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Insomnia

By Sabine Hiller, MIIMH

Sufficient good quality sleep is essential for your health and wellbeing, but most people have at some stage or another found it difficult to go to sleep or suffered from waking during the night. Usually this happens in response to stress or worry, and hopefully won’t last more than a few nights. However, if sleep problems persist on a regular basis (i.e. more than 3 nights a week) and for more than a month then it’s called chronic and a closer look needs to be taken. There are a number of possible causes for sleep disturbances:

Causes of insomnia  

• Noisy environment
• Being too hot or too cold
• Shift work
• Jet lag
• Alcohol or cocaine consumption
• Caffeine in coffee, tea, soft drinks and over-the-counter pain medication
• Conventional drugs, e.g. bronchodilators, thyroid hormone, anticonvulsants and others.
• Conditions causing pain or itching
• Conditions affecting breathing, such as asthma, sleep apnoea or congestive heart failure
• Tinnitus (ringing in the ears)
• Restless leg syndrome
• Stress, anxiety, depression

For transient or short-term cases of insomnia that are not caused by a medical condition, following a simple relaxation technique, changing your bedtime routines or taking a relaxing bath will often do the trick. For chronic cases it is advisable to see a medical herbalist, who will look into the causes, discuss lifestyle changes with you, prescribe a personalised combination of herbs, and if necessary refer you back to your GP for further investigations or treatment.

Here is an outline of the strategies medical herbalists may employ when treating a patient with insomnia:

1. Herbs

Herbs frequently used by medical herbalists in the treatment of insomnia include: Valerian, Passionflower, Hops, Californian poppy, Virginian skullcap, Green oats, Chamomile, Lime flower, Lemon balm, Motherwort, St. John’s wort, Jamaican dogwood.

In most cases a medical herbalist will not only give you a sleep mix to be taken at bedtime, but also a daytime mix that will deal with any underlying problems. If, for example, insomnia is caused by anxiety, calming and relaxing herbs will be included in such a general mix. Likewise, a sleep mix for a menopausal woman will be different from the sleep mix for somebody with restless legs. For best results herbs are always chosen to reflect the needs of the individual patient.

Herbs will usually be prescribed in the form of tinctures (alcoholic plant extracts) to be taken in water. If alcohol needs to be avoided, you may be given teas, powders or capsules.

2. Baths

Various dried or fresh herbs, like chamomile, limeflower, lemon balm and lavender can be filled loosely into a muslin bag, infused in boiling water for 5-10 minutes and added to the bath before you enter the water. The muslin bag can then be used as an aromatic sponge.

Alternatively, 2-4 drops each of chamomile and lavender essential oils can be added to one of the following:

• an egg cup full of cream
• an egg yolk
• a small cup of milk
• a few spoons of liquid honey
• a little liquid soap
• a handful of sea salt (allow to ‘mingle’ for a while before use)

stir well and add to the bath water. If a full bath isn’t practical, foot baths can often be just as effective.

3. Massage

1-2 drops each of lavender, chamomile, and / or rose essential oil can be diluted in an eggcup full of carrier oil (e.g. almond, jojoba, sesame or olive oil) for a gentle and relaxing massage at bed time. Alternatively you could just do a hand and foot massage, which can be surprisingly effective.  

4. Nutrition

The essential amino acid tryptophan is needed by the body to make serotonin and melatonin. Increasing the intake of tryptophan may result in higher levels of serotonin, which in turn is responsible for improved sleep and reduces the time needed to fall asleep. Foods rich in tryptophan include chicken, turkey, eggs, milk, cheese, tuna, halibut, tofu, cooked soybeans, nuts and seeds, oats, bananas. Try having a small snack of tryptophan rich foods 1 hour before bedtime, but make sure you combine them with a carbohydrate, as insulin helps deliver tryptophan to the brain:.

Examples:

• oatcake with nut-butter and banana slices
• a wholegrain cracker or toast with chicken, turkey or tofu-spread

Such a snack will also combat nocturnal hypoglycaemia (low night time blood sugar levels), which can play a role in causing disrupted sleep.

Ensure that your diet includes sufficient magnesium and calcium, found in foods such as: green leafy vegetables, nuts and seeds (especially hazelnuts, almonds), sardines eaten with bones, buckwheat, barley, yoghurt, chickpeas, tofu. Getting enough B-vitamins is likewise important, especially B6, which is found in spinach, turnip greens & other green vegetables, red peppers, potatoes, banana, chickpeas, oats, fish, chicken, turkey and other meats.

