Accurate Education, CAM – Sleep

Complementary and Alternative Medicine (CAM):

Insomnia

Conventional medical approaches to sleep often focus on the use of a hypnotic, a medication intended to induce sleep. In truth, hypnotic medications are often ineffective due to the complex nature of sleep. Some sedatives may induce sleep but disrupt normal sleep cycles. Many sedative hypnotics become habit-forming, even addictive, and lead to the seeming impossibility of sleep without them. Others work for awhile but gradually lose effectiveness while still others are effective but they leave one dragging the next day.

 

The most effective approaches to insomnia include environmental and behavioral interventions to achieve an appropriate state for sleep physically and mentally. That being said, there are also some natural sleep aids that offer benefits without many of the downsides mentioned above. As such they represent desirable options for initial use as hypnotics in order to possibly avoid prescription hypnotics and the problems often carried with them.

 See also:

• Insomnia (Conventional and Behavioral)

 

 

Definitions and Terms Related to Pain

 

Key to Links:

• Grey text – handout
• Red text – another page on this website
• Blue text – Journal publication

 

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Insomnia – CAM Treatment Options

 

Behavioral Solutions for Insomnia

Experts agree that behavioral solutions for insomnia are the best, safest means for effective long term management. Behavioral solutions include sleep hygiene in which activity and environment are maintained in support of sleep including avoiding exercise and eating before retiring for sleep, turning of the TV and radio, keeping the lights dim and avoiding activities in the bed outside of sex and sleep. Additional behavioral approaches include deep relaxation techniques, self-hypnosis and cognitive behavioral techniques.

See: CBT, meditation and hypnosis

  

Natural and Herbal Solutions for Insomnia

Safe and possibly effective OTC options to promote sleep include epsom salt baths, valerian root, hops and passion flower, especially in combination (see references below), chamomile, L-tryptophan, and melatonin.  

 

Epsom Salt Baths

There are no ideal natural, herbal or prescription medications for sleep. In general, it is recommended to try simple, inexpensive and safe OTC options to facilitate sleep before turning to prescription medications.  A starter that is surprisingly effective is taking an warm bath with epsom salts 30 minutes before retiring to sleep. Epsom salts, which are actually magnesium salts, are well absorbed through the skin – in fact, better than when taken orally when they act as a laxative. Magnesium promotes sleep and, along with warm soaks, can have be profoundly beneficial for muscle spasm and pain. In addition, magnesium improves depression and they can be remarkably effective in reducing the frequency and severity of migraine headaches. It is estimated that 80% of women and 70% of men are deficient in their dietary intake of magnesium which may be why epsom baths can be so benefitical.

 

Valerian

Valerian root, a common herbal remedy for sleep and anxiety for centuries, has been studied extensively and has been shown to be effective for insomnia, especially as related to stress. It appears to interact with GABA receptors in the brain, the same mechanism by which the benzodiaze
pines and “Z-drugs,” such as Ambien and Lunesta work. Recent studies suggest Valerian may be particularly helpful when insomnia is related to benzodiazepine withdrawal. The safety of Valerian has been well established with few side effects.

 

Chamomile

Chamomile, another common folk remedy for sleep that has been used for centuries, has some research to support it’s benefit to help induce sleep, though evidence remains weak. It may not be as effective at maintaining sleep as it is for falling asleep.

 

Kava Kava

 

Medical Foods for Sleep Disturbances

 Medical foods are defined by the FDA as “a food which is formulated to be consumed or administered under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.” The following are some commercial products that are medical foods with published evidence for their safety and benefits for sleep.

 

Insomnia

Sentra PM

Neurotransmitters, including serotonin and acetylcholine, modulate the sleep cycle and their adequate supply is important for the maintenance of proper sleep, including phase IV delta and REM sleep. A well-designed study of 111 adults with a history of sleep disturbance (defined as “a perceived lack of restorative sleep”) evaluated the benefit of an amino acid formulation (Sentra PM) containing acetylcholine and serotonin precursors compared with trazadone, a commonly prescribed hypnotic sleep medication. The results indicated the amino acid formulation reduced sleep latency (time required to fall asleep) and improved sleep quality without morning grogginess more effectively than trazadone alone but also acted synergistically with trazodone to improve outcome best with both together.

