SWEET DREAMS: My Top Ten Remedies for InsomniaDr. Zoltan P. Rona, MD, M.Sc. December 1, 2017
Winter is here, and with it comes seasonal setbacks that can cause problems with sleep. Can’t fall asleep? Or, is it that you wake up every hour and can’t get a restful night of sleep? Does this go on for days on end?
Let’s say that you have given up caffeine, alcohol, and a high sugar intake, have darkened your bedroom to eliminate all light sources, and turned off the WiFi – but still you are having trouble sleeping. You eat only organic food and exercise religiously, yet still have sleep problems. You have tried OTC sleep remedies from the drug marts but these have failed to help. You do yoga, meditate, and practice EFT (Emotional Freedom Technique), but nothing seems to help. Maybe you have even visited your doctor who diligently sent you for sleep studies that indicated you needed to use a CPAP machine. So, you used it but found it uncomfortable and gave it up.
You are now more than ready for prescription sleeping pills, but is that such a great idea? Today, annual pharmaceutical sales of tranquilizers, antidepressants, and sleeping pills are well over a billion dollars in North America. It is estimated that about 60 million people in Canada and the U.S. are taking one or more such prescriptions. Dependence, addiction, brain damage, and chronic organ disease could be the result. (Reading any of Dr. Peter Breggin’s books, including Toxic Psychiatry and The Antidepressant Fact Book will convince you of these facts.)
Fortunately, there are safer natural alternatives. In fact, there are at least 10 of them readily available, not including homeopathic remedies.
Using just one of the following alone will work for many people, and a combination of three or more is likely to be effective for optimal results. This is especially true if you suffer from a great deal of continuous stress or take prescription drugs that have adverse effects on sleep. So, in order of greatest to least evidence, here is my top ten:
- MELATONIN: The pineal gland at the centre of the brain secretes the hormone melatonin, best known in humans as a regulator of biological rhythms. Melatonin exists in every plant and animal, is structurally identical in all living forms, and is produced in the same circadian rhythm with higher levels at night than during daytime. Melatonin production peaks in early childhood, declining slowly after puberty and then more rapidly in middle age. After age 60, melatonin production is negligible.
The benefits of melatonin go well beyond its sleep-inducing properties. It triggers the body’s nightly cycle of rest and repair allowing refreshing sleep.
It is also a proven effective remedy for jet lag (0.5 to 3 mgs. before sleep). And melatonin boosts the immune system by increasing circulating immune factors. It defends against stress, aging, viruses, and bacteria partially by increasing interferon.
As well, this hormone helps to protect the body against cigarettes, alcohol, and pollutants through its antioxidant effects. It maintains cardiovascular health by reducing risk factors like high blood pressure. And melatonin even inhibits the growth of cancers: breast, lung, cervix, prostate and skin (melanoma); this benefit occurs through its antioxidant effects and control in balancing other hormones.
Melatonin has been shown as safe, non-toxic and non-addictive in hundreds of animal and human studies. Side effects are dose-dependent and reversible by reducing the dose or taking it at different times of the day. Potential side effects include vivid dreaming, daytime drowsiness, and anxiety. (Taking melatonin several hours before bedtime can prevent drowsiness the next day.) Those rare individuals who cannot tolerate melatonin should consider one or more of the following natural health products.
2. MAGNESIUM – Calcium is the mineral that has always had the most media attention, along with overwhelming approval from the medical profession as a supplement that women should be taking. Unfortunately, taking a calcium supplement on its own has some serious drawbacks. Never take calcium as a stand-alone supplement because that can cause hardening of the arteries, constipation, and a higher risk of cardiovascular disease. But when taken with an equal amount of magnesium and vitamin K2, calcium does not cause any problems of this kind.
Despite a great deal of published medical and biochemical research, there is little, if any, attention paid to calcium’s neglected cousin, magnesium. And certainly there have been no medical pronouncements that anyone should be supplementing this mineral in any serious way. I find that its underutilization in clinical medicine is nothing short of scandalous, especially regarding its use as a life-saving cardiovascular tonic. Notwithstanding the excitement generated by vitamin D, according to many experts magnesium may be the commonest of all nutrient deficiencies.
Magnesium is well absorbed from food sources such as legumes, vegetables (especially broccoli, squash, and green leafy vegetables), seeds, and nuts (especially almonds). Absorption from the gastrointestinal tract diminishes gradually with age, but this can be overcome in many ways.
Magnesium is the central element of chlorophyll, the substance that gives plants their green colour. Hence, if it’s green, consider the food as a potentially good magnesium source. Much of the popularity of health food supplements like spirulina, chlorella, and barley green is due to the beneficial effects of the high magnesium content.
