Perchance to Dream
Relaxation & Sleep
Americans are being robbed of quality sleep (and therefore, broken dreams)—here’s how you can help.
“Idon’t sleep well anymore,” is perhaps one of the most common admissions heard today. And, when one person comments about his/her lousy sleep, it sparks a rather convivial conversation wherein just about everyone agrees that quality sleep is now woefully elusive, more so than ever it seems.
The Issue
Insomnia is characterized by difficulty falling asleep, and/or waking up intermittently throughout the night, which results in disrupted sleep cycles. This common problem is known to contribute to the causation of numerous chronic illnesses that can impair physical and mental functioning as well as depress quality of life. And according to research, long-term sleep deprivation can disrupt healthy functioning of endocrine, metabolic, cardiovascular, immune and neurological systems. Impaired sleep causes elevated cortisol levels that negatively impact behavior, neuronal and molecular function, according to Mirescu et al (2006 Proc Natl Acad Sci USA).
Evidence shown by Anderson et al (J Sleep Res., 2005) indicates that sleep deprivation involves a temporary activation of the major neuroendocrine stress systems, the autonomic sympathetic system and the hypothalamic-pituitary-adrenal (HPA) axis. Further, Hu et al (J Med Food 2013) showed that sleep impairment and deprivation can impede memory and REM sleep, a sleep status that is involved in learning and memory in the hippocampus.
The Numbers
According to the comprehensive 2021 State of America’s Sleep report by the Better Sleep Council, there are large segments of the U.S. population who are only getting about 27 out of 40 winks on a regular basis. Here are the stats:
Contrary to common thought, those who experience “excellent sleep” are more likely to be older and poor sleepers are more likely to be younger—44 percent of excellent sleepers are 55-plus, which is significantly higher than poor sleepers (31 percent). More than one-third (36 percent) of excellent sleepers are Baby Boomers, which is significantly higher than poor sleepers (27 percent).
The study also found that 37 percent of poor sleepers experience pain when sitting or standing and 26 percent experience pain when lying down, which is significantly higher than excellent sleepers (27 percent/12 percent). Additionally, 23 percent of poor sleepers have been diagnosed with a medical condition (e.g., anxiety, depression, etc.) in the previous year, which is 2.3 times more likely than excellent sleepers (10 percent). Almost half (48 percent) of poor sleepers say their mental/emotional health has declined over the past year—which is 2.5 times more likely than excellent sleepers (19 percent).
Close to half (45 percent) of poor sleepers often or very often feel stress and are four times more likely than excellent sleepers (11 percent) to say they feel stress often or very often.
More than half (56 percent) of poor sleepers do not attain the recommended seven to eight hours of sleep per night. Poor sleepers are more likely to take more than 30 minutes to fall asleep, wake up more often, and struggle going back to sleep after waking up. Meanwhile, 35 percent of self-reported poor sleepers toss and turn for more than a half hour before falling asleep, and 53 percent say they often wake up frequently during the night. And, if that all were not enough, nearly 40 percent of poor sleepers have trouble getting back to sleep after waking up.
And finally, unsurprisingly, poor sleepers are more likely to use sleep-promoting medication or other tools to help them sleep. And here’s where you come in.
“When I was in private practice, sleep issues, and the concomitant daytime fatigue, were probably the most common symptoms my patients asked me about,” said Stacie Stephenson, DC, CNS, chair of functional medicine for Cancer Treatment Centers of Americas and an American Nutrition Association board member. “Anecdotally, I see even worse problems since the pandemic. I believe the primary cause to be chronic stress and anxiety, which has significantly worsened during the pandemic, followed closely by a lack of exercise and poor dietary habits, especially eating nutrient-deficient, high-fat and/or high-sugar foods habitually, and overeating too close to bedtime.”
Rosia Parrish, ND, owner of Naturopathic Wellness Center of Boulder (Colorado), asserted that there are numerous reasons why healthy adults experience sleeping issues. If a patient is describing problems with staying asleep, his or her pineal gland is likely underproducing sufficient melatonin. Additionally or in tandem, she pointed out, high stress increases cortisol and that can also impair the brain’s ability to produce melatonin. Cortisol ideally is at its highest circulating content in the morning and the lowest at night, but it can be imbalanced due to stress, grief, anxiety, depression, glucose dysregulation, not eating enough protein and inflammation. High nighttime cortisol compromises regenerative sleep in the REM state.
Further, according to Dr. Parrish, the caffeine discussion is more than just advising to stop consuming caffeinated beverages after 1:00 p.m. Some individuals may not have what she called the genetic capability to properly break down caffeine. “I’ve heard some say that if you’re a sleepless coffee drinker then try switching to black tea, and black tea drinkers should switch to green tea, those that are green tea drinkers need to switch to white tea, or some people just need to get off caffeine altogether. There are many other teas that provide a gentle increase in energy without the impact on sleep.”
