Insomnia

Insomnia is defined as the persistent difficulty or the inability to fall and/or stay asleep. It may be primary, but is often a symptom of an underlying medical or psychological condition. May be episodic, short-term or chronic. Three common types of insomnia are: delayed sleep onset, early morning arousal and frequent awakenings. 

Insomnia and sleep disorders are often a result of an underlying deficiency or an overstimulation of the brain.   Balancing neurotransmitters, hormones, mineral levels and practicing sound sleep hygiene are required to improve chronic sleep issues.

Causes / Risk factors of Insomnia

• Poor sleep habits: lack of sleep routine, afternoon napping, shift-work, spending too much time in bed while awake, using computer or TV while in bed, frequent air travel
• Poor sleeping environment: too much light or noise; too hot or too cold
• Over-use of stimulants: alcohol, caffeine, tobacco or other drugs
• Certain medications: diet pills, cold and flu tablets, anti-depressants, beta-blockers, thyroxine, bronchodilators
• Stress, depression and anxiety – imbalanced neurotransmitters
• Hypoglycemia – major reason for waking in the night
• Mineral deficiencies: Magnesium, calcium and zinc are common offenders
• Food sensitivities
• Pain and discomfort
• Hyperthyroidism
• Nocturnal myoclonus (restless leg syndrome)
• Indigestion
• Sleep apnoea

TREATMENT STRATEGY FOR INSOMNIA

• Identify and address underlying causes (Neurotransmitters, hormones, mineral deficiencies, methylation, blood sugar, gut dysbiosis and intestinal permeability)
• Regulate and support nervous system
• Enhance GABA activity
• Regulate circadian rhythm
• Establish good sleep

Diet plan guidelines for Insomnia

• Avoid overuse of stimulants such as sugar, caffeine, alcohol, nicotine and hot and spicy foods, especially in the evening
  • Caffeine antagonizes adenosine, which is needed to regulate the sleep cycle. The half-life of caffeine is 4-6 hours, therefore a coffee consumed at 1pm may still be in the system at 11pm. It is recommended to avoid caffeine drinks within 6 hours of bedtime.
  • Alcohol should be avoided before bedtime as it can lead to night-time awakening
• Unrefined low-GI diet high in complex carbohydrates, protein, fruit and vegetables.  We prescribe a paleo based diet is indicated in many cases
• Herbal teas to enhance GABA: chamomile, lemon balm, passionflower taken 45-60 minute before bed

Nutritional considerations

Depends on underlying cause – see individual treatment protocols

• L-tryptophan 100 mg before bed
• GABA 3000-5000 mg before bed
• Magnesium 300 mg before bed
• Vitamin E 400 IU: in nocturnal myoclonus

Herbal considerations

• Sedative nervines: valerian, passionflower, hops, lemon balm, chamomile, California poppy, corydalis, skullcap. Take 45-60 minutes before bed.

Lifestyle / Physical measures

• Establish good sleep hygiene:
  • Avoid phones and other computer type screens at least 2 hours before bed
  • Maintain consistent bedtimes and wake-times, including on weekends and vacations
  • Establish the bedroom as a place for sleeping and sexual activity only
  • Avoid naps, particularly in the afternoon. Short 20-minute powers naps can be rejuvenating if experiencing daytime sleepiness, but avoid deep sleeps.
  • Keep the bedroom cool, well-ventilated, quiet and dark
  • Have a 30-60 minute relaxation period in dim light before bed
  • Avoid a fixed bedtime or going to bed too early. Use feelings of sleepiness as a guide for bedtime.
  • If unable to fall asleep within 15-20 minutes or there are feelings of alertness or anxiety, get out of bed and go into another room to read or watch TV under dim lights. Then return to bed only when feeling sleepy
  • Have a fixed wake-up time.
• Regular exercise program that elevates the heart rate by 50-75% for at least twenty minutes each day (but avoid vigorous exercise at least 2 hours before bedtime)
• Exposure to late afternoon sun stimulates release of endogenous melatonin
• Warm baths with essential oils: lavender, chamomile
• Stress reduction techniques such as yoga, meditation, deep relaxation and massage

FUNCTIONAL MEDICINE TREATMENT OF INSOMNIA

Insomnia and sleeping disorders can be caused by many different factors and often accompany those with high levels of stress or chronic health problems.  Some patients cannot fall asleep, others wake in the night and then cannot get back to sleep.  As with all disorders, identifying and addressing the individualized underlying cause is required. 

Implementing the basic procedures as outline above will often resolve the issue, for those more deep rooted imbalances investigation into neurotransmitter levels, methylation, gut dysbiosis, food sensitivity and hormones production is required.

At our Perth clinic of Advanced Functional Medicine have experience with sleep disorders and Insomnia.  

What have been the best changes you have made that have improved your sleep?  Has changing your diet improved your sleep?  Have you assessed your neurotransmitter levels and found imbalances that are causing your sleep problems?  Please leave a comment below.

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