Insomnia

Insomnia is the inability to fall or stay asleep. It often makes daytime functioning more difficult. At some time during the year about one-third of adults suffer from insomnia.

Signs and Symptoms

• Difficulty falling asleep
• Frequent waking
• Early-morning waking
• Sense of unsatisfying sleep
• Daytime drowsiness and impaired functioning

What Causes It?

If your health care provider has ruled out physical and mental causes your insomnia is probably a result of one of the following.

• Idiopathic insomnia—no specific cause (about half of all cases)
• Situational insomnia—caused by work school stress or family stress
• Substance abuse—caffeine alcohol drugs stimulants decongestants bronchodilators or long-term sedative use
• Night work or jet travel across time zones
• Menopause—30 to 40 percent of menopausal women
• Age—as a person grows older it's normal for sleep to be less deep

What to Expect at Your Provider's Office

Your health care provider will check for possible medical causes for your insomnia. Sleep disorders such as sleep apnea and narcolepsy are diagnosed by a test called a polysomnogram.

Treatment Options

Treatment Plan

Your health care provider will work with you to maintain good sleep habits and may suggest the following.

• Keep a regular sleep/wake schedule
• Exercise early in the day never in the evening
• Do not nap
• Avoid spicy fatty or fried foods alcohol sugar and caffeine consumption in the evening
• Set up optimal conditions for sleep and have relaxing bedtime rituals
• Use relaxation techniques such as biofeedback or deep muscle relaxation

Your provider will prescribe sedative drugs if other measures are not adequate.

Drug Therapies

Prescription

• Benzodiazepines —help you fall asleep quickly and increase the length of time you sleep without waking; side effects include daytime sleepiness loss of muscle coordination and addiction; do not use with alcohol or if you have sleep apnea
• Tricyclic antidepressants—help you fall asleep quickly and increase the length of time you sleep without waking; various side effects

Over the Counter

N/A

Complementary and Alternative Therapies

Herbs and nutrition can help you treat insomnia. Mind/body treatments such as yoga psychotherapy and relaxation methods may be helpful.

Nutrition

• Calcium/magnesium: regulate relaxation especially with muscle tension and physical restlessness 500/250 Ca/Mg twice a day
• B-complex: B vitamins are depleted under stress; however they may be stimulating in certain individuals so take in the morning.
• 5-HTP is a form of tryptophan particularly helpful for difficulty staying asleep. Dose is 50 mg before bed. 5-HTP will help within one week if it will help at all. Dietary sources of tryptophan include turkey eggs fish dairy products bananas and walnuts.
• Melatonin: helps prevent jet lag. Dose is one to three mg before bed. Note that a lower dose may be effective when a higher dose is not.
• Niacinamide: muscle relaxant gentle tranquilizer. Dose is 70 to 280 mg per day either in divided doses during the day or at bedtime.

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Unless otherwise indicated teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Chamomile (Chamomilla recutita): mild sedative calms gastric upset. One cup of chamomile tea before bed is often all that is needed for mild insomnia. Causes gastric upset in some people.
• Lemon balm (Melissa officinalis) alone or with catnip (Nepeta cataria): nervous sleeping disorders and mild digestive complaints; one cup tea or 30 to 60 drops tincture one to three times a day.
• Passionflower (Passiflora incarnata): the above-ground (aerial) parts taken 2 to 4 ml one half hour before bedtime.
• Valerian (Valeriana officinalis): sedative soothing bitter. Side effects of too high a dose may be nausea or grogginess. Traditionally used with passionflower (Passiflora incarnata) and hops (Lupuli strobulus) to treat acute stress. If you have depression you should avoid hops. Dose is equal parts herb at 1 cup one to three times a day or tincture 30 to 60 drops one to three times a day.
• Kava kava (Piper methisticum): spasmolytic anxiolytic sedative; very effective for short-term management of stress and insomnia. Do not use for more than three months without medical supervision. Dose is 15 to 30 drops ( 1/2 to 1 ml) tincture one to three times a day or 1/4 to 1/2 ml of concentrated liquid extract three times a day.
• St. John's wort (Hypericum perforatum): for insomnia with anxious depression; dose is 15 to 60 drops ( 1/2 to 2 ml) three times a day or 250 mg three times a day for depression. Side effects may include skin rash sensitivity to sunlight and gastric upset.
• Jamaican dogwood (Piscidia piscipula): Jamaican dogwood is a powerful remedy for insomnia particularly when the sleeplessness is due to nervous tension and pain. Taken 1 to 2 ml just before bedtime. Jamaican dogwood combines well with passionflower valerian kava and St. John's wort.
• Essential oils (three to five drops added to a bath): commonly used herbs are lavender (Lavendula officianalis) rosemary (Rosemarinus officinalis) and chamomile (Chamomilla recutita).

Homeopathy

Some of the most common remedies used for insomnia are listed below. Usually the dose is 12X to 30C every one to four hours until your symptoms get better.

• Arsenicum alba for insomnia caused by anxiety
• Nux vomica for insomnia from overuse of stimulants caffeine drugs
• Coffea cruda for insomnia from a racing mind especially if the stress is caused by adjusting to a positive event
• Ignatia imara for insomnia (or excessive sleeping) after grief

Acupuncture

May be effective at treating both insomnia and some of its underlying causes.

Massage

May be beneficial for its overall relaxing properties.

Following Up

Often insomnia stops when the stressful events in your life end.

Special Considerations

Establishing good sleep habits is the best method to avoid insomnia. A healthy diet and regular exercise also help. Alcohol disrupts the quality of sleep so regular use before bed should be avoided.

Supporting Research

Blumenthal M ed. The Complete German Commission E Monographs. Boston Mass: Integrative Medicine Communications; 1998:422 431.

Bravo SQ et al. Polysomnographic and subjective findings in insomniacs under treatment with placebo and valerian extract (LI 156 ). Proceedings of the Second International Congress on Phytomedicine Munich. Eur J Clin Pharmacol. 1996;50:552.

DreBring H. Insomnia: Are valerian/balm combinations of equal value to Benzodiazepine? Therapiewoche. 1992;42:726.

Emser W. Phytotherapy of insomnia—a critical overview. Pharmacopsychiatry. 1993;26:150.

Fauci AS Braunwald E Isselbacher KJ et al eds. Harrison's Principles of Internal Medicine. 14th ed. New York NY: McGraw-Hill; 1998.

Goroll Allan H ed. Primary Care Medicine. 3rd ed. Philadelphia Pa: Lippincott-Raven; 1995.

Rakel RE ed. Conn's Current Therapy. 50th ed. Philadelphia Pa: WB Saunders; 1998.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.