You’ve probably got used to the notion of efficiency ratings. Your fridge, your car, your insulation: all these are judged by their efficiency. You may not have realised that your sleep can be too.
The amount of time spent asleep in relation to the amount of time spent in bed is known as sleep efficiency. 80-85% is considered optimal, while below 75% is considered a sign of poor quality sleep.  These busy days, with so many people coping with hectic schedules, constant caffeine intake and very little rest and relaxation, sleep is often illusive. The reasons for tackling this are compelling:
People getting less than 7 hours sleep per night are almost three times more likely to develop a cold than those achieving more than 8 hours per night. 
After a night of only 4 hours sleep, calorie intake can rise by up to 22%.
Patients with resistant hypertension high blood pressure that doesn’t come down even when on as many as three different medications for it have been found to sleep 33.8 minutes less than those with controlled hypertension and 37.2 minutes less than those with normal blood pressure. 
What’s more, when you enter REM or rapid eye movement sleep, when most dreams occur, you are better able to solve a new problem the next day with lateral thinking. So sleeping on it really can work.
Tips on improving sleep efficiency:
Keeping to a consistent sleeping schedule – going to bed and getting up at the same time each day will reinforce your body’s sleep-wake cycle.
Consider taking a nap during the day – power naps from ten to thirty minutes in the afternoon is best. Any longer that this, will risk falling into a deep sleep.
Avoid coffee and alcohol at night – the stimulating effects of caffeine can disrupt your sleep quality.
Try a mixture of Valerian and Hops to improve the way your body slips into sleep from a wakeful state, as well as increasing the likelihood of your subsequent sleep moving through all the stages including REM sleep, so that you wake refreshed and ready to solve those problems.
Keep the distractions at bay – switch off electronic devices and turn the lights off. Earplugs are also good to use to eliminate background noises.
 BMJ 2008; 337: a1245.
 Cohen S et al. Archives of Internal Medicine 2009; Vol. 169 (1): 62-67
 Bronel L et al. Am J Clin Nutr (March 31, 2010) doi10.3945/ajcn.2009.28523
 Friedman O et al. American Journal of Hypertension 2010; 23 2, 174–179
A recent study carried out by researchers at Northumbria University has found that tart cherry juice improves both the quality and duration of sleep.
Participants in the study slept for an extra 25 minutes each night after drinking two servings of the juice drink during the daytime.
Tart Montmorency cherries contain significant amounts of melatonin, a naturally occurring antioxidant that helps to regulate sleep in humans.
The study required 20 healthy volunteers to drink a 30ml serving of either tart cherry juice or a placebo juice twice a day for seven days. Urine samples were collected from each participant to measure levels of melatonin.
The researchers found that when participants drank cherry juice for a week there was a significant increase in their urinary melatonin (15-16%) both compared to the placebo group and to their own measurements taken at the beginning of the study.
Each participant wore an actigraphy watch sensor to monitor their sleep and wake cycle. Participants also kept a daily ‘sleep diary’ to record their own sleep patterns.
The actigraphy measurements showed that those who consumed the cherry juice saw an increase of around 25 minutes in their total sleep time and a 5-6% increase in their ‘sleep efficiency’, which means that they spent less time lying in bed awake.
The sleep diaries kept by the participants also showed that cherry juice drinkers spent less time napping in the daytime than they did before the study began. During the study, they also spent less time napping than the placebo group.
Study leader, Dr Howatson, said: “These results show that tart cherry juice can be used to facilitate sleep in healthy adults and, excitingly, has the potential to be applied as a natural intervention [to] populations with insomnia and general disturbed sleep from shift work or jet lag.”
In clinic, I often recommend the tart cherry concentrate, CherryActive, to sports nutrition clients. This is because its high antioxidant content improves muscle recovery between workouts. I suspect that the improved sleep quality afforded by the melatonin in cherry juice might also account for the benefits that athletes feel when using this drink.
