A sleepless night is bad enough, but insomnia and other chronic sleep disorders are a long-term threat to your health. Poor sleep often causes personal and health issues that cause anxiety leading to even more sleeplessness. This process can create a vicious and worsening feedback loop that seriously impacts your quality of life and can lead to illness. Sleep can come courtesy of over the counter or prescription drugs, but those often have unintended consequences. Natural sleep aids leading to natural sleep are the better choice if they can be had.

In this excerpt from the book Real Cause, Real Cure by Jacob Teitelbaum, MD and Bill Gottlieb, CHC the authors discuss the best natural sleep aids, explain how and why they work, and how to help you get back to restful sleep.

Insomnia and Other Sleep Disorders

Real Causes

  • Hormonal Imbalances. Sleep is controlled by the hypothalamus in the brain, and it takes energy for the hypothalamus to function normally. Because of this, anything that depletes energy can disrupt sleep. Low levels of estrogen, thyroid, and adrenal hormones also disrupt sleep
  • Happiness Deficiency. Chronic stress is a major energy robber, interfering with deep sleep
  • Nutritional Deficiencies. Low levels of magnesium and iron can cause restless legs syndrome. A nutrient-poor, high-calorie diet can also cause excess weight and obesity, which causes sleep apnea.

If you want to find out about the problem of insomnia—what it is, how many Americans aren’t sleeping well, and the health conditions it causes then…

  • More than 100 million Americans struggle with sleep.
  • Around 70 million have a sleep disorder, such as sleep apnea or restless legs syndrome.
  • Insomnia is a little-recognized risk factor for dozens of conditions and diseases, from anxiety, burnout, and depression, to big killers such as heart disease, stroke, and diabetes.

Real Cure Regimen

Sleeping pills are a popular solution, but they’re not a cure. For one thing, they’re not intended for long-term treatment. For another, they’re potentially addictive. And they can cause a lot of side effects, including short-term memory problems and next-day drowsiness.

But this chapter isn’t about the problem of insomnia. It’s about the solutions—the easy-to-form habits and natural remedies that can almost guarantee you’ll get a good night’s sleep.

Good Sleep Starts with Good Sleep Hygiene

You know about “dental hygiene” because your dental hygienist always bugs you about it: Brush your teeth and floss at least twice a day and see your hygienist every six months for a cleaning. The purpose of good dental hygiene is healthy teeth. By forming those regular habits, you prevent gum disease and decay.

But there’s no “sleep hygienist” to tell you about good sleep hygiene. And that’s too bad. Good sleep hygiene—the daily (and nightly) habits that can prevent and reverse insomnia—is the best cure for insomnia. Here are the habits that can help you write your own ticket to dreamland…

•Give caffeine a curfew. The caffeine in coffee, tea, cola, and chocolate stimulates your nervous system, and jumpy nerves aren’t very conducive to falling asleep. Stop ingesting caffeine seven or eight hours before your regular bedtime; 4:00 p.m. or so is a good cutoff point. Even better, reserve caffeine-containing food and beverages for the morning.

•Exercise early. Exercise is stimulating, too. Try to schedule your workout early in the day—at the latest, right after dinner.

•Bedtime is a good time for snacks. Hunger causes shallow sleep in all animals, and we humans are no exception. Have a light, high-protein snack before bedtime. A particularly good choice: foods rich in the amino acid tryptophan, which soothes the brain. Snack on a slice of turkey, a hard-boiled egg, or a chunk of cheese or soy cheese. This is especially important if you often find yourself wide awake in the middle of the night (which often occurs from a drop in blood sugar).

•It’s not a good time for a nightcap. Alcohol boosts blood sugar, which drops a couple of hours later, in the middle of the night, which might wake you up. Having one or two drinks in the early evening is okay, but if you wake up or have restless sleep later in the night, try cutting back on alcohol to see if your sleep improves.

•Limit fluids before bed. If you wake up more than once each night to urinate, stop drinking fluids an hour or two before bedtime.

