I Can't Sleep!

I can't sleep and I'm exhausted.  Help me.

What can cause insomnia?

We need to rule out any medications or herbs that could be causing insomnia.  The first and foremost of these is caffeine.   Caffeine consumption anytime during the day can cause sleep onset to be delayed, total sleep time reduced, normal stages of sleep altered, and the quality of sleep decreased.  Look for hidden sources of caffeine.  Most over the counter diet "cocktails" contain herbs that are converted to caffeine in the body.*

Other medications affecting sleep include antidepressants (fluoxetine, paroxetine, citalopram, trazadone), beta blockers (metoprolol, carvediolol), ADHD meds (methylphenidate, concerta, adderall,  strattera), phentermine, and too much thyroid hormone.*

Some medical conditions can cause poor sleep quality.  These include sleep apnea, restless legs, heartburn, frequent urination, depression, and chronic pain.*

Eating too much late in the evening can sometimes cause insomnia.  Low blood sugar while you are sleeping can cause you to awaken in the middle of the night.  I usually recommend high protein low-carb snacks before bedtime to help alleviate middle of the night awakenings.  If you are having trouble getting to sleep, try a small carbohydrate snack.*

Exercising late in the day can sometime cause insomnia, as can spending a lot of time on the computer or watching TV late in the day.  Food intolerances can also cause insomnia.*

Hormone disruption can cause insomnia.  Low progesterone, high or low cortisol, high testosterone, and high thyroid can all affect the ability to sleep.  For more information about this, you can read Perimenopause and Adrenal Health.*

What are some of the symptoms of sleep deprivation?*

• Irritability and nervousness
• Problems with concentration and memory
• Behavioral learning or social problems (increases bipolar disorder, ADD and ADHD)
• Frequent illness and slowed healing
• Blurred vision
• Weight gain
  • In a weight-loss study, when participants compared 8.5 hours of sleep to 5.5 hours of sleep, those with more sleep lost more fat, although pounds lost were the same.  Annals of Internal Medicine Oct 2010
  • People who got more 7.5 hours of sleep had less insulin resistance than those who got 6.5 hours of sleep.
  • People with less sleep typically eat more

• Performance drops after 17 hours of being awake by the equivalent of a blood alcohol level of 0.05%
• Sleep outside of the REM phase may allow enzymes to repair brain cell damage caused by free radicals. High metabolic activity while awake damages the enzymes themselves preventing efficient repair.
•  A 2004 study also found medical residents with less than four hours of sleep a night made more than twice as many errors as residents who slept for more than seven hours a night,

What can I do?*     Practice good Sleep Hygeine

• Don’t lay in bed & watch TV, do work, or read an exciting book.
• Don’t drink caffeine or take stimulant medications
• Exercise early in the day
• Don’t eat after 7 or 8 p.m. and eat lower amounts of carbohydrates at your evening meal.
• Establish a bedtime routine in a certain order every night.  This helps your body recognize that it’s time to start winding down.
• Don't watch the clock.
• Don't take naps during the day.
• Changing your diet can help.  Eat more bananas, papayas, dates, chicken, turkey, fish, almonds, avocaodos, and cheese.  Avoid wheat and rye.  This increases serotonin and dopamine production and helps sleep.*

What type of supplements and medications are available without a prescription? 

Benadryl (diphenhydramine) is an antihistamine and causes drowsiness as a side effect.  It is found in Tylenol PM.  It should be avoided if the patient has glaucoma or prostate problems.   Dose: 25-50mg 30 minutes before bedtime.  Dose lasts about 4 hours.*

Unisom (doxylamine) is an antihistamine that causes drowsiness as a side effect.  It should be avoided if the patient has glaucoma or prostate problems.  Dose: 1 tablet 30 minutes before bedtime.  Dose lasts about 6-8 hours. Make sure to get the tablets and not the sleep gels (which are just diphenhydramine).*

Melatonin: Commonly used, but not really effective for most insomnia.  Best for sleep problems due to travel or shift work.  Cautions: May decrease the anti-depressant activity of fluoxetine and duloxetine. Decreases the effects of warfarin (Coumadin) activity. Reduces effectiveness of Clonidine and corticosteroids.  Dosage: Up to 3 mg 20-30 minutes before bedtime  Does not work effectively unless you are in a completely dark room.   Sublingual form seems to work better.*

5-HTP:  Is metabolized in the body to melatonin and serotonin, a neurotransmitter (a messenger in the brain).  Sometimes used for depression.  Cautions: May cause nausea, dizziness, diarrhea. Safety in pregnancy and nursing has not been documented.  Should not be taken by children with Down’s syndrome.  Drug interactions:  Carbidopa, Dextromethorphan, MAO inhibitors, other drugs that increase serotonin, and tramadol.  Dosage is 100-300mg 30 minutes before bedtime.  Children should take 5 mg/kg not to exceed 100mg.  Please consult your pharmacist for the correct dose for a child.*

L-Theanine:  This amino acid helps normalize brain waves and can improve anxiety and sleep quality.  This is not a "sleeping pill" as is usually takes use over a week or so before its effectiveness is seen.  Warnings:  No documented use in pregnancy.  May increase activity of chemotherapeutic(cancer) drugs.  May increase the effects of other sedatives.  Can be taken during the day for anxiety, or at bedtime for relaxation.  Dosage is 50-200mg.  My favorite way to use this in a combination with GABA and Valerian.  Contact me to order this.*

GABA (Gamma-aminobutyricacid) - is a major inhibitory neutotransmitter (messenger in the brain).  It has a relaxing, anti-anxiety effect.  No documented drug interactions.  Can cause tingling in extremities at high doses. Dosage:  Range from 100 to 2000mg at a time.  You can start with capsules...open 1 capsule, dump 1/3 of the contents under the tongue, and leave under the tongue as long as you can stand it, then swallow any remaining contents.*

Valerian-  Improves sleep quality and helps with anxiety.  Cautions: Interacts with several prescription sleep and anxiety medications (diazepam, alprazolam).  Dosage is 450-600mg taken 2 hours before bedtime.*

Progesterone cream- Induces drowsiness and is especially helpful in perimenopausal or menopause. Dose:  25-50mg applied 1-2 hours before bedtime.*

Phosphatidylserine

-  When 100mg is taken twice daily at 6 pm and at bedtime, this supplement may help blunt the effect of cortisol and allow a person to sleep deeper and after continuous use (about a week), go to sleep better.*