In many countries, melatonin supplements are available over the counter. They are often used by shift workers, or those suffering with jet lag or other sleep difficulties. In the UK, where melatonin supplements are not freely available, tart cherry juice appears to represent a safe and effective natural alternative.
Written by Nadia Mason, BSc MBANT NTCC CNHC
Howartson G, Bell, PG, Tallent J, Middleton B, McHigh MP, Ellis J. Effect of tart cherry juice (Prunus cerasus) on melatonin levels and enhanced sleep quality. European Journal of Nutrition, October 30th, 2011.
Aromatherapy isn’t hocus pocus and it’s nothing to do with ‘hubble bubble toil and trouble’. It’s simply a natural practice of using natural plant oils and essential oils for psychological and physical wellbeing.
Whether these oils are inhaled or topically applied there is an array of benefits to using aromatherapy that go way beyond simply having a nice smelling house.
Essential oils, which come from the pure essences of a plant or herb, have been found to have a number of psychological and physical benefits. The term essential oil is used widely to include all natural, aromatic, volatile plant oils.
There is often much scepticism about aromatherapy but this is mainly due the fact that there are many products out there masquerading as essential oils but are merely perfume oils that contain synthetic materials and provide none of the benefits of true essential oils. When purchasing your aromatherapy products it is vital to check the ingredients label. Only choose products that contain no fragrance oils or un-pure and unnatural chemical components. Look for products that contain pure essential oils.
Inhaling essential oils
Essential oils can be applied either topically or inhaled. Inhaled directly into the lungs, essential oils can have a wide range of positive effects. When inhaling essential oils, not only does the aroma of natural essential oils simulate the brain, it can also have a number of therapeutic benefits. For example, if you suffer from a cold or congestions, try inhaling eucalyptus essential oils to help ease your symptoms and get rid of that horrible bunged up feeling.
Topically applying essential oils
When essential oils are applied to the skin, they can be absorbed into the blood stream and depending on the oil you use, can have a number of benefits for health and beauty. To apply powerful essential oils to the skin they must first be diluted into a carrier such as Sweet Almond Oil or Apricot Kernel Oil. If you often have trouble sleeping try applying a lavender essential oil such as the PRIMAVERA Organic Lavender Sleep Therapy Roll On, direct to the temples, earlobes, wrist and chest. The calming and relaxing fragrance aids a peaceful and natural sleep.
Other benefits of essential oils
There is a vast array of uses for essential oils that go way beyond the medicinal and physical benefits. They can be used in anything from home made household laundry cleaners to repelling mosquitoes and other nasty bugs. Citronella essential oil is the marvellous ingredient in some of the most effective mosquito repellents on the market.
In our efforts to remain healthy and youthful there is a lot of talk about antioxidants, omega oils, calcium and several other nutrients and yet we may have overlooked the missing link in our diets, the mineral magnesium.
Magnesium is the fourth most abundant mineral in the body and can be found in the teeth, bones and red blood cells. In fact half is found in bone and the rest in soft tissue in the body. The body jealously maintains about 1% of its magnesium within the blood making blood tests notoriously difficult to identify a deficiency (1). Magnesium is our most interactive mineral. It is essential for numerous biochemical reactions carried out within the body (over 350 in fact – more than iron and zinc combined) and interestingly the symptoms of magnesium deficiency are identical to those found in old age and include low energy levels, irregular heartbeat, clogged arteries, migraines and headaches, heavy metals build-up, high blood pressure and insulin resistance (2).
A study published in 2005 (3) showed that a staggering 70% of the US population may be magnesium deficient and 19% didn’t even reach half the Recommended Daily Allowance, which has just been raised to 360mg in the UK. People at serious risk of magnesium deficiency include the elderly, diabetics, children, those on low calorie diets, those over-indulging in alcohol and those engaged in heavy exercise and stressful lifestyles.