•Prop up your feet on a pillow. While sitting and relaxing in the evening, keep your feet propped up on a pillow. This allows fluid that normally pools in your legs to drain out of your legs and be urinated before you go to sleep.

•Take a hot bath before bed. It will soothe your mind and relax your muscles, allowing you to slip into sleep.

•Keep your bedroom cool. The ideal temperature for deep sleep is on the cool side, around the mid-60s.

•Make your bedroom a sanctuary for sleep. If you use the bedroom as a place to work… and pay your bills…and problem solve…it’s less likely you’ll find it easy to relax and sleep there. So don’t use your bedroom for work you’ve brought home from the office, for household tasks, or for personal problem solving.

•Head on pillow, mind on rainbows. If your mind is racing when it’s time to sleep, there are ways to shift it to a lower, sleep-friendly gear. After turning out the light and putting your head on the pillow, focus your thoughts on things that feel good and don’t require concentration or problem solving. A happy moment with your children or grandchildren. Your dog romping joyfully in a field. The peaceful face of a spiritual figure. A double rainbow.

•Make a list of your problems—and then forget about them! If you’re tossing and turning and worrying, trying to solve your problems, keep a pad and pen on your bed stand, and write down all your problems on a piece of paper until you can’t think of any more. Then go back to sleep. Do this as often during the night as you need to. (You might also find it helpful to schedule 30 minutes of “worry time” in the afternoon or evening, when you can update your checklist of concerns.)

•Wear earplugs. If your partner snores, get yourself a good pair of earplugs. I like the silicone plugs that mold to the shape of the ear. But earplugs might not do the trick. The average snore is 60 to 90 decibels (90 is the same as a passing train), and the best earplugs reduce noise by only about 30 decibels. Another solution: Sleep in another bedroom. Tuck your partner in, give him or her a sweet kiss goodnight, and give yourself a night of sweet dreams.

Other helpful technology for blocking out noise or getting to sleep are sound machines, and apps such as Sleep Genius , which is based on technology that helped NASA astronauts get better sleep. Whatever works for you is the best way to achieve restful, refreshing sleep.

•Limit your time in bed. If you have insomnia, you probably think that increasing the amount of time you spend in bed will increase the amount of time you sleep. But that’s not what happens. When you routinely stay in bed longer than you need to, you develop a classic pattern of insomnia. You sleep deeply in the beginning of the night; you have shallow sleep in the middle of the night, with long periods of being awake; and you sleep soundly when it’s time to wake up.

A Simple Strategy for Worry-Free Living

Worry and anxiety are common causes of insomnia. If you’re awake at 2:00 a.m. and can’t get back to sleep, you’re probably also worrying about what you have to do, what you haven’t done, and the problems you think you’ll never, ever be able to solve. I’ve been there and done that! And here’s a simple strategy I’ve devised to help me let go of worry and relax, particularly when it’s time to sleep.

  1. I create a page with three wide columns: #1, problems and projects; #2, plans; #3, “my” column.
  2. I list my problems and projects in the left-hand column, column #1.
  3. In the middle column, column #2, I write what (if anything) I plan to do soon about each of those problems and projects.
  4. I consider those columns #1 and #2 to be what I leave in the hands of God or the Universe or Spirit (or whatever name or idea is meaningful to you).
  5. Every so often, I move an item from the “Spirit” columns #1 and #2 over to the right-hand column—“my” column. The items in the third column are the one or two things that I want to work on—right now

I am constantly amazed at how the problems and projects in the “Spirit” columns move forward (on their own) as quickly as the items in “my” column. On a separate piece of paper, I also keep a list of everyday errands and put a star next to those that must get done soon. I do the other items on that list if and when I feel like it.

And I sleep very deeply every night.

You can break that pattern by limiting the amount of time you spend in bed to no more than eight or nine hours. This will gradually squeeze out those long, middle-of-the-night waking periods, restoring a full night’s sleep.

