Insomnia
Statistics:
In a 2006 study, almost 25% of people surveyed reported insufficient rest or sleep for 14 or more days out of every month. Over 10% reported getting insufficient rest or sleep every day. The Centers for Disease Control estimate that 50-70 million people in the United States have chronic sleep disorders.1 I see lots of people in my practice with some level of insomnia; it is literally one of the most common problems that I see.
The problems with poor sleep:
Insomnia is not just miserable; it is also detrimental to your health. Sleep is the time when our body gets a chance to recover and repair from the stresses of the day. Poor sleep causes:
- Disruption of hormonal systems
- Increased accidents, especially car accidents
- Poor concentration, therefore poor school and job performance
- Increases insulin resistance leading to heart disease and diabetes
- Increased inflammation – worsened arthritis, aches and pains, and heart disease
- Decreased ability to deal with stress, anxiety, and depression
The cause must be discovered and addressed:
There are many types of insomnia based on the person’s experience. Insomnia is really not a disease but a symptom present in many diseases. Some people have racing thoughts or anxiety that keeps them awake. Some people are in chronic pain or have some other external factor that keeps them awake. Some people have sleep apnea where they have difficulty breathing; they wake themselves up often and get poor quality of sleep. Some people have difficulty getting to sleep and some wake up and cannot get back to sleep. Some people’s circadian rhythms are disrupted so they are wide awake at night and want to sleep during the day. You will hear this from me with most conditions, but I will keep repeating: the cause must be addressed.
What can I do now?
So the first and most important step of treating insomnia is finding the cause. However, there are a number of things that can help you get better sleep while addressing the cause; this is called palliative care. In other words, it is a temporary measure to relieve suffering but will not ultimately be curative.
One of the most effective steps to helping get to sleep is creating a nightly routine. This is well-known to parents with children who do not want to go to bed, but it also works wonderfully for adults. This routine should be pleasurable, not a chore.
Night-time routine:
Establishing a routine that you do every night can be one of the most helpful things you can do to get a good night’s sleep. Try to start the routine and get to bed at the same time every night. This helps your circadian and hormonal rhythms establish a good pattern. Below are some ideas that are often helpful. Try several of these at first. Also, try to wake up at the same time every day even if you did not have a good night of sleep.
- Get exercise in the evening: Going for a walk after dinner is the simplest way to get yourself ready for bed time.
- Plan for tomorrow: People are often kept up by thoughts about what needs to happen tomorrow. Write out a list for the next day so you can forget about those concerns while going to sleep. Also, it is often helpful to keep the list by your bedside so that you can write any ideas that come to you while going to bed; that allows you to get them down and not have to worry about remembering the ideas the next day. Having useful lists was one of David Allen’s tips for getting things done efficiently without being stressed out.2
- Avoid stressful stimuli: Dim the lights and turn off televisions and computers. Your brain’s pineal gland is sensitive to sunlight; it makes serotonin to wake you up when there is light coming into your eyes and it makes melatonin to help you sleep when there is little light coming into your eyes. Staring into a lit screen messes with the pineal gland and can make it more difficult to get to sleep. Make the evening the time for quiet and calm. Do not watch the news with all of the disasters, the latest stock market crashes, and scandalizing politics when you need to be calming down and getting ready for all-important sleep. Be sure you get off of the “hamster wheel” of life in the evening. Leave your work at work; this is especially important for the self-employed and people who work from home. Avoid caffeine in the evenings. Also, avoid alcohol if at all possible; it can make you sleepy but the quality of sleep is usually poor.
- Take a warm bath: Warm baths have a great sedative effect on the body.
- Warm herbal tea: Chamomile or mint tea is a very nice tea to help calm the nerves. This can be drunk while taking the bath. If you have trouble with waking in the night, make sure you have the tea at least an hour before bed.
- Listen to relaxing music
- Read something fun and relaxing. Be sure it is not something so fun that you cannot put it down though!
- Prayer or meditation time in the evening is not only a great way to calm down and get the mind ready for sleep, it is also a wonderful way to address the worries or fears that often keep us up at night. There is wisdom to the habits we are taught such as prayer before bedtime.
- Be sure you are comfortable: A mattress that you are uncomfortable sleeping on can be the biggest barrier for some people. The best mattress for you does not mean the most expensive one. For myself, I do the best on a very firm mattress such as a futon. Others do well with soft mattresses. A firm mattress is often better for those suffering from back pain. Make sure you are warm enough or cool enough. Be sure the bedroom is dark and there is no noise. Getting dark shades or earplugs is sometimes necessary.
Waking at Night:
Often people have no difficulty getting to sleep, but waking up in the night is a big problem. Making sure your bedroom is a good environment for sleep is a must in this case. Review the “Be sure you are comfortable” section above. Some other tips:
- Be sure you use the bathroom before bed and do not drink too many liquids before bed.
