What is Insomnia?
Insomnia is a common sleep disorder present in the entire population at a rate of more than 30%. Approximately 10 million people in the U.S. use prescription sleep aids. Other common sleep disorders include sleep apnea and Restless Leg Syndrome. Sleep is vital to health and lack of it or a poor sleep quality is associated with a large number of medical and psychiatric conditions. For instance, insomnia is associated with anxiety, fibromyalgia, old age, menopause, pain and cancer to name a few. A restful sleep is essential for physiological repair and restoration of mental function. Therefore, sleep hygiene or improvements of sleep patterns and habits, is a priority in all of our treatment plans.
Our guidelines are
- Address the underlying medical or psychiatric cause
- Initiate lifestyle and nutritional changes
- Avoid pharmaceuticals such as benzodiazepine or non benzodiazepine drugs
- Control the sleeping environment and regulate sleeping habits
- Balance neurotransmitters and hormones responsible for sleep
Types of Insomnia
Insomnia presents under different forms. They are not all present in one person.
Difficulties to fall asleep
Waking up one or several times during the night
Waking up too early
Insomnia could be transient as in jet lag and does not need treatment. A small dose of melatonin or lying in the sun may be enough to restore the circadian rhythm. Or it could be occasional after a heavy meal at night or emotional upset. If insomnia is chronic: More than 4 week long, it requires medical attention.
Causes of Insomnia
Insomnia is often associated with pain, anxiety, depression, chronic illness, aging and most of the time with a poor lifestyle and nutrition. Sleep is regulated by hormones and hormonal and neurotransmitter imbalance is the hallmark of sleep disturbances. Any type of stress such as chronic pain or anxiety will stimulate the HPA axis and the production of the stress wake hormone cortisol, antagonizing melatonin and sleep.
Sleep, insomnia and pain
Physical pain is h2ly associated with difficulty sleeping. For instance someone suffering from fibromyalgia will have more severe body pain after a poor night sleep. Someone with cancer will wake up at night from the pain and have difficulties going back to sleep.
Sleep, insomnia and anxiety
One could say that anxiety is mental pain. Anxiety is a state of mind that is characterized by attachment to consciousness and sleep is a state of detachment from consciousness. Worrying about the future or feeding the thinking process creates a high arousal and wakeful state. The overactive negative mind causes the adrenal glands to produce high levels of cortisol that create a heightened awareness and a sympathetic state of arousal. 30% of people suffering from insomnia also suffer from anxiety.
Sleep, insomnia, oversleeping and depression
Depression can affect sleep in both direction oversleeping or under sleeping.
Sleep, insomnia and stimulants
Any substance stimulating excitatory neurotransmitters will disrupt sleep. For instance coffee, chocolate, sugar, nicotine, alcohol, marijuana or other drugs will create a state of arousal and may make falling asleep difficult.
Sleep, insomnia and sleeping pills and opiates
In our practice we deal frequently with rebound insomnia associated with withdrawal from opiate and benzodiazepine addiction. Opiates and benzodiazepines interfere with neurotransmitter balance and it may take a long time for the brain to recover.
Sleep insomnia and poor lifestyle
In most patients, insomnia is the result of a sedentary lifestyle and poor digestion. In particular, a late heavy meal or alcohol will make it hard to fall asleep or will wake you up in the middle of the night with difficulties to go back to sleep. Lack of exercise affects hormonal level and slows metabolic processes, but late exercise may raise your cortisol levels and make it difficult to find sleep.
Insomnia and obesity
Recent research shows that lack of sleep is a cause of obesity.
Treatment of Insomnia: Our Program
The first step consists of a hormonal and neurotransmitter testing. The test will include measurements of melatonin, serotonin, GABA, dopamine, norepinephrine, thyroid, cortisol and sex hormones. Trends associated with sleep disorders are low serotonin and low melatonin, high cortisol or one of the other excitatory neurotransmitters such as histamine.
A second step consists of taking a thorough history to reveal possible mental, emotional or physical causes of insomnia: Anxiety, depression, stress, lifestyle and nutritional habits or primary physical illness.