•Get out of bed at the same time every morning—even after a poor night’s sleep. This resets your body’s internal sleep/wake cycle (circadian rhythm), helping you fall asleep faster and sleep throughout the night. If you find that you’re sleepy during the day, you can nap for up to 90 minutes. When you nap, set the alarm for 60 to 90 minutes of nap time. If you feel groggy when you wake up, splash cold water on your face. (Try not to nap after 2:00 p.m., which can interfere with the next night’s sleep.)

Natural Sleep Aids Help Z’s

Most natural sleep aids aren’t sedating like sleeping pills, but they very effectively help you fall asleep and stay asleep. At the same time, they can help relieve pain, because they’re muscle relaxants.

The first six sleep aids listed below—my favorites—are available in a single product called the Revitalizing Sleep Formula, from Nature’s Way. I routinely recommend it to my patients with sleep problems.

•Suntheanine: 50 milligrams to 200 milligrams at bedtime. Theanine is an amino acid found in green tea. It not only improves deep sleep, but also can help you stay alert during the day. It works by assisting in the production of gamma-aminobutyric acid (GABA), an “inhibitory” brain chemical (neurotransmitter) critical for sleep (and the neurotransmitter stimulated by many prescription sleep medications). It also helps produce alpha waves, the type of electrical activity in the brain during relaxed, alert awareness, such as during meditation. In a study from Korean researchers, a theanine-containing supplement helped people fall asleep faster and sleep longer.

The only form of theanine that I use and recommend is Suntheanine (pure L-theanine), and it’s the only form that reputable companies use. Other brands contain inactive forms of the amino acid that actually block its effectiveness.

•5 HTP: 50 milligrams to 200 milligrams at bedtime. This amino acid raises your natural serotonin levels, which helps sleep. It also improves mood and decreases pain. Three studies support the use of 5 HTP for insomnia, according to a scientific paper on the amino acid in Alternative Medicine Review.

•Lemon balm extract: 20 milligrams to 80 milligrams at bedtime. A study by French researchers show this herbal compound is synergistic with passionflower, valerian, and other herbs for improving sleep quality, including falling asleep faster, sleeping longer, and clearing up daytime fatigue from poor sleep. (As a side benefit, it can help relieve anxiety, and prevent or ease viral infections.)

•Hops: 30 milligrams to 120 milligrams at bedtime. This herb is familiar to most of us as an ingredient in beer, but it has a long history of use as a mild sedative for insomnia and anxiety. One study from India showed that it was as effective as benzodiazepine drugs (such as Valium) in inducing sleep, but much safer.

•Passionflower (passiflora): 90 milligrams to 360 milligrams at bedtime. This herb is used widely throughout South America as a folk remedy for insomnia and anxiety, and a number of scientific studies have validated its effect. For example, Korean researchers studied 110 people with insomnia, giving half of them passionflower and half a placebo. After just two weeks, those taking passionflower had dramatically longer sleep times, and woke up less frequently during the night.

•Valerian: 200 milligrams to 800 milligrams at bedtime. Calming, relaxing valerian is a classic herbal remedy for insomnia. A number of studies show that it can shorten the time it takes to fall asleep and lengthen the amount of time spent sleeping. And in moderate doses, it doesn’t produce any next-day grogginess, a common problem with sleep medications. (High doses of 450 to 900 milligrams of valerian can cause next-day sedation.)

“Valerian is a safe herbal choice for the treatment of mild insomnia,” concluded a team of doctors in the journal American Family Physician, after reviewing the many scientific studies on the herb. “Most studies suggest that it is more effective when used continuously rather than as an acute sleep aid,” they added. In other words, though you can use it intermittently, it’s more effective when used regularly.

Caution: About one in 10 people who take the herb finds it energizing rather than calming. If that’s your experience, use this herb for daytime anxiety rather than insomnia.

The Restful Power of Essential Oils

The oral intake of essential oils add a whole new dimension to natural therapies for sleep problems. They can decrease brain fog and pain while improving immune function. Let’s take a look at four outstanding essential oils, all of which you can find in the supplement Terrific ZZZZ, from Terry Naturally.

