What is sleep?
Sleep is defined as a state of unconsciousness from which a person can be aroused, as opposed to a coma, from which a person cannot be aroused. It is an active process within the brain, where neurons (nerve cells) either stimulate or inhibit different parts of the brain. It serves as a restorative process essential for normal human health, affecting the daily activities and functions of the body systems, including the immune system and even mental health. Sleep is imperative for our nervous system to function properly; without it, our immune system would be unable to properly fight infection or endure illness. Sleep is a basic necessity of life, like drinking water and eating food; we all need sleep to be healthy and to face the daily struggles of life.
What exactly is a sleep disorder?
Sleep disorders are used to describe a disturbance of sleep. There are many types of sleep disturbances and related difficulties that range from trouble falling or staying asleep to excessive sleeping to abnormal sleep behaviors, such as falling asleep at inappropriate times. Currently, there are over 100 different types of sleep disorders, each with specific characteristics, causes and effects. This article will focus on the most commonly experienced disorders.
Insomnia is one of the most common sleep complaints. Whether experienced as difficulty falling asleep or the inability to stay asleep, nearly everyone will be affected by insomnia at some point in their lives. Frequent contributors are stress, tension or worries, jet lag, and a poor diet. Other factors can trigger insomnia as well. The result is a decrease in well-being and performance; in particular, school work, daily tasks and job productivity. Insomnia affects millions of people per year including both short-term and long-term periods. This problem typically increases with age as well, affecting about 1 in 3 people, women more often than men, and may be an indicator of an underlying medical condition.
Sleep apnea is a disorder that causes a cessation of breathing during sleep. It has been associated with obesity resulting from a build-up of fat and from loss of muscle tone due to aging. These cause the windpipe to collapse during respiration when sleep related relaxation occurs in the muscles (called obstructive sleep apnea). Sleep apnea can also be caused by a malfunction of the neurons responsible for our ability to breath during sleep. It is commonly accompanied by loud snoring, though snoring in itself does not necessarily indicate sleep apnea. In any case, the consequences of this particular disorder may be severe, as sleep apnea increases the risk of strokes, heart attacks, irregular heart beats, high blood pressure and even death from respiratory arrest during sleep.
Restless Legs Syndrome:
Restless legs syndrome is a disorder resulting in uncomfortable sensations of tingling, prickling, and crawling in the legs and feet that can only be relieved by moving them about. It has been identified as an extremely common sleep disorder, affecting millions of people, particularly the elderly, and has been associated with anemia, pregnancy and diabetes. Restless legs syndrome leads to insomnia and constant movement of the legs throughout the day.
Narcolepsy is characterized by frequent “sleep attacks” occurring at various times during the day, despite adequately sleeping at night, and lasting from several seconds to more than half an hour. It affects over a quarter million people and may result in loss of muscle control during emotional situations, a disruption of sleep at night, hallucinations and even temporary paralysis upon waking. These symptoms indicate that it is a disorder of the regulation of the sleep cycle, with aspects of REM sleep occurring while awake. It typically occurs during adolescence and is commonly associated with hereditary factors, but may also occur due to head trauma or neurological disease.
So how can you improve and increase the amount of sleep you get each night?
Healthy sleep habits have been found to be essential for treating insomnia. Some basic lifestyle changes one can make to address sleep difficulties are:
Exercise regularly to help reduce stress, release tension and increase the ability to fall asleep and remain asleep. Focus on exercising in the morning or early afternoon and avoid exercising in the evening, as it can be too much stimulation before bed time.
Maintain a sleep diary to help identify triggers, habits, and factors that may work for or against a restful sleep.
Avoid caffeine, alcohol and nicotine which act as stimulants or interrupters and make falling asleep more difficult, especially 4-6 hours within bed time.
Get exposure to the sun on a regular basis, up to half an hour a day, preferably late afternoon sun, which stimulates the release of melatonin and helps in the regulation of the circadian rhythm.
Perform stress reduction activities such as meditation, guided relaxations or yoga, which help to reduce anxiety and worries that interfere with sleep.
Maintain a consistent sleep schedule by following a daily waking and retiring practice.
Avoid engaging in stressful and stimulating activities before bed particularly television watching.
Establish the bedroom as a place of rest and intimacy and exclude activities such as reading, watching television and working.
Take hot baths about 2 hours before bed to help relax. Hot baths also affect body temperature and regulation resulting in a temperature conducive to falling asleep.
Ensure that your bedroom environment is quiet, dark, cool, and has good air circulation.
