Dr. Jacob Teitelbaum's Column
...expert advice on CFS, Fibromyalgia and other Health Topics.
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Monday, February 2nd, 2009:
Tips for a Great Night's Sleep
by Jacob Teitelbaum MD
(Parts used with permission from my book “From Fatigued to Fantastic!” Avery/Penguin Oct 2007.)
The Basics: Good Sleep Hygiene
Poor sleep hygiene is the major cause of poor sleep for most Americans, and it is important to address this first. The following are some important things to consider:
- Do not consume any caffeine after 4:00 p.m., and better yet, not after lunch.
- Take a hot bath before bed, but keep your room cool. The hot bath relaxes your muscles and mind, allowing you to drift into sleep. To stay asleep though, your body likes it cool.
- Have a light, high protein, snack before bedtime. Hunger causes insomnia in all animals, and humans are no exception. Adding foods high in the amino acid tryptophan, such as milk and turkey, also contributes to sleep.
- Exercise during the day, but not within an hour of going to sleep. Yoga during the day and meditation or prayer before bedtime makes a wonderful combination.
Natural Sleep Remedies
Most of the natural sleep remedies discussed here are not sedating, yet they help you fall asleep and stay in deep sleep. The good news is that many natural remedies that are very effective for sleep also directly help pain because they are also muscle relaxants. The first six herbs listed below are available in a combination formula as well, called the "Revitalizing Sleep Formula" by Enzymatic Therapy.
My 6 favorites natural sleep aids are:
1. SunTheanine. Theanine, an amino acid (protein) that comes from green tea, has been shown to not just improve deep sleep but also helps people maintain a calm alertness during the day. L-theanine likely plays a role in the formation of gamma amino butyric acid (GABA). This inhibitory neurotransmitter is critical for sleep, and is what is stimulated by many medications that help improve sleep. L-theanine also directly stimulates the production of alpha brain waves during the day. These brain waves are associated with an awake, yet relaxed (almost meditative), state. It is also often used in weight loss products, as studies show that green tea helps with weight loss and the animal model studies suggest that the theanine in the green tea contributes significantly to this. Green tea also is helpful as an immune stimulant and has many other benefits; however, the amount of L-Theanine present is not enough to advocate drinking it as a sleep aid. If you drink enough green tea to help you sleep, you'll be up all night peeing!
The only form of theanine that I use and recommend is called "SunTheanine" (pure L-Theanine) as most other brands include inactive forms of the theanine that block its effectiveness. In fact, SunTheanine is the only form that most companies that maintain high quality standards will use in their products. In the chapter in my book on "More Natural Remedies," I discuss SunTheanine at more length in the section on how to treat anxiety without worsening brain fog. As the FDA just approved its use as a food additive in the United States (it's been used in drinks in Japan for decades for its calming effects), it may just be a matter of time until the barista at the local Starbucks asks "One pump of SunTheanine or two?"
Take 50 to 200 mg at bedtime, although it can also be used several times a day for anxiety.
2. Wild Lettuce. Traditionally, wild lettuce has been found to alleviate for anxiety and insomnia, as well as for headache, muscle, and joint pain. Wild lettuce also helps to calm restlessness and reduces anxiety, and may help decrease restless leg syndrome.
Take 30 to 120 mg at bedtime.
3. Jamaican Dogwood. The extract acts as a muscle relaxant and also helps people to fall asleep while calming them. According to tradition, Jamaican Dogwood was once used by Jamaican fishermen. Large amounts were thrown in the water. The fish would then fall asleep and be easy to net!
Take 12-48 mg of the extract at bedtime.
4. Hops. The hops plant is a member of the hemp family, and the female flowers are used in beer making. It also has some hormonal activity, can suppress breast, colon, and ovarian cancer in test tube studies and has been reported to reduce hot flashes in menopausal women. It also has antibiotic and antifungal activity. It has long history of being used as a mild sedative for anxiety and insomnia and a study using showed an improvement in insomnia with effectiveness similar to Valium family medications. It is considered to be very safe. As any beer drinking college student can tell you, it helps your muscles to relax and helps to promote sleep as well!
Take 30-120 mg of a hops extract at bedtime.