•Lemon balm (Melissa officinalis). As I discussed earlier in this chapter, this lemon-scented herb is both an effective calming agent and a mild sedative. (In a study from England, lemon balm significantly improved calmness and cognitive function.) Research from Japan suggests that it optimizes the function of the GABA (gamma-aminobutyric acid) receptors in the brain, which calms the nervous system. Optimizing these receptors also decreases pain. Lemon balm also strengthens the immune system, helping to keep viral infections in check.

•Lavender (Lavandula angustifolia). Long recognized in France for improving people’s sense of well-being—even the smell of lavender is calming—lavender flowers were commonly placed in pillows to help promote sleep. Science fully supports this folk remedy: research shows that lavender oil—either taken orally or used topically—is sedating, relieving anxiety and improving deep sleep. Not surprisingly, people who use lavender also experience more energy and alertness in the morning. Research from Japan also shows that lavender supports the production of endorphins, molecules in the brain that tell your body to decrease pain. (They also trigger the “runner’s high” in athletes.)

•Mandarin (Citrus reticulata). In Traditional Chinese Medicine, this herb is used to calm the nervous system and induce sleep.

•Ravensara (Ravensara aromatica). The leaves, bark, and nuts of this rainforest tree have a long history of being used by the indigenous people Madagascar for their powerful effects in supporting sleep, improving mood, and calming anxiety.

Terrific ZZZZ is synergistic with the other natural products discussed in this chapter, as well as sleep medications—that is, they work very well together

Experiment with These Slumber Helpers

Below are a few other natural remedies that may help relieve insomnia. Try a few of them to find the remedy or remedies that work best for you.

•Magnesium (200 milligrams). Taken at bedtime, this muscle-relaxing, nerve-calming mineral can help you sleep.

Caution: If magnesium causes diarrhea (a possible side effect), lower the dose. Or use a magnesium supplement called MagSRT (for “sustained-release technology”) from Jigsaw Health—it’s highly effective, and it won’t cause the runs. (Magnesium is also very safe for insomnia during pregnancy.)

•Melatonin 5 milligrams. Although a lot of research supports the use of melatonin for insomnia, I have been unimpressed with the effectiveness of most melatonin products. The exception is a mixed immediate- and sustained-release product called Dual Spectrum Melatonin 5 Mg, from Nature’s Bounty.

•Ashwagandha, magnolia, and phosphatidylserine. If you find that you’re wide awake and your mind is racing when your head hits the pillow, this mix of two herbs and a nutrient is for you. Together, these three compounds can lower levels of cortisol, an adrenal hormone that’s a must for dealing with stress during the day but can keep you awake at night. All three are in the product Sleep Tonight from Nature’s Way. If needed, you can safely take Sleep Tonight with any of the other supplements discussed in this chapter. You’ll know within one week if it’s helping enough to make it worth continuing.

If, over time, you start waking during the night (because your cortisol and blood sugar are now too low), lower the dose or eat a bedtime snack rich in protein.

•Chamomile tea: good for pregnant women and children. Chamomile tea is a very mild sedative, and won’t treat moderate to severe insomnia as well as the other natural remedies in this chapter. But it’s safe for pregnant women and children to use for insomnia.

•Sleep medications. If natural sleep aids don’t work, consider medications. I think the safest sleep medications are zolpidem (Ambien), trazodone (Desyrel), taken in the range of 25 milligrams to 50 milligrams, and gabapentin (Neurontin), taken in the range of 100 milligrams to 300 milligrams. Avoid most benzodiazepines, such as Valium—they worsen sleep quality and are addictive. Clonazepam (Klonopin) and alprazolam (Xanax) are also addictive, but might be useful for a few weeks for a person who has insomnia and a severe anxiety disorder such as post-traumatic stress disorder (PTSD).

A Real Cure for Restless Legs Syndrome

Are your sheets and blankets scattered around the bed when you wake up? Does your spouse complain of being kicked at night? Do you notice that your legs are uncomfortable and restless when you’re trying to fall asleep?