A patient coming to you about sleep issues also may also be asked questions about nutritional status (for deficiencies), such as magnesium. Sleep apnea, restless leg syndrome, too much light exposure, hormonal imbalance (usually in peri-menopausal women), enlarged prostate in men, and even exercising too late in the evening can all impact sleep.
Too much alcohol will also impair sleep. Said Dr. Parrish, “Alcohol consumption is often overlooked but a common reason for poor sleep where people wake a bit past midnight—a result of alcohol interfering with REM sleep. Many find the best treatment for this is to abstain from alcohol or moderate.”
In her practice, Dr. Stephenson commented that prophylactically, she always recommends exercise during the day, preferably outdoors; good sleep hygiene including a regular sleep routine in the evenings to signal to the body that it’s time to wind down; and eating light and early in the evening. “Once someone is in a chronically sleep deprived state, however, these practices become even more critical, to break the cycle of nighttime wakefulness and daytime drowsiness,” she pointed out.
“If I had to pick just one thing, it would be exercise,” she emphasized. She believes that a 30-minute brisk walk outdoors can definitively improve sleep duration and quality. She also recommends getting the circadian rhythm back in sync by walking outside for at least five minutes every morning for sun exposure and again at sunset, allowing the natural light cues to trigger the pineal gland to suppress and release melatonin appropriately.
Meanwhile, she added, “I also believe supplements can help. I like energizing supplements for daytime drowsiness, including panax ginseng and astragalus. In the evening, melatonin can temporarily help with circadian rhythm synchronization, but I don’t recommend it long term. Ideally, it’s better to get natural melatonin production restored.”
For the sleepless patient, Dr. Parrish also likes to recommend sleep hygiene to ensure that the sleep environment is conducive to healthy slumber. Her plan includes sleeping in total darkness as any light source can disturb sleep, which includes turning off any electronics, preferably ceasing any blue-light device use an hour before bedtime. Also, keeping the bedroom at a cool temp helps.
“I also like to encourage journal writing, stretching, reading, Epsom baths with calming aromatherapy like lavender essential oils, guided meditations, prayer and anything else that is considered as relaxing,” she added.
Secondly, Dr. Parrish recommends adrenal stress functional lab testing to test for hormones that commonly contribute to insomnia and sleep concerns such as difficulty going to sleep, difficulty staying asleep or difficulty waking. In this lab testing, the primary stress hormones tested are four-point cortisol (four times in the day that cortisol is tested to see how it fluctuates in the day) and DHEA, a hormone related to adrenal glands. These two hormones are able to depict an individual’s stress response and thus allow for the practitioner to figure out how much stress is impacting someone hormonally.
Dr. Stephenson added that for individuals who have impaired sleep due to anxiety, she likes to recommend supplements such as magnesium glycinate or threonate—“these particular types of magnesium are best for relieving stress),” she commented. Ashwagandha is on her herbal list for adaptogenic balance, and the amino acid L-theanine for a natural anti-anxiety effect.
Both Dr. Stephenson and Dr. Parrish have found research that they find compelling in how to help patients effectively use supplements to lull into sleep and sustain it for the recommended seven or eight hours.
A 2020 meta-analysis (Chan, Postgrad Med J) looking at dietary supplements and their effect on sleep quality was cited by Dr. Stephenson. It analyzed 31 different controlled trials and found persuasive support for the positive effects of amino acids, melatonin and vitamin D on sleep. She said the study also found magnesium, zinc, resveratrol and nitrate supplements for improving sleep quality were worthy of consideration.
She commented that she already considers magnesium and vitamin D important supplements for most of her patients (as many are deficient, and vitamin D can’t be metabolized without sufficient magnesium), and she often recommends melatonin for short-term use. “This study not only underscores what I already advise, but has piqued my interest in amino acids, and whether taking them supplementally or through a diet with increased protein could help resolve sleep issues for more people,” she said.
Products to Recommend
Pennsylvania-based Boiron’s SleepCalm is a homeopathic remedy for occasional sleeplessness, according to Barbara Apps, product manager, who described SleepCalm as purposefully being formulated without melatonin to restore the balance of nighttime and daytime states in the body, rather than just masking symptoms with a substance that induces drowsiness. The product’s four plant-based active ingredients target different types of sleep disorder symptoms, she noted, so it works well for more than one type of occasional sleeplessness.
Conventional sleep aids usually only have one ingredient designed to sedate, so they don’t take specific symptoms into account. “Several double-blind, placebo-controlled studies of homeopathic sleep medicines have found they can increase total sleep time and improve sleep quality,” she commented.
