Why does sleep have to be so stressful? With the myriad of boring and listless things that we are subjected to in our day to day lives that could put us to sleep like traffic, waiting in a doctors office or listening to a droning presentation, why does trying to get to bed at 10pm become such an event? This is something I have dealt with and tackled my entire life. From staring at the ceiling for 4 hours while trying to force myself to fall asleep, drinking too much wine or being knocked out and awoken like a zombie from prescription sleep medication, I have had my share of sleep trouble. Since I am not the only one I know who has sub-par or too little sleep on a daily or at least weekly basis, and the cascading side-effects of lack of sleep are pronounced and all too real, this seems a fitting first post on the studies of various homeopathic sleep aids. I chose homeopathic remedies for three-fold reasons. One, they as a whole, present fewer side effects as they tend to come from natural and widely available sources. Two, they are generally much less expensive than any prescription drug. The last and most practical reason is that they are easy to obtain and implement. Before giving my own personal bias and experience, I will present some of the evidence and research conducted on popular homeopathic sleep remedies. There will be an accompanying post under my nutrition section that accounts my own personal experiences with these remedies but I want this information to be taken in an objective and unbiased manner. In other words, read this first!
Valerian root sounds like something that might be growing in our grandmother's backyard. In fact, it is a medicinal plant native to Europe and Asia and used as a sleep remedy for insomnia, anxiety, sleeplessness and trembling. Valerian root is on Germany's regulatory agency for herbs, Commission E, as safe for use. Dosage can be from 300 to 900 milligrams before bed to 50 to 100 milligrams multiple times per day for anxiety. It comes in tea, pill and capsule form but is traditionally chopped up and steeped in water for tea. Valerian root does have a natural “earthy” or “pungent” odor and it is said that the reaction to an unpleasant smell, pew, comes from the word phu, coined by a first century AD Roman physician named Dioscorides.
There is not a wide array of evidence concerning valerian root's effectiveness in promoting sleep. The few studies available are inconclusive at best. A 2011 research review of valerian root, carried out by the Acta Medica Portuguesa, found that of the 173 articles cited on valerian root research, only four met the criteria for proper research control. Of those, there was some evidence that valerian root could be effective in treating insomnia, but very little to support treating anxiety disorders. It was generally regarded as safe and benign in the use of occasional sleeplessness.
A compilation of existing data on Cancer.org suggests similar findings to the above study and recognizes the roots use and approval in Europe despite the inconclusive research evidence. They do cite a German study that compared valerian root to Oxazepam(an anti-anxiety drug) on 202 people over 6 weeks and found the valerian group had better sleep quality, time of sleep and feelings of restfulness. Warnings against taking this supplement long-term or in high doses was discouraged because of the possible effects of heart palpitations, headaches, blurred vision, nausea and even restlessness. Rare liver damage has also been linked to valerian but without concrete evidence. Drug interactions may be a concern when taking cholesterol medication, antihistamines, relaxants, sedatives, anti-seizure drugs and individuals with mental illness.
The data appears to be very mixed when discussing valerian root and most research and reviews cite a mix of studies that show both positive results and no results at all, suggesting it may be very individual and dose dependent. Aside from taking the supplement daily and long-term, but rather as an occasional sleep remedy, the research suggests it as generally safe and benign.
Melatonin is another common, inexpensive and well-known supplement to aid in sleeplessness and insomnia. So common in fact that the 2002 Alternative Health/Complementary and Alternative Medicine Survey found that of 31, 044 people surveyed 5.2% used melatonin and and 27.5% said insomnia was the reason for use. That is 1,614 people out of 31,044 which if projected nationally out of our roughly 307,000,000 citizens would be 15,964,000! Melatonin is most often recognized as being produced in the Pineal gland in the epithalamus but in fact, much of the melatonin production in the body comes from our gut. Therefore, a healthy gut and proper nutrition can aid in natural melatonin production. Photoreceptors in the eyes as well as the skin(melanocytes) sense both artificial and natural light and depress melatonin production, thus nighttime and long dark days increase melatonin production.