If you answered yes to one or more of those questions, you may have a nighttime subset of restless legs syndrome (RLS): periodic limb movements in sleep (PLMS), which bothers about 80 to 90 percent of people with RLS. RLS is a condition characterized by strange and unpleasant feelings in your legs (and possibly your arms) during the day—variously described as itching, tingling, burning, aching, creeping, crawling, or electric shocks—and the urge to move them.

If you have PLMS (which I’ll abbreviate as RLS/PLMS, since the two conditions are usually found together), you probably wake up exhausted. Although you may be asleep at night, your legs are running a marathon!

The cause of RLS/PLMS is suspected to be a deficiency of the “pleasure/reward” brain chemical dopamine. Iron is critical for producing dopamine, and iron deficiency is a key trigger for RLS/PLMS. A deficiency of the mineral magnesium can also aggravate RLS/PLMS, as can a deficiency of adrenal and thyroid hormones.

The drug often prescribed for the problem is a very expensive medication called ropinirole (Requip). I never prescribe it. I don’t think it’s as effective as natural (or even other prescription) therapies for RLS/PLMS, and I’m concerned about its safety. Common side effects include nausea (in up to 40 percent of people who take it), excessive tiredness or somnolence (12 percent), vomiting (11 percent), dizziness (11 percent), and sore throat (9 percent). There’s also a risk of addiction—not to the drug, but to impulsive activities such as gambling, shopping, and sex, because the drug may interfere with the inhibitory functions of the brain.

I think Requip is being prescribed mostly because it’s expensive and profitable and therefore well publicized by drug companies—and not because it’s uniquely effective. Here are the remedies for RLS/PLMS that I think are effective.

•Eat a sugar-free, high-protein diet, with a protein snack at bedtime. Low blood sugar during the night can worsen the problem.

•Take iron—it works better than Requip. In a three-month study, RLS patients who were treated with iron had an 89 percent greater improvement than people taking a placebo—a level of improvement twice that usually seen with Requip. If your blood test for ferritin (the stored form of iron) is lower than 60, iron deficiency may be triggering your RLS/PLMS. (Some labs still ridiculously consider a ferritin level over 12 to be “normal.” It’s not.)

For RLS/PLMS, I recommend an iron supplement containing 25 milligrams to 30 milligrams of iron and at least 100 milligrams of vitamin C (which is also good for RLS/PLMS, and aids in the absorption of the iron). Take the iron and vitamin C combo on an empty stomach. Also take them six hours before or after you take thyroid medication (iron blocks its absorption). If you develop side effects from the iron, such as constipation, take the iron and C every other day.

•Take magnesium. A 200-milligram dose at bedtime can settle restless legs and help sleep.

•Take vitamin E. Vitamin E can help RLS, but it takes six to 10 weeks for the treatment to work. I recommend 400 IU daily of a natural “mixed tocopherol” form, which delivers many types of vitamin E compounds, and is more effective.

•Consider folic acid. Some cases of RLS (in which numbness and lightning stabs of pain are relieved by movement or local massage) are helped by five milligrams of folic acid, three times a day (an amount available by prescription). It didn’t help people without those specific symptoms.

•Consider the amino acid L-tryptophan. Several case studies suggest that supplementing the diet with this amino acid may help, possibly because it boosts neurotransmitters that calm the nervous system.

•Try 5-HTP. I also recommend this tryptophan-boosting supplement for people with RLS/PLMS.

Caution: If you’re taking antidepressants, talk to your doctor before taking 5-HTP. In rare cases, the two together could lead to dangerously high levels of the brain chemical serotonin.

•Try medications. If after two to three months these natural remedies don’t work for RLS/ PLMS, consider the medications zolpidem (Ambien), gabapentin (Neurontin), or clonazepam (Klo[1]nopin), all of which are highly effective for the problem. (Klonopin, however, can be addictive.)

If one of my patients with RLS/PLMS is taking Neurontin for insomnia, I work with them to increase the dose not only to get adequate sleep, but also to keep the bedcovers in place and stop kicking their partners.

•Watch out for antidepressants and antihistamines. They can worsen RLS/PLMS. If you’re taking them, talk to your doctor about alternatives.

