There’s a reason that sleep deprivation is used as a form of torture. You desperately want to sleep, but it’s not in your control and seems like it’ll never happen. You’ve been religious at optimizing sleep hygiene and perhaps you’ve even left your cool, dark room to peruse this with your blue light blockers on. You’ve come to the right place, o weary one — read on for integrative approaches to insomnia.
WHAT EXACTLY IS INSOMNIA, ANYWAYS?
We define chronic adult insomnia as:
- difficulty getting to sleep, taking more than 30 minutes
- difficulty staying asleep
- happens 3 or more times a week for more than 3 months
- impacts functioning during the day
- mood issues
- impaired performance
- sufficient opportunity for sleep exists and other conditions have been ruled out
- includes sleep apnea, restless leg syndrome, bladder issues necessitating nighttime urination
HOW MUCH SLEEP DO I NEED?
Studies show that 7-9 hours are ideal for adults and recommends bedtime around 9-11 pm.
Typically, falling asleep takes less than 20 minutes, and less than 45 minutes is spent awake within the 8 hour sleep window.
This allows sufficient time for varied phases of sleep. Normally, about 3-5 non-REM / REM sleep cycles occur, each about 90 minutes long.
- Non-REM sleep
- Broken down in 3 different phases, each with a unique role for the body
- N1: light sleep
- N2: decreasing core body temperature and activity of the brain and heart
- N3: deepest sleep with delta brain waves. The brain cements memories and the body is repaired during this phase.
- Broken down in 3 different phases, each with a unique role for the body
- REM sleep
- Last stage of sleep cycle
- The brain functions as though you’re awake and dreaming occurs.
N3 non-REM sleep is predominant in the first part of the night, with the latter half shifting to more REM and less N3 sleep.
THE BENEFITS (AND BEAUTY) OF SLEEP
Sleep repairs our muscles and bones, quiets our cortisol and our cardiovascular system. This results in decreased risk of heart disease and stroke, compared to those who suffer lack of sleep. Those with insomnia have increased risks for diabetes, obesity, depression, and even cancer. With better sleep, we are mentally tougher, physically stronger, and happier.
Dr. Rubin Naiman’s perspective on sleep is wonderful — he wants us to reclaim sleep as an essential and equal partner to our waking lives. He states, “To view sleep as purely functional is to miss its essence. Reducing sleep to function is like reducing relationships to function. We can open up the brain and look at how neural networks buzz when people report being in love – but to say that love is nothing more than a brain function really seriously guts it. It does not show the whole story.”
This shift in thinking may help you look at sleep with a different lens.
IS IT INSOMNIA OR A CIRCADIAN RHYTHM ISSUE?
Light affects circadian rhythms, which give rise to various hormone pulses. This releases the famed (or infamous, again depending on your perspective) melatonin hormone. Interestingly, there’s a natural peak of this around 4 am and a dip around 2 pm. So, enjoy that early afternoon catnap, but try to keep it less than 30 minutes.
There can be changes in a person’s natural circadian rhythms that impact daytime activities but are distinct from insomnia.
- Delayed circadian rhythm occurs when one regularly goes to bed 2 or more hours after a than socially acceptable time and has trouble waking up at a needed or desired time for 3 months (or, most teenagers).
- Advanced sleep wake disorders occur when a person can’t stay awake at night but then wakes up before they want to.
- Irregular sleep-wake rhythms happen when insomnia and long daytime napping result in no regular, prolonged nighttime sleep for a few months.
- Shift work can markedly affect the circadian rhythm as well.
BOTANICALS FOR INSOMNIA
Of course, please see a doctor to ensure that there aren’t any other conditions or medications that may be affecting your sleep. This includes alcohol and stimulants, like my beloved coffee.
This root has been used for millennia to aid sleep. Studies overall support its use in improving sleep quality and decreasing time to sleep. In fact, one randomized double blind study showed valerian was similar to a benzodiazepine in improving sleep.
Various doses have been studied and typically start at 300 mg, taken about 2 hours before bedtime. If used for a prolonged period, valerian should be decreased slowly and under a physician’s care.