This recap is important to note because how much endogenous melatonin we produce can be directly affected by our lifestyle. We obtain and ultimately make melatonin from ingestion of tryptophan, which is converted to 5-htp, then serotonin and then melatonin. Another important mention is the very real impact artificial light has on our melatonin production. One study conducted by Wahnscaffe et al found that the common occurrence of getting up and using the bathroom during the night can impact alertness under different bathroom lighting. Five different light wavelengths were used and the three that had blue-wavelength light from conventional lamps significantly decreased melatonin production. Melatonin production even stopped 20 minutes after to exposure to blue portion light and did not return to starting levels even 30 minutes later!
There are many studies showing positive benefits of using melatonin and through the dozens I read, not one mention ill or poor effects. In fact, a 6-week study conducted on children with developmental disorders (who have particularly hard time fall and staying asleep) benefited from varying melatonin doses. From 0.5 to 6mg of melatonin was used pre-bed and the children on average slept 23 minutes longer and fell asleep 45 minutes faster. This could mean the difference between another completed sleep-cycle, of which we typically have 3 to 5 per night.
A review article by Rituger Hardeland (which goes into fascinating depths) found that both immediate and prolonged release melatonin were both effective in inducing sleep in patients, especially older populations. Melatonin is cited as not only important for sleep but as a powerful antioxidant, mitochondrial modulator and anti-inflammatory agent. Thus, its decrease has been linked to dementia, mood disorders, severe pain, cancer and type-2 diabetes. Chronic insomnia from low melatonin production has also been used as a predictor and possible trigger for depressive disorders.
One last review concerning melatonin supplementation among both elderly and mulitple-age groups: A study performed by Rikkert found that 5 out of 6 elderly patients experiencing insomnia improved either time to sleep or sleep duration. Zhdanova found that elderly patients taking melatonin increased sleep efficiency in the middle and latter third of the night, suggesting decreased chance of waking prematurely. Finally, an all-age study conducted by Brzezinski et al found that melatonin caused statistically significant decreases in sleep onset latency(time to fall asleep), increases in sleep efficiency, and increases in sleep duration. One note is that subjects also did not experience the “next-day hangover” associated with many prescription sleep medications.
I will not delve into details of the multitude of additional benefits cited from melatonin supplementation but will briefly mention them if anyone is interested in reading further. Melatonin has been linked to higher growth hormone levels in young men and women (http://www.ncbi.nlm.nih.gov/pubmed/17956623), delays endoplasmic reticulum cell death in elderly patients (http://www.ncbi.nlm.nih.gov/pubmed/21086186) and even been linked to slowing neurodegeneration in Alzheimer's-like patients(http://www.ncbi.nlm.nih.gov/pubmed/16364209). A quick search of melatonin and mice/rat studies link its use to prolonging age, preventing cancer, improving diabetic symptoms and reduce genetic damage. Whether these translate to humans or not is debatable but interesting to ready regardless(http://tpx.sagepub.com/content/31/6/589.long).
Overall, melatonin has been cited as safe, effective at low to high doses, produces few side-effects and has many potential health benefits besides improving sleep quality and quantity. It has been noted that melatonin may interfere with anti-psychotic medications so consultation with a doctor is recommended before use in that population.
Our final nutrient in question is magnesium. This is a fascinating mineral involved in numerous bodily functions and metabolism, with a wealth of research behind its various processes. Magnesium is involved in contraction and relaxation of muscle, enzyme activity, energy production and transport and protein production. Magnesium also contributes to nerve conduction and peristalsis of the bowels.