The treatment of insomnia includes a biochemical rebalancing of the brain based on test results, treatment of anxiety and depression or any primary illness, counseling and in-depth therapy to address post traumatic stress syndrome, fears, or possible compulsive thoughts, lifestyle changes to eliminate stimulants, poor dietary habits, sedentary lifestyle and intervention on the bedroom environment to create optimum sleep conditions.
Neurotransmitters are classified under excitatory or inhibitory. Excitatory neurotransmitters are responsible for the state of wakefulness. These are Epinephrine, norepinephrine, glutamate, histamine and phenylepilamine (PEA). Inhibitory neurotransmitters: Serotonin, GABA, Taurine, Glycine are responsible for the state of drowsiness. In the evening the drop of excitatory neurotransmitters and raise of inhibitory neurotransmitters stimulates the production of melatonin, the sleep hormone produced by the pineal gland. The rise in sleep hormone inhibits the production of cortisol from the adrenals, the stress hormone responsible for the state of wakefulness.
Low levels of inhibitory neurotransmitters can lead to insomnia. Levels of Inhibitory neurotransmitters, Serotonin, GABA, Taurine, Glycine rise in the evening and must stay elevated during the night to insure uninterrupted sleep.
Levels of Excitatory neurotransmitters Epinephrine, norepinephrine, glutamate histamine and phenylepilamine (PEA) are high during the day and low at night. Cortisol levels should drop at night and high levels of cortisol in the evening or peaks during the night can cause sleep disturbances.
Anxiety is a major issue commonly associated with insomnia. Anxiety is a state of mind characterized by overstimulation of the brain and an overactive sympathetic system. It is the anticipation or the reactivation of a painful or stressful event. It could also be the perception of a sense of threat coming from common present events, as in Post Traumatic Stress Syndrome. Whether this anxiety is triggered by the fear of death in a major life threatening illness or whether it is a pattern of worrying about the future or dwelling in past traumatic events, it gets more intense at night as the unconscious mind needs to take over from the conscious mind for sleep to happen. Holding on to the conscious mind is a protective mechanism against confrontation with unconscious issues that the person is trying to avoid. Worrying is a habit characterized by a negative attachment to the mind and the inability to detach from it. One is going over and over unresolved issues associated with a negative emotional content, guilt or fear or suffering or pain.
Breaking the worrying cycle involves looking at the underlying belief system sustaining the worrying pattern, learning how to detach consciously from the mind with meditation and taking a rational approach to analyze and understand the mechanism of worrying.
Treatment of anxiety and sleep disorders
Conventional treatment uses anti-depressants and benzodiazepines, such as Klonopin or Ativan. Benzodiazepine drugs have serious long-term side effects such as dependence, memory loss, confusion, daytime drowsiness and depression, and are better avoided. In addition to benzodiazepine drugs prescribed for sleeping disorders, non-benzodiazepine drugs such as Ambien are also used to treat sleep disorders. Non-benzodiazepine drugs can have many digestive and neurological side effects such as constipation or change in appetite and tingling, dizziness and loss of balance.
Our holistic approach to treating anxiety is multifaceted and addresses biochemical, psychological and mental factors. We multiply awareness approaches to switch the center of gravity from the mind to the body and the heart to bring about feelings of inner peace and serenity conducive to a regenerating sleep.
Hormonal and neurotransmitters rebalancing
It is useful to obtain measurements of major hormones such as thyroid, cortisol, insulin, estrogen, testosterone and progesterone.
Brain chemistry is also useful to assess: Stress, lack of exercise, poor nutrition and pharmaceutical drugs deplete neurotransmitters. Neurotransmitter testing will guide us in a precise neurotransmitter rebalancing with herbs and amino acid precursors.
Meditation is a tool to learn detachment from the mind. Meditation is the art of learning how to watch one’s thought and get disengaged with the thinking process.
Deep psychotherapy to address unresolved traumas
Reichian Breathwork is a non-verbal method developed by Wilhelm Reich to bring the unconscious to the surface and resolve past emotional traumas.
Lifestyle counseling for behavioral modification regarding poor nutrition or lifestyle habits.
