Fix Your Sleep Naturally: A Naturopathic Approach

Whether you have difficulty falling asleep, wake up frequently during the night, or feel fatigued after a long night’s rest, not getting consistent restful sleep can have negative implications for your health. Getting to the root cause of sleep issues can be difficult and takes investigation into hormones, mental health and stress management. 

Why is sleep so important? 

Our body relies on sleep not only to rest and restore, but to build. While we sleep we generate important immune molecules to fight off illness including cells to fight off tumours. We rely on sleep to solidify our memories and to learn. Sleeping is one of the most protective, if not the most important, way to prevent memory loss and memory concerns when we age. Lack of sleep increases your risk of developing cardiovascular disease and worsens symptoms of mental health. Lack of sleep has been linked to increased suicide ideation and reduction in male and female sex hormones (testosterone and estrogen).

 

4 Common Causes of Trouble Sleeping or Insomnia: 

1. Stress – An active mind (racing thoughts & worrying) often works against relaxation and rest. It can increase your stress hormones, cortisol and norepinephrine in particular. An increase in these hormones at night can promote alertness and wakefulness, disrupting your body’s need to feel tired enough to sleep. It can also prevent you from properly cycling through sleep cycles leading to “light sleeping” and frequent waking. Consistently waking between 2-3 am? It could mean your circadian rhythm is being affected by stress both short term and long term.

2. Irregular sleeping schedule – inconsistency in bedtime and waking time can be affecting your capacity to regulate and sync your circadian rhythm, ultimately, affecting how well you can fall and stay asleep. Your circadian rhythm is your body’s internal clock that signals your sleep wake cycle. Things like shift work, breastfeeding throughout the night or inconsistencies in sleep wake times can easily disrupt this rhythm. Your circadian rhythm relies on cortisol and melatonin to be balanced. See below for ways to keep them in sync.

3. Late night snacking or going to bed hungry – Unfortunately, your late night snack could be contributing to your sleeplessness.  Snacking before bed can disrupt your blood sugar levels. This could in turn be contributing to waking in the night, or waking early morning. This could also aggravate existing conditions like reflux which can cause waking in the night due to discomfort.

4. Breathing Issues - upper airway resistance syndrome (UARS) and obstructive sleep apnea(OSA)  - conditions in which breathing is either impaired or diminished can cause snoring, restlessness, frequent waking and poor quality of sleep. These conditions, similar to insomnia, can have severe long term health consequences and should be addressed as soon as possible.

If you suffer from any of the following your should check in with your family doctor for a referral to a sleep clinic :

• Snoring - loud, frequent and disruptive to others

• Moments of “apnea” snoring is interrupted and breathing stops followed by a snort

• Gasping and choking that can sometimes wake you from sleep

• Frequent waking in the night

• Insomnia due to restless sleep, tossing and turning.

• Daytime sleepiness, lack of focus and concentration

 

Improving Your Circadian Rhythm

The key to protecting your circadian rhythm and keeping your body's internal clock regulated is routine, routine, routine.  Your sleep cycle is governed by hormones and hormones love consistency.

Things you can start to do to improve your circadian rhythm, independent of natural sleep aids or sleeping pills :

• CONSISTENT SLEEP AND WAKE TIME. Set a wake time and a bedtime, and stick to this consistently. Your circadian rhythm is just that, it likes to maintain a consistent pattern. Having a consistent bedtime and wake time is an important key to optimizing its function.

• Keep your room DARK, light in any capacity can impact our secretion of melatonin.

 DARK ROOM CHECKLIST : No TV or bright screens, turn off lights in other rooms, remove night lights, black out curtains

• AVOID BLUELIGHT 2 HOURS BEFORE BED. Our reliance on technology has brought us into a time where our blue light exposure is significantly higher than what our bodies have evolutionarily been adapted to. Blue light is a type of high-energy visible light emitted by electronic devices such as smartphones, computers, and some lights. Blue light exposure can suppress melatonin production. The most effective way to eliminate blue light exposure is to avoid using screens before bedtime ( roughly 2 hours). If that is unavoidable the following options can help: 

• F.lux blue light blocker app. This app is available on your computer. It works to  automatically adjust the colour and brightness of your screen depending on your location and time zone. Filtering out blue light for you by adding in red light.