Sources:

http://dietary-supplements.info.nih.gov/factsheets/vitaminb6.asp

http://www.whfoods.com/sitesearch.php

Whitney EN, Cataldo CB, Rolfes SR (1998) Understanding normal and clinical nutrition, West/Wadsworth, Belmont

5. Relaxation and other non-pharmacological methods

The longer the duration of a sleep disturbance, the more important non-pharmacologic interventions become due to various learned behaviours that may perpetuate the sleep problem. For example, somebody who for several months has taken hours to go to sleep, will go to bed tense with the fearful expectation that they will lie awake yet again. To break this pattern becomes a crucial task and the following strategies have been shown to help.

5a. Relaxation

Amongst the many methods of relaxation, PMR (progressive muscle relaxation) is one of the easier ones to learn, but joining a yoga class, learning meditation or autogenic training are all great ideas.

Progressive Muscle Relaxation (PMR)

This is a simple technique in which the major muscle groups of the body are alternately tensed and relaxed. Relieving muscle tension will result in physical relaxation, which in turn directly induces mental calmness. This technique was first described in the 1930s by Edmund Jacobsen and has been shown to be very successful in reducing stress, tension, anxiety and depression, as well as helping in the treatment of insomnia. Used over time it will also help you to accurately identify the first signs of stress and tension in your body - allowing you to take prompt action!

This is how you do it:

Start with the feet and legs, working your way up via buttocks, abdomen and chest to the shoulders, arms and head, or alternatively you can start with the head and work your way down the body. It can be done seated, but for insomnia it is best done lying down!

1. While inhaling, contract one muscle group (for example your upper thighs) for five seconds, then exhale and suddenly release the tension in that muscle group.
2. Give yourself ten to 15 seconds to relax, then move on to the next muscle group (for example your buttocks).
3. While releasing the tension, try to focus on the changes you feel when the muscle group is relaxed. Imagery may be helpful as you release the tension, such as imagining that stressful feelings are flowing out of your body.
4. Gradually work your way along the body contracting and relaxing each muscle group.

Different people carry muscle tension in different parts of their bodies, so the muscle areas that need extra emphasis will vary from person to person. While most people will report increased levels of mental relaxation and reduced physical tension after just one session of PMR, regular practice will allow you to achieve even deeper levels of relaxation.

Source:

Greenberger D, Padesky C, 1995. Mind over Mood. Guildford Press, New York .

5b. Sleep Hygiene

Sleep Hygiene guidelines are part of the behavioural treatment of insomnia, and most can be easily implemented. The key points are: Make sure your bed and bedroom are comfortable, quiet, dark and neither too hot nor too cold.

• Avoid heavy meals, caffeine, alcohol, nicotine, other stimulants and excess liquids 4-6 hours before bed, and review all medications to see could they interfere with your sleep.
• Use the bedroom only for sleep and sexual activity; avoid excessive wakeful time in bed (no more than 15-20minutes).
• Avoid daytime napping
• Exercise regularly, but not in the hours before bedtime
• Avoid upsetting or stimulating activities before you go to bed (e.g. distressing films or books, arguments). Instead, establish a relaxing routine before bedtime.
• Restrict time in bed and maintain a consistent sleep-wake time, even after a poor night’s sleep the previous night, aim to get up at the usual time.

Other cognitive-behavioural therapy (CBT) approaches include sleep restriction, stimulus control, paradoxical intention and identifying and addressing a patient’s thinking and behaviour around sleep. Several measures can be combined for maximum effect. (For more information see reference below or contact a CBT therapist).

Source:
Lynch A M et al, State of the Art Reviews: Nonpharmacologic Approaches for the Treatment of Insomnia, American Journal of Lifestyle Medicine 2007; 1; 274  

6. Other measures  

Some people can’t go to sleep because their pillow feels too warm. In this case wrapping your pillow in a plastic bag and leaving it in the freezer for a few minutes can make all the difference, especially when you are suffering from a headache or hot flushes.

Compiled by: Sabine Hiller, MIIMH, MNIMH, Knockrooskey, Westport , Co.Mayo, 098-35909

 

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