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~ Insomnia ~ A Naturopathic Approach
Paula Cluney, ND Sarah Ackerly, ND, CPM
Northern Sun Family Health Care 53 Main Street Topsham, Maine
207-‐798-‐3993
Sleepless in Portland
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Sleep disorders affect 30% of the population
• “Most of my patients have trouble sleeping”
From Health Care Providers
• “70 million Americans suffer from chronic sleep problems”
From the Centers for Disease Control and Prevention
• “Americans spent about $2 billion on prescription sleep drugs in 2010”
From IMS Health
* Difficulty Falling Asleep * Interrupted Sleep * Waking too Early * Poor Quality of Sleep
* Light Sleep /Frequent waking * Not refreshed on waking
Symptoms of Insomnia
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Sleep Problems Are A Symptom Of Many Other Health Concerns
Mental health problems
Substance-induced Pain
Low mood Medications Infections
Stimulants e.g. Caffeine,
Energy drinks Changes in
thyroid function Anxiousness
Excess energy Drugs e.g., Cocaine,,
Ritalin, Adderall http://
Sleep Regulation
Sleep is a process that is controlled by the nervous
system, neurotransmitters,
and chemical messengers
* Allergies, especially with respiratory symptoms * Hormonal changes like thyroid imbalances, pregnancy and menopause * Depression * Stress * Anxiety * Gastrointestinal problems like reflux
Causes of Insomnia
* Sleep Apnea * Bladder problems * Chronic pain or low back pain * Lifestyle issues like shift work, napping and screen time * Neurological conditions like Parkinson’s disease or RLS * Medications or stimulants including caffeine and alcohol
Causes of Insomnia
Age Amount of Sleep
Newborns (0-‐3 months) 14-‐17 hours/day
Infants (4-‐11 months) 12-‐15 hours/day
Toddlers (1-‐2 years) 11-‐14 hours/day
Preschoolers (3-‐5 years) 10-‐13 hours/day
School Age Children (6-‐13 years) 9-‐11 hours/day
Teenagers (14-‐17 years) 8-‐10 hours/day
Young Adults (18-‐25 years) 7-‐9 hours/day
Adults (26-‐64 years) 7-‐9 hours/day
Older Adults (65+) 7-‐8 hours/day
National Sleep Foundation
Recommended Sleep
* Rafael Santana, medical specialist at the Sleep Disorders Clinic, says that there is no fixed number of sleep hours * It depends on the age and needs of the body, for example an infant sleeps up to 16 hours a day, but for an adult 4-‐5 hours may be enough * What matters more is the quality of sleep
How Much Sleep Do We Need?
* Deep Sleep or “Slow-‐Wave-‐Sleep" heals the body and helps memory by taking pieces of a day's experiences, replaying them and strengthening them for better recollection * REM sleep heals the mind
Deep versus Light Sleep
* Normally, we start REM sleep -‐ the sleep in which your brain is most active -‐ about 90 minutes after we fall asleep and cycle every 90 minutes through the night 4-‐5 times * Deep sleep (SWS-‐slow wave sleep) generally promotes rest and restoration and is where your body’s repair mechanism kicks in and the body releases growth hormone * Growth hormone is needed for kids to grow and adults to repair their bodies
Light & Deep Sleep
* Tumors grow two to three times faster in laboratory animals with severe sleep dysfunctions, primarily due to disrupted melatonin production * Melatonin inhibits a wide range of cancer cell types, as well
as triggering cancer cell apoptosis (self-‐destruction) * It also interferes with the new blood supply tumors
required for their rapid growth (angiogenesis) * Poor sleep is also associated with an increased risk of
insulin resistance and weight gain—two additional factors that also play an important role in cancer development
Insomnia & Cancer
* Progesterone has a sedative effect but reduces the deep sleep stage that occurs before REM sleep * Premenstrual insomnia-‐ occurs from a rapid drop in progesterone * During ovulation and the luteal phase of our menstrual cycle, progesterone causes REM sleep to occur earlier in the sleep cycle, within 60 minutes
Hormonal Causes of Insomnia
