Sleepless nights can be triggered by countless factors, but by controlling confronting the issue head on, practitioners are able to gain a better understanding of what causes them. By Nicholas Saraceno
As the old saying goes, time flies when you’re having fun (or sleeping for that matter). Unfortunately for some, this is not always the case. According to the American Sleep Association (ASA), 50 to 70 million adults in the United States have some sort of sleep disorder. These disorders can range from dyssomnia’s to parasomnias.
Often times, this inability to rest results in sleepless nights. Although there are a plethora of causes linked to difficulty sleeping, integrative practitioners are able to pinpoint the most popular ones, while finding potential solutions.
Causes & Common Conditions
As previously mentioned, the causes that influence the lack of sleep are numerous, but doctors and experts alike have been able to narrow these down to ones backed by science, such as brain function, which could be the root of the problem.
“There are cycles of sleep: rapid eye movement (REM) and non-rapid eye movement (non-REM),” said Jeremy A. Holt, associate director of Ajinomoto North America’s health services section in New Jersey. “REM is typically 25 percent of the sleep period. Non-REM is divided into four stages. Stage One is the period between being awake and falling asleep. Stage Two is the onset of sleep and becoming disengaged from your surroundings. Stages Three and Four are the deepest and most restorative sleep, where muscles are relaxed, blood pressure drops and breathing becomes slower.
“A restless sleeper will wake up while transitioning between these stages. Once the body wakes, it doesn’t return to the state it awoke from – it must go back to stage one. Continually waking during the night and not reaching Stages Three and Four is what causes poor sleep quality.”
However, lack of sleep can also stem from gender-related issues that interfere with the REM process.
Gina Besteman, RPH, is the director of compounding and dispensing at the Women’s International Pharmacy in Wisconsin, a compounding pharmacy that provides high-quality bioidentical hormone therapies.
“One of the more common symptoms of peri-menopause and menopause that patients complain of is difficulty sleeping. There is a significant amount of research showing how hormones affect sleep,” she noted. “Progesterone affects GABA receptors which are responsible for non-REM sleep, the deepest of the sleep stages. Progesterone also affects breathing. Its’s been shown to be a respiratory stimulant and has been used to treat mild obstructive sleep apnea. Estrogen’s role in sleep appears to be more complicated than that of progesterone. Estrogen is involved in breaking down norepinephrine, serotonin and acetylcholine in the body. Estrogen has been shown to decrease the amount of time it takes to fall asleep, decrease the number of awakenings after sleep occurs and increase total sleep time. Low estrogen levels may lead to hot flashes which can also affect sleep.”
Perimenopause refers to the menopausal transition, normally occurring in a women’s 40’s, sometimes mid-30’s (mayoclinic.org). Dr. Besteman also cited that if there is a disruption in cortisol, the stress hormone produced by the adrenal glands and melatonin, the hormone responsible for sleep and wakefulness manufactured by the brain’s pineal gland, these could be contributors to the issue.
As a result, different sleep conditions affect different societal demographics. According to Svetlana Kogan, MD, an integrative doctor in New York, NY and author of Diet Slave No More!, individuals affected by difficulty sleeping can be broken up into three categories.
“Young people have over stimulated nervous systems due to cell phones, video games, computers, TV and other electronic gadgets,” she said. “Older people (ages 35-60) are having difficulty sleeping due to all of the above, plus the stress of having to balance family, children and work. Much older people (over 60) have physiologic issues during sleep that cause them to wake up many times during the night (urinary incontinence or frequency, sleep apnea, insomnia, pain syndromes). Overall, people who live in big cities sleep much less than the rest of the country. This could be due to overstimulation of the nervous system, work stress and lack of time spent outdoors (that is, less oxygen to the brain).”
Solutions to Better Sleep
After hearing of patients’ difficulty sleeping, the next question is: what exactly can practitioners recommend to their patients to help combat these issues?
A great starting point would be in the mineral magnesium, which notably has a calming effect to it.
“Magnesium is an essential electrolyte and is known as the anti-stress mineral, and is a natural sleep aid,” mentioned Carolyn Dean, MD, ND, advisory board member of the Nutritional Magnesium Association. “Numerous Studies have shown its effectiveness in reducing stress levels as well as helping with deeper more restful sleep. This mineral has been depleted from our soils and foods due to modern farming methods and food processing. More than 75 percent of Americans do not get their recommended daily allowance of this mineral, which is a co-factor in 700-800 enzyme reactions in the body.
