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

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“If your compassion does not include yourself, it is incomplete.”

 – Jack Kornfield

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.

 

L-Tryptophan

L-Tryptophan, an amino acid found in foods including eggs, cheese, chocolate, oats, fish, poultry, sesame, and sunflower seeds, is a common, effective sleep aid. L-Tryptophan is a precursor to serotonin and ingestion has been shown to raise levels of serotonin and melatonin, considered a likely mechanism for its sleep effectiveness. L-tryptophan is generally well-tolerated with limited side effects but should be used with caution when taken with other medications that increase serotonin, notably the antidepressant class of medications.

 

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 benzodiazepines 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.

 

Melatonin

Melatonin has been shown to help fall asleep, increase total sleep time and improves overall sleep quality. The effects of melatonin on sleep are modest but do not appear to diminish with continued use, a common problem for many sleep aids. Although the benefit of melatonin is mild, melatonin may have a role in the treatment of insomnia given its relative lack of side-effects compared to these agents.

 

Insomnia Due to Jet Lag and Shift Work

Melatonin is a hormone secreted by the pineal gland in the brain in response to variations in the circadian cycle. For this reason it is often used specifically for insomnia related to shift work or travel to different time zones. It’s effectiveness for improving response to shift work and time zone travel is controversial.

 

Insomnia Due to Discontinuing Benzodiazepine (Xanax, Valium, Klonopin etc.).

A few reports have suggested that melatonin supplements may especially help with sleep and anxiety when discontinuing therapy with benzodiazepine (Xanax, Valium, Klonopin etc.).

 

Dosage

Melatonin is available in time-release and immediate release formulas, including sublingual versions which offer more rapid onset and possibly more effectiveness.

The dosage for melatonin in studies varies from 0.5 mg to 5 mg, with doses as high as 10mg shown to b be effective and well tolerated.

(See Melatonin).

 

Kava Kava

Kava Kava is a plant native to the South Pacific, including Hawaii, known for it’s sedative and anxiolytic properties. It has been shown to be a very effective for sleep. However, a number of safety concerns regarding Kava have been raised though these concerns are a matter of controversy. The primary safety concern is the possibility of liver toxicity, possibly leading to liver failure, though reports of this are rare. Due to concerns about safety, sales and import of Kava has been restricted in many countries, particularly in the European Union where it had been banned from import. The controversy surrounding Kava is at least in part based on beliefs that any toxicity related to Kava lies in the preparation or extraction process. It has been suggested that preparations made from the root of the plant are generally safe, whereas other portions of the plant, such as the stems or leaves, might be toxic.

 

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.

 

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

 

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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