When unable to fall asleep do not lie in bed or look at the clock. Instead, leave your bedroom and perform something relaxing, such as meditation, breathing exercises, or guided imagery.
Avoid taking naps, especially in the evening or for longer than 1 hour.
Avoid eating greasy, fatty, heavy foods, especially late in the evening. Also consume water or fluids throughout the day and limit amounts before bed time.
Botanical preparations or teas can be used to help reduce the tension and anxiety experienced by people with insomnia. Herbals can provide relaxation to the nervous system to ensure a restful and restorative sleep. The following herbs are commonly used to help provide a sedative, calming, and sleep inducing effect:
Passionflower: Passion flower has been traditionally used to provide relief from anxiety, stress and aids in the transition into a restful sleep. It acts within the nervous system and brain by providing a sedative action and can inhibit the breakdown of serotonin (a neurotransmitter responsible for mood and sleep).
Catnip: Catnip acts as a sedative on the nervous system and adds to a general sense of relaxation. Animal studies have indicated that it helps to increase sleep by its mild tranquillizing and sedative effect.
Valerian: Valerian is one of the most popular herbs purchased by people and is widely used for the treatment of anxiety and insomnia. Numerous clinical studies have been conducted into the efficacy of valerian’s ability to improve sleep quality and relieve insomnia. Studies have indicated that valerian was significantly better than a placebo in improving sleep and was comparable to benzodiazepams in its ability to increase deep-sleep stages 3 and 4 when combined with lemon balm. Additionally there was no report of daytime sleepiness, impairment of physical performance or diminished concentration. Valerian is not addictive or does not promote dependency and its sedative effect is not significantly exaggerated by alcohol and barbiturates unlike benzodiazepams.
Hops: Hops is used for insomnia, tension and anxiety by providing a calming and relaxing effect upon the nervous system. It is used in the treatment of insomnia due to its sleep inducing and sedative properties.
Chamomile: Chamomile is another herb that is used frequently by people commonly in the form of teas or herbal combinations for its relaxing and mild sedative effects. It is a mild nervine that tonifies the nervous system, reduces anxiety, tension and helps to provide a restful sleep.
Oats: Oats is used in instances of stress, exhaustion, illness, depression, and jet lag. It is an excellent nervous system tonic providing a nourishing and tranquillizing effect.
Lemon Balm: Lemon balm has been used for generations in teas to help relieve tension, depression and anxiety. It provides a sedative effect on the nervous system.
Essential oils are concentrated, highly potent oils extracted from plants and used for their restorative and health promoting properties. They may be added to your bath water or used in foot baths but most essential oils should be diluted in a carrier oil (such as almond oil) before being applied directly on the skin. The following oils are beneficial in the treatment of insomnia by providing a relaxing and calming effect on the nervous system:
Chamomile: Chamomile oil possesses antidepressant properties and helps to relieve stress, anxiety, and stress leading to insomnia.
Lavender: Lavender oil is beneficial in the treatment of nervousness, depression, irritability through its calming, balancing and sedative effects. It is specific for nervous system imbalances and problems.
Sandalwood: Sandalwood has traditionally been used in meditation, spiritual practices, and rituals. It has a grounding and opening effect, improving depression, anxiety and insomnia.
Ylang ylang: Ylang Ylang is a common herbal added to beauty products as a hair tonic and to balance oil production. It is useful for alleviating depression, frustration, anger, and stress related disorders. It also acts as a sedative and nervous system tonic improving insomnia and relieving stress and anxiety associated with insomnia.
Marjoram: Marjoram is used for helping those who feel emotionally irritable or unstable due to overexertion and excess external stimuli. It provides relief through its calming effect on obsessive thinking, its sedative effect on the nervous system and its soothing effect on loneliness, neediness and sense of rejection.
5-HTP: 5-HTP (5-hydroxytryptophan) is an intermediate amino acid in the synthesis of serotonin from L-tryptophan. Serotonin modulates your mood, emotions, sleep and appetite and is involved with numerous physiological and behavioral factors. 5-HTP affects sleep, depression, anxiety, aggression, sexual behaviour, temperature, and pain sensation, by its conversion to serotonin. Its main action is by increasing serotonin levels within the nervous system and brain. It is beneficial in the treatment of insomnia by improving sleep quality and increasing REM sleep. Side effects may include mild nausea, vomiting, diarrhea, and anorexia, from large doses and it has been associated with eosinophilia myalgia syndrome and asymptomatic eosinophilia (likely due to a manufacturing process contaminant). Caution should be taken by those who are pregnant or who have peptic ulcers, Down syndrome, platelet disorders, and kidney disease.
