Wilmington Living Magazine Article: “Got Sleep?”
By: Dr. R. Todd Shaver
Submitted: 18 June 2014
Did you sleep poorly last night? If so, you have lots of company. 54% of American adults report difficulty falling asleep or staying asleep at least a few times each week. The healthcare costs associated with insomnia total $42 BILLION annually. This month, we’ll take a closer look at the consequences, causes, and natural treatment of insomnia.
Insomnia may manifest in different ways. Difficulty falling asleep is known as sleep latency. Another form of insomnia is a problem with sleep maintenance; in this instance, people have trouble staying asleep or they have inappropriately early awakening. Problems with sleep maintenance seem to be emerging as the more common form of insomnia. Insomnia appears to be more common in women.
There are serious consequences related to insomnia. Research demonstrates that poor sleep increases the risk of various diseases including cancer, heart disease, diabetes, and obesity. A 2006 study in the medical journal, SLEEP, demonstrated that people who sleep poorly miss twice as much work as those without sleep problems. Medical professionals-in-training who work 24-hour shifts with minimal sleep make 36% more serious medical errors and five times more critical diagnostic errors than their peers who work only 16 consecutive hours. A 2007 study in SLEEP reveals that insomnia costs employers 4.4 days of wages per untreated insomniac worker over a 6 month period, and this did not include indirect costs such as lost productivity and the costs of medical treatment for the consequences of insomnia (i.e. obesity, etc.).
How much sleep is enough? The National Institutes of Health (NIH) recommend that adults get 7 – 8 hours of sleep, teens should get 9 – 10 hours and younger children should get at least 10 hours each night. A 2012 study in the Journal of Clinical Endocrinology and Metabolism indicates that, for adults, “It may be important to sleep about 8 hours every night to maintain a stable & healthy body weight”.
Various factors can contribute to insomnia. Among the most common is dysglycemia (poor control of blood sugar). Dysglycemia is a general term which includes high levels of blood sugar, low levels of blood sugar, or blood sugar which is on a roller-coaster vacillating back and forth from high to low. Dysglycemia has direct and indirect impact on sleep quality. For instance, episodes of low blood sugar during the night may stimulate the body to release adrenaline which will trigger awakening. Circumstances which may cause nighttime episodes of low blood sugar include an excessive over-night fast, i.e. the time between the last evening meal or snack and breakfast is too long.
Poor macronutrient balance is another cause of nighttime low blood sugar. The macronutrients are carbohydrates, proteins, and fats. Proper macronutrient balance means that each meal or snack consists of roughly 40% carbohydrate, 30% protein and 30% fat. If the evening meal and/or snack is weighted too heavily toward carbohydrates, then nighttime episodes of low blood sugar may result; this is especially so if the carb choices were starchy or sugary.
Adrenal dysfunction also contributes to sleep problems. The adrenal glands produce various hormones which help us to deal with stress. Adrenal fatigue can result if the body experiences chronic stress (i.e. in the form of unrelenting mental/emotional stress, chronic pain, chronic infections, etc.). Cortisol is one of the hormones produced by the adrenal glands. One function of cortisol is to raise blood sugar when blood sugar is too low; however, if the adrenal glands are fatigued, there may be inadequate cortisol to perform this function. In the absence of adequate cortisol, the adrenal glands produce adrenaline which is stimulating and promotes wakefulness as discussed above. Conversely, in the early stages of adrenal fatigue, cortisol may be produced excessively; excessive cortisol can also be disruptive of sleep patterns. In short, adrenal function is very important to healthy sleep.
Neurotransmitter imbalance can also cause insomnia. Neurotransmitters are chemical messengers released by nerve cells. For instance, GABA is the body’s main inhibitory neurotransmitter. One job of GABA is to help calm the mind so that we can relax and fall asleep. When GABA is deficient, it becomes difficult to “turn off” the mind and sleep becomes difficult. Dysglycemia (poor control of blood sugar) is one of the most common causes of GABA deficiency.
An important side-note: if GABA supplements help you to sleep, then you have a problem. Compounds like GABA are too large to cross a healthy blood-brain barrier unless that barrier is damaged. A damaged blood-brain barrier allows dangerous materials (i.e. poorly digested food particles, environmental toxins) to access the brain and cause inflammation and degeneration of brain tissue. If straight GABA supplements work at calming you, then you probably have a compromised blood-brain barrier. This problem typically improves nicely with certain therapeutic nutritional protocols; find a natural medicine physician to help with this.
Many people turn to drugs to help them sleep; this is a dangerous trend. About 30% of American women use some sort of sleep medication at least a few times a week. Over 100 million people are prescribed benzodiazepine drugs (i.e. Xanax, Ativan, Valium) which are often used to treat insomnia and anxiety. Recent research demonstrates that people who use sleeping pills are at a higher risk for cancer, dementia, addiction, car accidents and premature death. Adults over age 65 who use benzodiazepine drugs are 50% more likely to develop dementia over a 15-year period. Sleeping pills are also associated with side effects including depression, hallucinations, sleep activity (i.e. eating, walking, driving) and amnesia.
Insomnia is a symptom. It is most prudent to understand and treat what is causing the symptom. It is unwise to simply mask symptoms with drugs, hormones or supplements. Natural medicine physicians will seek to discover the underlying cause of the symptom so that the cause can be addressed and resolved. Simple lab tests can be used to evaluate whether dysglycemia and/or adrenal dysfunction contributes to your insomnia. Thorough health history and symptom surveys can provide clues indicating whether neurotransmitter imbalance is a problem. Dietary modification, lifestyle modification, and therapeutic nutrition can be effectively employed to eliminate the underlying problem once it is discovered.
In the meantime, here are some simple tips to help avoid/resolve sleep problems:
• Avoid caffeine 10 hours before sleep
• Avoid heavy meals, alcohol and nicotine 1 – 2 hours before sleep
• Avoid exercise 4 hours before bed
• Avoid TV/Computer viewing 1 – 2 hours before bed
• Use macronutrient balance when planning meals and snacks
• Establish routine, i.e. retire and rise at the same time daily.
Explore these safe and effective ways to address your sleep issues and, if necessary, find a natural medicine physician to assist you further. Sweet dreams!