Modern Western diets
Unfortunately modern farming methods have depleted the soils and artificial fertilizer favours certain minerals over others. Over processing food depletes magnesium levels as does increasing the shelf life of food. Did you know that we lose over 80% of the magnesium in wholegrain flour when we convert it into white bread? In fact, magnesium levels in our diet are half what they were hundred years ago. Foods rich in magnesium include pumpkin seeds, nuts, wholegrains and dark green vegetables but these rarely feature within our daily staple diet. In addition our calcium intake has never been higher (4). Asian and African populations have a dramatically lower intake of calcium with little incidence of osteoporosis. Their magnesium intake however is at least double that of Western diets.
Magnesium deficiency develops over time so we often only notice problems when we experience changes due to age, the menopause or when our body is under stress.
Low Energy & Fatigue
Magnesium is a key mineral in the enzyme processes that convert food into energy and several studies show that individuals with low magnesium levels use more energy and therefore tire quickly. Magnesium is critical for both the synthesis and secretion of insulin so diabetics are often found to be deficient in magnesium (5).
PMS & Hormonal Imbalances
Sufferers of PMS have significantly lower levels of magnesium suggesting a clear association. In fact research by Dr David Thomas showed sufferers of severe PMS will tend to have common elements within their diet consuming only a quarter of their necessary magnesium but almost 80% more dairy and a staggering 275% more sugar (6)!
The inability to sleep may also be linked to magnesium deficiency. If you find it difficult to sleep or find yourself waking up in the middle of the night with muscle spasms, cramps or stiffness you may benefit from higher levels of magnesium (7).
Although calcium is the most abundant skeletal mineral it is very poorly soluble on its own. It requires sufficient hydrochloric acid (quantity of which reduces as we age) magnesium and vitamin D in order for it to be absorbed into the bone. Calcium that is not made soluble cannot enter the bone and settles in soft tissue such as joints, muscles and in arteries as cholesterol plaque (8).
Cramps & Spasms
Magnesium is essential for the proper function of muscles. Calcium is responsible for the contraction phase of muscles whilst magnesium is needed for the relaxation phase. Cramping at night and irritating twitches in the eyelids are often clear signs of magnesium deficiency. Restless Leg Syndrome, a poorly understood neurological disorder, responds favourably to magnesium chloride rubbed into the muscles (9).
Many studies indicate that there is a relationship between headaches, migraines and low levels of magnesium in the bloodstream. Magnesium helps to relax blood vessels, encouraging normalised oxygen flow to the brain (10).
Anxiety, Nerves & Irritability
A deficiency in magnesium can result in the symptoms of anxiety and irritability since magnesium is required for the manufacture of adrenal stress hormones.
Kidney stones, one of the most painful urinary disorders, have beset humans for centuries. A kidney stone is a hard mass of chemicals from urine. The most common type of kidney stone contains calcium oxalate. Studies indicate that magnesium helps prevent recurrence of calcium oxalate kidney stones due to its effects on solubilising calcium in urine (11).
Magnesium is necessary for the elasticity and dermal protection of the skin and low levels will reduce skin cell health (12).
Magnesium absorption through the skin
Our intestines are simply not efficient at absorbing relatively large doses of magnesium from supplements and increasing the intake simply results in diarrhoea. Absorption is dramatically reduced with poor digestive efficiency, particularly as we age or when unwell. This is why hospitals will always favour a slow, gradual supply (IV drip) rather than an oral supplement.
Magnesium chloride is the form favoured by our bodies as it is the result of all other magnesium compounds being exposed to the hydrochloric acid in our stomachs. Magnesium chloride is in fact the result of evaporation of sea water. As pure and as simple as that and it is perfectly suited to absorption through the skin. Cardiff University has just completed the first clinical trial to produce evidence that magnesium is excellently absorbed through the skin (13). And an earlier trial in 2010 showed that the body could remineralise five times faster by skin application than by oral supplementation (14).
