Is Anxiety the Cause of Your Insomnia?
It’s been a long, busy day. Meetings at work meant that you accomplished almost nothing else. Then, you arrived home and had to cook dinner, handle chores and take care of the kids. Finally, exhausted you crawl into bed in hopes of a good nights sleep. You sigh as your head hits the pillow and tuck the blanket around you. You close your eyes and wait. Ten minutes, fifteen, twenty, thirty . . . Yes, still awake. You count sheep, read in bed and yet are still awake. The question is… “Why?”
First of all, it is important to understand insomnia. Insomnia is defined as the difficulty falling asleep or staying asleep. It is considered chronic if it happens at least three nights per week for three months or longer. Symptoms of insomnia include:
- Difficulty falling or staying asleep
- Waking up too early in the morning
- Unrefreshing sleep
- Fatigue or low energy
- Cognitive impairment
- Mood disturbance
- Behavior problems (impulsive or aggressive)
- Difficulty with work, school, and interpersonal relationships
Insomnia and Stress
The hectic pace of modern life can cause chronic stress for many individuals. The physiologic response to stress is for the adrenal glands, which sit on top of each kidney, to secrete stress hormones. During acute stress, the adrenal glands secrete DHEA and cortisol. When stress becomes chronic the adrenals have trouble keeping up with this and first DHEA levels will become depleted. If stress continues to persist, cortisol will also plummet. This leaves one exhausted and is therefore called adrenal fatigue. Typically, cortisol should be released in the greatest quantities early in the morning to help you wake up and decrease throughout the day till it is at its lowest point at night so that you may fall asleep. This is often referred to as your circadian rhythm. When dealing with chronic stress cortisol often becomes elevated, particularly in the evening hours. This can make it very difficult to sleep and is one of the most common causes of insomnia. People with insomnia due to stress often describe the feel as being, “tired but wired.”
This type of sleep disturbance is often called a circadian rhythm sleep disorder. It is marked by the inability to fall asleep at a desired, conventional time and wake up at a socially acceptable morning time. Sleep is generally of normal quality and duration for age and they maintain a stable but delayed sleep-wake pattern.
Typically, adrenal issues are corrected with adoptogenic herbs. Adaptogens are botanicals that help the body better cope with stress and help to normalize physiologic reactions in the body. Examples of adaptogens include: ashwagandha, rhodiola, panax ginseng, maca, and holy basil. One of my favorite interventions for insomnia due to high cortisol is holy basil tea. This is generally sold as Tulsi tea and is a pleasant tasting herbal tea that does not contain caffeine. This herb is quite calming and can help one relax sufficiently to be able to sleep. It is not, however, a sedative. Therefore, it can also be used during the daytime and won’t impair one’s ability to make a decision, work heavy machinery or respond to a problem. For those with autoimmune disease, it is not always a good idea to use adaptogenic herbs other than maca or holy basil as they may increase the activity of the immune system worsening autoimmunity.
Insomnia, Anxiety and Norepinephrine/Epinephrine
For some, regardless of what has been happening earlier in the day, they find that they cannot get their brain to stop spinning so that they may relax and fall asleep. This can occur during the daytime as well. So, for example, one might have a minor disagreement with a colleague at work. While one person may brush it off as nothing all that alarming, another might not be able to get it out of their mind. In fact, by the time they have played the event over and over again in their mind they may think that the person hates them. This could even go as far as to cause the person to avoid the colleague.
While the individual may not describe themselves as anxious, this is one type of anxiety caused by increased levels of the neurotransmitters norepinephrine and epinephrine. These neurotransmitters (technically also the hormones noradrenaline and adrenaline, respectively) are catecholamines that are released as part of our sympathetic nervous system’s “fight or flight” response. They are released to make us alert, focused and vigilant. While technically important for times of high stress, frequently we have increased levels from the constant stress of modern life.
For many this is exacerbated by their genetics. A common single nucleotide polymorphism (SNP—pronounced “snip”), or change in the genetic code, to the enzyme catechol-O-methyltransferase (COMT) can worsen the effect of modern stress. This enzyme is important for the breakdown of catecholamines including: dopamine, norepinephrine, epinephrine and estrogen. When there is a SNP to the COMT enzyme the enzyme’s function is decreased. This leads to increased levels of catecholamines such as norepinephrine and epinephrine. This can cause a hypervigilant state. While this can make one’s executive function (think Type “A” personality) much better, for the individual it can lead to problems quieting the mind and sleeping. This can be particularly problematic the week prior to menstruation for women with the COMT SNP as the enzyme is further taxed by the estrogen load. This can cause increased anxiety and sleep issues just before her period.