 

Gabadone

In another 2009 study, 18 patients with sleep disorders, it was shown that an amino acid preparation containing both GABA and 5-hydroxytryptophan (Gabadone) reduced time to fall asleep, increased the duration of sleep, and improved quality of sleep.

 

Relaxium

Relaxium® is a formulation of various herbs and sleep inducers including melatonin, L-tryptophan, gamma-aminobutyric acid (GABA) and the herbal extracts ashwagandha, Valerest® (a blend of hops and valerian), chamomile and passionflower.

 

Lucid Dreams and Nightmares

As a consequence of PTSD and other Reward Deficiency Syndrome (RDS) disorders, patients may suffer from recurrent and disturbing dreams that feel real and are very disruptive and stressful. Due to proposed mechanisms for RDS, supplements that are designed to increase brain dopamine levels have been researched and found to be helpful in reducing the frequency and impact of these nightmares. One medical food formulation with an excellent safety and effectiveness profile is Synaptamine.

See Synaptamine

 

 

CAM, Sleep – References

 

Sleep – Natural and Herbal Preparations for Sleep

Natural and Herbal Preparations – Overview

1. Accurate Clinic – Diet, CAM & Supplements – Sleep – handout
2. Herbal Insomnia Medications that Target GABAergic Systems – A Review of the Psychopharmacological Evidence – 2014
3. Herbal triple combination: An effective alternative to benzodiazepines
4. Efficacy and safety of a polyherbal sedative-hypnotic formulation compared to Ambien
5. Updates on Nutraceutical Sleep Therapeutics and Investigational Research – 2015

Medical Foods – Amino Acids for Sleep

1. medical-foods-hold-promise-in-chronic-pain-patients-2016
2. sentra-pm-a-medical-food-and-trazodone-in-the-management-of-sleep-disorders-2012
3. sleep-deprivation-and-pain-perception-2006
4. a-randomized-placebo-controlled-trial-of-an-amino-acid-preparation-on-timing-and-quality-of-sleep-2009

   

Medical Foods – Amino Acids for Sleep – Sentra

1. medical-foods-hold-promise-in-chronic-pain-patients-2016
2. sentra-pm-a-medical-food-and-trazodone-in-the-management-of-sleep-disorders-2012

 

Medical Foods – Amino Acids for Sleep – Gabadone

1. a-randomized-placebo-controlled-trial-of-an-amino-acid-preparation-on-timing-and-quality-of-sleep-2009

 

Medical Foods – for Lucid Dreams and Nightmares

 Synaptamine – Lucid Dreams

See Synaptamine

1. Putative dopamine agonist (KB220Z) attenuates lucid nightmares in PTSD patients – Role of enhanced brain reward functional connectivity and homeostasis redeeming joy – 2015
2. Using the Neuroadaptagen KB200zTM to Ameliorate Terrifying, Lucid Nightmares in RDS Patients – the Role of Enhanced, Brain- Reward, Functional Connectivity and Dopaminergic Homeostasis – 2015

Synaptamine – PTSD

See Synaptamine

1. Putative dopamine agonist (KB220Z) attenuates lucid nightmares in PTSD patients – Role of enhanced brain reward functional connectivity and homeostasis redeeming joy – 2015
2. Diagnosis and Healing In Veterans Suspected of Suffering from Post-Traumatic Stress Disorder (PTSD) Using Reward Gene Testing and RewardCircuitry Natural Dopaminergic Activation-2012

 

