Insomnia is a growing disorder and has seen a significant rise within the last few decades, in parallel with our obesity epidemic. Insomnia symptoms are apparent in 35–50% of the adult American population annually, while the actual disorder ranges from 12–20%. Short term insomnia follows a chronic course in 40–70% of people. What’s changed to have caused this shift? Is it our go-go lifestyles, our westernized diets, our weights, or maybe the rise in artificial lights since the 1900s (e.g. TVs and computers)? Do you have problems with falling or staying asleep? Read on for more information on insomnia.
What is insomnia? Insomnia can be defined as a difficulty falling or staying asleep (i.e. frequently waking, waking too early, and/or having a hard time falling back to sleep). People at a higher risk for insomnia include females, people who are depressed or anxious, people who are divorced, and people with long hours at work, job stress, night shifts, etc. So what’s the impact of lost sleep? Sleep loss reduces insulin sensitivity, increases appetite (decreased leptin and increased ghrelin), and results in whole body inflammation. As a result, insomnia is a major risk factor for many mental and chronic diseases including hypertension, diabetes, and heart disease. On top of the disease risk factors, insomnia also has a major impact on work performance. This disorder is thought to cost, directly and indirectly, between 30–35 billion dollars per year in the US.
Clearly less sleep isn’t a good thing, but I still haven’t answered why sleep loss is more prevalent nowadays. The answer to this question is multifactorial and has huge variation from person to person. Some people lose sleep from too much sugar, too little sugar, too much stress, not enough activity, etc. To get a better understanding of sleep loss, the regulations for sleep should be considered.
So what regulates sleep? The answer to this question is extremely complex and still being researched. Sleep and wakefulness are thought to be largely controlled by a few systems including the sympathetic nervous system. Slow wave sleep is primarily seen in the first third of the night, with lower sympathetic activity (which helps us fall asleep and results in a lower arousal), while rapid eye movement (REM) dominates the remainder of the night, with higher sympathetic activity. Stress is seen to activate the sympathetic nervous system and is a major contributor to a hyper-arousal around bedtime. What does that mean? Typically a racing mind when you try to fall asleep that’s hard to shut off.
Sleep cycles are also regulated by various hypothalamic hormones. Melatonin is an important hormone, released primarily from the pineal gland, that has a role in making us sleepy at night time and helping us stay asleep. Melatonin secretion varies due to a number of factors including light stimulation, age, and diet. Melatonin is significantly lower in elderly individuals, due to an age related degradation of the pineal gland, which is a factor for the prevalence of insomnia in elderly individuals. With the physiology of sleep in mind, it’s easy to see why there is such a huge variation in the causes for sleep loss.
How is insomnia treated? Benzodiazepine sedative-hypnotic drugs are widely used to manage insomnia but come with many side-effects such as a next-day hangover, dependence, and decreased memory. As a result, other options are advisable. On a non-pharmacological basis, what else can you do? Nutraceuticals can serve as a relatively quick fix, similar to a pharmaceutical, while trying to work through a particular time of stress. Lifestyle interventions are also powerful tools to manage insomnia. So what’s out there on neutraceutical or lifestyle interventions?
In terms of neutraceuticals, melatonin supplements are promising for managing insomnia and do not have the addictive potential or hangovers seen in pharmacological agents. Melatonin supplements have a high safety profile and are well tolerated, even at high doses over years. Although there’s a lack of consistency on its therapeutic potential, largely from its short half-life and low doses, melatonin has been shown to be quite effective, especially in individuals over 55 (lower melatonin). If you are on a sleep medication and are interested in switching to a neutraceutical, I would recommend looking at an AOR product called ortho-sleep, but definitely consult with your doctor or naturopath first.
Lifestyle interventions, especially ones with higher exercise levels, have also been shown to be effective. Meal regularity, fewer refined carbohydrates, and more fruits, vegetables, nuts, and legumes are seen to promote a good night’s sleep. Why does what we eat affect how we sleep? That is another multifactorial question. Diets that may promote sleep will typically increase serotonin which is an intermediate in melatonin production and have higher amounts of tryptophan, a serotonin precursor. Melatonin, serotonin, and tryptophan can be taken in through the diet from nuts, seeds, legumes, fruits and vegetables. B vitamins are also important for increasing melatonin—they’re cofactors in the pathway that makes melatonin—and also help improve sleep. Most B vitamins can be easily accessed through the foods above but unfortunately for vegetarians, B12 is very hard to come by as it is mostly only in animal products (but it is in nutritional yeast). Some B12 can also be found in soil around organic vegetables which means many vegetables can have trace amounts of B12. It can also come from algae and natural bacteria in our intestines. However, it is still quite important in terms of not only sleep, but also overall health, for vegetarians to consider taking b12 supplements. Magnesium is another important nutrient that has been speculated to help us sleep (and can also be found in the foods listed above).
Stress management is also critical for a lifestyle intervention. Is there something stressing you out to the point of you losing sleep? Perhaps work, an unhealthy relationship (or even a healthy one), or school? The first step for dealing with stress is figuring out what your stressor is. You can’t always eliminate the stressor, but taking steps for improvement are definitely helpful. For example, try to get a better work-life balance, talk to a loved one about things bothering you, or stay on top of your work-load at school. Exercise can also be a powerful tool when dealing with stress.
How can you work these tips into your life? Try to avoid doing work right before bedtime (especially in front of a computer) and try to avoid bright lights towards bedtime (computer again). Try to incorporate more veggies, fruits, nuts, seeds, and legumes while limiting unhealthy foods (e.g. fried or refined foods). Try to establish some meal regularity, with 3–5 meals a day—and please, please, please don’t skip breakfast! Try to get more exercise also. Yoga has been seen to be particularly effective at stress reduction, although any exercise would be helpful (especially if you like it). Find something that you enjoy so that you will stick to it.
And that marks the end of my article! Hopefully you now have a better idea on how to deal with insomnia!Bittencourt L, Santos-Silva R, Mello M, Anderson M, Tufik S.(2010) Chronobiological Disorders: Current and Prevalent Conditions. doi:10.1007/s10926-009-9213-0Bixler E. (2012) Sleep and society: An epidemiological perspective. doi:10.1016/j.sleep.2009.07.005.Cardinali D, Srinivasan V, Brzezinski A, Brown G.(2012) Melatonin and its analogs in insomnia and depression. doi:10.1111/j.1600-079X.2011.00962.x.Passos G, Poyares L, Santana M, Tufik S, Mello M. (2012) Is exercise an alternative treatment for chronic insomnia? doi:10.6061/clinics/2012(06)17.Peuhkuri K, Sihvola N, Korpela R.(2012) Diet promotes sleep duration and quality. doi:10.1016/j.nutres.2012.03.009.Siebern A, Suh S, Nowakowski S. (2012) Non-Pharmacological Treatment of Insomnia. doi:10.1007/s13311-012-0142-9.See this and other articles on Jennifer Novakovich’s website JennovaFoodBlog.com1:29 Photo Credit: Smiley Stew via CompfightccStress Ball Photo Credit: Amy McTigue via Compfight ccRunning Photo Credit: mikebaird via Compfight cc