FACTS:

• More than 100 million Americans (30% of us) experience some type of sleep disorder.  60 million experience insomnia regularly (40% of women; 30% of men).  
• Sleep disorders are grouped by category:

1. Problems falling and staying asleep (insomnia): Most common. Episodes may come and go and last up to 3 weeks (be short-term) or be long-lasting (chronic).
2. Problems staying awake (excessive daytime sleepiness; feel tired all the time): Causes include: Medical conditions (i.e. fibromyalgia; low thyroid function), Mononucleosis or other viral illnesses, Narcolepsy or related sleep disorders and Obesity.
3. Problems sticking to a regular sleep schedule: Jet Lag, Shift or nighttime workers, Paradoxical insomnia (when someone sleeps a different amount than they think they do).
4. Sleep-Disruptive Behaviors: Sleep terrors/bad dreams, Sleep Walking, REM sleep-behavior disorder.

Correct diagnosis of the "why" for the sleeping problem is critical to success, especially if it’s a symptom of a more serious medical condition.

• We all have a unique day-night cycle of about 24 hours called the “circadian rhythm.” The closer we are to our unique rhythm (when we go to sleep and when we awake) the better the quality of our sleep (wake-up refreshed). Our cycles are easily altered, however, by naps, bedtime habits, job/child care requirements, exercise, psychological stressors and depression, exposure to light, food and drugs we take, eating or drinking too late or the aging process (awakenings throughout the night).
• The average adult needs a total sleep time of seven to nine hours per day. Older people may sleep less due to frequent night waking, but their bodies still need 7-9 hours per day. Teens need at least 8.5 to 9.25 hours of sleep each night. Some people do, however, function very well with less sleep.
• Americans today are averaging 7.5 hours per day in bed, but only 6.1 hours actually asleep. Statistically, Blacks sleep the least; women more than men and the poor less than the wealthy. Fewer hours of sleep will eventually need to be replenished with additional sleep in the next few nights. Our body does not seem to get used to less sleep than it needs (our individual circadian rhythm dominates).
• Poor quality and/or chronic insufficient sleep often correlates with chronic health conditions, such as; high blood pressure, depression and especially diabetes (impairs the body's ability to use insulin; impairs or decreases growth hormone secretion). It also impairs our body's natural ability to heal from acute illness, injuries or to maintain proper metabolism or adequate appetite hormones for weight management.
• Nightly or episodic snoring is not harmful. However, it can be a sign of dangerous sleep apnea (episodes of reduced or no airflow throughout the night; waking up gasping for breath) which effect 18 million Americans. Sleep apnea is often related to other medical problems, especially cardiovascular disease and diabetes.
• While the body rests during sleep, the brain DOES NOT. Our brains remain active, get recharged and still control many body functions including breathing during sleep. If our brains fail to get adequate regeneration from sleeping, it is easy to understand how reduced ability to concentrate, trouble learning, decreased attention to detail and increased risk of car accidents can follow. According to WebMD, "reducing sleep by as little as 1 ½ hours for just one night reduces daytime alertness by about 1/3rd".
• We fall asleep easier and our brains work best with a daily pre-sleep ritual (i.e. warm bath, tea with honey and lemon, making an action list for tomorrow, reading a love story, meditating and prayer). Goal: break the connection between all the stress in your life and bedtime. Also, if you wake up in the night and can't get back to sleep within 15-20 minutes, most experts advise to get out of bed and do something relaxing. Only go back to bed when you feel tired.

TREATMENT OPTIONS:

PRESCRIPTION AND OTC MEDICATION:

• Media ads are filled with medications used to treat or reduce the symptoms of insomnia. While the infrequent use of prescription and non-prescription medications appear to have only modest problems (use is not recommended for more than 2 weeks at a time), the chronic use of medications to get to sleep are filled with problems that include addiction and synergy or enhanced sedation when combined with alcohol. In 2008, there were 56 million prescriptions filled in the USA for sleeping pills.
• The number one hypnotic/sedative or sleeping pill prescription medication is “Ambien” (Zolpidem; immediate release or extended release tablets). Like all sleeping pills, the drug is most effective when taken 30 minutes before bedtime and when one is able to get 6-8 hours of sleep. Ambien, in particular, has been featured widely for its dependence or addiction potential and dangerous potential side effects like sleep walking, sexsomnia, sleep eating or withdrawal. Other newer available prescription sleeping pills include “Sonesta” and “Lunesta.” “Halicon” (triazolom) is a highly effective short-acting sleeping pill.
• A recent article in the British Medical Journal (BMJ) reported that "people who take 18 or fewer sleeping pills a year have a 3.5 time higher risk of dying compared to those not taking any sleeping pills". Other experts suggest that chronic insomnia can be a risk factor for suicide and mortality.
• Other prescription drugs used to help with sleeping disorders include:

