Vitality Advocates

Tag: insomnia

  • Herbals for Insomnia? Now You Can Test Them at Home

    Herbals for Insomnia? Now You Can Test Them at Home

    Herbal remedies for insomnia are abundant online—valerian, hops, and chamomile, among the most common. Tested against placebo, none has been found to be definitively effective for insomnia. Yet some medicinal herbs have a long history as traditional calming, sleep-promoting agents. Might one work for you?

    Researchers at Massachusetts General Hospital and Harvard Medical School have proposed a method you can use yourself to test herbal remedies via personalized therapeutic trials. Here’s more about herbals and how the trials work:

    Why Herbals for Sleep?

    Interest in herbal and other alternative treatments for insomnia seems to be on the rise. About 5% of the participants in a national survey reported use of complementary and alternative medicine (CAM) for insomnia in 2002. A recent analysis of the same national survey conducted in 2007 found that almost 50% of participants with insomnia symptoms used some form of CAM therapy.

    Some insomniacs see alternative medicines as less risky than prescription sleeping pills, with fewer potentially harmful side effects. Because they are “natural,” they’re viewed as more appropriate for long-term use than many sleeping pills, which, if used nightly, tend eventually to degrade sleep quality.

    Scant Testing, Mixed Results

    Most herbal remedies for sleep have not undergone as much testing as prescription sleeping pills (one reason may be that there’s relatively little money to be made on them). But as with sleeping pills, tests that have been conducted on herbals often show subjective sleep improvements that exceed objective measures.

    The perception that herbal supplements improve sleep could be due to a placebo effect. Or, say the Massachusetts researchers, it could be attributable to basic differences among trial participants, including different insomnia symptoms. It could be that, just as a particular sleeping pill works for some insomniacs and not others, a particular herb may relieve insomnia in some people and not others.

    Herbals That May Relieve Insomnia

    Since the overall efficacy of herbal preparations for insomnia is still unknown and may differ from person to person, the researchers opted to consult six authoritative resources in their search for herbal and supplement remedies of potential relevance for insomnia, including reference books such as the Physician’s Desk Reference for Herbal Medicines (PDR) and online sources such as Medline Plus. In all, they came up with a list of over 70 herbal agents of possible benefit to sleep.

    These 15 medicinal herbs were listed by 4 or more resources as a remedy for insomnia or another condition indirectly related to sleep, such as anxiety or nervousness:

    1. Ashwagandha
    2. Bitter Orange (Neroli)
    3. Catnip (Nepeta)
    4. Chamomile (German)
    5. Hops
    6. Kava
    7. Lavender (English)
    8. Lemon Balm
    9. Linden
    10. Nutmeg (and Mace)
    11. Oats (Avena sativa)
    12. Passion Flower
    13. Schisandra (Wu-Wei-Zi)
    14. St. John’s Wort
    15. Valerian

    Safety of Herbal Supplements

    Natural substances are not necessarily safe for unrestricted use. The PDR for Herbal Medicines cautions against using several during pregnancy. Some herbs may be harmful to the liver. And, as herbal supplements are unregulated in the United States, the contents of a supplement do not necessarily reflect what appears on the label. In fact, a majority of herbal remedies evaluated in a recent study had contamination, substitution, or use of fillersnot listed on the label.

    For safety concerns associated with herbs used for insomnia, see these sources:

    Find Out If a Sedating Herb Works for You

    Let’s say you’re a sleep maintenance insomniac, awakening at least twice a night to feelings of anxiety. You’ve heard that passion flower is good for sleep and anxiety, and you’d like to try it to see if it cuts down on your nighttime wake-ups. But how long should you try it? Two nights, three nights or more?

    Many insomniacs experience quite a bit of night-to-night variability in their sleep. When you’re stressed out you might sleep poorly for 4 or 5 nights in a row before you get a decent night’s sleep. If you tried taking a passion flower supplement for just 2 or 3 nights during a time of stress, the results you obtained wouldn’t be reliable. You might obtain a different result if you tested the passion flower during a 3-day period when your life was moving along on an even keel.