“A magnesium deficiency can magnify stress because of serotonin, the feel-good brain chemical that is boosted artificially by some medications, depends on magnesium for its production and function. Not all forms of magnesium are easily absorbed by the body. Magnesium citrate powder is a highly absorbable form that can be mixed with hot or cold water and sipped at work or at home throughout the day.”
As another option, Boiron USA, a Pennsylvania-based manufacturer of homeopathic medicine, offers Quietude, dissolvable tablets that help target lack of sleep, without the effects that come with it. Christopher Merville, DPharm, director of education and pharmacy development at the company, explained how exactly the medication is effective.
“Quietude temporary relieves sleeplessness, restless sleep and occasional awakening without grogginess or risk of dependency,” he said. “The biggest advantage of this sleep aid is that it doesn’t knock you out. It may sound funny for a sleep medicine to be non-drowsy and non-doping, but this means you won’t have that groggy hangover effect the next day like you are still in a fog, which is typical with sleep aids that mask the problem by sedating you. Instead, Quietude helps and overactive mind calm down. It’s perfect for when your head hits the pillow but you keep going over that to-do list or replaying the day’s events. If you’ve had a particularly exciting day- whether it’s from good or bad news- prepare for bed by taking Quietude once in the early evening and then again at bedtime.”
A common trend among those struggling with sleeplessness is the fact that the body, especially the brain, is operating at full capacity even during the late evening hours, when it should be resting. Glycine, and amino acid found in Ajinomoto’s Glysom, is able to affect he body accordingly.
“Glycine is a naturally occurring amino acid that induces sleep by setting the body’s internal clock and reducing the core body temperature,” said Holt. “It signals the body to relax and prepare for a better sleep cycle, improving the body’s sleep architecture. Taking Glysom together with melatonin provides a combo effect- the melatonin helps you fall asleep, the Glysom keeps you asleep.”
State of the Market
Being that difficulty sleeping is an ongoing issue, there are positive strides being made in the market, precisely in terms of both traditional and natural medications respectively. In fact, a major contributor to traditional medicine’s success is the severity of the conditions that it treats.
“Insomnia is recognized as the fourth most prominent health issue just behind stress,” said Dr. Dean. “The projections for sleep aids for 2018 are approximately $732 million with a 27 percent category growth rate. The recognized drawbacks are side effects and addictive nature of these medications.”
Moreover, as Dr. Kogan stated, “the sales are unprecedentedly high- especially those of generic sleep meds, as they are cheaper.”
On the other hand, natural sleep medication has continuously garnered attention, partly due to individuals that are popular in the public eye. “Awareness of the importance of sleep an getting proper sleep is growing, and with high profile celebrity deaths (Michael Jackson, Prince) related to sleep issues, consumers are searching for and demanding natural alternative to otherwise harmful side-effect ridden medications,” added Dr. Dean.
As a result, being that pros and cons lie in both forms of medication, practitioners must fairly provide both options to their patients.
There are endless questions surrounding sleep, such as what in fact is the best solution to a good night’s sleep and how one gets to that point. Progress has been made in this regard, and to further enhance this progress, practitioners are thinking out of the box with their interest in research.
“I am interest in researching auto-hypnosis and sleep- specifically how teaching patient’s self-hypnosis techniques can help them fall asleep easier,” noted Dr. Kogan.
In fact, she is quite fond of this delivery method, as it takes more of a holistic approach to medicine. “Self-hypnosis (which I admire) is the least popular method because it’s an acquired skill that needs to be rehearsed many times over, until it becomes a lifestyle,” she mentioned. “Teaching patients self-hypnosis is my favorite modality, because it empowers patients to tap into their own inner resources, instead of depending on pills.”
Although the medical world may not have received all the answers is has been looking for thus far, one ideas is for sure: good sleep is king.
“There is a much greater understanding of the overall physiological and emotional role sleep plays on a body’s health,” said Holt. “Polysomnographic studies have proven that there is no substitute for good sleep. If a body is deficient in vitamin C, a supplement will help adjust that. The same cannot be said of sleep deficiency. Lack of sleep affects the whole body, including metabolism. That’s why good sleep is so important for weight loss.”