• Smooth Muscle Relaxants/Tranquilizers like “Valium”, “Xanax”, “Restoril” or “Ativan”.
• Anti-depressive Medications like “Zoloft”, “Paxel” or “Prozac”.
• Barbituates like “Phenobarbital”.
• Anti-histamines like “Promethazine” or “Hydroxyzine”.  
• Anti-inflammatory Medications like “ibuprofen”.
• Analgesic/Narcotics like hydrocodone.

Numerous over-the-counter (OTCs) medications are available either as a single ingredient product or in combination with other drugs (i.e. antihistamine and analgesic). One of more effective OTCs is the antihistamine “Benadryl” (diphenhydramine HCL) which produces drowsiness as a side effect. Other highly used products include “Sominex”, “Unisom”, “Advil PM” and “NyQuil”.

NATURAL REMEDIES FOR INSOMNIA:

Herbal Products:

• Valerian: A safe herb that has long been used as a remedy for insomnia especially in Europe. Taken as a tea, liquid extract or in capsule form one (1) hour before bedtime; results may be seen in 2-3 weeks. It's not recommended to take Valerian for more than three months at a time or to take with other medications like sedatives or antihistamines.
• Kava: An anti-anxiety herb that may be helpful for anxiety-related insomnia. However, the FDA has issued an advisory to consumers about the potential risk of severe liver injury resulting from dietary supplements containing Kava.
• Chamomile, Lemon balm, Hops and Passionflower:  Other herbs often used as teas to help with insomnia. Taken 1-2 hours before going to bed. Chamomile, in particular, can reduce anxiety, calm the digestive system and relieve muscle tension.

Non-herbal Supplements/Foods:

• Melatonin: A popular remedy to help people fall asleep when the sleep/wake cycle has been disturbed, such as shift workers or people experiencing jet lag. The pineal gland in the brain makes serotonin which is then converted into melatonin (a natural hormone) at night when exposure to light decreases. Melatonin is typically taken 30 minutes before the desired bedtime and is not recommended for patients with mental health disorders, autoimmune disease or pregnant and nursing women.
• 5-HTTP: Made from tryptophan (an amino acid) and helps the body make serotonin. Low levels of serotonin are a known factor in sleepless nights. Low levels of serotonin are most common in people who are depressed. A starting 100mg dose of 5-HTP is recommended. Nuts and seeds, bananas, cottage cheese, soybeans, tuna, honey, many meats (chicken and turkey), eggs and dairy products contain high levels of tryptophan. Many old timers still recommend a warm cup of milk with honey to help with getting to sleep.
• Bed Time Snacks: High carbohydrate, low-protein (protein-rich foods hard to digest) bedtime snacks can help make sleeping easier. Toast with honey & crackers are sleep-friendly carbs.
• Magnesium: A natural sedative. Deficiency of magnesium can result in difficulty sleeping, constipation, muscle tremors or cramps, anxiety, irritability, pain and restless leg syndrome. Foods rich in magnesium are legumes and seeds, dark leafy green vegetables, wheat bran, almonds, cashews, blackstrap molasses, brewer's yeast and whole grains.

Alternative Medicine:

• Aromatherapy: The scent of an essential oil like English lavender, chamomile or ylang ylang is an old folk remedy to help people fall asleep. In particular, lavenders’ sedative qualities tend to work quickly and have been found to lengthen total sleep time, increase deep sleep and make people feel refreshed. A lavender sachet can be placed under the pillow or drops of lavender oil can be placed in a handkerchief or added to a warm bath (drop in body temperature helps with sleep).

