Non-Drug Help for Insomnia – Part II

Non-Drug Help for Insomnia-Part II

David J. DeRose, MD, MPH
As presented on the Three Angels Broadcasting Network’s Health for a Lifetime
Taped December 2005


10. Get adequate exercise during the day. Physical exercise during the day often helps promote more restful sleep. However, vigorous exercise before going to bed may interfere with sleep by causing undue stimulation. Such is not the case with less intense exercise. When you are having trouble sleeping, getting up out of bed and engaging in some light useful exercise or mild stretching can be a useful sleep aid.


11. Get out of bed when struggling with sleeplessness. Individuals with chronic sleep difficulties can develop an association between being in bed and feeling anxious and tense. Lying in bed awake can trigger thoughts like “here we go again, I’m probably in for another sleepless night.” You can counter this association by getting up out of bed if you can’t fall asleep in a reasonable amount of time. Similarly, if you wake up in the middle of the night and are having trouble getting back to sleep, then get up and get out of the bedroom. Regardless of how you are tempted to feel, look at sleeplessness as an opportunity to do something productive rather than lying in bed feeling frustrated. Return to bed only when you begin to feel sleepy. Such a pattern will help restore the mental connection between your bed and sleep—rather than frustration.


12. Trust in God’s power. Whether or not the bedroom has become associated with sleeplessness, many perpetuate their insomnia by worrying about it. Trust God to help you accomplish your needed tasks and rightly represent Him regardless of how much sleep you get. This can remove much of the stress that often compounds our sleeping problems.


13. Be content with less sleep. As we age, total sleeping time tends to decrease. Therefore, older individuals may sleep better if they arise earlier and avoid daytime naps. If they feel a need to rest, they should take any naps in the late morning rather than in the afternoon or evening. (Older individuals should avoid sleep medications as these drugs often cause more harm than good—increasing the risk of confusion, falls, and incontinence).


14. Learn relaxation techniques. If you are lying in bed unable to sleep and don’t want to get up right away, consider another approach. You can use strategies like progressive relaxation to help decrease stress in your muscles, promote relaxation, and focus your attention on something other than your problems. Progressive relaxation involves sequentially tensing and then relaxing your major muscle groups beginning with your toes, and then working your way up the rest of your body. Deep breathing exercises may also be effective.


15. Put a stop to racing thoughts. If your mind is in high gear when your body is lying in bed in neutral, take steps to quell your mental turmoil. Perhaps you are thinking about mistakes made earlier in the day; maybe you are worried about all you need to accomplish tomorrow. Regardless of the causes, rambling thoughts can be one of your worst enemies. One successful way to put a damper on racing thoughts is by listening to a “sleep tape.” The optimal tape contains engaging but not stimulating material.

I enjoy listening to the Bible, especially the narrative portions. For example, listening to the story of the exodus will help your mind focus on something uplifting. Furthermore, the story’s familiarity ensures you won’t be lying awake wondering if Pharaoh will destroy God’s people. (This is why a tape recording of the latest suspense thriller or romance novel is not a good substitute.)


16. Consider sedative herbal preparations. A variety of herbs appear to have sedative properties. These include catnip, chamomile, hopps, and valerian root. Valerian root is perhaps the most commonly used sedative herb. A common dosage is 400 to 900 mg of a preparation standardized to contain 0.8% valerenic acid. Especially if you are taking prescription drugs or are otherwise under treatment for a medical condition, check with your physician before adding any herbal preparations to your regimen.


17. Consider short-term melatonin use. Melatonin is a compound naturally produced within the brain by the pineal gland. I discourage the use of “natural” melatonin supplements because the compound can be harvested from animal brains—theoretically introducing the risk of transmissible brain disorders like the human equivalent of “mad cow” disease. However, synthetic melatonin supplements appear to be relatively safe when used for a short time, (a period of days or weeks). The safety of longer-term use, for months and years, is not clear at the present time. A typical dosage is 2 mg of a sustained release preparation at bedtime. (Some reports suggest that taking higher dosages, in the range of 5 mg, in the early afternoon may be more beneficial for certain sleep difficulties.) As with herbal preparations, consult with your doctor before taking melatonin. It may adversely impact the blood levels of a variety of drugs including the blood thinner, Coumadin ®, and the antibiotic, erythromycin.


18. Ensure optimal vitamin B12 intake. Vitamin B12 appears to be a two edged sword: insufficient amounts can contribute to restless legs (a common contributor to insomnia); yet excessive intake (in the range of 3000 mcg daily) may suppress melatonin production. Therefore, without ingesting extreme amounts, ensure sufficient intake of this vitamin (as little as 5 mcg daily in a healthy young person with normal digestion; up to 2000 mcg in elderly individuals with absorption problems).


19. Consider herbal preparations if you have perimenopausal insomnia. Perimenopause begins some 7 to 10 years prior to the cessation of menses. During this phase many women experience sleep difficulties. Using the herb, black cohosh, may help to alleviate symptoms. (Note, however, there are rare reports of muscle and/or liver irritation among black cohosh users.) Some have suggested that increasing soy intake may be an alternative aid for perimenopausal insomnia; however, evidence for this is currently lacking.


Questions and Answers


Q. I recently was diagnosed with shingles. The pain is terrible and it is keeping me up at night. Is there anything natural I can do to help me get some better sleep?

A. Yes. Shingles pain is often considerably helped by capsaicin, a natural ingredient found in peppers (e.g., chili, cayenne pepper, and red pepper). A variety of creams containing capsaicin are commercially available. These creams have been used by shingles sufferers as well as those with painful joints and other acute and chronic painful conditions.

Q. I’ve heard that imbalances in the levels of some naturally occurring compounds like cortisol can be a factor in sleep disruption. Is this true?

A. Yes. There are a variety of compounds that can directly or indirectly influence sleep. For example, both cortisol and melatonin have effects on inflammatory processes in the body. Cortisol decreases inflammation while melatonin increases inflammation. Therefore if someone is being kept awake by an inflammatory process like rheumatoid arthritis, melatonin would probably not be a good supplement to use for sleep induction because of the potentially undesirable effect of worsening inflammation. Although one may think cortisol would therefore be a good sleep aid for people with chronic inflammation, increased levels of this natural compound interferes with sleep, increasing nighttime wakefulness.


Q. It seems clear then that I probably shouldn’t take melatonin since I am suffering from an inflammatory condition (lupus). But could it actually be good for my joint inflammation to be sleep deprived? (I mean, wouldn’t this decrease my melatonin levels and raise my cortisol levels—the very things you said would help fight inflammation?)

A. Unfortunately, sleep deprivation doesn’t help inflammation. Other inflammation-promoting compounds (technically called IL-6 and/or TNF-alpha) rise even if you just shortchange yourself of two hours of sleep per night. Furthermore, although controversial, some evidence suggests that peak cortisol levels are depressed by modest chronic sleep deprivation.


Q. Since cortisol interferes with sleep what can I do to lower my levels of this compound?

A. Because chronic stress raises cortisol levels you will want to follow a good stress management program.


Q. What do you think of the herb, kava kava? I’ve had good results using it as a sleep aid.

A. Kava kava has properties helpful for inducing sleep. It is reported to relax muscles and reduce anxiety and pain. Unfortunately, although still a relatively rare complication, a growing number of reports link kava kava to liver damage. Furthermore kava interacts with many drugs. For these reasons I generally do not recommend kava kava. If you do choose to use it, first check with a doctor or pharmacist to make sure it will not interact with any of your prescription drugs. Second, try to limit your use to one or two weeks. Conservative experts recommend in no case using it for more than four weeks.