Sleep Remedies that Work: Neurotransmitters and Hormones
November 7, 2017 | 41 Comments | SAFM Team
We all know it: high-quality sleep is vital to every client’s healing. While the body appears from the outside to be still and inactive, sleep is a time when the body is quite busy. During the night, we restock our supply of hormones, process significant toxins, repair damaged tissue, generate vital white blood cells for immunity, eliminate the effects of stress, and process heavy emotions. Unfortunately we have an epidemic of sleep disorders – from trouble falling asleep to often-interrupted sleep to actual insomnia. There are, however, several straightforward remedies you can offer your patients in this area. Whenever a new client is struggling with sleep, it is always the first priority I address in their healing journey. Sleeping soundly will increase your patients’ motivation to make further lifestyle changes (e.g. when well rested, it is always easier to eat more healthily). And your help in making it happen will increase your credibility with them substantially.
We fall asleep due to the gifts of the pineal gland, a small ant-sized lobe near the middle of our skull in the interbrain. Following our circadian rhythm, the pineal gland secretes a neurotransmitter and hormone called melatonin. Melatonin suppresses the activity of other neurotransmitters and helps to calm the brain (in part by countering the stress hormone cortisol from our adrenal gland). And as we become more drowsy, the brain slowly begins to turn off our voluntary skeletal muscle functions, so we don’t move around too much and try to act out our dreams or disrupt the body’s internal revitalization work. (Note this is also why it’s so hard to move your limbs or shout out in response to a nightmare.)
For ideal sleep, melatonin should be rising steadily and cortisol should be rock-bottom low at bedtime. But there’s a catch: the pineal gland secretes melatonin largely in response to darkness. And our evening cortisol levels are lowest in environments with low noise. With our addictions to TV, video games, and email in the evening, however, our choices can get in the way of these natural pro-sleep chemical shifts. These devices mostly display full-spectrum light which can confuse the brain about whether it’s night-time or not. We also, unfortunately, tend to watch shows or view email that can be loud and/or stressful (e.g. the evening news, a crime show, work email, or ever-longer to-do lists). Digesting a heavy meal eaten later in the evening can also prevent (or interrupt) sleep.
So the first thing we can offer our sleepless patients is support with their “sleep hygiene”. I am amazed at how often this is all they need in order to get better sleep. Help them to identify more calming, quieter evening activities (e.g. reading a book, taking a warm bath, going for a light stroll outdoors, playing with a pet, folding laundry). I recommend no email, TV, next-day-planning, or stressful conversations in the full hour prior to bedtime. If noise is an issue, I often recommend soft foam ear plugs or the white noise of a fan. It is also important to the bedroom not be too hot, as this can disrupt sleep during the night. Herbal tea (e.g. lavender, chamomile, valerian, passionflower) can also help one to relax and set the tone for sleep. I also recommend no food a full two to three hours before bed and no caffeinated food or drink after 2pm in the afternoon (e.g. tea, coffee, soda, chocolate, mate). Many of my patients are stunned to realize how much a later-evening, heavy meal prevents sound sleep. Here is a helpful patient handout on the power of Sleep Hygiene.
There are definitely many cases, however, where pro-sleep behavior is simply not enough. For some clients, their brains simply aren’t able to make enough melatonin to ensure solid sleep all night long. Or there is a chemical imbalance preventing sufficient relaxation.
- If they have trouble falling asleep, I recommend 1mg of melatonin taken 30 min. prior to bedtime (start with the lowest dose for several days before increasing, as this or even 0.5mg may be enough; taking too much will result in grogginess the next morning). This is safe and effective for short-term use (avoid using every night long-term to keep your own pineal gland secreting to its best ability). Note that melatonin actually helps also to reduce blood pressure during the night too, a key respite for our patients with hypertension. Use of beta blocker medications or frequent use of NSAIDs can deplete melatonin and cause these sleep difficulties.