• Acupuncture: Over an extended period of time holds the potential of naturally increasing melatonin secretion in the evening and improving total sleep time.
• Ayurvedic Medicine: Relates insomnia with a vata imbalance. Vata regulates breathing and circulation. People with a vata imbalance often notice irritability, anxiety and fear with insomnia. One type of Ayurvedic treatment is the application of oil (coconut, warm sesame or mustard) on the head and feet.
• Traditional Chinese Medicine: Sees insomnia as a kidney energy weakness with signs of low back ache, tiredness and fatigue and a burst of energy at about 11 PM in the evening. Women in menopause or taking anti-estrogen drugs often experience this type of insomnia.
• Music: Another remedy that can improve sleep without medication. Gentle, slow music has been found to improve sleep quality, decrease nightly wakenings and lengthen sleep time.
• Mindfulness Meditation: Involves the focusing of your mind on the present. To be mindful is to be aware of your thoughts and actions in the present, without judging yourself.
• Progressive Muscle Relaxation: A great technique for reducing overall body tension. As you reduce the tension you carry in your body, your whole being feels less stress and you enjoy increased physical and emotional health.

• Yoga: Combines breathing, meditation and stretching. It has been shown to improve total sleep time and the time to fall asleep, if used daily over an extended period of time.

 HELPFUL HINTS TO IMPROVE SLEEP HEALTH:

• Cut out or limit caffeine intake especially after noon. Caffeine can have a pronounced effect on sleep, causing insomnia and restlessness. In addition to coffee, tea, and soft drinks, looks for hidden sources of caffeine such as chocolate, cough and cold medicine and other over-the-counter medicine.
• Avoid sweets especially after 6PM. Although sugar can give a burst of energy, it's short-lived and can cause uneven blood sugar levels. This can disrupt sleep in the middle of the night as blood sugar levels fall.
• Nicotine is a stimulant and should be avoided, particularly near bedtime and upon night awakenings.
• Although alcohol is a depressant and may help you fall asleep, the subsequent metabolism that clears it from the body when you are sleeping causes a withdrawal syndrome. This withdrawal causes awakenings and is often associated with nightmares and sweats.
• Avoid heavy meals close to bedtime. The body will have a hard time metabolizing the food, which can cause gastrointestinal problems and interfere with sleep.
• While exercising is excellent for stress reduction and weight loss, do not exercise vigorously just before bed, especially if you are the type of person who is aroused by exercise.
• Minimize noise, light and temperature extremes during sleep with ear plugs, window blinds, or an electric blanket or air conditioner. Even the slightest nighttime noises or luminescent lights can disrupt the quality of your sleep. Try to keep your bedroom at a comfortable temperature- not too hot or too cold. Humidify the air during winter or when needed. Use an air purifier periodically to ensure clean air. Do not expose yourself to bright light if you need to get up at night. Use a small night-light instead. Also, for most people, having pets in the room is not recommended.
• Avoid watching TV, eating or discussing emotional issues in bed. The bed should be used for sleep and sex only. If we associate the bed with other activities it can be difficult to fall asleep. If you wake up in the night and can't fall back to sleep within 15-20 minutes, get out of bed and do something relaxing. Do not sit in bed and watch the clock. Experts recommend going into another room to read or listen to music. Retire again to bed only when you feel tired.
• Stop or limit fluids after 8PM. This may reduce awakenings due to urination.
• Avoid naps, but if you do nap (naps are good for you), limit it to no more than about 25 minutes about eight hours after you awake. However, if you have problems falling asleep, then naps are for you.
• Make sure your bed is comfortable for you (not too hard or too soft) and that pillows are just right. Even slight discomforts can impact sleep more than one thinks.
• Establish a bedtime ritual. A ritual that works for you will reinforce a signal that it's time to settle down and get ready for sleep. For example; Naturopathic practitioners recommend adding one to two cups of Epsom salts to a hot bath and soaking for 15-20 minutes about two (2) hours before retiring for the night.
• Try hard to keep a strict sleep-wake schedule, even on weekends, holidays and vacations. If you can't sleep one night, get up at your usual time that next morning and don't take naps. If you nap, you'll have more trouble getting to sleep the next night, thereby compounding your insomnia.
• Keeping a personal sleep journal or log of what is working and what is not is an excellent way for helping to find the right formula for improving your sleep health. There is no magic formula for perfect sleep - different things work for different people. The important thing is to give everything a fair and persistent trail (for at least a week or two, not just one night) and see what works best for you. A sleep journal will also help your health professionals to observe patterns of behavior or association with other medical conditions. So, note even small observations like what time of night are you awakening, how many times were you up, dreams you were experiencing, any new drugs, any new animals in the house, financial problems and most important, the quality of sleep (how many hours and how you felt waking-up).

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