INSOMNIA
YOU TOSS, YOU TURN, YOU SIP warm milk, your readjust the pillow, you count
sheep, you pray. And still, sleep won't come.
If you are sometimes plagued by insomnia, you are not alone. A significant
proportion of the population has trouble sleeping at some time and many people
experience frequent insomnia.
The main cause of temporary insomnia is psychological stress and the worry
and anxiety that arise from it. Other culprits include consuming caffeinated
beverages or other stimulants too soon before you go to bed.
Insomnia is one
condition that often is better treated with herbs than with drugs. Most herbs
have far fewer side effects than sleeping tablets. They're effective for
sleeplessness from a wide variety of causes. Their effects range from very
mild relaxants to effective sleep aids. They can be taken internally or used
topically as bath teas or essential oils.
The sedative herbs discussed in this chapter appear in order from strongest
to mildest.
DRUG TREATMENT
Benzodiazepines
Diazepam (Valium), flunitrazepam (Rohypnol), flurazepam (Dalmane), loprazolam,
lormetazepam, nitrazepam, temazepam. Function: act on the central nervous
system to reduce anxiety and induce sleep. Side effects: clumsiness, drowsiness,
dizziness; may be habit-forming or cause temporary impairment of short-term
memory.
Antihistamines
Diphenhydramine (Medinex, Nytol, Panadol Night), doxylamine. Function: cause
sedation. Side effects: grogginess, clumsiness, dry mouth, constipation,
visual disturbances.
Other Drugs
Zolpidem tartrate (Stilnoct). Function: acts on the central nervous system to
induce sleep. Side effects: daytime drowsiness, lightheadedness, dizziness,
clumsiness, headache, diarrhoea, nausea.
SETTING THE STAGE FOR SLEEP
Almost all people with long-term insomnia need behavioural treatment, says
Dr Sonia Ancoli-Israel, director of the sleep disorders clinic at the Veteran's
Administration Medical Center in San Diego and author of All I Want Is a
Good Night's Sleep. Both herbs and drugs are temporary remedies. If you frequently
have insomnia, you may need to revamp your night-time routine. A report in
the Journal of the American Medical Association found that adopting good
sleep habits works better in the long run than taking sleeping pills.
Here
are ways to practise good sleep habits.
· Eliminate stimulants. Cut out coffee, tea, caffeinated soft drinks,
chocolate and sugary desserts, or don't consume them within six hours of
bedtime. Two stimulant herbs to watch out for are guarana and ephedra.
· Avoid alcohol and tobacco. And definitely don't partake within a couple
of hours of bedtime.
· Check your medications. Many drugs can interfere with sleep.
Ask your doctor whether something you're taking may be giving you insomnia.
· Wind down with pleasant rituals. Try yoga, a hot bath, sex, light
reading, massage or meditation.
· Get regular exercise. People who are sedentary often have trouble
sleeping because their bodies simply aren't tired. Be aware, on the other
hand, that strenuous workouts right before bedtime can disrupt sleep.
· Nap with caution. Naps not only make you feel groggy afterwards
but also can interfere with night-time sleep. Try exercising instead. If
you choose to snooze, do so before 3 P.M. and for only 30 minutes.
· Wait until you're truly sleepy. Light sleepers who stay in the
sack long hours are sometimes cured by spending less time in bed, which results
in deeper, more efficient sleep.
· Establish regular bedtimes. Do so even if it reminds you of a
parental voice saying `No more television!' Avoid sleeping late on weekends,
which can lead to Sunday-night insomnia.
· Set aside a worry time. Rather than fretting in bed, designate
a time earlier in the day to worry, plan and make to-do lists - and do these
in a room other than the bedroom.
· If you can't sleep, get up. Go do something soothing. Reading
may help, but it's best to do it in another room.
HERBAL REMEDIES
Valerian (Valeriana officinalis)
This is the best-studied herbal sleep aid. Like benzodiazepine drugs, valerian
puts you to sleep but, unlike drugs, doesn't cause a morning hangover, interact
with alcohol or lead to addiction. Research shows that extracts of the root not
only help you fall asleep faster but also improve sleep quality. Typical dosage
(taken 30 to 45 minutes before bedtime): one 150- to 300-milligram capsule standardised
to 0.8 per cent valeric acid; or 300 to 400 milligrams in non-standardised capsules;
or 1/2 to 1 teaspoon of tincture in water. Caution: valerian is not addictive,
but, if you're convinced you can't sleep without it, you could develop a psychological
dependence. For a very small percentage of people, valerian produces a stimulating
rather than a sedating effect. If this occurs, stop using it.
California Poppy (Eschscholzia californica)
The above-ground parts and roots of this wildflower show promise in the treatment
of insomnia. Higher doses of California poppy are sedating; lower doses
reduce anxiety. A commercial formula that combines California poppy and
corydalis (Corydalis yanbusuo) is used to treat insomnia, agitation and
anxiety. Typical dosage: up to 4 cups of tea per day (steep 1 teaspoon
of dried plant in 1/4 litre of hot water for 10 minutes); or 30 to 40
drops of tincture two to three times per day. Caution: not recommended
for use during pregnancy.