Stress is a common reason for sleep disorders. Stress is the perception of a threat coming from the external or the internal environment.
Any event can create stress since it is a personal perception. Stress management, an important part of our recovery program teaches how to disengage emotionally from life events.
Depression is associated with neurotransmitter imbalance in particular low serotonin levels in the brain. Melatonin the sleep hormone is manufactured from serotonin and consequently a deficiency will lead to insomnia. Our strategy is to restore of the proper brain biochemistry and address the pertinent psychological or social issues that are associated with depression.
In depression, there is an over-stimulation of the brain by negative ideation that manifests in a more disturbing way at night. Unconscious issues take advantage of the sleeping time to merge to the consciousness of the depressed individual. Dealing with these issues with psychotherapeutic tools will bring peace and balance over time. We use the following modalities: cognitive behavioral therapy, counseling, EFT, Reichian breath work or the Work of Byron Katie. On the spiritual plane we can consider that depression is imbalance in the vertical dimension with a h2er pull of gravity and a weaker sense of uplift from the cosmic pull. Reestablishing happy activities as simple as walking, swimming, practicing laughter therapy will affect the brain’s chemical balance as well as reestablish a sense of connectedness and belonging. Exercise increases the levels of serotonin and is an easy natural treatment for the treatment of insomnia due to depression. Walking in nature oxygenates the body and the brain and creates a natural uplift. The speed may be progressively increased to running.
Post Traumatic Stress Syndrome (PTSD)
PTSD is associated with sleep disturbances. The pathways of the initial trauma in the brain get reactivated and create a state of fear and hyper-alertness detrimental to sleep.
Physical pain due to a physical illness
It is necessary to deal with the illness. In case of injury it is a temporary situation and doing some mental exercises to take the attention away from the physical pain may be enough to induce sleep. In cases where the inability to fall asleep is due to pain from the last stage of cancer, pain medications are often necessary. Relaxation training and meditation are useful in learning how to dissociate from the pain.
Sedentary lifestyle, Lack of exercise
TV and computer overuse create stagnant nervous energy. Creating simple daily exercise habits such as walking or walking will counter the effect of sedentary life. A sedentary lifestyle is often the unique cause of insomnia. During the day, we were meant to expend energy seeking food and not to sit in an office or in front of a TV for hours. With low levels of activity, the energy stagnates and metabolism slows down. In addition electricity extends the wake time at night and we maintain longer than necessary activity levels that encourage cortisol secretion rather than melatonin secretion, the appropriate hormone associated with drowsiness and sleep. Often dinner is too late after dark. The eyes and the ears are over-stimulated and a state of wakefulness is hormonally created with high secretion of the stress hormones and low secretion of the hormones that produce rest and relaxation
An important cause of insomnia is the consumption of foods and beverages late in the evening. Our raw food nutritional program eliminates all over stimulating hard to digest toxic foods and beverages.
These substances are coffee, tea, sugar, alcohol, chocolate, spices soft drinks and tobacco. Some other foods such as fried oil, high protein content, poor combination of foods and processed foods containing chemical preservatives are toxic and require over working of the liver. An overactive liver may be the cause of insomnia. Many pharmaceutical drugs are stimulating: Anti depressants, thyroid, asthma, ADHD Attention Deficit Hyperactivity Disorder) and heart medication can affect both the quality of sleep and sleeping time. Drugs for insomnia create rebound insomnia when the person quits.
Waking up during the night may be due to the need to urinate. This need may be the sign of too high intake of fluids during the day or in the evening. Reducing this intake is an easy fix. Many men as they are aging suffer from an enlargement of the prostate and must address this issue as early as possible. In this case reducing the fluid intake in the evening will be a good strategy to limit the wake up time episodes.
Snoring may be a reason why people wake up from their sleep. Diet is an important reason for this type of insomnia. Breathing exercise will be helpful in this case.
Noises or electrical lights, excessive temperatures or lack of ventilation are all factors that can interfere with sleep. It is better to use cotton sheets and a comfortable mattress. Blanket weight, pillow sizes and material, room temperature ventilation position of the bed in the room all need to be carefully reviewed. We guide our patients into a ritual prior to going to bed to optimize the room and bedding conditions.