    I’ll skip the authors’ discussion of statistical power and cut to the chase: you need to test a substance for 10 nights in a row to have reasonable certainty that the result you obtain is repeatable and you’ve got enough data to answer the question of whether passion flower improves your sleep.

    Self-Testing Flow Chart

    Follow these 5 steps to determine whether an herbal insomnia remedy works for you:

    1. Simplify sleep. For you, does “good sleep” mean falling asleep sooner, sleeping longer, waking up feeling more rested, or waking up less at night? Choose the one thing that for you would most improve your sleep.
    2. Set a goal. Choose your target “good night” value and a percentage of nights for which this target value must occur. Let’s say you decide that a good night is a night when you awaken just 1 time or less (and on a bad night you awaken 2 times or more). Let’s say you set your goal at awakening 1 time or less on at least 70% (7 out of 10) of the nights.
    3. Choose a therapy. Try one intervention at a time. Starting a passion flower supplement and a yoga class at the same time will muddle the results.
    4. Do the 10-day test. Every day, record good nights and bad nights in a diary.
    5. Calculate the outcome. Did you achieve your goal? If so, you can conclude that passion flower improves your sleep. If you didn’t achieve your goal, clearly the passion flower did not work. Choose another therapy, starting the process at #3. If your results are borderline, continue testing for another 10 days. Then recalculate to ascertain whether you’ve met your goal of awakening 1 time or less on 70% of all 20 nights.

    Insomniacs are big experimenters, I learned as I was conducting research for my book, The Savvy Insomniac. Several expressed interest in herbal and other alternative treatments. If you’re going to experiment, you need a systematic way to assess whether the remedy you’re trying improves your sleep or not. These Massachusetts researchers have given us a goal-oriented algorithm for doing exactly that.

  • Prebiotics Improve Stress Resilience and Sleep

    Prebiotics Improve Stress Resilience and Sleep

    Is stress the driver of your insomnia? Eating more high fiber foods—sometimes called prebiotics (different from probiotics)—may help both your stomach and your sleep.

    In a new study on rats conducted at the University of Colorado, a high fiber diet promoted the growth of healthy gut bacteria, increased resilience to stress, and made sleep more robust following a stressful event. Here are the take-aways and what the study suggests about human sleep.

    Stress, Sleep, the Gut, and Probiotics

    Most of us sleep better when life is moving along on an even keel. It’s when we have to cope with stressors—a divorce, a bullying boss, sustained combat—that insomnia tends to occur. Chronic stress may eventually lead to chronic insomnia.

    Likewise, stress has a harmful impact on the gut. A healthy gut has diverse beneficial bacteria spread evenly throughout the gastrointestinal tract. Stress makes the bacterial community less diverse and less evenly distributed.

    One approach to reestablishing a healthy community of gut bacteria is to use a probiotic such as yogurt containing live bacteria, soft cheeses, or a probiotic supplement. Probiotics help repopulate the gut with beneficial bacteria. They’ve also been shown in rodents and humans to reduce the effects of stress on both the body and the brain.

    A Prebiotic Diet Has Beneficial Effects

    Prebiotics are non-digestible fibers found in certain foods that promote the growth of beneficial gut bacteria such as those found in yogurt and probiotic supplements. The researchers at University of Colorado wondered if feeding young rats a diet rich in prebiotics would increase beneficial gut bacteria and reduce the effects of stress, including its effects on sleep.

    So they conducted a controlled experiment using 52 rats. One group was fed a control diet and the other was fed a prebiotic diet. After several weeks, half of the rats in each group were administered a series of tail shocks. The lead author of the study has described these shocks as “the equivalent of a single intense acute stressful episode for humans, such as a car accident of the death of a loved one.”

    From analyses of the rats’ fecal material, body functions, and sleep before and after the tail shocks, the authors concluded that the prebiotic diet:

    • Increased stress-protective bacteria in the rats’ gastrointestinal tracts
    • Reduced measurable symptoms of stress
    • Cut down on stress-related wake-ups during recovery sleep
    • Increased beneficial REM sleep during recovery sleep

    Overall, the prebiotic diet made the rats more resilient to stress and their sleep more robust.