* Estrogen is more complicated than progesterone * It increases REM cycles, decreases the number of awakenings after sleep and increases total sleep time * Estrogen has an effect on the neurotransmitters: norepinephrine, serotonin and acetylcholine * It also affects sleep via its effect on cortisol * Cortisol has a diurnal variation-‐highest in am and lowest at night before bed
Hormonal Causes of Insomnia
Women’s Experience of Insomnia
• 57% of women experience insomnia at least a few nights per week
• 74% of stay at home moms report symptoms of insomnia
• Only 7% of women report receiving treatment for insomnia
• For many women, insomnia is linked to depression
* 50% of women have insomnia during menopause, due to changes in hormones, neurotransmitters or hot flashes * Lower estrogen decreases serotonin, leading to decreased melatonin and more pain because of lower levels of circulating endorphins * Estrogen itself may also have an antidepressant as well as a direct sleep effect
Menopause
* Sleep studies show a progressive worsening of sleep quality through pregnancy, with significant sleep problems after delivery, which may persist for at least the first 3 months post partum * A big drop in hormones postpartum affects neurotransmitters and sleep * An association between maternal depression and children's sleeping problems has been observed and depression improves when children sleep better
Insomnia – Pregnancy & Postpartum
* 25% -‐45% of adolescents in the US fail to get adequate sleep * Of these, 75% experience chronic insomnia * Sleep is critical to brain maturation, which is why it’s so important in infants and adolescents * Mean sleep requirement for 10-‐18 year olds is 9.2 hours * Up to 16% of adolescents experience DSPS, Delayed Sleep Phase Syndrome, where the internal circadian rhythm is out of synch with environmental time
Adolescent Insomnia
* Process S is the drive to sleep that accumulates with increasing hours of wakefulness, changes during adolescence * This is associated with development of puberty * A 1 to 3 hour delay in melatonin secretion occurs, with girls experiencing an earlier onset of of this circadian delay – one reason they go through menarche earlier than boys * A resistance to this sleep pressure allows adolescents to stay awake -‐ up to 4 hours past scheduled bedtime
Adolescent Insomnia
* Alcohol increases SWS, which may also increase vulnerability to certain sleep problems such as sleepwalking or nightmares * A review of scientific studies on the impact of drinking on
nocturnal sleep has clarified that alcohol shortens the time it takes to fall asleep, increases deep sleep, reduces REM sleep and causes more sleep disruption * Increases in alpha-‐delta activity, which are associated with
poor or unrefreshing sleep and daytime function, have also been observed in individuals with chronic pain conditions
Alcohol & Sleep
* Women (58%) suffer from nighttime pain more than men (48%), according to a 1996 NSF Gallup Poll * In a more recent 2000 NSF Sleep in America poll, one in four women reported that pain or physical discomfort interrupted their sleep three nights a week or more * Pain conditions like migraines, tension headaches, rheumatic and arthritis conditions as well as heartburn are all more common among women
Pain & Sleep
* Changes in exposure to light and lost sleep caused by shift work may have biological or hormonal effects that are not yet entirely understood * One large study of women who worked night shifts over a 3-‐year period found a 60% greater risk for developing breast cancer
Shift Work
* Sleep apnea is a serious sleep disorder that is characterized by snoring, interrupted breathing during sleep and excessive daytime sleepiness * An estimated 18 million Americans
have sleep apnea including one in four women over 65 * While apnea is more common in men,
it increases in women after age 50
Sleep Apnea
* Being overweight is a risk factor for sleep apnea, the increase in abdominal fat during menopause may be one reason menopausal women are 3.5 times as likely to get this sleep disorder * Some attribute the prevalence to hormonal changes such as the decrease in progesterone to sleep apnea * Studies have found that sleep apnea is associated with atrial fibrillation and increased blood pressure, a risk for cardiovascular disease and stroke
