It is one thing to be sick, but it is yet another to be sick and tired—and the two often go hand in hand. Not only is sleep important for waking up refreshed, but it is a key factor in health and well-being. Sleep is one of our most essential functions and a crucial element in many physiological processes, including development, energy conservation, brain waste clearance, immune modulation, cognition, performance, disease, and psychological state. Sleep deprivation can have significant impact on health and has been shown to affect pain, metabolism, and immunity. Thus, if sleep is compromised our immune function, energy, and other processes necessary for regaining health may be compromised as well.
Far-Reaching Effects of Sleep Deprivation
Sleep disorders are among the most common health problems, affecting an estimated 50–70 million people in the U.S. Approximately 85% of adults with significant sleep-disordered breathing remain undiagnosed. In adults, sleep duration less than 7–8 hours significantly impacts health, with cumulative effects associated with a wide range of health consequences, including an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke. Decreased sleep has also been associated with weight gain, low libido, poor balance, and increased accidents.
In humans, there are different sleep states that can be seen on electroencephalograms (EEGs). These states cycle between rapid eye movements (REM) and non-rapid eye movements (nREM) usually 4 to 5 times a night, with each cycle lasting approximately 90–120 minutes. Ideally, a greater proportion of sleep (20–25%) occurs in the REM cycle, during which dreams, functional memory consolidation, and sometimes even problem solving take place. Thus, if REM sleep is not optimal, memory issues can occur. In disease states such as Lyme disease, REM cycles tend to be shallower and shorter. REM sleep can also be suppressed by smoking, caffeine, alcohol, marijuana, narcotics, antidepressants, benzodiazepines, and lithium. Sleep disorders such as obstructive sleep apnea and narcolepsy can also cause disrupted REM sleep.
During sleep there is typically reduced body movement, decreased electrical activity in the brain, reduced responsiveness to external stimuli, slower breathing rates, and altered body position, including closed eyes. However, some people experience REM sleep behavioral disorder (RBD), in which the paralysis that usually happens during sleep is incomplete or absent. Thus, behaviors such as talking, yelling, kicking, jumping from bed, flailing, or grabbing can occur. RBD can happen with (and often precedes) neurodegenerative disorders such as Parkinson’s disease and multisystem atrophy. Restless leg syndrome may also be caused by the tick-borne infections Babesia and Bartonella. Treating these will often correct restless leg syndrome. As with all disease states, it is imperative to decrease inflammation and address the underlying causes of disease. Achieving adequate sleep is a key factor in achieving health and fighting disease.
Healthy Practices to Improve Sleep
In addressing sleep disorders, it is important to have good sleep hygiene. This includes the following:
- Eliminating alcohol consumption before bed
- Not consuming caffeine after 4 p.m.
- Not using the bed/bedroom for work or problem solving
- Not using electronics before bed
- Using room-darkening shades to minimize light
- Keeping phone and electronics on airplane mode and preferably in a different room
- Writing down racing thoughts
- Having a light snack before bed to make sure hypoglycemia is not waking you up during the night
- Limiting fluids before bed
- Not allowing kids and animals to sleep in your bed
- Using earplugs or a sound generator if there are sleep sounds, such as snoring
Natural Supplements for a Better Night’s Sleep
If sleep hygiene is not enough, it may be necessary to use herbal supplements and/or medications to help achieve adequate sleep. When starting a new supplement or medication, it is best to start one at a time and at the lowest dose. The dose can then be increased each night until the maximum dose is reached, side effects occur, or eight hours of sleep are achieved. If eight hours of sleep are not achieved, the next remedy may be tried or added. Most individuals will need a combination of three or more sleep herbs, and it is better to take more supplements at a lower dose to avoid side effects. Typically, sleep medications can be tapered off at 18 months, decreasing after six months of sleeping well, because the hypothalamus can recover and reset. However, some individuals may need to stay on sleep medications for longer periods, or even forever.
Below are some sleep supplements that have been shown to be effective for sleep:
- Melatonin, 3–60 mg. Melatonin has been shown to improve sleep quality and duration in healthy and diseased individuals. It helps synchronize circadian rhythms, can help RBD, and is a very strong antioxidant that can boost immunity.
- Wild lettuce, 30–120 mg. Wild lettuce helps anxiety and insomnia, headache,
muscle and joint pain, and decreases restless leg syndrome. - L-theanine, 5–200 mg. An amino acid from green tea, L-theanine improves deep sleep and promotes calmness during day. It also plays a role in the formation of GABA (a chemical created in the brain that has anti-seizure and anti-anxiety effects), helps with weight loss, and is an immune stimulant.
- Jamaican dogwood extract, 20–48 mg. This extract is a muscle relaxant that aids in falling asleep and has a calming effect.
- Hops extract, 30–120 mg. Hops can be a mild sedative for anxiety, improve insomnia, promote good sleep, and relax the muscles. It has some hormonal activity and can reduce hot flashes in menopause and has some antibiotic and antifungal activity as well.
- Passionflower extract, 90–360 mg. Passionflower is a calming agent that treats muscle spasms, colic, dysentery, diarrhea, anxiety, and menstrual cramps. It helps with pain management, including in fibromyalgia, and may also increase men’s libido.
- Valerian extract, 200–800 mg. Valerian extract improves deep sleep and quality of sleep and can be used for anxiety during the day. In 10% of individuals, however, it may energize them and keep them awake. It is best used in combination with other sleep supplements.
- D-ribose, 5–30 g. This supplement helps sleep while increasing energy.
- Magnesium, 75–150 mg. Magnesium can help sleep by relaxing muscles.
- Lemon balm, 80–160 mg. Lemon balm improves deep sleep, especially when used with valerian.
- 5-HTP, 100–400 mg. 5-HTP is a precursor to serotonin. It improves sleep, anxiety, and fatigue in as little as four weeks. Be careful when taking with serotonin reuptake inhibitors (SSRIs), however, as the combination may cause serotonin syndrome, which can be deadly.
- Sleep combination products. Some sleep combination products can be effective, such as Sleep by Restorative Formulations.
- Homeopathic remedies. Homeopathic remedies such as Sleep Calm by Boiron Homeopathic Remedy can be extremely effective as well.
If herbal sleep supplements are not strong enough, prescription sleep medications may be necessary. These should be discussed with a physician with prescribing capabilities.
Jennifer Letitia, MD, is a functional medicine physician at The Center for Holistic Healthcare in Glastonbury (ctrforholistichealthcare.com) and at Whole Body Medicine in Fairfield (wholebodymed.com). She treats a variety of chronic and environmental issues and uses bioidentical hormones to optimize health and wellness in her patients.