Water with a high mineral content, or “hard” water, is also a source of magnesium. So-called “soft water” (e.g. distilled or reverse osmosis water) is not only void of magnesium but may actually promote its loss from the body. Absorption of magnesium from supplements (i.e. bioavailability) varies. Magnesium bis-glycinate, a combination of magnesium and the amino acid L-glycine, is the most bioavailable and the least likely to cause loose bowel movements or diarrhea. Magnesium oxide has a bioavailability of only about 4%. It is best used for treatment of constipation but will help sleep only marginally.
Magnesium-L-threonate, a different form of magnesium complexed with the essential amino acid L-threonine, may well be a better sleep remedy than the bis-glycinate form. Magnesium-L-threonate offers some major advantages to the brain and nervous system that are not possible with other magnesium compounds. It is the best form of magnesium to easily penetrate the blood-brain barrier.
Since magnesium is an anti-spasmodic or relaxant, one expects and sees symptoms of severe magnesium deficiency to include seizures, convulsions, confusion, muscle weakness, abnormal muscle movements such as spasms, tremors, myoclonus, and tetany.
Magnesium is often referred to as nature’s calcium channel blocker. When intracellular levels of magnesium are low, this causes an increase in intracellular calcium. In addition to contributing to insulin resistance, higher intracellular calcium levels enhance calcium-mediated vasoconstriction, and inhibit cardiac and smooth muscle relaxation. The increased vascular tone can cause increased blood pressure. The pharmaceutical industry makes use of calcium channel blocking drugs to reverse this. Practitioners in the natural health care industry use magnesium to accomplish this with fewer side effects.
Magnesium supplementation has been demonstrated as effective in the treatment of anxiety, ADHD, chronic fatigue, fibromyalgia, muscle spasms, muscle cramps, restless legs, insomnia, migraine headaches, cluster headaches, heartbeat irregularities, insulin resistance, metabolic syndrome, and PMS.
If you use high doses of zinc, you might also need a magnesium supplement. Supplementation with high doses of zinc, 142 mg/day, decreases magnesium absorption and magnesium balance in healthy adult males. Alcohol abuse also increases the risk for magnesium deficiency because alcohol impairs the ability of the kidney to conserve magnesium. Taking high doses of vitamin D also increases the need for magnesium supplementation.
Those with sensitive stomachs or weak digestion who have difficulty tolerating magnesium orally can opt for transdermal forms. Simply rubbing magnesium gel on to any skin surface will help raise blood levels of magnesium and help resolve sleep problems.
Before reaching for that sleeping pill, anti-spasmodic, analgesic, or anti-inflammatory drug, consider healthy doses of magnesium instead. The optimal doses depend on the health situation, the current magnesium level, and other biochemical individuality factors. For anxiety and insomnia, the usual effective dose for most adults is between 300 and 600 mg of magnesium. If you are not sure what to do, consult a natural health care practitioner.
3. L-TRYPTOPHAN AND 5-HTP – The amino acid, tryptophan, is very effective for insomnia. Although it is a natural substance, it requires a doctor’s prescription in Canada (1000 – 3000 mgs before bedtime). Foods high in tryptophan include a glass of warm milk, bananas, figs, dates, and nut butters. To date, none of these foods require a doctor’s prescription, but, with Health Canada, you never really know.
Another related remedy that has not yet been banned by Health Canada, and is easily available at health food stores is 5-HTP (5-hydroxy-tryptophan). This is a metabolite of L-tryptophan that gets converted in the brain to the sleep-inducing neurotransmitter, serotonin.
The usual effective dose of 5-HTP is 100 – 300 mgs before bedtime, but this is one supplement which can also be taken during the day to treat anxiety, depression, and obsessive-compulsive as well as eating disorders without causing drowsiness. In fact, many people interested in weight loss use 5-HTP to control appetite. Also noteworthy: 5-HTP has been found to be more effective for sleep problems than L-tryptophan in cases of fibromyalgia and chronic fatigue syndrome. High doses can cause nausea, so reduce the dose if that happens.
4 L-Theanine – Green tea contains many beneficial components. The one that gives green tea its relaxation or calming effect is the amino acid L-theanine (gamma-ethylamino-L-glutamic acid). Green tea also contains caffeine, and it is L-theanine that somewhat offsets the stimulating effects of caffeine in green tea.