A Real Cure for Sleep Apnea

This condition is also called obstructive sleep apnea. That’s because the soft tissue at the back of your throat (the soft palate) obstructs the airway during sleep, repeatedly cutting off your breath[1]ing and rousing you to a semi-awake state. As the sagging soft tissue vibrates, you snore. In severe sleep apnea, you can have more than a dozen episodes of breathlessness every hour throughout the night. Needless to say, you’re exhausted during the day.

Sleep apnea is common among older, overweight men. And it’s linked to a higher risk of heart disease, stroke, type 2 diabetes, depression, and erectile dysfunction—and a five-times-higher risk of dying from any cause. In fact, there’s probably not a single condition that’s not worsened by sleep apnea.

My recommendations…

•Videotape yourself while you sleep. A test for sleep apnea in a sleep lab is uncomfortable and time-consuming. (Though, on the upside, Medicare and most insurance companies cover the cost which is approximately $2,000.) An alternative is to simply videotape yourself for an hour or two while you sleep. Because if you’re snoring and you stop breathing, you have sleep apnea. Or just ask your spouse. If you snore, are overweight, and fall asleep easily during the day—and your spouse says you stop breathing during the night—you have sleep apnea.

•Ace apnea with a tennis ball. If the video showed that you snore and that you stop breathing mostly when on your back, you can wear a tight pajama top or T-shirt at night with a tennis ball sewn into the area at the small of your back. This may help stop you from sleeping on your back, which may eliminate the problem.

•Lose weight. Overweight is the main cause of sleep apnea, and losing just 10 to 15 pounds may be enough to make it go away.

•Ask your dentist about an oral appliance. This mouthguard-like device, worn during sleep, adjusts your mouth and jaw in a way that helps keep your airway open. Over-the-counter versions are unlikely to work.

•Ask your doctor about using a continuous positive airway pressure (CPAP) machine. This small machine—typically about eight by six by three inches—generates a constant flow of pressurized air into a flexible tube connected to a strapped-on breathing mask. Studies show that for people with moderate or severe apnea (15 or more episodes of breathlessness per hour), CPAP cuts the episodes by about 75 percent. A few science-proven tips to help make CPAP a more pleasant experience (many people who start using the device don’t stick with it because of discomfort)…

  • Humidify the bedroom.
  • Choose a nasal pillow mask rather than a full-mouth mask.
  • Consider an APAP (a device that pumps out air only when you’re having an apnea episode).
  • Follow up with your sleep specialist in the first few weeks of CPAP therapy to help you make any needed adjustments in air pressure and the use of the mask.

Though folks with sleep apnea tend to take off the mask because it’s uncomfortable, stay with it if you can. Your body will get used to it—and using CPAP at night will have you feeling much better during the day.

•Ask your doctor about surgery. A 20-minute outpatient surgery called Inspire, which internally stimulates airway muscles to keep them open, has been shown to be very effective for permanent relief of sleep apnea. Two other outpatient surgeries that can help with the problem include turbinate coblation, a 20-minute procedure that relieves breathing obstructions in both the soft palate and the nose; and laser tonsillectomy, a 20-minute procedure that reduces the size of the tonsils, which can obstruct breathing.

Relief from Night Sweats

Waking up with night sweats? Consider these causes in addition to low estrogen or progesterone…

  1. Acid reflux. When this occurs during sleep, it can wake you with a sweat. To diagnose this, take a Pepcid at bedtime for two or three nights (no longer, because acid blockers are addictive and long-term use is dangerous). If the sweats stop, get a pillow wedge, and add 1 ⁄2 teaspoon of baking soda to four ounces of water and drink before bedtime to turn off stomach acid. (You don’t need it during sleep.)
  2. Low blood sugar. Eat a one-ounce protein snack at bedtime.
  3. Candida or other infections. Clear any sinusitis, candida, or other infections.

For more ways to fix root causes of common health problems, purchase Real Cause, Real Cure from Bottomlineinc.com.

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