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Insomnia, difficulty in falling or staying asleep, is a relatively common concern for Canadians. In the course of one year, up to 30% of the population may experience difficulty falling asleep or staying asleep at night. About half of these people have resorted to using a prescribed sleep aid when they are unable to sleep. In fact, nearly 100 million prescriptions are written each year for sleep-enhancing medications. Due to the prevalent nature of this condition, I see people with sleep disturbances quite frequently in my practice and have extensive experience in treating this troublesome condition.

Sleep is important to our bodies in more ways than one. Although it may seem like our body is just resting, a lot is happening while you are asleep. During deep sleep, the body’s major organs and systems are working on repairing and regenerating. The body needs roughly 7 to 9 hours to complete this process, depending on the person. Getting less than 6 hours of sleep has been associated with health problems such as memory loss, depression, elevated blood pressure, poor concentration, headache, irritability, depressed immune function, low libido, and weight gain. Needless to say, it is important to allow your body to sleep!

When treating insomnia, it’s important to start with the basics. For many people, simple lifestyle changes can result in drastic changes in sleep quality. Try making the following changes to your daily routine for a medication and supplement-free way to get back to sleep.

Top 5 Sleep Aid Supplements

  • Melatonin: 1-3 mg
  • 5-HTP: 100-200 mg
  • Valerian*: 600 mg
  • Theanine: 50-100 mg
  • Chamomile tea: 2-5 tbsp steeped for 5-10 min.

Caution: Supplements that promote sleep should only be used occassionally as it’s important to address the underlying causes of insomnia.

* Some people may experience a paradoxical reaction to valerian and feel anxious and restless as opposed to calm and sleepy.

Dr. Hartman’s Top 10 Dietary & Lifestyle Changes to get a Restful Sleep

  1. Avoid stimulants, especially caffeine.
    The average Canadian consumes about 150-225 mg of caffeine per day (roughly equivalent to 1-2 cups of coffee). Although this amount may be okay for many people, the ability to detoxify caffeine from the body varies dramatically between individuals due to genetic differences in liver enzymes. For example, in some people, it may take 12 hours to detoxify the caffeine from a single cup of coffee. I recommend that if you are having troubles sleeping, completely avoid caffeine (e.g. coffee, tea, chocolate, drugs with caffeine, energy drinks) for 7 to 10 days.
  2. Invest in a proper mattress and pillow.
    If you are physically uncomfortable and your bed doesn’t adequatey support your body, it will be hard to get a sound sleep. Although a high quality mattress doesn’t come cheap, remember that you spend roughly a third of your life in bed and you are investing in your health. I recommend trying out a few different mattresses in store to determine which style you find most comfortable; however, the only true way to determine the best mattress for you is to take it home and try it out for a couple weeks. Make sure to purchase your mattress from a store that allows for exchanges if the mattress you choose doesn’t work out. It is a myth that people with back pain need firm mattresses so be open to mattresses you wouldn’t normally try. My last tip is that more expensive doesn’t always mean better. Only your body will tell you which one works for you.
  3. Maintain a bedroom temperature that is slightly cool.
    Both a bedroom that is too hot or too cold can impair sleep quality. The ideal temperature for your bedroom is 18°C. If the temperature of the bedroom is too high, this can induce nightmares in some people.
  4. Establish a consistent bedtime.
    The body likes routine. When you establish a sleep and wake routine, the circadium rhythm of cortisol and melatonin release is consistent. If you are having difficulty sleeping, ensure that you are going to bed and waking up at the same time throughout the week, even on weekends.
  5. Exercise.
    Studies examining the link between sleep and exercise have consistently shown that people who exercise throughout the day get better sleeps at night. The key is to not exercise too late in the day in order to get the sleep-promoting benefits. Aim for at least 20 minutes of moderate aerobic exercise in the morning or early evening.
  6. Dim the lights in your house an hour before bed.
    Melatonin, the sleep hormone made in your brain, is secreted in response to light cues. As it gets darker, melatonin levels start to rise to make us sleepy. This process can be inhibited by bright lighting in your home. To ensure proper melatonin secretion, use dim “night-time” lighting in the last hour before bed.
  7. Avoid napping.
    Naps during the day can impede your ability to fall asleep at night. That insomnia, in turn, can cause you to want to nap the following day. Break that insomnia-nap cycle by refraining from napping, even when you feel tired. Bring the energy back into your body by going for a brisk walk in the fresh air. Your body will thank you later when it comes times to sleep at night.
  8. No screen time 30 minutes to 2 hours before bed.
    Electronics should be avoided for up to 2 hours before bed, depending on how sensitive you are. The blue light emitted by electronics suppresses melatonin production and negatively interfere with circadian rhythms more strongly than any other wavelength.
  9. Do not eat or drink anything in the 2 hours before bed.
    It is important to give the body time to finish digesting food and to settle down. Avoiding water prior to bed is especially important for those of us who wake frequently to use the washroom. Many people find that alcohol helps them fall asleep. However, it is also the cause of sleep maintenance insomnia, or frequent wakenings through the night. If you have a hard time staying asleep at night, try avoiding alcohol in the three hours before sleep.
  10. Don’t sleep with your phone beside your bed.
    Phones and other electronics in the bedroom can be disruptive to people for many reasons. The first being that if you get constant notifications, this frequent buzzing or ringing will constantly stir you from sleep. Secondly, the frequencies emitted by the phones have the ability to interfere with the brain’s ability to get a restful sleep. Either keep your phone out of the bedroom or, at the very least, turn it onto airplane mode each night.

