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Natural Cures for Insomnia

An herbal supplement containing valerian was associated with a significant improvement in sleep-onset insomnia, Paul J. Mills, Ph.D., said at the annual meeting of the Society of Behavioral Medicine.

In a double-blind, crossover study patients taking Blissful Sleep, an herbal supplement made by Maharishi Ayurvedic Products International, Colorado Springs, had significant decreases in sleep latency.

A study published in the Journal of the American Medical Association this month revealed that the cure for insomnia is not necessarily in a bottle, and could be all in your head.

Dr. Jack D. Edinger and colleagues, of Duke University Medical Center in Durham, N.C., conducted a six-month study on 75 patients suffering from chronic insomnia. At the end of the study, the patients who were treated without drugs and were, instead, educated about better sleeping habits and put on a consistent sleep schedule (including a nightly routine to get ready for bed) got over 50 percent more sleep through the night than without the therapy. Patients who took sleeping pills reported a 16 percent reduction in the amount of time they spent awake at night and those taking a placebo reported only a 12 percent reduction.

Edinger's study shows that many patients are unaware of proper bedtime habits and those who tend to wake up during the night do not practice these behaviors. Therefore, taking simple steps such as developing a consistent routine, sleeping the same number of hours each night and eliminating daytime naps, can help you sleep through the night without making a pit-stop for the medicine chest.

Insomnia strikes 30%-40% of American adults annually and 10% have insomnia that is chronic or severe.

Behavioral therapy is the first step recommended by some experts. But for patients whose primary insomnia has lasted for more than 4 weeks, drug therapy is the most common treatment.

Now researchers are finding that the land of Nod may be especially difficult to reach for women. Factors ranging from hormonal influences to lifestyle stresses are among the culprits.

The latest in a series of surveys conducted annually by the National Sleep Foundation (NSF), women are more likely to experience insomnia than men are. Of the women surveyed, 63 percent said they couldn't fall or stay asleep a few nights a week, a complaint experienced by 54 percent of the men.

How hormones affect sleep

So what's keeping women up at night? Biology plays a big part, "Women are subject to all the sleep disorders men have, plus those that are related to hormones," says Rochelle Zak, M.D., attending physician at the Sleep-Wake Disorders Center. For instance, during the week prior to the start of the menstrual flow, when both estrogen and progesterone levels fall, women are likely to experience insomnia, disrupted sleep and daytime sleepiness. And the physical discomforts associated with the onset of menstruation, such as cramps, are enough to prevent a good night's sleep for many.

Pregnancy, it comes as little surprise, can drastically interfere with sleep as well. Of the women in the NSF's 1998 Women and Sleep Poll, 79 percent said they had difficulty sleeping due to physical or emotional stresses brought on by childbearing.

Weight gain and insomnia

Forget the notion of the bleary-eyed night owl who stays thin from pacing about. In fact, the effects of insomnia may even cause weight gain. The probable mechanism is complex, but a variety of studies implicate several hormones: leptin, which helps quell hunger; cortisol, the "stress hormone" that also affects fat storage: and insulin, which sweeps excess sugar from the blood to keep blood sugar stable. In a study by Eve Van Cauter, Ph.D., a professor of medicine at The University of Chicago, subjects who were allowed only four hours of sleep each night for a week showed a sustained increase in blood sugar, a condition that is considered a risk factor for diabetes and can lead to increased fat storage. Other research suggests that lack of sleep lowers the body's production of leptin. As a result, it seems possible that appetite is stimulated among the sleep-deprived.

Toward better sleep hygiene

But the news isn't all bad for insomniacs. While tried-and-true methods--exercising during the day, avoiding caffeine and alcohol and eating right--are still the best, the latest approaches favor more focused tactics. New York-Presbyterian's Zak promotes a regimen called good sleep hygiene--a prescription for day-to-day living that results in better sleep at night.

Many of her recommendations are intuitive, but others are not so obvious. For instance, Zak says women suffering from insomnia might benefit from spending less time in bed. Retiring for the evening before drowsiness sets in can lead to frustration at not being able to fall asleep quickly and thus more difficulty drifting off. Zak also tells patients trying to establish good sleep habits to wake at the same time each morning, even if they had trouble sleeping the night before.

Diet is also key in developing good sleep hygiene. Some foods, chocolate being the most common, are sources of hidden caffeine.

Eating smart isn't lust a healthy way to keep your weight in check; it can also help you sleep better. The fact is, some foods promote sleep, while others are bound to keep you up at night.

Most people know that the caffeine in coffee, especially consumed in the evening, can lead to sleeplessness. But other foods are stealth sources of this sleep-stealing chemical. "Everybody says they can't drink coffee after six, but they don't think about all the other ways that caffeine may be entering their system," says Arlington, vermont-based nutrition counselor Lynn Grieger, R.D., C.D.E. Grieger notes that certain teas can contain almost as much caffeine as coffee does: "Even herbal teas that are supposed to be relaxing can contain significant amounts of caffeine. Herbal and caffeine-free are not the same thing." Coffee-flavored yogurt may also contain about half the caffeine as a cup of the real thing. Chocolate and cola, too, can contribute to keeping you wired and awake. (Caffeine hits neuroreceptors in the brain in a manner similar to that of amphetamines.)

Plus, some herbal products billed as energy boosters or fat burners contain caffeine-rich herbs such as guarana or stimulants such as ephedra. When in doubt, check the label, and if you don't recognize an ingredient, look it up in a reliable reference, like WebMD.com's drug and herb database, to see if it's a stimulant.

On the other hand, there are foods that promote sleep. Carbohydrates aid the body's production of serotonin--a chemical produced in the brain that regulates mood and can induce sleep. So include starchy foods like fruit, whole-wheat pasta, potatoes, oatmeal and brown rice in your sleep pantry. Most of us, too, have experienced the post-Thanksgiving meal snooze, thanks to generous helpings of turkey. That's because turkey, and to a lesser extent chicken, contains tryptophan, an amino acid that induces drowsiness. Milk also contains tryptophan, which probably explains why a warm glass of milk at bedtime is a long-standing home remedy for sleeplessness. "There's solid science behind some of these so-called old-fashioned remedies," Grieger says.

Of course, you don't want to dine on carbohydrates to the exclusion of other macronutrients, like protein and healthy fats, although you may want to choose the higher-carb foods for dinner and an evening snack and eat your more protein-rich meals earlier in the day. And, even if you're trying to lose weight, don't skip on carbs; eliminating or extremely restricting carbohydrate intake can raise levels of the "stress hormone" cortisol, disrupting the all-important deep, restorative REM sleep.

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