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Many Americans suffer from insomnia, and prescription sleep aids are becoming a very big business.  However, many of these medications can be addictive, cause abnormal sleep patterns, and have significant side effects.  Morning drowsiness is commonly reported, which can lead to further insomnia, as a person then needs something to get going in the morning (typically coffee), worsening the insomnia. 

While sleep medications can be beneficial in acute cases or for short-term use, they do not address the underlying causes of insomnia.  The most common causes of insomnia are psychological, such as anxiety, stress, or depression.  Other causes include foods, drinks, nutritional deficiencies, or side effects from other medications.

The causes of insomnia are divided into two types: sleep-onset (i.e., trouble falling asleep) or sleep-maintenance insomnia (i.e., trouble staying asleep).  According to the Encyclopedia of Natural Medicine, causes of sleep-onset insomnia include anxiety, stress, environmental changes/disruptions, fear of insomnia or of sleep, pain, caffeine, and alcohol.  Causes of sleep-maintenance insomnia include depression, environmental changes, sleep apnea, hypoglycemia, muscle twitching/spasms or restless-leg syndrome (RLS), pain, drugs, and alcohol.  Hormone fluctuations with menses, pregnancy, and menopause can add to sleep disruption for women.

Natural treatment of insomnia starts with developing healthy sleep habits.  First, establish a consistent bed-time routine, including developing habits before bed (e.g., brushing teeth) and allowing wind-down time before getting ready for bed.  Bed time and waking time should be the same every day (including weekends) to establish normal circadian and cortisol rhythms.  Sleeping in a completely quiet, dark room, followed by bright light in the morning, will also help establish normal rhythms.  Progressive relaxation and meditation can be a good way to unwind and let go of the day. 

Patients should avoid stimulating foods and drinks during the day, including caffeine and alcohol.  Everyone reacts to caffeine differently, and some people are sensitive enough to it that the caffeine in a cup of decaf coffee in the morning can disrupt sleep that night.  Alcohol disrupts serotonin levels, and serotonin is the neurotransmitter that initiates sleep.  Patients with insomnia may benefit from lab testing to evaluate neurotransmitter and/or hormone levels, especially serotonin or cortisol.

Nutrient deficiencies should also be evaluated. Iron or magnesium deficiencies are commonly seen with RLS and muscle twitches.  In many cases, the iron deficiency is not significant to cause anemia, and more specific lab tests for iron may be needed.

Hypoglycemia is a very common cause of night-time waking, as the drop in blood sugar stimulates the release of adrenaline and other hormones that signal the brain that food is needed.  Complex carbohydrates (that also increase serotonin) and protein (that stabilizes blood sugar) make good before bed snacks.

There are several natural options to prescription sleep aids.  5-HTP may be beneficial for patients with low serotonin, as melatonin may benefit patients with low melatonin levels.  Patients with RLS may benefit from iron and/or magnesium supplementation.  There are also several sedative herbs to help calm an overactive nervous system and treat pain, including passionflower, valerian, lemon balm, chamomile, kava, and tilia.  Regular exercise has also been shown to increase sleep quality and decrease anxiety.  Homeopathic remedies, flower essences, cranio-sacral work, and counseling can help release stuck emotional issues.

Patients who snore or have significant daytime fatigue may need to be evaluated for sleep apnea and/or need oxygen at night.


© Kimberly Hindman, 2007



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