Those who have never experienced insomnia, difficulty getting to sleep or staying asleep, often take it for granted, but getting a good night’s sleep is extremely important in achieving overall health. Although it may seem like our body is just resting, the body is working on repairing and regenerating. Getting less than 6 hours of sleep for a prolonged period of time has been associated with health problems such as memory loss, depression, elevated blood pressure, poor concentration, headache, irritability, depressed immune function, low libido, and weight gain. Needless to say, it is important to allow your body to sleep OR figure out how to get it to sleep!
When treating insomnia, it is important to start with the basics. For many people simple lifestyle changes can result in drastic changes in quality of sleep. Try making the following changes to your daily routine for a medication and supplement free way of getting back to sleep.
Dr. Rachel Bell’s Top 10 Simple Changes to get a Restful Sleep:
- Avoid stimulants, especially caffeine. The ability to detoxify caffeine from the body varies dramatically between individuals due to genetic differences in liver enzymes. In some people it can take up to 12 hours to detoxify the caffeine from a single cup of coffee. Additionally, many people are not aware that even decaffeinated coffee contains some caffeine and should not be consumed right before bed. If you are having trouble sleeping it may be helpful to completely avoid caffeine (eg. coffee, tea, chocolate, energy drinks) for 7-10 days to see if there is any improvement in sleep quality.
- Maintain a cool bedroom temperature. The ideal temperature for your bedroom is 18 degrees Celsius. Some people experience nightmares when the temperature in the bedroom is too high.
- Establish a consistent bedtime. The body likes routine. When you establish a sleep and wake routine, the circadian rhythm of cortisol and melatonin release is consistent. If you have having difficulty sleeping, ensure that you are going to bed and waking up at the same time throughout the week, even on weekends.
- Engage in exercise. Studies examining the link between sleep and exercise have consistently shown that people who exercise throughout the day get better sleeps at night. The key is to not exercise too late in the day in order to get the sleep promoting benefits. Aim for at least 20 mins of moderate aerobic exercise in the morning or early evening.
- Dim the lights in your house an hour before bed. Melatonin, the sleep hormone made in your brain, is secreted in response to light. As it gets darker, melatonin levels start to rise to make us sleepy. This process can be inhibited by bright lighting in the home. To ensure proper melatonin secretion, use dim lighting the last hour before bed.
- No screen time before bed. Electronics should be avoided for up to 2 hours before bed, depending on how sensitive you are. The blue light emitted by electronics suppresses melatonin production and negatively interfere with circadian rhythms more strongly than any other wavelength.
- Do not sleep with your phone beside your bed. Phones and other electronics in the bedroom can be disruptive to people for many reasons. The most significant is that the frequencies emitted by the phone have the ability to interfere with the brain’s ability to get a restful sleep. Either keep your phone out of the bedroom, or at the very least, turn it onto airplane mode each night.
- Invest in a proper mattress and pillow. If you are physically uncomfortable and your bed doesn’t support your body, it will be hard to get a good nights sleep. I would recommend taking the time to try out various mattresses in the store, but also making sure that the store has a 30 day exchange program. Sometimes it is impossible to be sure the mattress will work until you have spent an entire night on it.
- Avoid napping. Those who take naps during the day to “recover” after a poor nights sleep often fall into a vicious cycle of sleeping during the day and disturb natural sleep patterns.
- Drink plenty of water early in the day. Consuming too much water right before bed can cause people to wake throughout the night to use the washroom. Try to stay properly hydrated in the morning and afternoon.
Common Causes of Insomnia
If you are doing all the above and still can not get a good night sleep, then it is often helpful to work with a naturopathic doctor to explore whether there is an underlying condition resulting in your inability to get some rest. The following are some of the most common causes of insomnia that I see in my practice:
The endocrine (hormone) system in the body is complex and is made up of a multitude of different hormones that all communicate with each other to carry out the daily job of running your body’s processes. When a few of these hormones are not functioning properly it can lead to a sleep disturbance.
Cortisol: The adrenal glands are the glands that sit on top of the kidneys and are responsible for dealing with day-to-day stressors. They release both adrenaline and cortisol. Cortisol is a stress hormone that is released when we are under prolonged stress but it is also released in a cyclical nature throughout the day. It is highest in the morning and lowest at night. This fluctuation in hormone levels is what allows up to feel sleepy at night and awake in the morning. If you have been under a lot of stress and your insomnia started with that stress, your adrenal system may be responsible. Stress interferes with the natural rhythm of cortisol release in the body resulting in a vast array of symptoms ranging from fatigue, insomnia, cold hands and feet, anxiety and frequent illness. There is a test available called the adrenal stress index that is able to measure your cortisol curve to see if cortisol is playing a role in your insomnia.
Progesterone: I have several peri-menopausal patients in my practice who have developed trouble sleeping as progesterone levels start to decline. The good news is that there are several natural treatments that help to raise progesterone levels and consequently also help decrease the incidence of night sweats and hot flashes.
Thyroid Hormones: The thyroid gland is an important organ in the body that regulates metabolism. When the thyroid gland is overactive, known as hyperthyroidism, insomnia can be a symptom. If you have been experiencing sensations of heat, frequent sweating, heart palpitations or weight loss, you may want to have your doctor examine you for an overactive thyroid.
Melatonin: Melatonin is a hormone that is secreted by the pineal gland in the brain to regulate the sleep-wake cycle. Normally, melatonin levels are low during the day and significantly increase at night. As we age, melatonin levels decline and this is one cause to the increased frequency of insomnia in the elderly. If you notice that your sleep has been getting worse with age, trying melatonin may be a good option for you. For those who are truly deficient, even 1 mg of melatonin will be enough to get a restful night’s sleep. It is often said that melatonin should be dosed to “dream tolerance” meaning that taking too high a dose of melatonin can cause nightmares.
Depression and Anxiety
Mood disorders such as anxiety and depression are thought to account for up to 50% of all cases of insomnia. A multi-faceted approach is necessary in these cases to address the root causes.
Medication Side Effects
Several medications can cause insomnia as a side-effect. If you start to experience difficulty sleeping shortly after starting a new medication, check with your doctor about that medications potential side-effects.
Sleep apnea is a breathing disorder characterized by brief interruptions in breathing during sleep. The pauses in breathing may occur hundreds of times a night and frequently accompanied by snoring in between apnea episodes. Rarely will the apnea rouse someone from their sleep enough to be aware of it, but the sufferer will usually experience excessive daytime drowsiness and a sensation of unrestorative sleep. Proper diagnosis of sleep apnea is important as the condition has been linked to heart arrhythmias, high blood pressure, heart attack, and stroke. If your partner has noticed that you snore heavily or stop breathing intermittently during sleep, I would recommend going to a sleep clinic to receive a proper diagnosis.
Restless Leg Syndrome and Nocturnal Myoclonus
Restless leg syndrome (RLS) and night-time leg cramps (myoclonus) can cause insomnia. RLS is characterized by an inabilitiy to sleep due to an irresistible urge to move the legs. Almost all patients with RLS have nocturnal myoclonus. In nocturnal myoclonus, there are repeated muscle contractions, usually in the legs, during sleep. Often the patient is unaware of the muscle contractions but instead experiences excessive daytime fatigue. For some, simply taking a magnesium supplement may relieve the cramping. Naturopaths often talk about dosing magnesium to bowel tolerance as too much will cause loose stools.
As you can see, there are a variety of different issues that can cause insomnia and there is no one approach to treatment that will work for everyone. It can take a bit of time and investigative work with your naturopathic doctor, but ensuring that you get a good nights sleep is foundational in achieving overall health!