Sleep Apnea
* Research shows that sleeping pills don’t work, but your brain is being tricked into thinking they do... * In one meta-‐analytic study, sleeping pills help people fall asleep approximately 10 minutes sooner – an insignificant improvement * On average, sleeping pills increase total sleep 15 minutes * They result in poor, fragmented sleep -‐ they also create amnesia, so upon waking , participants could not recall how poorly they’d actually slept
Sleeping Pills
* A study of 10,500 people who received drugs for poor sleep (hypnotics) had a 4.6 times higher risk of death compared to those prescribed no sleeping pills – even in those who took fewer than 18 pills in a year * Sleeping pills linked to these risks included
benzodiazepines (such as Temazepam), non-‐benzodiazepines (such as Ambien, Lunesta, and Sonata), barbiturates, and sedative antihistamines * The study showed increased risk for cancer and heart
disease was 35% higher -‐British Medical Journal 2012
Sleeping Pills
Risk of Sleeping Pills
Natural Approaches to Treatment
Insomnia Treatment
Lifestyle Interventions And
Behavioral Strategies Are The First Line Of Treatment For All Sleep Disorders
* Naturopathic medicine emphasizes prevention, treatment and optimal health by treating the whole person and educating patients to empower themselves to be part of their own health care * Naturopathy encourages the body’s inherent self-‐healing through the use of therapeutic methods and substances * The practice of naturopathic medicine includes scientific, traditional and empirical methods
Naturopathic Medicine
* Botanical medicines * Diet and Nutrition/Nutritional Supplements * Homeopathy * Lymphatic Massage * Lifestyle changes/Counseling: -‐Stress Management -‐Detoxification -‐Weight loss -‐Sleep Hygiene * Constitutional Hydrotherapy
Naturopathic Modalities
* SQck to a Sleep Schedule and sleep in a cool, dark room * Develop relaxing bedQme rituals, like taking a bath with Epsom salts * Exercise daily results in less anxiety, depression, and fewer hot flashes * Sleep on a comfortable maVress/pillows * Beware of interfering factors like alcohol and caffeine * Turn off all electronics 1-‐2 hours before bedQme
Healthy Sleep Tips
* Restless Leg Syndrome-‐results in involuntary leg twitching or jerking movements during sleep that can occur every 20-‐30 seconds. * Recent research indicates that iron or folate deficiency
may be a risk factor * Magnesium Threonate-‐crosses the blood brain barrier to
aid in neurological and nervous system relaxation for sleep -‐This form of magnesium is also effective for anxiety and pain
relief
Nutritional Considerations
* Losing ≥5% of initial weight was associated with short-‐term improvements in sleep duration and sleep quality * There were favorable short-‐ and long-‐term changes in mood * Weight loss also decreases incidence of sleep apnea
Weight Loss & Insomnia
* Homeopathy is a natural healing system of medicine that originated in Europe over 200 years ago, and has been used in the U.S. since the early 19th century * It is based on the philosophy that the body has an inherent wisdom to heal itself
What Is Homeopathy & How It Can Help with Insomnia
* Homeopathic medicines work by stimulating this innate ability in the body and strengthening the entire system without harmful side effects * Homeopathy is based on 3 principles: * Like cures like * Using the minimum dose * Individualized treatment -‐ tailored
for each person using the minimal dose required
Principles of Homeopathy
Urinary Neurotransmitter Testing
A New Way to Sleep Better
Calming
Serotonin
GABA
Taurine
Glycine
Stimulating
Epinephrine
Norepinephrine
Dopamine
Glutamate
Histamine
PEA
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There are calming and stimulating neurotransmitters
Difficulty falling asleep, waking
during the night, and waking too early
results from imbalances in
neurotransmitters
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What causes neurotransmitter imbalances?