Last week I wrote about the herb valerian and how it might help some individuals suffering with insomnia. A very recent study (1) investigated the herbal remedy passionflower (Passiflora incarnata) for the treatment of sleep disturbance in 41 individuals. In the study passionflower in the form of a tea preparation was investigated but passionflower is also available in the form of supplements, tinctures and tonics. The researchers of the study found that sleep quality was significantly better with passionflower compared with placebo tea. They conclude that (1) “These initial findings suggest that the consumption of a low dose of Passiflora incarnata, in the form of tea, yields short-term subjective sleep benefits for healthy adults with mild fluctuations in sleep quality.”
Traditionally passionflower has been used as a herbal sedative and sleep aid as well as for its anxiolytic, anxiety reducing, properties. Anxiety is a problem that impacts many individuals and I have previously written about some natural solutions to anxiety which can be found here: including the benefits of walking, chamomile, Ashwagandha (or Indian Ginseng), antioxidants and omega 3 fatty acids.
A review paper last year looked at nutritional and herbal supplements for anxiety and anxiety-related disorders (2) based on the results the authors concluded that strong evidence existed for the use of passionflower for the treatment of anxiety symptoms and disorders. The review comments that several studies involving the biochemical makeup of passionflower have been conducted and between the 1970 s and 1990s passionflower was listed as an official plant drug by the pharmacopoeias of America, Britain, Germany, France, Switzerland, Egypt and India. Passionflower contains many hundreds of different phytochemicals (bio active plant chemicals), it is difficult to elucidate which specific biochemicals are responsible for the active, anti-anxiety, properties of passionflower. So, although passionflower supplements often produce positive results, identifying the active ingredients can be difficult. It is also possible that some herbal passionflower remedies may be ineffective due to not containing the active anti-anxiety components.
One of the studies (3) included in the review paper compared the use of passionflower supplements to oxazepam in patients with GAD (generalised anxiety disorder). Oxazepam is a prescription medical drug used to treat anxiety symptoms and insomnia (marketed under brand names such as Alepam, Medopam, Murelax, Noripam, Opamox, Ox-Pam, Purata, Serax and Serepax). The results showed that Passiflora extract and oxazepam were both effective in the treatment of generalized anxiety disorder. In fact no significant difference was observed between the passionflower and oxazepam at the end of trial. Oxazepam did show a rapid onset of action, however, significantly more problems relating to impairment of job performance were encountered with subjects on oxazepam. The authors of this study conclude that “The results suggest that Passiflora extract is an effective drug for the management of generalized anxiety disorder, and the low incidence of impairment of job performance with Passiflora extract compared to oxazepam is an advantage. A large-scale trial is justified” (3).
The authors of the review paper (2) say that evidence does suggest that passionflower is an effective anti-anxiety agent but that studies have, to date, been conducted in different types of individuals and that more research is needed to prove its usefulness in anxiety related disorders. There are many herbal preparations containing passionflower, such as these available to buy. If you are experiencing anxiety symptoms it is important to visit your medical doctor where you can discuss the option to try passionflower containing remedies as a treatment. If you do try passionflower supplements please follow the dosage guidelines carefully, there is some evidence to suggest (2) that in some cases passionflower may cause dizziness, drowsiness and confusion.
(1) Ngan A, Conduit R. 2011. A Double-blind, Placebo-controlled Investigation of the Effects of Passiflora incarnata (Passionflower) Herbal Tea on Subjective Sleep Quality. Phytother Res. 2011 Feb 3. doi: 10.1002/ptr.3400. [Epub ahead of print]
(2) Lakhan SE, Vieira KF. 2010. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 9:42.
(3)Akhondzadeh S et al. 2001. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 26:363–367. doi: 10.1046/j.1365-2710.2001.00367.x
A few years ago I wrote about a variety of different measures that might be useful for the treatment of insomnia, a condition which can be deeply upsetting and frustrating and which can have a vast impact on daily functioning.