• Blue light blocking lenses.

• ROOM TEMPERATURE .Your body naturally drops its temperature in the evening to signal you to feel SLEEPY. When you are asleep, we need our bodies to stay cool to stay asleep. During the REM cycle of sleep or temperature modulation switch is turned OFF, meaning if you are warm it can wake you from REM sleep as your body will heat up. Therefore, keeping your room at a low temperature – between 15 to 17 degrees Celsius – may improve the quality of your sleep. Wearing appropriate clothing to bed and not having too many blankets will be important as well.

 *If you are experiencing night sweats, this can be a symptom of significant health concerns, please contact a health professional.

• AVOID CAFFEINE. Caffeine is a stimulant therefore it will promote wakefulness. Everyone metabolizes caffeine differently, so you need to play with the timing of when your last one should be. Caffeine can also deplete serotonin, which is important for sleep and reducing anxiety (which can disrupt sleep as well). 

• SALT LAMPS. Red light can reduce stress and improve melatonin production both of which will have a positive impact on your sleep quality. Salt lamps are an excellent way to add in more red light. Try using one as an alternative to your reading light.

• TAKE A BATH OR SHOWER. As we mentioned above dropping your body temperature can help make you feel drowsy. Taking a hot bath before bed may seem counterproductive to “dropping your body temperature” , but the warm water helps to drop our core temperature to help us fall asleep quicker. Timing is important!! One study found that participants who took a bath for at least 10 minutes, 90 minutes before bedtime, fell asleep on average 10 minutes quicker than those who did not.

Whether you experience chronic stress in your daily life or are going through some circumstantial stress. It is likely your stress response is in overdrive. This can cause what we call overactivity of the hypothalamic pituitary response. Most insomnia and sleep disorders are caused by overactivity of this response. The biggest contributors to overactivity: chronic stress, anxiety and depression. To make matters worse, the worse your sleep is, the more overactivity of this response.

So when dealing with any sleep disorder, we need to reduce our stress hormones before bed and ensure we are taking steps to reduce overactivity of the stress response. Reducing the stress response requires supplementation in combination with all of the above listed sleep hygiene suggestions. Things you can do independent of supplements to reduce cortisol and stress hormones in the evening :

1. Relaxing activities. Avoid exercise 1-2 hours before bed, TV shows or emotionally charged conversations that could stimulate your stress response.

2. Try taking a bath an hour and half before bed

3. Diffuse Lavender essential oil in your bedroom

4. White noise machines can be helpful for light sleepers

5. Meditation - progressive muscle relaxation, body scans and guided meditation are shown to be the most effective. Try implementing them 10-15 minutes before you would like to fall asleep.

   • Our favourite apps are insight timer and calm

      

Supplements & Natural Sleep Aids

MELATONIN

 Melatonin is a naturally occurring hormone in our body.  When it is working optimally it peaks between 11pm-3am, If it is correlating with the rising and setting of the sun. The consistent and appropriate secretion of this hormone helps us fall asleep, stay asleep and enters into our deep restorative sleep . Melatonin relies on the decrease of cortisol late in the day, to rise and peak during the night. IF we are experiencing chronic stress, anxiety, or circumstantial stress, we may be increasing our cortisol later in the day. This will impact the amount of melatonin we secrete, and subsequently our ability to fall and stay asleep. Managing this stress is often a key piece of our sleep protocols. 

Additionally, research has shown that our organs function on their own circadian rhythms and the key to keeping them relatively in sync is to maintain a consistent sleep and wake schedule.

