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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
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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.
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| 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
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| 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.
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