The herb Valeriana officinalis, or valerian, as it is commonly known, was used by the ancient Greeks over 2000 years ago as a treatment for nervous unrest and sleep disorders. A recent review (1) paper has looked in detail at research studies, for the treatment of insomnia with the herb valerian, that were published between 1950 and 2009. The data indicated that the use of valerian, on its own, or in combination with hops, is associated with improvements in some sleep parameters such as quality of sleep and time to fall asleep.
Interestingly in one study (2) published in 2002 the effects of valerian extract (600mg daily) was compared to oxazepam (10mg daily), a medical drug prescribed for insomnia (marketed under brand names such as Alepam, Medopam, Murelax, Noripam, Opamox, Ox-Pam, Purata, Serax and Serepax), for 6 weeks in over 200 patients. The study found that valerian treatment was at least as efficacious as oxazepam with both treatment groups reporting improvements in sleep quality (1,2).
If you have been having problems sleeping recently please read my previous blog post on insomnia as it is full of information that you might find useful. If you decide to try taking valerian please follow the dosage recommendations carefully and do not exceed these. There are many valerian products available on the market.
The results from the numerous studies were varied (1) and the methodological quality also varied – so the authors of the review paper conclude that “Further randomised, double blind, placebo controlled trials are needed before such herbal treatments can be confidently recommended for the treatment of primary insomnia”. Valerian is considered safe when consumed within the recommended dosage range and when taken for short term treatment of insomnia. If your insomnia persists for more than two weeks then it is advisable to see your medical doctor since insomnia can be linked to other medical conditions.
One reason for the varied results from the use of valerian may stem from the fact that absorption of valerian in to the body and its distribution through the body as well as the way it is metabolised may vary from individual to individual(3). The study of what the body does to a substance (e.g. absorption, distribution, metabolism), in this case valerian, is called pharmacokinetics. A recent study looked at the activity of valerian in the body in a group of women who were given valerian to aid sleep. The research scientists found that “In conclusion, large variability in the pharmacokinetics of valerenic acid may contribute to the inconsistencies in the effect of valerian as a sleep aid”. This might mean that some people find valerian much more useful as a sleep aid than others – again, further research will be necessary to look into the usefulness of valerian for treatment of insomnia, however trying the herb for a week to see if it is helpful to you might be an option to consider or to discuss with your medical doctor. As mentioned earlier there are many valerian products available such as “Bio Health Valdrian – Valerian Root” and “Higher Nature Valerian Sleep Aid” Always read the labels and consider checking with your doctor before taking the supplement.
(1) Salter S & Brownie S. 2010. Treating primary insomnia – the efficacy of valerian and hops. Aust Fam Physician. 39(6):433-7.
(2) Ziegler G et al. 2002. Efficacy and tolerability of valerian extract LI156 compared with oxazepam in the treatment of non-organic insomnia: a randomized, double-blind, comparative clinical study. Eur J Med Res. 7:480–6.
(3)Anderson GD et al. 2010. Pharmacokinetics of valerenic acid after single and multiple doses of valerian in older women. Phytother Res. 24(10):1442-6.
Exercise, tai chi and meditation all seem to be helpful for the treatment of insomnia and sleep problems.
On Monday I wrote about some of the natural ways that insomnia may be treated. Continuing on the same theme I wanted to look at some new evidence which links different types of physical activity to sleep promotion.
There is recent evidence to suggest that regular daytime exercise can work very well for the treatment of insomnia, especially in women (1,2). Being physically active seems to be linked to sleep improvement, totality of sleep time and decreased time to sleep onset. The same kind of benefit also seems to be gained for simple stretching and strengthening exercises as well as massage and relaxation techniques (2).
Walking has been investigated as a technique to help individuals suffering from anxiety and mild depression with great results. I would also suggest that it is a simple and effective way to integrate physical activity into any day. Walking for 20-40minutes a day (not necessarily all in one bout) may well help to reduce anxiety and therefore help alleviate sleep problems and insomnia. Personally I find walking to be an essential part of my daily routine, it brings me clarity of mind and reduces any tension. If you wish to try exercise in an attempt to ease sleep difficulties it is usually best to exercise during the day, at least three hours before sleep. Exercising just before bed tends to wake the body up and may exacerbate sleep problems.