Lemon Balm (Melissa officinalis)
This common garden herb has many virtues, including an ability to ease insomnia.
It also relieves fever, fights viral illness, calms the digestive tract and
eases headaches. So, if your insomnia comes with any of these annoyances,
lemon balm is a good choice. It also tastes good, so you can include it in
a blend with other not-so-palatable insomnia herbs. Typical dosage: 1 to
2 cups of tea (steep 2 teaspoons of dried leaf in 1/4 litre of hot water
for 10 minutes); or one to two 300- to 400-milligram capsules. Take before
bedtime.
Passion
Flower (Passiflora incarnata)
Extracts of this herb have been shown in a study to decrease anxiety and
induce sleep. Some herbalists find passion flower especially good for times
when worry or an overactive mind interferes with sleep. Typical dosage: 1
cup of tea before bedtime (steep 1/2 teaspoon of dried herb in 1/4 litre
of hot water for 10 minutes); or 20 to 40 drops of tincture in water before
bedtime. Caution: do not take passion flower with monoamine oxidase-inhibiting
antidepressants.
Kava-Kava (Piper methysticum)
When insomnia results from anxiety, this herb is particularly effective.
Studies suggest that kava-kava promotes sleep by acting upon the brain's
emotion centres and by relaxing muscles. Take kava-kava one hour before bedtime.
Typical dosage: one or two 400- to 500-milligram capsules; or 20 to 30 drops
of tincture in water; or a standardised extract containing 180 to 210 milligrams
of kavalactones. Caution: do not use kava-kava while pregnant or breastfeeding,
or in combination with alcohol or other sedatives.
Camomile (Matricaria recutita)
A bright, daisy-like flower, camomile has an age-old reputation for calming
nerves and gently aiding sleep. Typical dosage: 1 to 2 cups of tea before
bedtime (steep 1 teaspoon of dried flowers in 1/4 litre of hot water for
10 minutes); or 10 to 40 drops of tincture in water before bedtime. Caution:
if you're allergic to other members of the daisy family, such as ragweed,
you might also be allergic to camomile.
Skullcap (Scutellaria lateriflora)
Because it functions as both a nerve tonic and a gentle sedative, skullcap
is a time-honoured remedy for anxiety and insomnia. Typical dosage: 1 cup
of tea (steep I to 2 teaspoons of dried herb in 1/4 litre of hot water for
10 minutes); or 20 to 40 drops of tincture in water. Take at bedtime.
Catmint
(Nepeta cataria)
Well-known to cats and cat lovers, this herb, sometimes called 'catnip',
has a gentle sedative effect on humans. It also expels intestinal wind, reduces
fevers by inducing sweating and is antispasmodic. So if your insomnia comes
with these symptoms, catmint can be useful when blended with stronger sedative
herbs. Typical dosage: 1 cup of tea before bedtime (steep 1 teaspoon of dried
leaf in 1/4 litre of hot water for 10 minutes). Caution: not for use during
pregnancy.
THE SWEET SMELL OF SLEEP
Marcel Lavabre, author of Aromatherapy Workbook, says that essential oils
can coax sleep. His favourites are neroli (orange blossom), marjoram, spikenard,
Roman camomile, lavender and ylang ylang. Lavabre recommends putting a couple
of drops of undiluted neroli, marjoram or lavender essential oils on your
pillow, or adding 10 to 15 drops to a bath. Don't apply any of these oils
to your skin, but you can blend a massage oil using 15 drops of essential
oil and 2 tablespoons of almond or other vegetable oil. Rub the blended oils
into your temples, forehead and the back of your neck.
MELATONIN: MAGIC OR MALARKEY?
You may have heard about the supplement melatonin in connection with insomnia.
Melatonin is a hormone secreted at night by the pineal gland, a tiny gland
deep inside the brain. It regulates several bodily processes, including sleep.
Production of this hormone usually begins to drop after the age of 40. Many
older people, but not all, have decreased melatonin levels.
The results of studies using melatonin to treat insomnia are inconsistent. Supplements of the hormone seem to work best when they're used to reset the biological clocks of people who perform shift work, who travel by jet across time zones, who are blind or who have become habitually nocturnal. Although the optimal dosage of melatonin for insomnia has yet to be clearly defined, the typical recommendation is between 0.5 and 3 milligrams 30 minutes to 1 hour before bedtime. Because melatonin production requires the amino acid tryptophan, a safer bet may be to eat plenty of tryptophan-rich foods such as turkey, fish, meat and beans.
Although no serious side effects have surfaced,
most experts consider this hormone experimental. Authorities also worry about
product purity. Synthetic melatonin is safer and probably more effective
than a supplement derived from animal sources. Caution: avoid melatonin if
you are trying to get pregnant, are already pregnant or have an autoimmune
disease. Children and adolescents should not take it.