*Caution- Melatonin should not be used in children under 21 as it can influence the pituitary gland and subsequent hormone release. It should also be avoided in women actively trying to conceive naturally as it can interfere with ovulation.

We usually begin dosing at 1.5 mg and you can safely work up to 3mg. Morning grogginess and vivid dreaming are signs of too high a dose of melatonin. If you experience this, decrease your dose.

Our recommended brands :

• Douglas Labs Prolonged Release Melatonin. 1 cap 0.5 hours before bed

• NFH Liquid Melatonin - 1.5-3 mg, 0.5 hour before bedtime.

MAGNESIUM

Magnesium is an essential mineral in the body, used for a variety of different functions. It’s role in sleep is to help promote deep restorative sleep. Magnesium helps promote the secretion of GABA, a chemical messenger in the brain that promotes sleep. Magnesium deficiencies have been linked to insomnia and restless leg syndrome. We prefer to use magnesium bisglycinate as it is more likely to be absorbed into the nervous system tissues and the muscle tissues. The glycine molecule has a calming effect helping to relax both the tissues and the mind.

Our recommended brands :

• NFH Magnesium SAP - 300 mg before bed = 2 capsules. During times of stress, 1 capsule in the am upon waking.

• Designs for Health Magneisum Chelate - 300 mg before bed = 2 capsules. 1 capsule in the am upon waking.

 

AMINO ACIDS

1) 5HTP (5 hydroxytryptophan) is a derivative of the amino acid tryptophan . It is the immediate precursor for serotonin and also further down that pathway melatonin. It has been shown to help enhance sleep. It is also helpful in reducing symptoms of anxiety, which could be at the root of restless sleep. 5HTP has a variety of interactions including antidepressants and other sleeping pills. It should only be used under the supervision of a healthcare professional.

2) Glycine similar to 5HTP is an amino acid that has a calming effect in the brain. It also has the ability to help reduce body temperature, which as mentioned earlier is an important factor for deep sleep.

3) L-theanine This amino acid helps boost serotonin, dopamine and GABA in the brain. All of which play an important role in mood and relaxation. L-theanine can help boost wakeful relaxation, therefore it is not sedating. Which is why most people choose to use it during the day .However, it has been shown to help improve sleep quality in those who are restless or anxious before bed, due to its ability to promote relaxation.

4) Gaba This amino acid derivative is the brain’s more inhibitory neurotransmitter. Theoretically, supplementing with GABA should help promote relaxation and improve deep restorative sleep. There is not enough clinical evidence to support this and more research is needed. GABA has a variety of interactions including with antidepressants and other sleeping pills. It should only be used under the supervision of a healthcare professional.

Our recommendation:

• Cytomatrix Cyto Calm - blend of 5HTP, glycine and B6. This combination is excellent for those who have an active mind at night and suffer from anxiety. This product is not recommended for people who are currently taking anti-depressant or anti-anxiety medications.

  • 1 cap 1 hour before bed, 1 capsule upon waking.

• Bio Clinic Calm Pro - L-theanine. For those who struggle to relax prior to bed time.

  • 2 capsules 1 hour before sleep.

• Bioclinic Somnopro - blend of 5HTP, L-theanine and Melatonin. Helps to calm the mind for those who have an active mind and feel anxious throughout the day. This product is not recommended for people who are currently taking anti-depressant or anti-anxiety medications.

  1 capsule 1 hour before bed.

 

HERBS

There are several herbs that have promising evidence for their ability to help improve sleep quality. The majority work by helping to reduce anxiety and increase GABA. GABA as mentioned above is an important inhibitory signal to the brain which promotes deep sleep.

1) Valerian, Passiflora and Hops. This combination of herbs was studied in comparison to zolpidem (a popular sleeping pill), they were found to be effective at improving sleep, decreasing waking time and improving time it took to fall asleep. It was shown to be an effective alternative to this common sleeping pill.