- If your client falls asleep fine but awakens in the middle of the night and cannot easily go back to sleep, their problem is likely an insufficient supply of melatonin throughout the night. Giving them melatonin before bed probably will not help much Instead, I recommend 100-200mg of 5-HTP (5-hydroxytryptophan) before bed. The body makes melatonin from a neurotransmitter called serotonin. And we make serotonin from an amino acid called tryptophan. 5-HTP is a precursor to serotonin that, in a healthy body, can be converted to melatonin a few hours later. A steady flow of melatonin will help patients to sleep more deeply, soundly, and without interruption. Note: do not recommend 5-HTP to any client taking an SSRI or SNRI (or other serotonin-enhancing) antidepressant or sleep medications without their doctor’s review (e.g. Zoloft, Trazadone, Wellbutrin, Ambien); you do not want to risk them developing serotonin sickness, a toxic surplus of serotonin.
- If a client has trouble with overnight “hot flashes” (especially if they are not perimenopausal/menopausal women), then the cause is usually abnormal cortisol rhythms. If the flashes occur in the later hours of night (e.g. 2-4am), that is usually associated with high cortisol that is rising to meet the day early and aggressively (showing that the body has been primed to expect very stressful circumstances). Significant, sustainable stress relief is key. Night-time intake of calming adaptogenic herbs can often be helpful (e.g. holy basil, ashwagandha, magnolia, l-theanine e.g. Xymogen’s “CortiSolv”). On the other hand if the hot flashes are earlier in the night, especially if they are associated with hunger, might be due to low cortisol and thus low blood sugar overnight during the natural fasting that occurs then. The flash is due to a surge of epinephrine to force blood sugar back up to an acceptable level. A bedtime snack that includes protein and some healthy fat might be helpful in the short-term (e.g apple with almond butter). But don’t stop there! It’s also important to investigate the true root cause drivers such as insulin resistance (e.g. Fasting insulin greater than 5 mIU/L).
- If a patient has full-fledged insomnia, a combination of melatonin and 5-HTP (yes, you can take both at the same time) is often quite helpful in combination with the sleep hygiene methods mentioned above – at least temporarily while you are helping them to reduce chronic stress and increase primary food satisfaction.
- If a client has trouble getting stressful thoughts out of their minds at bedtime or cannot sleep due to pain, it is often because of an imbalance of excitatory and inhibitory neurotransmitters in the brain (specifically glutamate and GABA, respectively). They will likely benefit greatly from taking calming herbs one to two hours prior to bedtime. I have explored many blends with patients and find that 500mg of ashwaghanda and/or holy basil leaf works best (perhaps combined with 1-3 capsules (~300mg each) of valerian in extreme cases). All of these are long-standing herbal remedies. It is also key to ensure your client isn’t getting surplus glutamate from their diet, likely via the artificial sweetener aspartame (e.g. Nutrasweet) or MSG (often hidden in food e.g. autolyzed yeast extract, hydrolyzed vegetable protein). If these options don’t work to calm a “racing mind”, they likely need more targeted neurotransmitter support; here are some very specific suggestions.
- If a client has trouble sleeping when they have had an alcoholic beverage(s) in the evening, this is usually because alcohol interferes with GABA/Glutatmate balance in the middle of the night. Initially alcohol increases GABA (inhibitory) and blocks Glutamate (stimulatory). Once the alcohol is metabolized and its effects wear off, however, there is a rebound effect that increases glutamate which wakes you up and makes sleep light and/or interrupted the rest of the night. Another calming neurotransmitter (and amino acid) called Taurine can be taken at bedtime to ease and reduce the rebound effect. Taurine increases GABA receptor binding and thus promotes an inhibitory state. You may easily recommend they try 1000mg of taurine prior to bedtime to help reduce this interference.
There are many sleep medications available to clients today. These can be useful for triage when one is going through short-term trauma or stress. Unfortunately, all of them work essentially as mild sedatives and are not addressing the root cause of any long-term sleep disturbance. They also come with a wide range of side effects that render them unacceptable for long-term use – from dry mouth to stomach ache to a hangover-like fatigue the following day. But it’s also important to make sure your patients understand that many of these medications can increase the risk of both cancer and death – even with just occasional usage. If your clients wish to stop taking these medications, encourage them to do so slowly (weaning) to avoid any chemical backlash from neurotransmitter imbalance.
Without restful sleep, it can be challenging for any of us to consider lifestyle change. Help your clients to be wildly satisfied by addressing poor sleep as an initial priority in your work together. You can do it! Please feel free to be in touch if you have other unusual cases you’d like to share. I am happy to help.