    A High Fiber Diet for Humans?

    Would a diet high in prebiotics be similarly protective of the human gastrointestinal tract and human sleep? That, say the researchers, is what they’re going to study next.

    For now, given prior clinical research and the fact that there are no known downsides to consuming prebiotic foods, it’s probably a good idea to incorporate more high fiber foods into your diet—especially if you’re prone to stress related insomnia.

    Prebiotic Foods

    Here are several foods high in prebiotics. You get more mileage from plant fibers when fruits and vegetables are eaten raw, but a light steaming may not do much to diminish their effectiveness.

    • asparagus
    • leeks
    • garlic
    • onions
    • dandelion greens
    • apples
    • bananas
    • jicama
    • Jerusalem artichoke
    • wheat bran
    • bread made of wheat flour
    • barley
    • oats
    • seaweed
    • flaxseeds
    • legumes

    Originally posted at The Savvy Insomniac, 2/15/2017

     

  • Overcoming Insomnia at the Approach of Summer

    Overcoming Insomnia at the Approach of Summer

    Insomnia at the Approach of Summer

     

    It happens every year in the spring: someone writes in to The Savvy Insomniac complaining of an inexplicable onset of insomnia. No stress is involved, no abrupt change in circumstances.

    Here’s how a reader described the problem this year:

     

    “Every year at the same time (between the end of April and the end of June, I don’t know why?), my sleep becomes very capricious. I don’t sleep when I go to bed and, inexorably, I have to start again a new ‘sleep restriction.’ I feel pretty jaded because it’s difficult!”

    Whenever you’re having trouble sleeping, it helps to tighten up your sleep window and stay out of the bedroom until you’re really sleepy. But if insomnia tends to strike at about this time every year, the problem may have to do with lengthening days. The solution may lie in reducing your exposure to sunlight.

    Seasonal Variation in Light Exposure

    The further away from the equator you live, the greater are the seasonal differences in your exposure to sunlight. Not many comparative studies have measured how these seasonal variations in day length affect people’s sleep. But one study published in 2012 compared the sleep timing and quality of people living in Norway (far from the equator) and others living in Ghana (close to the equator) in the winter and the summer.

    Ghanaians rose and went to sleep at about the same time in both seasons. The Norwegians rose 32 minutes earlier (and went to bed 12 minutes earlier) in the summer than in the winter, suggesting that seasonal variation in day length can affect our internal clocks. When the days are longer and sunrise is earlier, people may tend to get up (and go to bed) a little earlier than they do in the winter.

    Seasonal Affective Disorder

    However, the Norwegians in this study experienced more insomnia and reported lower moods in the winter when the days were short. This finding aligns with the results of other research—from Norway, for example, and from Finland—showing that in the late fall and winter, insufficient exposure to daylight is associated with seasonal affective disorder, or SAD, and trouble sleeping.

    I see anecdotal evidence of this phenomenon every year. Readers write in complaining of insomnia that typically starts in November or December. The solution to this seasonal insomnia is bright light therapy, appropriately timed.

    Too Much Light?

    Other people report that their insomnia typically occurs in the spring and summer. There’s a dearth of research on this phenomenon, but I suspect that excessive exposure to daylight could trigger insomnia in those who, for whatever reason, are particularly sensitive to light. Light blocks secretion of melatonin, a hormone helpful to sleep, so restricting your exposure to bright light early in the morning and later in the evening may help.

    Here are suggestions for how:

    • Install light blocking curtains on bedroom windows so the morning sunlight doesn’t wake you up too early
    • Draw blinds and curtains in your home before the sun sets and keep indoor lighting low in the evening
    • Wear sunglasses if you’re outside in the sunlight very early in the morning or after about 8:30 p.m.
    • Steer clear of devices with screens in the run-up to bedtime.
    • Buy a comfortable eye mask and wear it when you sleep

    If you find eye masks uncomfortable, perhaps a towel wrapped around the eyes and head will do the trick. A few years ago a neuroscientist–sleep researcher told me she was super sensitive to light at night, and this was her way of solving the problem. Do whatever works!