At night the body temperature must go down to a certain set point for sleep to happen. Sleeping in a room that is too hot or too cold makes it harder for the body to find its ideal temperature for sleep. The body temperature must be even and if you have cold feet, it is better to wear wool socks.
Too many electrical appliances in the bedroom may generate disturbing EMF keeping the mind in a state of alertness. The contact of synthetic fibers may stimulate the nervous system and we prefer to use 100% organic cotton fiber for our sheets and pillowcases. If someone is allergic to feathers, they may need to use synthetic fibers. We prefer feather to synthetic fibers if people do not have any allergy because it is more pliable and adaptable to the body.
Sometime sounds even thought pleasant can also be too stimulating such as the sound of the ocean or the birds and silence needs to be created with earplugs.
Darkness must be as total as possible if the room is exposed to streetlights and thick curtains drown at night. A mattress that is too soft or too hard may be a source of physical discomfort and contribute to difficulties to fall asleep.
Drinking fluid later at night causes a physical stimulation to void the bladder and it is better to stop drinking fluids at 5 or 6 PM.
Fear of the night
Fear of the night is the fear of the unseen and the unknown fear of mystery and the unconscious. To deal with that fear it takes confronting that fear. I often prescribe a night walk with psychological tools to move through the fear. After doing this exercise a few times, darkness is not seen as a threat but as an ally.
Natural tools to fall asleep quickly
Remove computers, cell phones or other electronic devices.
Unplug electrical appliances
Create darkness in your room, turning off all lights.
Check ventilation and temperature of the room
Check number and weight of blankets.
Fluff up pillows and lay them in the right position
Creating a favorable peaceful relaxing state of mind is the next important condition after a comfortable environment.
Prepare sleep with meditation, listening to peaceful music, or to read a book.
Create a ritual to welcome darkness, feeling gratefulness for the day and saying goodbye and bring inner peace
Releasing the past and the future: Do a ritual to feel safe. Pledge no attachment to the past and enjoy the mystery of the future.
Releasing fear: focus on the heart not on the head.
Get in the parasympathic mode, nurturing the belly brain: feel your belly, breathe into your belly.
Pray for a deep rest.
Natural tools to avoid waking up
Stop drinking fluids and food around 5 or 6 o’clock PM
Eat a light dinner
Get your bed made properly.
Avoid synthetic material. Use cotton sheets
Wear non-constrictive clothing or no clothing.
Prior to going to bed have a picture in your mind of a full night sleep
Tools to get back to sleep quickly
Go to the bathroom
Read a book until you feel sleepy again
Take a hot shower
Get into a nurturing position in your bed
Drink a glass of water
Tips to have a restful sleep
Go to bed early, 9 PM is best or 10 PM at the latest. We are meant to go the sleep with darkness and wake up with light.
Have an early dinner, 5:30 PM or 6:00 PM.
Do not drink liquids past 6 PM
Do not drink alcohol or drink moderately. Do not smoke. Avoid pharmaceutical drugs with a side effect of insomnia.
Exercise, in particular take a walk in the afternoon before sunset.
Surrender to the power of the night and its magic
Let go of control and offer yourself to god, life, karma or nature.
Surrender to yourself and this beautiful moment.
Think rest, going back to the source, letting go of the mundane world, merging with your true self and true reality. When you wake up in the morning think: the dream begins.[/note]
Natural remedies for insomnia
Melatonin 2 or 3 mg ½ hour prior to going to bed to help falling asleep
5HTP, L tryptophan to help going back to sleep when awake at night
Hypnotic herbs such as valerian, lemon balm, chamomile and hops or muscle relaxant such as Kava
Aswhaganda for adrenal support
Stages of sleep as recorded by electroencephalography (EEG). The slowest and h2est waves on an EEG, delta waves, are where mammals sleep the deepest (stages 3 and 4). This slow-wave sleep is very important because the body performs maintenance tasks during this sleep. For example, bone and muscle growth as well as hormone secretion are performed.