Between one and two percent of green tea leaves contain L-theanine. A calming effect can be felt within 30 to 40 minutes of ingesting 50 – 200 mg of theanine; it does this by stimulating the production of alpha waves in the brain. This phenomenon has actually been measured by meticulous scientists and is an established fact. Alpha waves are present in the wakefulness state when they are associated with a relaxed and effortless alertness. Some people call this a “Zen” state.
If you benefit from meditation you are actually increasing alpha waves in the brain. While inducing a state of deep relaxation, L-theanine can also enhance mental alertness. For people who do not have the luxury of spending several hours a day meditating, L-theanine is a good alternative. Memory and learning is enhanced by L-theanine and blood pressure is lowered naturally, if elevated. I have had several patients who were able to reduce or eliminate their blood pressure medications simply by taking L-theanine on a regular basis.
L-theanine is currently being studied as a potential replacement for Ritalin, an amphetamine prescribed to children and adults for attention deficit disorder (ADHD). It is also being studied for its benefits in treating PMS (premenstrual syndrome) as well as for enhancing the immune system in conjunction with various cancer treatments.
L-theanine gets converted in the brain into the inhibitory neurotransmitter gamma amino butyric acid (GABA). GABA, in turn, optimizes the levels of two other neurotransmitters, dopamine and serotonin, producing further relaxation effects. Many of you who are familiar with psychiatric drugs know that the most commonly prescribed tranquilizers and antidepressants work by modifying the levels of these neurotransmitters. The only difference between these drugs and the natural compounds is the fact that the drugs are loaded with side effects too numerous to list here.
The nice thing about L-theanine is that it can mitigate the effects of stress without sedation. In fact, it enhances awareness and has applications for learning disabilities and attention deficit disorders as well as various hyperactive states. It can also offset the over-stimulation that can result from drinking high caffeine products such as coffee and soft drinks.
Unlike prescription anti-anxiety agents, even a massive overdose of L-theanine 100 times the recommended dose does not produce further relaxation or drowsiness. It is considered so safe that there are no limits to how much one can take before any possible toxicity occurs. Studies indicate that it crosses the blood-brain barrier quite easily. It competes for absorption in the small intestine as well as the brain with other amino acids so, to have maximal impact, L-theanine should be taken on an empty stomach away from food.
The best time to take L-theanine is at the first sign of stress, at a dose of 50 – 200 mg, every four to six hours as needed. For most adults, its effects can be felt in the body up to 10 hours after ingestion. The U.S. FDA recommends a maximum dose of 1,200 mg per day, but this does not appear to be based on any evidence of potential adverse effects. Its safety in pregnant women has not yet been established.
L-theanine does not directly cause sleep, but it helps anyone with a sleep disorder because it can aid elimination of anxiety and boost the brain levels of GABA, an inhibitory neurotransmitter.
5. NIACINAMIDE & B COMPLEX – Many people worry that taking any B-complex vitamins will prevent sleep due to its effect on boosting energy levels. Yes, energy is enhanced if you take B vitamins early in the day, but the effect is different before bedtime.
Insomnia can often be helped by a trial therapy with high doses of vitamin B3 (niacinamide) 1000 – 3000 mgs, B6 (100 mgs), and inositol (1000 mgs). Vitamin B3 gravitates to the same receptors in the brain that attract benzodiazepines like lorazepam (Ativan), diazepam (Valium), and many others. Daytime drowsiness and brain injury can occur with the benzos, but not with any of the B-complex vitamin supplements.
Although the other form of B3, niacin, will work for the purpose just as well as niacinamide, it’s best to avoid niacin due to the flushing and itching effect experienced by most people. The flushing reaction is harmless, but annoying nonetheless. Both niacin and niacinamide can cause liver irritation in high doses, so if nausea occurs reduce the dose to tolerance level. High niacin doses taken for extended periods of time can cause stomach ulcers and liver damage in susceptible individuals. If you are taking large doses for months on end, get liver function tests periodically to ensure safety.
The non-flush form of niacin (Inositol hexaniacinate) might be effective for some people but the cost is much higher than plain niacinamide. High dose niacin is effective at reducing high blood cholesterol levels but the other forms of B3 do not have that property. They will all help with sleep problems. Niacinamide is the preferred form of B3 to use for insomnia.
6. VALERIAN (Valeriana officinalis) – One of the most popular herbal remedies used to help sleep problems is valerian. Many double-blind studies show that it improves sleep quality and relieves insomnia equally as well as the benzodiazepine prescription drugs. Unlike the benzos, valerian does not cause daytime sleepiness, diminished concentration, or impairment of physical performance.