Melatonin: Melatonin is a hormone that is naturally secreted by the pineal gland, located within the brain. It is involved with the sleep-wake cycle and is closely regulated by light input from the eyes. Melatonin has been reported to be low in people with insomnia. Melatonin supplementation has rapid and mild sleep inducing effects, by interacting with melatonin receptors in the brain it acts as a sedative and hypnotic. It regulates the body’s circadian rhythm and sleep patterns, body temperature and performance, and lowers alertness, for up to four hours after taking it. Side effects for some people may include headaches, daytime fatigue, drowsiness, dizziness, irritability and abdominal cramps. Caution should be taken by pregnant women and those with autoimmune diseases as it stimulates the immune system.
L-theanine: L-theanine is an amino acid derived from the tea plant that increases both serotonin and dopamine production. Clinical studies have indicated that it increases relaxation by increasing alpha wave activity. L-theanine has been shown to be safe with minimal side effects.
L-Tryptophan: L-tryptophan is an essential amino acid (an amino acid that the body cannot synthesize and must consume in the diet) that is present in many plants and animal proteins. L-tryptophan is a precursor to serotonin and has sedative effects similar to 5-HTP. When taken orally for sleep disorders, it has been reported to improve sleep and also to improve the response to sleep treatment protocols. Side effects may include nausea, headaches, lightheadedness, and drowsiness. It was taken off the market in the USA due to manufacturing process contamination of the product resulting in eosinophilia myalgia syndrome (a potentially fatal disorder affecting multiple body systems including joints, skin, muscles, connective tissue, liver and an increase in the white blood cell eosinophil count). Pregnant women should not take L-Tryptophan and caution should taken with people with eosinophilia and liver disease.
I am tired and I want to go to bed:
The best option for an individual with sleep difficulties is to be proactive and seek the appropriate care. Lifestyle changes are a simple way to provide relief and can be incorporated into your daily sleep habits. Further treatments such as botanical medicines and nutritional supplements are best taken when prescribed by a licensed Naturopathic Doctor or other qualified health professional. A Sleep disorder may be a complicated concern requiring further testing and proper diagnosis. A qualified health professional can provide insight and support to help address the causes, risk factors and treatment strategies associated with sleep disorders.
Tierney LM, McPhee SJ, Papadakis MA. Current Medical Diagnosis and Treatment, 42nd Ed. McGraw Hill Companies Inc. 2003.
Ziegler G; Ploch M; Miettinen-Baumann A; Collet W. Efficacy and tolerability of valerian extract LI 156 compared with oxazepam in the treatment of non-organic insomnia–a randomized, double-blind, comparative clinical study. Eur J Med Res 2002 Nov 25; Vol. 7 (11), pp. 480-6.
Poyares DR; Guilleminault C; Ohayon MM; Tufik S. Can valerian improve the sleep of insomniacs after benzodiazepine withdrawal? Prog Neuropsychopharmacol Biol Psychiatry 2002 Apr; Vol. 26 (3), pp. 539-45.
Herrera-Arellano A; Luna-Villegas G; Cuevas-Uriostegui ML; Alvarez L; Vargas-Pineda G; Zamilpa-Alvarez A;Tortoriello J. Polysomnographic evaluation of the hypnotic effect of Valeriana edulis standardized extract in patients suffering from insomnia. Planta Med 2001 Nov; Vol. 67 (8), pp. 695-9.
Dressing H, Riemann D, Löw H, et al. Insomnia: Are valerian/balm combination of equal value to benzodiazepine?Therapiewoche 1992;42:726-36.
Dressing H, Kohler S, Muller WE. Improvement of sleep quality with a high-dose valerian/lemon balm preparation: A placebo-controlled double-blind study. Psychopharmakotherapie 1996;6:32-40.
Natural Medicine Comprehensive Database. Therapeutic Research Faculty. Stockton, CA. 2000
Thorne Research Inc. Melatonin Monograph. Alternative Medicine Review. Volume 10, number 4, December 2005. pp 326-336.
Birdsall, Timothy C. 5-Hydroxytryptophan: A Clinically-Effective Serotonin Precursor. Alternative Medicine Review, Volume 3 Number 4, 1998, pp 271-280.
L-Theanine Monograph. Alternative Medicine Review. Volume 10, Number 2, 2005, pp 139-138