Ashwaganda use has exploded. Every juice bar worth its salt seems to carry some iteration of it. It’s an adaptogen, which means it’s designed to help the body adapt to stress. However, not everyone knows that it’s from the plant Withania somnifera. That’s right: somniferous. It’s a sedative so it’s best avoided if you want to be alert. It can take up to a month to have a sedative effect and is especially helpful for the anxiety component of insomnia. Though people overall tolerate it well, it shouldn’t be used if pregnant, nursing, or if you have liver issues.
A common dose is 300 mg up to twice daily for a few month.
This botanical is gentle and slow-acting, and has anti-anxiety and sedative effects. There isn’t much data examining its use in insomnia but the trials to date are promising for its benefit in sleep quality. However, don’t use in pregnancy.
This botanical has well-documented anti-anxiety effects, but its use in insomnia isn’t as fleshed out. Prior trials support its help in decreased insomnia and anxiety, but side effects may include vivid dreams and dizziness. Avoid use in pregnancy or with liver issues. Typical dose is 120 mg of kava lactones.
Many use chamomile as a sleep aid, though the studies on its use in insomnia are sparse. It helps decrease anxiety and is considered quite safe. Therefore, it may be a useful adjunct for insomnia.
SUPPLEMENTS FOR INSOMNIA
This hormone has anti-oxidant and anti-inflammatory properties in addition to its well-known sleep promotion. Certain conditions (Alzheimer’s, high blood pressure, and diabetes) and medications (including commonly prescribed beta blockers and even non steroidal anti-inflammatories like ibuprofen) may decrease its production. A starting dose is usually 1 mg and prolonged release may be most physiologic.
Though magnesium is touted as a supplement for calm and constipation relief, there are some studies showing promise for insomnia.
Doses range from 225-500 mg daily.
A non-protein amino acid found in teas but most known in green teas, L-theanine modulates neurotransmitters. It can decrease stress, improve focus, and help sleep. 200 mg is a typical starting dose.
MIND BODY TECHNIQUES TO HELP INSOMNIA
Exercise helps sleep and the more exercise, the more profound the effect. But the timing of when you’re exercising matters. I am an afternoon / evening exerciser, but I may be switching this up, because studies show that early morning exercise is best for restful sleep.
One study showed a difference in sleep quality even depending on time in morning, with best results if exercise happened 3 hours after waking, compared to 7 hours after.
And another study compared exercise in the morning, afternoon, and evening on nighttime blood pressures and sleep quality. The conclusion: 7 am exercisers slept deeply for the longest time.
Seems simple, right? We do it without thinking. But becoming more mindful of our breathing and changing its patterns helps with anxiety, stress, and even sleep. Studies examining heart rate variability (a balance between the parasympathetic and sympathetic nervous system) show improvement (ie, high HRV) when we breathe in for 6 counts and exhale for 5.
Dr. Andrew Weil popularized the 4-7-8 breath and helps focus our breathing. You inhale through the nose for 4 counts, hold your breath for 7, and then exhale through pursed lips for 8 counts (4 breath cycles both morning and night).
Perhaps all this medical speak has almost put you to sleep by now! But if not, hopefully there are some tips to help ease into sleep.
I am a USC-trained Reproductive Endocrinology & Infertility physician with a boutique practice in Orange County, CA. I am also a Fellow in Integrative Medicine at the Andrew Weil Center at the University of Arizona, a FEMM Fellow at the Reproductive Health Research Institute, and serve as Associate Clinical Faculty at UC Irvine. My goal is to radically reimagine my field by focusing on whole body methods to identify the root cause and heal reproductive issues, like fertility, miscarriage, and abnormal cycles. I do this through integrative medicine practices coupled with traditional REI techniques, all while avoiding aggressive procedures. I’m grateful to have been selected for multiple years running as a Southern California Super Doctor and Rising Star, Orange County Physician of Excellence, and Top Doc in Pasadena. I am a Healthcare Task Force member for Life Perspectives, a leader in education, research, expertise and support after reproductive loss; serve on the Advisory Board for Pre-Health Shadowing, a non-profit that makes discovery of different medical specialties accessible to students; and have been an invited guest at multiple conferences and podcasts as well as an author of book chapters and multiple articles. I am excited to use an integrative medicine lens to educate about women’s issues!