INSOMNIA IN A NUTSHELL

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What is Insomnia?

Insomnia can involve the inability to fall asleep (onset insomnia) or stay asleep (maintenance insomnia). Sleep deficiency can not only significantly diminish quality of life, but may also increase risk of multiple health problems such as anxiety, cardiovascular disease, and obesity.

Acute or transient insomnia can last several days or weeks, often in response to a stressful life event. Chronic insomnia, which lasts at least three days per week for three months or more, can have profound long-term effects on health. Insomnia may arise without any clear underlying cause (primary) or may be due to a comorbid condition (secondary), such as chronic pain that makes it difficult to sleep.

Several natural interventions such as melatonin and valerian may help improve sleep and restore the body’s natural circadian rhythm.

What are Causes and Risk Factors for Insomnia?

  • Female gender—hormonal shifts from menstruation, pregnancy, and menopause can contribute to sleeping problems
  • Advanced age
  • Mental health problems such as anxiety, depression, and bipolar disorder
  • Physical health conditions such as cardiovascular disease and urinary and respiratory problems
  • Certain medications such as decongestants, chemotherapy drugs, and beta-agonists
  • Stimulants such as caffeine and nicotine
  • Excess stress levels
  • Shift work

What Lifestyle and Non-Pharmacological Changes Can Be Beneficial for Insomnia?

  • Improving “sleep hygiene”
    • Minimize light and noise
    • Avoid large meals before bedtime
    • Avoid bedtime activities not related to sleep
  • Sleep restriction therapy, which limits the amount of time spent in bed
  • Cognitive-behavioral therapy
  • Relaxation therapies

What are Conventional Medical Treatments for Insomnia?

  • Over-the-counter drugs such as antihistamines for occasional use
  • Benzodiazepines such as alprazolam (Xanax), clonazepam (Klonipin), and diazepam (Valium)
  • Benzodiazepine-like drugs such as zaleplon (Sonata), zolpidem (Ambien), and eszopiclone (Lunesta)
  • Antidepressants with sedative properties such as doxepin (Silenor), trazodone (Desyrel), and amitriptyline (Elavil)

What are Novel and Emerging Therapies for Insomnia?

  • Drugs that target melatonin receptors (MT1 and MT2) such as ramelteon (Rozerem)
  • Orexin receptor antagonists like suvorexant (Belsomra) that block wakefulness-promoting neuropeptides from binding their receptors
  • Serotonin receptor antagonists – activation of these receptors can interfere with deep sleep.
  • While sedation and sleep are different, short-term use of the anesthetic drug propofol may help reset sleep rhythms.

What Natural Interventions May Be Beneficial for Insomnia?

  • Melatonin. Melatonin is a hormone that is highly correlated with the body’s sleep-wake cycle. Low melatonin levels have been linked to insomnia in the elderly and supplementation may help improve sleep.
  • L-tryptophan. L-tryptophan is a precursor to melatonin and serotonin. Supplementation with L-tryptophan may increase melatonin production to aid sleep and may help alleviate some forms of depression.
  • Magnesium. Magnesium helps regulate the body’s circadian rhythm. A study showed supplementation with magnesium, zinc, and melatonin improved sleep in elderly subjects.
  • Zinc. Higher zinc levels in the body may be correlated with longer periods of sleep. Oral administration of zinc can improve sleep quality and duration.
  • Valerian. Valerian is a sedative herb that has been used since ancient times to treat insomnia. A study comparing valerian supplementation to a commonly prescribed tranquilizer found comparable efficacy.
  • Ashwagandha. Ashwagandha is an herb shown in several animal models to reduce stress and anxiety and improve sleep. Human trials indicate ashwagandha may improve stress and anxiety scores, but further research is needed.
  • Lemon balm. Lemon balm has been shown to improve mood and feelings of calmness. Lemon balm, alone or in combination with valerian, may also improve sleep and symptoms of insomnia.
  • Lavender. Aromatherapy with lavender essential oil may improve sleep quality and reduce feelings of drowsiness after waking.
  • Other natural interventions that may improve sleep include honokiolglycinechamomilepassion flower, and bioactive milk peptides.
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