Insomnia can be defined as a problem falling sleep, maintaining sleep, waking up early or poor quality of sleep despite adequate opportunity for sleep. This usually results in some form of daytime challenge or impairment such as sleepiness, low energy or poor concentration.
Various studies worldwide have shown the prevalence of insomnia is 10%–30% of the population, with some studies even as high as 50%–60%! It is common in older adults, females, and people with medical and mental health issues. (1)
Studies also show that insomnia negatively affects work performance, impairs decision-making, can damage relationships, increase chances of work-related/motor vehicle accidents, and lead to an overall decline in the quality of life. (2)
As you talk with your doctor, the following criteria must be met for it to be considered insomnia, rather than a short-term sleep issue:
- The problem should be present for at least 3 nights per week.
- It has occurred for at least 3 months.
- It is not the result of medication or a medical/mental disorder.
Diabetes and increasing age are significantly associated with insomnia. Hence, all diabetic patients should be screened for insomnia by the primary care physician using a self-assessment questionnaire.
A Traditional Chinese Medicine Understanding of Insomnia
From a Traditional Chinese Medicine (TCM) perspective, there should be a balance between Yin and Yang energies in the body. This balance is in harmony with nature. As the sun rises, the Yang energy increases and as the sun sets and the moon and stars are visible the Yin energy increases in the body. If during the night time either the Yang is more than normal or Yin is deficient, the result will manifest as insomnia, dream disturbed sleep or waking up early in the morning. The way TCM describes it is very simple, but the treatment can be more complex and a series of acupuncture may be needed to bring the body back to a normal Yin and Yang balance.
Natural Therapies to Help Insomnia
Reactive hypoglycemia and food allergies have been reported to cause insomnia. Many patients report that they sleep better after undergoing a nutritional program designed to improve blood glucose regulation or after identifying and removing allergenic foods. Reactive hypoglycemia may be considered in patients who develop various symptoms in the late morning or late afternoon and crave sweets. A food allergy, on the other hand, may be more common in patients who have other symptoms caused by food and may experience migraine, allergic rhinitis or eczema. Also, caffeine consumption for people who drink it in the evening has been connected to anxiety and insomnia. Patients with caffeine-induced insomnia have been found to metabolize caffeine more slowly than individuals who are not adversely affected by caffeine. (Alan R. Gaby reference)
Sleep Hygiene Education
Studies show that caffeine, tobacco and alcohol use, exercise, stress, noise, sleep timing and daytime napping are the areas commonly covered during an insomnia intake. (3)
Sleep hygiene education is given priority for treating insomnia due to its low cost and easy availability. Good sleep hygiene includes establishing a good sleep schedule (going to bed and waking up at the same time each day), no blue light exposure from cell phone or computer prior to bed, a darkened room with a cooler temperature, limiting caffeine and nicotine, and finding a nighttime ritual that is calming.
Supplements for Insomnia
Tryptophan is a precursor of serotonin which plays a role in sleep function. Some studies have shown that patients who took 1-2 grams of tryptophan 20-30 minutes before bed time improved insomnia. (4)
A typical western diet has less than the recommended dietary allowance for magnesium. Also, different types of physical and mental stress can deplete the magnesium in our bodies. That’s why so many people have sub-optimal magnesium levels. Magnesium is calming to the body and has been reported to improve insomnia in patients with restless leg syndrome or periodic limb movement in sleep. (4)
Melatonin is the main hormone involved in the control of the sleep-wake cycle. It is easily synthesized and can be administered orally, which has led to interest in its use as a treatment for insomnia. Moreover, as production of the hormone decreases with age in inverse correlation with the frequency of poor sleep quality, it has been suggested that melatonin deficit is at least partly responsible for sleep disorders. Treating this age-related deficit would therefor appear to be a natural way of restoring sleep quality, which is lost as patients age. (5)
Valerian root: In research studies the administration of valerian root (Valerian Officinalis) decreased sleep onset latency and improved sleep quality. Valerian is typically taken 30-60 minutes before bedtime and is usually well tolerated. However, there have been occasional reports of sleepiness the next morning. (4)
It is best to discuss sleep issues with your physician so you can work together to find the best treatment option for you.
Paymon Sadrolsadot ND, PhD, is a highly skilled naturopath in Washington, D.C., with over 20 years of integrative medicine experience. He is a licensed, board certified Doctor of Naturopathic Medicine (ND) and on the faculty at Virginia University of Integrative Medicine (VUIM). His practice is varied, and patients can take advantage of his master training in pain management, chronic fatigue, insomnia, facial rejuvenation, neurological problems and cancer supportive treatment. His deep knowledge of conventional, complementary, and integrative medicine allows him to think deeply and find solutions for his patients' health. In addition to English, Dr. Sadrolsadot also speaks Mandarin and Persian.
(1). Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities Swapna Bhaskar,1 D. Hemavathy,2 and Shankar Prasad3 PMCID: PMC5353813 PMID: 28348990
(2). Kessler RC, Berglund PA, Coulouvrat C, Fitzgerald T, Hajak G, Roth T, et al. Insomnia, comorbidity, and risk of injury among insured Americans: Results from the America Insomnia Survey. Sleep. PMCID: PMC3353035
(3) Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis PMID: 29194467 DOI: 10.1093/fampra/cmx122
(4). (Alan R. Gaby reference): Nutritional medicine textbook by Alan R. Gaby 2011
(5). Melatonin Reference: Melatonin in sleep disorders J J Poza, M Pujol, J J Ortega-Albás, O Romero, en representación del Grupo de estudio de insomnio de la Sociedad Española de Sueño (SES) PMID: 30466801 DOI: 10.1016/j.nrl.2018.08.002