- Have a relaxing herbal or homeopathic remedy next to your bed. If you wake and cannot get back to sleep, take the remedy. I will list some useful herbs below.
- If you are tossing and turning, get up and do something relaxing. This can be reading, writing, knitting, sewing, drawing, or painting. It is often helpful to do a creative activity that uses the right side of your brain so you are not thinking so much. I personally find journaling a favorite night-time activity.
- Relaxation techniques are often very helpful. A tape or CD guiding you through a technique is often useful at first. Here is a useful one:
- Take a deep breath and tense your legs and feet for about 5 seconds. When you exhale feel the tension draining out of those muscles as you relax them.
- Breathe normally and quietly for a few breaths while focusing on your body’s sensations.
- Repeat tensing the chest and abdomen, arms and hands, neck and face in turn, finally ending the series by tensing the whole body and then letting everything relax.
Herbs for Sleep:
There are many herbs that help us relax without the groggy effects that are common with sedative pharmaceuticals. When patients come to see me with insomnia, I will usually design a formula for that specific person. Below I list several herbs and their indications. I have seen over and over again that an herb will often work for one person, but the next person will be helped by a different herb. These are very safe herbs but please seek advice from a qualified practitioner if you are taking medications, pregnant, or breastfeeding. All of the doses listed are for adults.
Chamomile (Matricaria chamomilla or Anthemis nobilis): This makes a wonderful tea or can be used as a tincture (alcoholic extract). A few drops of the essential oil can also be put into a bath. It is best to use an infusion of high-quality loose teas rather than the tea bags. This is a mild sedative. Its specific indications are nervous irritability, discontent, sensitive to discomfort, often associated with abdominal pain and indigestion.3 It is used for insomnia with difficulty relaxing.4
Dose: Infuse 1 tablespoon of dried flowers per cup of water for 5 minutes; slowly sip 1-2 cups. 1-2 dropperfuls of tincture in water.
Hops (Humulus lupulus): This is a somewhat bitter tea so it is best used in combination with another herb or as a tincture. Hops is specifically indicated with insomnia due to excitement, worry, nervousness, muscle twitches, and nervous headaches.5
Dose: Infuse 2 teaspoons dried strobiles per cup of water and drink 1-2 cups in an evening. 1-2 dropperfuls of tincture in water.
Lemon Balm (Melissa officionalis): This a wonderful mild sedative. It is indicated for nervousness and insomnia with an upset stomach though the upset stomach is not required. The tea is not as yummy as you would think from smelling the fresh plant but it tastes fine. Those with poor thyroid function should be cautious using this herb daily for more than a week.
Dose: 2 teaspoons of dried leaves per cup of water taken in the evening. 1-2 dropperfuls of tincture in a little water.
Passion Flower (Passiflora incarnata): This extraordinary flower and name contrasts to its medicinal use as a mild sedative. It is specifically indicated for insomnia from worrying about the next day or of work, especially with “mind chatter” or “circular thinking.”5 Circular thinking is best illustrated by the song, “There’s a Hole in the Bucket, Dear Liza.” This is very common in my practice and I often see this among those with insomnia due to overuse of coffee.
Dose: 1-3 dropperfuls of the tincture. Infusion of 2 teaspoons of the flowering herb per cup of water.
Valerian (Valeriana officinalis): This is a stronger sedative than many of the other herbs listed here. It is very helpful in those with tension and nervousness that are having difficulty relaxing.7 The tea is an acquired taste but is a great way of taking this herb. Many object to the smell likening it to “dirty socks.” I personally think that is a grand overstatement.
Dose: Infusion of 2 teaspoons dried root per cup of water. Take 1-2 cups before bed. 1 teaspoon of the tincture is necessary for a good sedative effect.8
Conclusion: There are many more herbs out there useful for insomnia but these are a few that are especially useful as a tea before bed or as a tincture if you awake in the night.
References:
- Centers for Disease Control. Perceived insufficient rest or sleep—Four states, 2006. MMWR. 2008; 57(08): 200-203. ↩
- Allen, D. Getting things done: the art of stress-free productivity. New York: Penguin Books; 2001. ↩
- Felter, HW. The eclectic materia medica, pharmacology, and therapeutics. Cincinnati, OH: Eclectic Medical Publications; 1922. ↩
- Wood, M. The book of herbal wisdom: using plants as medicines. Berkeley, CA: North Atlantic Books; 1997. ↩
- Wood, M. An herbal materia medica. ↩
- Wood, M. An herbal materia medica. ↩
- Sherman, JA. The Complete Botanical Prescriber. Published by the author. 1993. ↩
- Weiss, RF. Weiss’s Herbal Medicine. Stuttgart, Germany: Thieme; 1960. ↩