5. Passionflower (Passiflora). This herb is commonly used throughout South America as a calming agent, even present as an ingredient in sodas. A number of studies support its have a calming effect. Herbalists have also used it to treat muscle spasms, colic, dysentery, diarrhea, anxiety, and menstrual pain, and it may also increase men's libidos, all problems often associated with CFS/FMS. Passionflower has other pain management benefits as well. In one animal study, it was shown that it decreases morphine tolerance, so that less medication is needed, as well as decreasing withdrawal symptoms from morphine. Passionflower may, then, decrease the pain of fibromyalgia.
Take 90-360 mg of the extract at bedtime.
6. Valerian. Valerian is commonly used as a sleep remedy for insomnia. A number of studies show numerous benefits, including an improvement in deep sleep, speed of falling asleep, and quality of sleep without next-day sedation. In these studies, the benefits were most pronounced when people used valerian for extended periods or time, as opposed to simply taking it for one night. Valerian's effectiveness has been compared to a Valium family medication (Oxazepam), without the "hung-over" feeling present with most Valium medications. However, valerian doses from 450 and 900 mg are associated with this feeling.
A review of multiple studies found that "Valerian is a safe herbal choice for the treatment of mild insomnia and has good tolerance… Most studies suggest that it is more effective when used continuously rather than as an acute sleep aid." Clinical experience shows that for around 10% of people, valerian is energizing and may keep them up. If this happens to you, you can use valerian during the day instead of at night, as Valerian does have a calming effect and can be used during the day for anxiety as well. It is nontoxic, even at high doses.
Take 200-800 mg of the extract at bedtime.
All 6 of these herbs can be found in combination and in the optimal dose in the Revitalizing Sleep Formula by Enzymatic Therapy. Take one to four capsules at bedtime to help sleep or take the same dosage one to three hours before bedtime if the main problem is falling asleep. These capsules can also be used during the day for anxiety and muscle pain.
Other natural remedies include:
D-Ribose. Most "energy drinks" are largely sugar and caffeine and act like energy loan sharks while causing insomnia. Ribose is an energy superstar, and this special sugar was shown to increase energy an average of 45% in a recent study, while also improving sleep and brain functioning. Pitch your "energy drink" and substitute Ribose (Corvalen by Bioenergy) 5 grams 2x day added to a cup of tea or water.
Magnesium and calcium. Taking 200 milligrams of magnesium at night is a good idea because it can help your sleep. Lower the dose if it causes diarrhea. Taking 600 milligrams of calcium at bedtime also may improve the quality of your sleep and you may wish to take the two supplements together.
Turn off your stress hormones so you can sleep! Cortisol helps you deal with stress during the day, but can keep you up at night. Ashwaganda and magnolia (250 mg each) are stress busting herbs that can help lower cortisol levels, so your mind can turn off and you can sleep at night. They can be found in a new product called Sleep Tonight! By Enzymatic Therapy. This, Revitalizing Sleep Formula, and sleep medications can all be taken together if needed for 8 hours of solid sleep a night.
Melatonin. This is a hormone made by the pineal gland. Although it is natural and available over the counter, this does not mean that it is without risk. My concern with any hormone is that although it might be quite safe when used within the body's normal range, I worry about toxicity when people take more than the body would normally make. For most people, all it takes to restore melatonin to normal levels is 1/3 milligram. The usual dose you find in stores, however, is 3 milligrams, which is ten times the level I recommend. Except for a small subset of people, who likely have trouble absorbing it properly, a half milligram is every bit as effective for sleep as higher doses. Moreover, high levels of melatonin may raise the level of another hormone, prolactin, aggravating the risk of depression or infertility. Although I don't know of any danger yet from using melatonin in higher doses — and it may even have immune stimulating and antioxidant effects that could well be beneficial — I would only use a dose higher than 1/2 milligram under close supervision of your doctor.
Aromatherapy. The smell of lavender has been shown to help sleep, and sleeping with a small lavender filled pillow can be helpful.
For children and pregnant women. Although Chamomile tea is mild and won't handle severe insomnia like the other treatments above, it has the benefit of being OK for children and pregnant women to use. Ambien may be used in pregnancy if required, and calcium and magnesium at bedtime would certainly be OK in pregnancy.
For severe insomnia as is seen in CFS and fibromyalgia, start with the natural aids, but also add Ambien, Desyrel, neurontin, Flexeril, and even Klonopin (if you have restless legs — but may be addictive) in as needed to get your 8 hours sleep a night. Our sleep section of the treatment protocol has over 30 sleep aids, and we can find a combo that gets virtually everyone 8 hours of restful sleep each night.
Sweet Dreams ;-)
Jacob Teitelbaum, M.D.
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
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