Stress
Toxins
Genetics
Poor diet
Emotional Physical Sickness
Pesticides Insecticides Mercury
Junk food Food additives
Excess sugar
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Trends linked to poor sleep
Sleep disturbances
Low calming neurotransmitters
Elevated excitatory
neurotransmitters
Hormone imbalances
Neurotransmitter Patient 1 Patient 2 Patient 3 Patient 4
Epinephrine
Norepinephrine
Dopamine
PEA
Histamine
Glutamate
GABA
Serotonin
Glycine
Cortisol
Melatonin
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Different patients, different imbalances, same problem – can’t sleep
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Normal sleep treatment ignores individual differences: Trial and error
• Patient presents with poor sleep
• Patient prescribed sleep medication
• Try a new medication if sleep isn’t improved
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Is there a better way?
Better sleep!
Use therapy that
addresses those
imbalances
Identify unique
imbalances
Patient presents with poor
sleep
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When a therapy targets the specific imbalance, the likelihood of symptom relief increases
Low Serotonin
Serotonin Support
Medication 2
Serotonin Precursor
Perlis, R.H., Vlosifescu, D., & Renshaw, P.F. (2003). Psychiatric Clinics of North America, 26(2), 323-‐344.
Medication 1
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What can be done to improve
neurotransmitter levels?
• Healthy diet • Exercise • Toxin avoidance • Direct support
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Your diet provides the nutrients essential for optimal health
Fat
Fiber Carbohydrates
Protein
Amino Acids
Vitamins
Iron
Calcium
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Amino acids are the building blocks for neurotransmitters
Your health care provider can use amino acids in his/her custom-tailored program to
help relieve symptoms
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A poor diet reduces your body’s ability to make neurotransmitters
Fast food
Sugars
Processed food
Junk food
Exercise & Insomnia
One recent study found that overweight, post-‐menopausal women who exercise in the morning experience less difficulty falling asleep and better quality sleep than evening exercisers.
Raises the levels of many
neurotransmitters
Yoga
Walking
Strength Training
Jogging
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Exercise improves neurotransmitters
Toxins kill brain cells containing
neurotransmitters
Toxins stop communication in
the nervous system
Industrial cleaners
Water pollution
Heavy metals
Air pollution
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Avoiding toxins
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Taking amino acids can increase
neurotransmitter levels When you can’t get enough from
your diet to correct
neurotransmitter imbalances.
Case Review
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Trouble falling asleep
Trouble staying asleep
Tired upon awakening in morning
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35 year old female
High excitatory neurotransmitters
Low calming neurotransmitter
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Take-‐away Points Sleep is affected by many neurotransmitters and hormones. Imbalances can contribute to sleep problems.
Identifying which neurotransmitter is out of balance is the first step in addressing sleep disturbances.
Amino acids (the building blocks for neurotransmitters) are an effective approach for addressing sleep disturbances.
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Ask your health care provider if neurotransmitter testing is right
for you.
So You Can Sleep Like a Baby
And Wake Like This
And Not Like This
For More Information: Call Northern Sun Family Health Care
# 207-‐798-‐3993
Or visit us online at: Northernsunhealth.com
~ Insomnia ~ A Naturopathic Approach
* National Sleep Foundation.org * Harvard Healthy Sleep Website: Sleep and Disease. Healthysleep.med.harvard.edu * Adolescent Insomnia, Lisa Watson, ND. Naturopathic Doctor News and Review. March 23,
2012. * Hidden Causes of Insomnia, Bradley Bush, ND. Naturopathic Doctor News and Review. April
1, 2012. * Neurotransmitters and Sleep. sleepdex.org/neuro.htm * Neurotransmitters and Insomnia. Neuroscience/neurorelief.com * Hypnotics association with mortality or cancer: a matched cohort study. BMJ Open 2012;2. * Major sleep disorders among women: (women's health series) South Med J. 2013 Aug;
106(8):470-‐8. doi: 10.1097/SMJ. * Sleep in women.Semin Neurol. 2011 Sep;31(4):397-‐403. Womens Health 2008 Sep;17(7):1191-‐9 * Sleep disorders and medical conditions in women. Proceedings of the Women & Sleep
Workshop, National Sleep Foundation, Washington, DC, March 5-‐6, 2007.
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