Magnesium is cited in insomnia research because low levels of magnesium are often accompanied by type I and II insomnia patients. Insomnia from magnesium deficiency can also be accompanied by fatigue, irritability, poor memory, muscle twitching, confusion and even rapid heartbeat. Type I and II insomnia are differentiated by by difficulty falling asleep and difficulty staying asleep, respectively. One point to note is that if you are deficient in magnesium, it can be an absolute or relative deficiency. Absolute correlates to increased excretion of magnesium with decreased absorption. Relative deficiency is marked by an abnormal compartmentalization of magnesium in one area of the body, leaving other areas deficient. This difference characterizes the varied response in magnesium supplementation from person to person.
Having already discussed melatonin, a study by Rondanelli et al. combined melatonin, magnesium and zinc together to ease insomnia in long-term care patients. 225Mg of magnesium was used in this study and all patients reported greater ease in falling asleep, staying asleep and waking rested. The results are obviously not totally correlated because of the inclusion of melatonin and zinc but this is a good starting point for our research.
There is a good deal of research relating to the anti-depressant properties of magnesium, which is an important link because insomnia and difficulty in staying asleep are often linked to depression, through reduced serotonin and thus reduced melatonin. The following research relates directly to depression and indirectly to sleep. There are studies correlating decreased magnesium in people with insomnia and even report increased magnesium when insomnia subsists but results are often inconclusive. Since many depressed patients in these studies also had insomnia, this data is relevant for our use.
A Polish study conducted by Szewczyk et al. studied the anti-depressant properties of magnesium in stress-induced states in laboratory animals. Magnesium was active in the stress induced state in animals, leading to depression-like behavior. Magnesium was linked to anti-depression in the context of glutamate, which is an excitatory neurotransmitter involved in learning and memory and is a precursor to GABA, an inhibitory neurotransmitter that aids in relaxation and stress reduction. Magnesium was also correlated to inhibition of GSK-3, which is an enzyme that inhibits neurotrophic factor signaling. Anti-depressant medications also inhibit GSK-3 to promote anti-depressant changes.
Other factors contributing to poor sleep include low blood sugar and imbalanced cortisol. Numerous studies have been conducted on magnesium's role in balancing inflammation, preventing diabetes and improving insulin resistance. I will not make my own correlation for this data but your own interpretation is welcome. A study conducted by Dae Jung Kim et al investigated the long-term associations of magnesium intake in relation to diabetes, systemic inflammation, and insulin resistance in young American adults. 4,497 Americans, aged 18-30 with no incidence of diabetes were tested for magnesium levels, inflammation markers and indicators of diabetes. A follow up was conducted 20 years later with 330 people developing diabetes. In almost all cases low levels of magnesium were associated with diabetes and all inflammation markers collected. The participants who had lowest risk of diabetes largely had high dietary levels of magnesium as well as fiber, being non-smokers, Caucasian and female. They also had lower BMI and waist circumference. Researchers concluded that higher magnesium intake was correlated to lower risk of diabetes, improved insulin sensitivity and decreased inflammation.
The final research cited here connects magnesium supplementation with both depression and diabetes. The study, conducted by Jui-Hua Huang et al examined 210 Type-2 diabetes patients of which 88.6% had lower than recommended magnesium levels, with 37.3% having hypomagnesia(extremely low). Both metabolic syndromes and depression were correlated to lower magnesium levels. In addition, increased magnesium was associated with lower symptoms of depression and reduced body fat, triglycerides and waist circumference and higher HDL. Researchers also found that patients with depression consumed lower levels of magnesium than non-depressed patients and they cite that magnesium has been found to be as effective as Imipramine in treating depression. Researchers concluded that low magnesium levels exacerbate metabolic syndromes and depression.
Although there was inconclusive date on magnesium directly affecting sleep, many of the issues associated with decreased sleep and insomnia are related to depression and this must be take in consideration for those with trouble sleeping. The association of increased magnesium with greater metabolic health, decreased depression and increased insulin sensitivity is also considerable and links can be made between these health markers and sleep as well. My corresponding article with be light, quick and break down useful facts and considerations for using these supplements for sleep.
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