For a long time individuals practicing relaxation techniques, meditation, Tai Chi and yoga have said that their sleep greatly benefits. Until recently evidence has been anecdotal but studies are now being carried out on these ancient practices and scientists are finding that these techniques really are usful in aiding calmness and improving sleep quality.
A very recent study (3) assessed the usefulness of Tai Chi exercise for individuals suffering with insomnia. The study involved 112 healthy adults aged 59-86 years old. The individuals were either assigned to a health education class for 25 weeks or they undertook Tai Chi classes. The Tai Chi group received 16 weeks of taught Tai Chi followed by home-practice and an assessment 9 weeks later. Sleep quality was assessed using a special medically tested sleep quality index. Tai Chi was found to help improve sleep quality score and participants also reported a greater sleep efficiency, sleep duration and less sleep disturbance. The authors conclude that Tai Chi is a useful non-pharmacological approach to improving sleep quality. Tai Chi has also been found to be useful in previous studies (4). I tried Tai Chi last year and really enjoyed the gentle form of movement. There was a big focus on correct breathing which was very relaxing in itself, it certainly helped me to sleep more deeply and I would highly recommend trying it out if there are classes in your area.
Many people suffering with insomnia and sleep problems often find that they are going through a period of anxiety or emotional upset. In such cases talking-therapies or counselling can be helpful to deal with the underlying anxiety and are therefore helpful for sleep. Meditation techniques are also useful for calming the mind and reducing anxiety. Simple techniques such as focussing on the breath, bringing yourself back to the moment or repeating a calming word or phrase (a mantra) can be very useful.
Two recent studies (5,6) have found that combining mindfulness meditation with cognitive-behaviour therapy (a form of counselling) is useful in the treatment of insomnia. These were preliminary studies but the data strongly suggests that this combined form of treatment really does improve sleep quality. The authors of these studies call for larger trial and additional testing. This form of combined therapy appears to be particularly useful in relieving insomnia symptoms in individuals suffer from worry and anxiety (6). CBT is a form of counselling and mindfulness meditation helps individuals to stay in the moment and calm their thoughts. The Counselling Directory is an online resource that can help you find qualified CBT practitioners in your area, some of these counsellors are also trained in mindfulness meditation techniques.
I do hope that these last two posts have provided some ideas that may help you to sleep more easily this year.
(1)Llanas AC et al. 2008. Physical therapy reduces insomnia symptoms in postmenopausal women. Maturitas. 61:281-284 (2)Tworoger SS et al. 2003. Effects of a Yarlong moderate-intensity exercise and stretching intervention on sleep quality in postmenopausal women. Sleep. 26:830-836 (3)Irwin MR et al. 2008. Improving sleep quality in older adults with moderate sleep complaints:A randomised controlled trial of Tai Chi Chih. Sleep. 31:1001-1008 (4)Li F et al. 2004. Tai Chi and self-rated quality of sleep and daytime sleepiness in older adults: a randomised controlled trial. J Am Geriatr Soc. 52:892-900 (5)Ong JC et al. 2008. Combining mindfulness meditation with cognitive-behaviour therapy for insomnia:a treatment-development study. Behav Ther. 39:171-182 (6) (6)Yook K et al. 2008. Usefulness of mindfulness-based cognitive therapy for treating insomnia in patients with anxiety disorders:a pilot study. J Nerv Ment Dis. 196:501-503
Sleep is something we all need in order to function effectively! Not getting enough sleep can leave us feeling irritable, unable to perform tasks properly and generally unwell. Aiming to get between 7 and 8 hours of sleep a night is usually recommended by health professionals. December saw the publication of two studies (1,2) linking adequate sleep to heart health. The relationship has been previously explored and it really does seem that sleep is vital for our health and wellbeing, not just in order to prevent tiredness. The second study (2) found that either too little sleep, 5 hours or less, or too much sleep, 9 hours or more, was associated with an increased risk of heart disease.