Boiron offers a white paper, Homeopathy for Sleep: A Comparison of Herbs, Supplements, OTCs and Sedatives specifically for health care practitioners. According to Apps, the white paper is a deep dive into commonly used sleep remedies including melatonin and possible side effects. “Many people turn to melatonin as a natural solution for sleep problems, but they’re unaware of concerns, cautions and contraindications surrounding its safe use,” she said. “Many consumers consider melatonin a natural ingredient, but most commercially available melatonin supplements are synthetic. Scientific research on melatonin’s efficacy is mixed. It does appear to shorten the time needed to fall asleep, but only by seven to 12 minutes. It also increases sleep duration for about the same amount of time. Short-term use of melatonin seems to be safe for most people.”
However, Apps added, side effects can include drowsiness, headache, dizziness and nausea. Additionally, another caution—long-term use of melatonin is not well-studied in children, even though many parents give it to their kids. There are also concerns about overconsumption and accuracy of amounts reflected in labeling.
Texas-based Elevated Wellness’ 2,000 mg Sleep Aid, Melatonin Infused, CBD Isolate Tincture contains CBD Isolate from hemp and pharmaceutical-grade melatonin, according to Chris Adlakha, PharmD. He explained, “CBD on its own is often not sedative, but it guarantees a lack of THC. So, for those who would prefer to abstain from THC, our 2,000 mg Isolate Sleep Aid is a safe option; though, due to the fact that it is only CBD in reference to its cannabinoids, we have put a heavy dose of melatonin to make up for the lack of sedative abilities; though, CBD on its own is often relaxing, anti-inflammatory and de-stressing, which also helps tackle a multitude of sleep based issues in the user.
Because of the increased melatonin dose (10 mg/ml ultrasonic homogenized), it does create a risk of mental and physical drag in the morning.”
According to research cited by Dr. Adlakha, evidence points toward a calming effect for CBD in the central nervous system. Researchers wanted to determine whether CBD helps improve sleep and/or anxiety in 72 adults, using sleep and anxiety scores at baseline and after CBD consumption. (Shannon, Permanente Journal 2019).
The 72 participants presented either with primary concerns of anxiety (47) or poor sleep (25). Anxiety scores decreased within the first month in 57 patients (79.2 percent) and remained decreased during the study duration. Sleep scores improved within the first month in 48 patients (66.7 percent) but fluctuated over time.
North Carolina-based Gaia Herbs’ SleepThru phyto-caps contain ashwagandha, passionflower and jujube date to promote a healthy night of rest for occasional sleeplessness, described Susan Hirsch, formulation manager. “This formulation of soothing and stress-supportive herbs works together so restful sleep can be achieved. The product uses a harmonizing blend of nervine and adaptogenic herbs that support the body’s stress pathways for a healthy night of rest,” she noted.
Hirsch explained that ashwagandha is an energy support herb that promotes sleep while also supporting daytime energy and stress. It rejuvenates the entire system, especially the endocrine and immune systems. Passionflower promotes healthy sleep, especially where wakefulness and interrupted sleep take place. The plant has been used to gently restore debilitated nerve centers by promoting nutrition at a cellular level.
Jujube dates are used to support calmness and function as a general health tonic, while at the same time, supporting healthy sleep throughout the night. Magnolia has been used in traditional Far Eastern medicines for hundreds of years. It has been shown to modulate cortisol production and is used in formulations to support a healthy response to stress and support sleep.
According to Hirsch, Gaia Herbs’ Sound Sleep phyto-caps is a new and improved formula. The supplement helps support a natural transition to sleep for occasional sleepless nights. It contains hops, passionflower, valerian, California poppy, American skullcap and gotu kola to promote relaxation and prepare the body for restful sleep.
She explained that hops are used to support deep and restful sleep, as well as promote a healthy response to stress to promote relaxation. Valerian has long been used to promote a normal restful night’s sleep. California poppy is known for its calming actions for the nervous system, even acting as a mild tonic for the nervous system when it is stressed. American skullcap has long been used in Western botanical medicine to support exhausted nerves and help maintain normal balance in times of muscular tension. It also promotes normal sleeping patterns. Gotu kola is a rejuvenating nervine, known for balancing the nervous system and helping the body to acclimate to temporary stress.
Getting and maintaining a good night’s sleep on a regular basis is often difficult in a stressed-out society. Natural tools and techniques can help turn 20 winks into 40.
Healthy Take Aways
• Impaired sleep causes elevated cortisol levels that negative impact behavior, neuronal and molecular function.
• Sleep impairment and deprivation can impede memory and REM sleep, a sleep status that is involved in learning and memory in the hippocampus.
• Almost half (48 percent) of poor sleepers say their mental/emotional health has declined over the past year.
• Over half (56 percent) of poor sleepers do not attain the recommended seven to eight hours of sleep per night.
For More Information:
Boiron USA, www.boironusa.com
Elevated Wellness, www.elevatedwellness.com
Gaia Herbs, www.gaiaherbs.com