Although highly variable, the dosage for the standardized valerian extract (0.8% valerenic acid content) is 150 – 300 mg 45 minutes before bedtime. Unfortunately, people give up too early with it when it doesn’t work the first time. One has to use it up to a full 3 weeks before concluding on its effectiveness. It will definitely work better in combination with the other natural health products discussed in this article.
7. LEMON BALM (Melissa Officinalis) – Lemon balm primarily promotes relaxation. It is a member of the mint family and has traditionally been used as a calming herb. For centuries, it has been used to offset stress, anxiety, and insomnia. It’s never going to knock you out like a drug, but will relax you enough so that the other natural remedies discussed here will work better.
In studies of people with minor sleep problems and anxiety, over 80% of those who took an herbal combination of valerian and lemon balm reported sleeping much better than those who took a placebo. Side effects of lemon balm have never been reported. One should experiment with the dose used to see how much is beneficial.
8. HOLY BASIL – People often complain about waking up frequently through the night. Interrupted sleep can often make people feel like they never had any refreshing sleep at all. This results in very low energy levels during the day, and poor performance at work, or the lack of enjoyment of time off work. This is where holy basil comes in.
Holy basil is an adaptogenic herb that balances cortisol levels. Excessive stress raises the blood levels of cortisol, making restful, uninterrupted, sleep difficult. Holy basil balances that negative cortisol effect. The main components of holy basil are eugenol and caryophyllene which help to lower cortisol levels and improve the way the body reacts and responds in times of increased stress. Aside from helping to create more restful sleep, it can improve mood and mental clarity. I have found it useful in some cases of depression that had no obvious cause.
Studies have also shown that it has beneficial effects in balancing blood sugar levels in diabetics and those suffering from hypoglycemic episodes. Along with the amino acid L-glutamine, it could help many with strong sugar cravings. Effective dosage is variable and side effects have never been reported.
9. PASSION FLOWER (Passiflora incarnate) – This highly popular herbal remedy is often used for reducing stress, anxiety, panic, and insomnia. Its benefits are enhanced when combined with lemon balm and valerian. Passion flower appears to work by boosting the levels of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain. Research shows it to be comparable to the prescription drug, oxazepam, a very common benzodiazepine often prescribed for anxiety and insomnia. It works best for insomnia if taken about an hour before bed.
Be careful with passion flower if you’re using antidepressants, blood thinners, or blood pressure drugs due to interactions. In those cases, get advice from a healthcare professional familiar with this herb and drug-herb interactions.
10. CANNABIS – I left this natural remedy for last because, for many people, it appears to be a last resort. Proponents would argue that the evidence for its safety and efficacy should place it much higher on my list of top 10 natural sleep remedies. The two major active ingredients of cannabis are cannabidiol (CBD) and tetrahydrocannabinol (THC), the latter of which produces the psychoactive effects. CBD has anti-inflammatory effects in the brain and has multiple applications for just about all neuro-psychological disorders.
If or when the natural sleep remedies discussed earlier are either ineffective or tolerated poorly, varying concentrations of CBD and THC, in either an oil or edible form, may be worth a try. I don’t recommend smoking or vaping cannabis due to the inhalation of potential toxins that could damage the lungs.
Many of my patients tell me that their doctors are reluctant to prescribe cannabis for sleep. The conventional preference is to prescribe various benzodiazepine drugs or antidepressants. Most of these patients then visit “Medical Marijuana Clinics” for that elusive prescription. I would always choose cannabis over prescription chemicals to help insomnia simply based on long-term safety considerations. Conventional doctors appear to restrict cannabis prescriptions to cases of terminal cancer pain and post-traumatic stress disorder (PTSD). Conventional doctors may occasionally prescribe it for seizure disorders but only if all the other drug remedies have failed to control the seizures.
Unfortunately, legal access requires an MD’s prescription that needs to be registered with Health Canada. For many, this is an invasion of privacy. Does one need to register to Health Canada for drinking vodka or smoking cigarettes? Tobacco and alcohol will kill millions more than marijuana ever will. All this may change in July of 2018 when recreational marijuana becomes legalized in Canada. This should end the difficult access to this vital herbal medicine.
Well, there you have it. One or more of these top 10 are infinitely safer than any prescription tranquilizer or antidepressant. To find the right non-drug solution for your sleep concerns, see a natural health care practitioner.
Dr. Zoltan P. Rona practises Complementary Medicine in Toronto and is the medical editor of The Encyclopedia of Natural Healing. He has also published several Canadian best-selling books, including Vitamin D: The Sunshine Vitamin. Visit his website at: http://www.highlevelwellness.ca For appointments, call (905) 764-8700; Office: 390 Steeles Ave. W. Unit 19, Thornhill, ON