Many individuals find that they suffer from the odd bout of insomnia, others find that their insomnia may go on for many months, especially if they are going through an emotionally difficult period. Pharmaceutical sleeping-pills are an option, however they often leave the user feeling heavy-headed in the morning or as if they are suffering from a ‘hang-over’. Many people don’t want to take prescribed sleep medication and worry becoming dependent on such pills. Since sleep is so important for our health and wellbeing I thought I would take some time to look at the many natural ways that can aid good sleep.
Insomnia is the term used to describe problems with quality, quantity and timing of sleep (3). Sleep problems can include trouble falling asleep, problems staying asleep (frequent night waking) and waking early in the morning with difficulty resuming sleep. A typically described feature of insomnia is feeling tired and fatigued the next day to a degree that can disrupt normal daily activities. There are three main categories of insomnia (3):
1.Transient insomnia – which typically lasts for about a week, usually caused by jet lag, stress, environmental factors, exams etc. 2.Short term or sub-acute insomnia – lasting 1-4 weeks, usually related to emotional problems or serious illness. 3.Chronic insomnia – usually lasts for more than a month and is sometimes related to psychiatric disorders or drug abuse.
Reduced amount of sleep can have considerable impact on the life of the patient, their family, friends and work colleagues. It can reduce physical and mental energy, cause irritability, an inability to concentrate and is linked to a deterioration of general health. For someone feeling very tired and fatigued it becomes dangerous to drive or operate machinery. Insomnia can also lead to feelings of low self-esteem and confidence. Worrying about insomnia can make the situation worse so I hope that the following information provides a little helpful advice on how the problem can be approached naturally.
Caffeine Caffeine has a stimulant effect in the body, it triggers the release of certain stimulating hormones such as adrenaline. Studies have shown that individuals drinking caffeinated drinks such as tea, coffee and cola are more likely to suffer from sleep disruption (4,5). Caffeine tends to arouse us and in some people the effects can last for many hours. If you are going through a period of sleeplessness, especially associated with anxiety it may well be very helpful to eliminate caffeine for a few weeks, or at least try to only consume one cup early in the day until sleep patterns are normalised. Also check the labels of any painkillers you may be taking as they often contain caffeine. Alcohol and nicotine also act as stimulants so be wary of these.
Blood sugar levels Some individuals find that they can get to sleep very easily but then tend to wake in the middle of the night, often finding it difficult to get back to sleep again. This problem may be related to a drop in the level of sugar in the blood during the night (6). Normally, the body manages to keep a stable blood sugar level during the night. However, if the level drops, the body attempts to normalise it by producing stimulating hormones such as adrenaline and cortisol (known as stress hormones) which can cause night waking. Adrenaline levels often peak at around 3-4am, a time when many individuals wake. The key to resolving such cases of insomnia is to eat a diet during the day that helps the body to maintain stable blood sugar levels. I have written about eating to normalise blood sugar levels previously (8th and 10th September). Blood sugar problems may also be the reason why some individuals wake up hungry during the night or early morning (6)
Balancing blood sugar levels through eating a healthy diet that provides a slow and steady supply of energy throughout the day may also help to prevent cravings and daytime fatigue. A diet rich in vegetables and fruits, healthy fats; especially omega 3 fatty acids from oily fish, fish oil or flax seed oil supplements, and proteins; from nuts/seeds, eggs, lean unprocessed meats, fish and pulses/beans may help to minimise blood sugar imbalances. Vegetables and fruits are great sources of unrefined carbohydrates as are wholegrains with a low glycaemic index (GI) these will help to ensure a steady supply of energy to the body. Please read my previous posts for more detail on glycaemic index and eating to minimise blood sugar swings.
