Top Ten Reviews


Insomnia Sleep Disorders
 

Insomnia Introduction

:insomnia.jpg Insomnia is defined as a difficulty falling asleep, staying asleep, or a disturbance in sleep patterns that results in inadequate amounts, or quality of sleep. Insomnia can be categorized into to two broad groups, including; sleep onset insomnia (also called Initial Insomnia) and sleep maintenance insomnia (also called early morning insomnia).

The most common causes of sleep onset insomnia are:

  • anxiety
  • pain
  • stimulant drugs
  • respiratory problems
  • poor sleep hygiene
  • alcohol use
  • withdrawal from hypnotic medications

Sleep maintenance insomnia, or early morning waking, is often due to factors, such as:

  • aging
  • poor glycemic control
  • depression
  • self-reproach

Other chronic conditions can contribute to insomnia and may be to blame. Among the most popular of these concomitant conditions are Restless Legs Syndrome, and Sleep Apnea.

Insomnia Statistics

It is estimated that 10% of the population experiences chronic insomnia, with as many as 50% having significant episodes of insomnia at some point in their lives. [1]

Insomnia Symptoms

Generally, insomnia manifests in two main forms: sleep onset insomnia where patents have difficulty falling asleep, and sleep maintenance insomnia where patients can usually fall asleep but then wake up in the early morning hours and are unable to return to sleep. Signs of depression, anxiety, and drug use may be present in both forms.

Insomnia Treatment

Standard medical treatment for insomnia is dependent on the underlying cause of the problem. Counseling is indicated in cases where anxiety, depression, and stress are associated with insomnia. It is important to reassure patients about normal changes in sleep patterns that can occur with age. Issues of sleep hygiene and one’s pattern before resting are often addressed, and may include; bedroom should only be used for sleep, avoidance of stimulants, proper sleep environment, and regular exercise. Hypnotic pharmaceuticals can be used in the treatment of insomnia. Although, it is important to monitor patients for signs of drug dependence with these classifications of drugs. [2]

Carbohydrates and Protein:

If control of blood sugar is unstable, large peaks and drops in blood sugar can occur during sleep. When blood sugar levels drop, hormones are released by adrenal glands. These hormones include adrenaline and cortisol. The best bedtime snacks to avoid nocturnal hypoglycemia are complex carbohydrates such as oatmeal, whole grain breads, and other whole grain products. Not only will complex carbohydrates prevent nocturnal hypoglycemia, they can help to increase the levels of serotonin in the brain, which can also help with sleep. [3]

Supplements helpful for Insomnia

Melatonin:

Melatonin is a hormone that is secreted by the pineal gland in the brain. This hormone is involved in sleep, as well as light-dark cycling. The use of Melatonin has been studied in a number of groups of people, including the elderly and children. Insomnia has been improved by the use of melatonin in children, adolescents, and especially, the elderly. It seems to be most effective in individuals that have low natural secretions of melatonin. Melatonin has also been shown to help with muscle retention after exercise. Melatonin is also often used to correct disturbances in sleep patterns that are related to jet-lag and working graveyard shifts. [4, 5, 6]

L-Tryptophan:

L-Tryptophan is an amino acid that is a precursor for the neurotransmitter serotonin. L-Tryptophan has hypnotic properties, which tend to induce sleep. L-Tryptophan has been shown to be effective mainly in cases of sleep onset insomnia, possibly due to the fact that this amino acid decreases the amount of time it takes to fall asleep. L-Tryptophan also lacks many of the side effects of sleep medications, such as developing tolerance, sleepiness, and forgetfulness. [7, 8, 9]

5-HTP (5-Hydroxytryptophan)

5-HTP is L-Tryptophan that is one step further along the process to becoming serotonin. 5-HTP has been shown to have good oral availability, and can increase the levels of serotonin in the central nervous system. By increasing serotonin levels, sleep onset time is reduced and there are fewer awakenings during the night. When taking 5-HTP, it is important to supplement with other cofactors necessary for the conversion of 5-HTP into serotonin, like the nutrients magnesium, vitamin B6, and niacin. [10, 11]

Caution: Patients taking any type of antidepressant or other psychoactive drugs should only use L-Tryptophan or 5-HTP under the supervision of a qualified health professional, as this combination has the potential to produce adverse reactions.