Natural and Herbal Preparations – Melatonin

1. Melatonin for the Treatment of Primary Sleep Disorders – 2013
2. The effectiveness of melatonin for promoting healthy sleep – a rapid evidence assessment of the literature – 2014
3. Insomnia associated with valerian and melatonin usage in the 2002 National Health Interview Survey. – 2007
4. Ramelteon: MedlinePlus Drug Information
5. Melatonin hypothesizing-that-putative-dopaminergic-melatonin-benzodiazepine-reward-circuitry-receptors – 2013
6. Melatonin therapy in fibromyalgia. – PubMed – NCBI

Natural and Herbal Preparations – Valerian

1. Valerian-HealthProfessional
2. Valerian | University of Maryland Medical Center
3. Valerian – No Evidence for Clinically Relevant Interactions 2014
4. Can valerian improve the sleep of insomniacs after benzodiazepine withdrawal? – PubMed – NCBI
5. Critical evaluation of the effect of valerian extract on sleep structure and sleep quality. – PubMed – NCBI
6. Insomnia associated with valerian and melatonin usage in the 2002 National Health Interview Survey. – 2007

 

Sleep – Dreams

1. Understanding Spontaneous Symbolism in Psychotherapy Using Embodied Thought – 2024
2. The use of dreams in psychotherapy- a survey of psychotherapists in private practice – 2000
3. Introduction to the Special Section on Working on dreams, from psychotherapy to neuroscience – 2021
4. Working on dreams, from neuroscience to psychotherapy – 2021
5. Such stuff as dreams are made on John Bowlby and the interpretation of dreams
6. Dreaming during the COVID-19 pandemic_ A narrative review – PMC
7. PSQI-Instrument
8. Exhibit A-PSQI scoring
9. Sweet dreams are not made of this- no association between diet and sleep quality – 2023
10. The influence of intentions on dream content – 2024
11. What about dreams? State of the art and open questions – 2022
12. Exploring the role of dreams – insights from recent studies – 2024
13. Dreaming and the brain- from phenomenology to neurophysiology – 2010

 Sleep – Nightmares

1. Nightmare disorder – Mayo Clinic
2. Sleep terrors (night terrors) – Mayo Clinic
3. Imagery rehearsal therapy – An emerging treatment for posttraumatic nightmares in veterans
4.  Putative dopamine agonist (KB220Z) attenuates lucid nightmares in PTSD patients – Role of enhanced brain reward functional connectivity and homeostasis redeeming joy – 2015

 Sleep – Reiki

1. A Large-Scale Effectiveness Trial of Reiki for Physical and Psychological Health – PubMed Reiki 2019
2. Clinical Studies of Biofield Therapies- Summary, Methodological Challenges, and Recommendations – 2015
3. Complementary and Alternative (CAM) Treatment Options for Women with Pelvic pain – 2020
4. Does Reiki Benefit Mental Health Symptoms Above Placebo? – 2022
5. Effect of Reiki therapy on pain and anxiety in adults- an in-depth literature review of randomized trials with effect size calculations – 2015
6. Effects of Reiki Versus Physiotherapy on Relieving Lower Back Pain and Improving Activities Daily Living of Patients With Intervertebral Disc Hernia – 2018
7. Evaluation of the Impacts of Reiki Touch Therapy on Patients Diagnosed With Fibromyalgia Who Are Followed in the Pain Clinic – 2024
8. Is reiki or prayer effective in relieving pain during hospitalization for cesarean? A systematic review and meta-analysis of randomized controlled trials – 2017
9. Reiki improves heart rate homeostasis in laboratory rats – PubMed – 2008
10. Reiki Is Better Than Placebo and Has Broad Potential as a Complementary Health Therapy – 23017
11. Reiki therapy for pain, anxiety and quality of life – PubMed – 2019
12. Reiki_ How Energy Healing Works – 2024
13. Self-Reiki, Consideration of a Potential Option for Managing Chronic Pain during Pandemic COVID-19 Period – 2021
14. The effect of reiki on pain_ A meta-analysis – PubMed-2018 Therapeutic effects of Reiki on interventions for anxiety- a meta-analysis – 2024

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

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