Food sensitivities/allergy Food sensitivity or allergy may also be an underlying problem in some cases of insomnia. Foods causing allergic reactions are known to provoke many responses in the body such as an increase heart rate which may cause or aggravate insomnia (6). If you think you may be suffering with a food allergy/intolerance it is important that you seek the advice of a health professional who will carry out proper allergy tests, undergoing your own elimination diet is not recommended.
Calcium and Magnesium Anecdotal evidence suggests that taking calcium and magnesium in the evening, prior to sleep may help to ease trouble falling asleep. These minerals may work by aiding relaxation and reducing anxiety. Women in particular may find these nutrients useful, in the UK many women do not achieve desirable intakes of these minerals, especially magnesium (which is naturally found in high levels in nuts, seeds, pulses and wholegrains). A supplement containing up to 1000mg calcium and 500mg magnesium taken prior to sleep may be helpful.
Herbs There are many herbal sleep aids sold online and in supermarkets, pharmacies and health-food stores. Of the most popular are chamomile tea, lavender oil fo use in the bath and on the pillow, valerian supplements, hops supplements and supplements containing a mixture of herbs. The scientific evidence for the use of these herbs is not well documented, however research is beginning to mount. In practice many individuals do tend to find herbal remedies helpful and they may well be worth a try, especially if you suffer from insomnia linked to anxiety and not being able to fall asleep. Most of the herbal remedies available are thought to be calming.
5-HTP Sleep is induced by the production of certain feel-good brain chemicals including a substance called ‘serotonin’. In the body, serotonin is manufactured from the amino acid tryptophan and tryptophan depletion can lead to insomnia(7). Although tryptophan cannot be bought as a supplement an intermediary in the production of serotonin, 5 hydroxytryptophan (5HT), can be purchased. Supplementing with this substance may help induce and maintain sleep (8). I have used this supplement in the past and found it to be very helpful. The normal recommended dose is 50 mg, taken an hour before bedtime. Often 5-HTP supplements also contain a variety of B vitamins that are naturally part of the serotonin pathways in brain.
Some additional advice to insomniacs (6) *Avoid napping during the day *Go to bed and get up at regular times *Take regular exercise but avoid this 3 hours before bed *Try to do something relaxing before going to bed e.g. reading, listening to music, taking a warm bath or shower *If possible avoid emotional upsets before bed *Avoid working in bed or in the bedroom *Ensure that the environment is suitable for sleeping e.g. not too cold/hot, not too noisy, comfortable mattress
If insomnia persists for more than a couple of weeks please go to see your doctor. Insomnia can be linked to medical conditions such as pain, bladder problems, gastrointestinal upsets, coughs, upper airway obstruction and depression.
(1)King RC et al. 2008. Short Sleep Duration and Incident Coronary Artery Calcification JAMA. 300(24):2859-2866 (2)Shankar A et al. 2008. Sleep Duration and Coronary Heart Disease Mortality Among Chinese Adults in Singapore: A Population-based Cohort Study. American Journal of Epidemiology. 168(12):1367-1373 (3) Lader M. 2000. Insomnia. Family Medicine Jan/Feb: 8¬12 (4)Shirlow MJ & Mathers CD. 1985. A study of caffeine consumption and symptoms; indigestion, palpitations, tremor, headache and insomnia. In J Epidemiol. 14:239- 248 (5) Bonnet MH & Arand DL. 1992. Caffeine use as a model of acute and chronic insomnia. Sleep. 15:526-536. (6) Holbrook AM et al. 2000. The diagnosis and management of insomnia in clinical practice: a practical evidence based approach. JAMA. 162:21620 (7)Riemann D et al. 2002. The tryptophan depletion test: impact on sleep in primary insomnia – a pilot study. Psychiatry Res. 109:129-135 (8)Sourlairac A et al. 1977. Action of 5-hydroxytryptophan, serotonin precursor, on insomniacs. Annals Medico-Psychologiques. 135:792-798.