28, issue 295 (24), pp. 2851-8.
- A Naska et al, Siesta in Healthy Adults and Coronary Mortality in the General Population, Archives of Internal Medicine (2007), vol. 167, pp. 296-301.
- L. Shilo et al., ‘The effects of coffee consumption on sleep and melatonin secretion’ Sleep Medicine, 2002;3(3):271-3
- T C Birdsall, ‘5-Hydroxytryptophan: a clinically-effective serotonin precursor’, Alternative Medical Review, 1998, vol. 3(4), pp. 271-80
- P. Peppard et al., ‘Sleep disorders linked to heavy drinking in men’, Journal of Clinical Sleep Medicine, April 2007
- V Coiro et al., ‘Alcoholism abolishes the growth hormone response to sumatriptan administration in man’, Metabolic Clinical Experiments, 1995
AND A. Heinz et al., ‘Blunted growth hormone response is associated with early relapse in alcohol-dependent patients’, Alcoholism, Clinical and Experimental Research, 1995, vol. 19 (1), pp. 62-65
- W. Shell et al., ‘A Randomized, Placebo-Controlled Trial of an AminoAcid Preparation on Timing and Quality of Sleep’, American Journal of Therapeutics, 2009
- L.Yai, ‘Brain music in the treatment of patients with insomnia’, Neuroscience and Behavioural Physiology, 1998, 28:330-335
- I .Olszewska and M. Zarow, ‘Does music during dental treatment make a difference?’ See: www.silenceofmusic.com/pdf/dentists.pdf
- M Mahowald & C Schenck, Insights from studying human sleep disorders, Nature (2005), vol. 437|27.
- C. Drake et al, ‘Caffeine effects on sleep taken 0, 3 or 6 hours before going to bed’, J Clin Sleep Med, J Clin Sleep Med, 2013; 9(11): 1195–1200
- S. Jarupat et al., ‘Effects of the 1900 MHz electromagnetic field emitted from cellular phone on nocturnal melatonin secretion’, J Physiol Anthropol, 2003;22:61-63
- A. Naska et al., ‘Siesta in Healthy Adults and Coronary Mortality in the General Population’, Archives of Internal Medicine, 2007, vol. 167, pp. 296-301
- L.R. Juneja et al., ‘L-Theanine, a unique amino acid of green tea and
its relaxation effects in humans’, Trends in Food Science and Technology
(1999),vol OR10, pp. 199–204; A.C. Nobre et al., Modulation of Brain
Activity by Theanine, report for Unilever by the Department of
ExperimentalPsychology, University of Oxford, 2003; see also K. Unno et
al., ‘Anti-stress effect of theanine on students during
pharmacypractice: positive correlation among salivary α-amylase
activity, traitanxiety and subjective stress’, Pharmacology,
Biochemistry and Behaviour(2013), vol. 111C, pp. 128–135.