Valerian on it’s own also has a lot of evidence to support its ability to help improve sleep quality. It does not have any reported symptoms of morning grogginess and did not affect alertness the next day compared to most sleeping pills. We believe that the combination of several plants with valerian has the best results.

Our recommended formulas : 

• Sleep by Restorative Formulations 1-2 capsules 1 hour before bedtime.

• Valerian Complex by MediHerb - 1-2 capsules 1 hour before bedtime.

*It is not recommended to take valerian root in addition to other sleep medications, unless under the supervision of your medical doctor and naturopathic doctor. Speak to a naturopathic doctor prior to taking and dosing this herb.

2) Lavender - This herb has traditionally been used to reduce anxiety and calm the mind.  Its aroma has strong calming properties, which is why diffusing lavender in the bedroom or using an essential oil oil roll on can be effective as well. Recently studies have shown taking a lavender oil supplement can reduce symptoms of anxiety, restlessness, agitation and poor sleep. It is important you do not ingest essential oils. It is important you take a professional supplement. Ingesting essential oils can be very dangerous and can easily disrupt the gut and cause significant side effects. 

• The only lavender supplement we recommend is NFH lavender SAP at 1 capsule before bed. It is produced in a facility with a high degree of quality control ensuring the dosing is consistent and safe.

3) Chamomile + Lavender tea, these herbs when combined can be an effective sleep aid. They promote relaxation. Not only are they effective, but they are also highly accessible and safe. To dose them therapeutically. Steep the tea for 20 minutes and cover the cup with a plate. This prevents some of the medicinal oils escaping through the vapour.

Our recommendation:

Living Apothecary Snooze Brew (available at EASTND),  

Traditional Medicinals (Health Food Stores + Natural Section Grocery Stores), 

Local farmers or herbal suppliers (Argyle Farm PEI)

Lastly, if correcting the stress response, reducing anxiety, and creating proper sleep hygiene does not work, we would consider sleep restriction therapy. We have included our handout and instructions below. This is a challenging but effective technique. This should be done with the supervision of a health professional. If you are considering starting it, book in with one of our NDs to get proper guidance.

 

Sleep Restriction Therapy

Sleeplessness, poor sleep quality and insomnia can all develop due to stressful life events, chronic stress or poor sleep habits. Time spent in bed is not always the solution to poor sleep quality. Spending long periods of time in bed awake can exacerbate feelings of anxiety and frustration, which contribute and exacerbate a poor quality sleep cycle. Sleep Restriction Therapy is used to bridge the gap between the amount of time you spend in bed with the amount of sleep your body is producing. Spending long periods of time in bed awake can exacerbate feelings of anxiety and frustration, which contribute to poor quality sleep. Sleep Restriction was designed by Arthur Spielman and was designed to eliminate night wakings. It initially restricts time in bed not with the intention of restricting sleep time (although this can happen in the first week).  

The following provides guidance on how to use Sleep Restriction to help you sleep.

Step 1 : create a sleep diary for one week. Log when you go to bed, estimated time you were asleep. Any waking and duration you spent awake and wake time. Tally each night’s total time spent asleep. Take an average for the week. Use this number for step 2.

Step 2 :  Limit your time spent in bed to ________________ --the average time you slept from above plus a little to fall asleep). This should not be less than 5.5 hours.  If it is adjust accordingly to meet that minimum. 

This means you should have a bedtime of _________________ and a wake time of ______________. 

Example : someone who goes to bed at 10:00 p.m. and gets out of bed at 7:00 a.m. but sleeps on average only 6 hours per night. During the first step of this procedure this person will be in bed only 6 hours (e.g., 11:00 a.m. to 5:00 a.m.). This sounds tough but after a week or so there will be a marked decrease in time spent awake in the middle of the night.