Common Causes of Insomnia

If you are doing all of the above and still can’t get a good sleep at night, this is the point where I recommend working with a naturopath to explore whether there is an underlying condition resulting in your inability to get some rest. The following are common causes of insomnia that I see in my practice.

Hormone Imbalances

The endocrine (hormone) system in the body is complex and is made up of a multitude of different hormones that all communicate with each other to carry out the daily job of running your body’s processes. A few of these hormones, when they are not functioning properly, can lead to sleep disturbances.

Cortisol

The adrenal glands are glands that sit on top of the kidneys and are responsible for dealing with day-to-day stressors. They release both adrenaline (epinephrine) and cortisol. Cortisol is a stress hormone that is released when we are under prolonged stress but it is also released in a cyclical nature throughout the day as well: it is highest in the morning and lowest at night. This is what allows us to feel energized when we wake up and sleepy at bedtime.

If you have been under a lot of stress and your insomnia started with that stress, your adrenal system may be to blame. Stress interferes with the natural rhythm of cortisol release in the body resulting in a vast array of symptoms ranging from fatigue, insomnia, cold hands and feet, anxiety, and frequent illnesses. There is a test available called the Adrenal Stress Index that is able to measure your cortisol curve to see if cortisol is playing a role in your insomnia.

Progesterone

Sleep disorders are especially common in peri-menopausal women as progesterone levels start to decline. Similarly, in women with hormonal disorders such as PCOS where progesterone levels are low, there is an increased incidence of insomnia. For peri-menopausal women, hot flashes and night sweats compound the problem by further interfering with sleep. Increasing progesterone either through bioidentical progesterone or through herbs can improve sleep for a lot of these women.

Thyroid Hormones

When the thyroid gland is overactive, known as hyperthyroidism, insomnia is a symptom alongside many other unnerving symptoms. If you have been experiencing sensations of heat, frequent sweating, heart palpitations, or weight loss, you may want to have your doctor examine you for an overactive thyroid.

Melatonin

Melatonin is a hormone that is secreted by the pineal gland in the brain to regulate the sleep-wake cycle. Normally, melatonin levels are low during the day and significantly increase at night. As we age, melatonin levels decline and this may contribute to the increased frequency of insomnia in the elderly. If you notice that your sleep has been getting worse with age, trying melatonin may be a good option for you. For people who are truly deficient, even 1mg of melatonin will be enough to get a restful night’s sleep. Higher doses of melatonin can cause nightmares for many people so it’s important to always start at a low dose and increase as needed.

Depression & Anxiety

Mood disorders such as anxiety and depression are thought to account for up to 50% of all cases of insomnia. Cognitive behavioural therapy can be useful in these instances to not only help with the insomnia but also to regulate mood without medication.

Medication Side Effects

Many medications can cause insomnia as a side-effect. Be sure to check with your doctor if your medication could be interfering with your sleep. You may be able to switch to a different medication or lower your dose under your doctor’s supervision.

The most common medications that can result in insomnia are:

  • central nervous system stimulants
  • antihypertensives (blood pressure medication)
  • respiratory medications
  • decongestants
  • hormones (corticosteroids, thyroid medication)
  • antiepileptic drugs
  • antidepressants
  • statins
Caution: Do not discontinue or lower medication dosage without the consent of a physician.

Sleep Apnea

Sleep apnea is a breathing disorder characterized by brief interruptions in breathing during sleep. The pauses in breathing may occur hundreds of times a night and are almost always accompanied by snoring in between apnea episodes. Rarely will the apnea rouse someone from their sleep enough to be aware of it, but the sufferer will usually experience excessive daytime drowsiness and a sensation of unrestorative sleep.

Proper diagnosis of sleep apnea is important as the condition has been linked to heart arrhythmias (irregular heart beats), high blood pressure, heart attack, and stroke. If your partner has noticed that you snore heavily or stop breathing intermittently during sleep, I would recommend going to a sleep clinic to receive a proper diagnosis. Obesity is a major risk factor for sleep apnea and weight loss is the most important aspect of long-term management.

Restless Leg Syndrome & Nocturnal Myoclonus

Restless leg syndrome (RLS) and night-time leg cramps (myoclonus) can cause insomnia in its sufferers. RLS is characterized by an inability to sleep due to an irresistible urge to move the legs. Almost all patients with RLS have nocturnal myoclonus. In nocturnal myoclonus, there are repeated muscle contractions, usually in the legs, during sleep. Usually the patient is unaware of the muscle contractions but instead experiences excessive daytime fatigue. The patient’s partner is usually aware of the contractions and is able to help with the diagnosis.

Conclusion

As you can see, the treatment of insomnia cannot be a one-size-fits-all approach. There are many different factors that influence the quality of our sleep ranging from lifestyle choices to underlying medical conditions. The silver lining of this is that if one approach to treatment hasn’t worked for you, it just means that you and your doctor need to dig just a little further to treat the cause of your insomnia.

Good night, sleep tight, and don’t let those bed bugs bite!

Dr. Nicole Hartman

About Dr. Nicole Hartman

Dr. Nicole Hartman is a naturopathic physician, a world traveler, a hiker, and a blogger. She focuses her practice in fertility and women's health and takes an integrative, evidence-based approach to healthcare.