    Originally posted on The Savvy Insomniac, May 31, 2016

  • Tart Cherries: Helpful to Sleep

    Tart Cherries: Helpful to Sleep

    Woman drinking cherry juice

    First, the good news: a small body of research suggests that tart cherry juice holds promise as an alternative treatment for insomnia, especially in older adults.

    Now for the bad news: tart cherry juice, already pricey, is set to become pricier still as growers weigh whether to give up on cherries and plant apple trees instead. Here’s more on the benefits of tart cherry juice for sleep and why it may soon become scarce.

    Sleep Benefits of Tart Cherry Juice

    A handful of studies conducted on the effects of tart, or Montmorency, cherry juice on sleep suggest it may be helpful for people with insomnia:

    • It may help you sleep longer. In a randomized controlled trial (RCT) published in 2012, drinking tart cherry juice concentrate mixed with 8 oz. of water twice daily for 7 days increased the total sleep time of 20 healthy volunteers by an average of 39 minutes.
    • Seven older adults with insomnia slept over an hour longer after 2 weeks of drinking 8 oz. of tart cherry juice twice a day. Results of a randomized crossover trial presented at the 2014 meeting of the American Society of Nutrition (still unpublished) showed that participants’ total sleep time increased by an average of 84 minutes.
    • Tart cherry juice may cut down on nighttime wake-ups and improve sleep quality. In an RCT published in 2010, drinking 8 oz. of tart cherry juice twice daily for 2 weeks significantly cut down on wake-ups and insomnia severity in 15 older adults with sleep maintenance insomnia.
    • The same twice-daily regimen of tart cherry juice had similar effects on the sleep of 30 healthy young, middle-aged, and older adults in a study published in 2013. Older participants’ sleep improved the most.

    The evidence is not conclusive: these studies were small and only two looked specifically at the effects of tart cherry juice on people with insomnia. Still, unless you dislike or can’t tolerate tart cherries, drinking tart cherry juice twice a day is worth consideration as an alternative treatment for persistent insomnia.

    Melatonin and Tryptophan-Enhancing Effects

    Montmorency cherries are rich in melatonin, a sleep-friendly hormone secreted by the pineal gland at night. Melatonin production often falls off as people age, and lower levels of endogenous melatonin can make it harder to get to sleep and stay asleep at night. Tart cherry juice may exert its soporific effects mainly by increasing levels of melatonin at night.

    Another mechanism by which tart cherry juice may benefit sleep can be found in the effect it has on tryptophan. Tryptophan is an amino acid humans need but cannot produce themselves, so it must be gotten in food. Tryptophan is a precursor to both melatonin and serotonin, a neurotransmitter important to sleep. Researchers who conducted the 2014 study found that tart cherry juice inhibited the degradation of tryptophan, thereby making more of it available for serotonin synthesis.

    The sleep benefits of Montmorency cherry juice may be due to both its melatonin and tryptophan-enhancing effects.

    Climate Change and Market Forces

    But some fruit growers are now on the verge of abandoning cherry orchards and planting apple trees instead. Two factors are behind the change, according to an Interlochen Public Radio report last week:

    1. Most of the nation’s tart cherries are grown in northern Michigan, where almost the entire cherry crop was lost in 2012 due to an early spring followed by over 2 weeks of below-freezing temperatures. Cherry trees planted in Michigan are actually shipped from nurseries in the Pacific Northwest. Extreme weather events there have killed off thousands of cherry saplings. Michigan orchardists who want to continue producing cherries now can’t buy enough young cherry trees to replenish aging stock.
    2. Also, the demand for apples is on the rise, and growers are planting high-density varieties so they can plant many more trees per acre of land. Commercial nurseries are now struggling to keep pace with the demand for apple trees. Nursery owners may decide that planting for small specialty crops like cherries just isn’t worth it any more.

    Now back to trouble sleeping: if you find that tart cherry juice helps you sleep, you’d be wise to stock up on it now.