Although you may feel sleepy, do NOT go to bed earlier than you are supposed to. Your internal clock may not be ready to sleep and if you go to bed too early you may not have built up enough sleep pressure to fall asleep or stay asleep throughout the night.

Go to bed only if you are sleepy (and not before your scheduled bedtime). Again, if you are not sleepy, going to bed too early will only cause stress and frustration that you are not sleeping. By keeping a consistent bedtime and wake time you are also helping to set your internal clock, as well as building up sufficient sleep pressure to fall asleep. 

Wake up and get out of bed at the designated wake time. Even if you haven’t had the best night of sleep, it is really important that you stick to the set wake time of _______________, even on weekends. Although challenging, it is really important to provide your internal clock with a consistent schedule. Also, if you sleep in, you may not have enough sleep pressure to help you fall asleep quickly at bedtime. 

No Napping. Unless you have activities that may be unsafe if you do not have a short nap, naps will interfere with your ability to fall asleep at night by reducing your sleep pressure. 

Although it may seem strange to hear that you should stay up later when your goal is to sleep more, until your body learns to sleep more efficiently you need to limit how much time you spend in bed. For the first few nights, it may feel as if you are sleeping less than before, but soon you should be falling asleep faster and waking less frequently or for shorter periods of time.

Extending Bedtime. If you have reduced the amount of time you spend awake in bed (falling asleep and waking) to less than 30 minutes you can extend your bedtime by 30 minutes. Use this as a rule of thumb, so not extend your bedtime if you are spending more than 30 minutes awake in bed. If you begin to experience trouble falling asleep or increased wakefulness add 30 minutes to your current bedtime. Be sure to check in with your ND to ensure root cause issues like anxiety, hormone changes and stress levels are being managed.

Adapted from :

• https://stanfordhealthcare.org/medical-treatments/c/cognitive-behavioral-therapy-insomnia/procedures/sleep-restriction.html

• https://www.sahealth.sa.gov.au/wps/wcm/connect/b4ccb7004033fe2599bcbbd30eb2c8cd/7+-+Bedtime+Restriction+Therapy+2017.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-b4ccb7004033fe2599bcbbd30eb2c8cd-mxTZZIY

• https://www.acfp.ca/wp-content/uploads/tools-for-practice/1495207198_tfp188sleeprestrictionfv2.pdf

• http://supp.apa.org/books/Pediatric-Sleep-Problems/Sleep_Restriction.pdf

 

Our thoughts on sleeping pills.

This is a difficult conversation to have with patients, as most times patients have or continue to take sleeping pills to sleep through the night. Firstly, sleeping pills and the most commonly used classes of drugs for sleep, are sedatives. They help to sedate the body to “sleep”. This sleep does not mimic our natural deep restorative sleep. Over time, this can impact health in the same ways poor sleep quality does (mentioned at the beginning of the article).

These medications are not designed to be a long term solution and frequently are not recommended for more than 6 weeks to 3 months. However, we find people have been on them for substantially longer than this. To compound an existing issue with sleep, some of these medications can cause tolerance (needing a higher dose over time), dependence (requiring them for sleep), withdrawal when stopped and rebound effect (insomnia is worse than before taking the sleeping pill). One of the most alarming of the adverse effects is the increased risk of suicidal ideation and depression. Sleeping pills can be difficult to wean off and this should absolutely be done with the supervision of your doctor. Working with a naturopathic doctor to identify the underlying causes of sleep issues (hormones, nutrient deficiencies, mental health concerns, etc) can help reduce the need to begin sleeping pills, and can help reduce the side effects of weaning off medication.

It is important you always discuss any changes in medications with your doctor before starting to wean off of these medications yourself. This article is not designed to be used as medical advice, and any changes to your current protocol should be discussed with a medical professional.

 

Sleep is often one of the most challenging things to treat, and the biggest commitment to sustainably improving your sleep has to be routine. Book now with one of our NDs to learn about your options.

 

In Health,

EASTND Naturopathic Team