Botanicals:

Valerian Root (Valariana officianlis):

The strong smelling roots of this plant contain several compounds that are thought to have sedative effects. Numerous clinical trails, including preparations of valerian, have been shown to be effective in reducing sleep latency (time to fall asleep) and improving sleep quality. Valerian has also been rated as being more preferable treatment for insomnia by subjects in one particular study. Valerian was also rated as having less impairment in performance the day after treatment when compared to a popular pharmacological agent. [13, 14]

Passionflower (Passiflora incarnata):

Passion flower is an herb that grows as a vine and has a long history of use as a sedative and psychoactive substance. One of the primary constituents of Passion flower is Harmine, which has the activity of inhibiting the breakdown of serotonin (see above section) and thus can lead to amplified effects of supplements that increase serotonin, such as 5-HTP and L-Tryptophan. [15, 16]

References

[1] Beers and Berkow, The Merck Manual (Whitehouse NJ: Merck Research Labs, 1999), 1410-13.

[2] Beers and Berkow, The Merck Manual (Whitehouse NJ: Merck Research Labs, 1999), 1410-13.

[3] Murray and Pizzorno, Encyclopedia of Natural Health Prima Health, (1998), 603-8.

[4] Ivanenko A, Crabtree VM, Tauman R, Gozal D. Melatonin in children and adolescents with insomnia: a retrospective study. Clin Pediatr (Phila). 2003 Jan-Feb;42(1):51-8.

[5] Atkinson G, Drust B, Reilly T, Waterhouse J. The relevance of melatonin to sports medicine and science. Sports Med. 2003;33(11):809-31.

[6] Smits MG, van Stel HF, van der Heijden K, Meijer AM, Coenen AM, Kerkhof GA. Melatonin improves health status and sleep in children with idiopathic chronic sleep-onset insomnia: a randomized placebo-controlled trial. J Am Acad Child Adolesc Psychiatry. 2003 Nov;42(11):1286-93.

[7] Hartmann E, Spinweber CL. Sleep induced by L-tryptophan. Effect of dosages within the normal dietary intake. J Nerv Ment Dis. 1979 Aug;167(8):497-9.

[8] Schneider-Helmert D, Spinweber CL. Evaluation of L-tryptophan for treatment of insomnia: a review. Psychopharmacology (Berl). 1986;89(1):1-7.

[9] Hartmann E. L-tryptophan: a rational hypnotic with clinical potential. Am J Psychiatry. 1977 Apr;134(4):366-70.

[10] Soulairac A, Lambinet H. [Clinical studies of the effect of the serotonin precursor, L-5-hydroxytryptophan, on sleep disorders] Schweiz Rundsch Med Prax. 1988 Aug 23;77(34A):19-23. [Article in French]

[11] Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Altern Med Rev. 1998 Aug;3(4):271-80.

[12] Murray and Pizzorno, Encyclopedia of Natural Health Prima Health, (1998), 603-8.

[13] 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;7(11):480-6.

[14] Mills and Bone, Principles and Practice of Phytotherapy (Toronto: Churchhill Livingstone, 2000), 581-9.

[15] Murray and Pizzorno, Encyclopedia of Natural Health Prima Health, (1998), 603-8.

[16] Krenn L. [Passion Flower (Passiflora incarnata L.)–a reliable herbal sedative] Wien Med Wochenschr. 2002;152(15-16):404-6.

[17] Murray and Pizzorno, Encyclopedia of Natural Health Prima Health, (1998), 603-8.