Thankfully, there is a simple nutritional solution. For every enzyme there is a cofactor. Cofactors are helpers that are required to allow the enzyme to function. These are generally vitamins and minerals. In the case of the COMT enzyme, the mineral magnesium is required as a cofactor. By dosing supplemental magnesium we can enhance the function of the COMT enzyme which then helps to decrease the level of norepinephrine and epinephrine. It is important to choose a form of magnesium that is readily usable by the body. Magnesium citrate, oxide and sulfate are osmotic laxatives that bring water into the colon and can therefore cause loose bowel movements. Choosing a magnesium glycinate, malate or threonate is more appropriate when trying to increase magnesium levels and will not cause diarrhea.
Anxiety, Insomnia and Histamine
Most people think of histamine as being involved in allergies. While this is true, it is certainly not the only role for this widespread neurotransmitter. It is used throughout the body in a wide range of processes including water balance, regulation of other neurotransmitters, body temperature control, release of gastric juices and even our sleep/wake cycle. For this reason, elevated histamine can cause insomnia. Anyone who has ever taken the over-the-counter antihistamine Benadryl can tell you that it typically makes you very sleepy. This is because as it decreases histamine, it will decrease wakefulness. On the other hand, when histamine levels are elevated sleep can be challenging. This can be further compounded by the fact that histamine can increase levels of excitatory neurotransmitters including norepinephrine and epinephrine while decreasing inhibitor (calming) neurotransmitters including gamma-aminobutyric acid (GABA) and serotonin. Often those with elevated histamine will complain of anxiety. For those with COMT SNPs, this can compound the problem.
How do you tell if you have a histamine problem? Quite often you will have other signs and symptoms including acid reflux, itching, hives, flushing, stuffy nose, increased mucus production, gastrointestinal dysregulation, or asthma. Many will also have dermatographism, or skin writing. What this means is that if scratch your skin a red, generally raised line will develop and may last ten to 15 minutes or more. Individuals may also have known environmental or food allergies.
Here too genetics may play a role in histamine-induced insomnia. Propensity for allergies is certainly inherited. Additionally, genetic SNPs to the enzyme diamine oxidase (DAO) can cause increased histamine levels. DAO is an enzyme required to breakdown histamine. When one has genetic SNPs to this enzyme it causes histamine levels to rise. It also makes people have intolerance to foods that are high in histamine including alcohol, fermented foods, tomatoes, peppers, grapes, citrus fruits, older fish, shellfish, older meats (particularly ground meats), aged cheeses, chocolate and wheat. Decreasing or avoiding these foods can help to decrease histamine levels. Increasing intake of the B-vitamin riboflavin may also be helpful as it is the cofactor for DAO. Another option would be taking supplements containing the enzyme DAO 15 to 20 minutes prior to a high histamine meal.
Additionally, there are other supplements that may be helpful in decreasing histamine levels. Quercetin may be helpful since it stabilizes mast cells, the cells that release histamine, preventing the mast cell from losing its histamine load. Unfortunately, quercetin is poorly absorbed and must be taken away from food for proper absorption. The botanical butterbur may also be helpful. This herb has been proven in randomized clinical trials to be as effective as the antihistamines Claritin, Zyrtec and Allegra. Those with a ragweed allergy, unfortunately, may not tolerate this herb as it is a member of the ragweed family. Vitamin C can also help to decrease histamine. This vitamin is the cofactor for the enzyme alcohol dehydrogenase which is responsible for the final step of histamine breakdown.
Depression, Insomnia and Serotonin/Melatonin
According to the Centers for Disease Control (CDC), depression affects nearly 8% of individuals ages 12 years or older. For many (though not all), this is caused by a depletion of the neurotransmitter serotonin. While often depressed individuals will want to sleep all the time they often have sleep disturbances. This is because serotonin is also linked to melatonin, a hormone released by the pineal gland that allows us to fall asleep. This important hormone requires serotonin as a precursor. When serotonin levels are low this will severely compromise melatonin synthesis. For individuals that are depressed and having sleep problems, melatonin may be taken supplementally to help with sleep. However, in the long run, improving serotonin levels is even more important for relieving both the depression and insomnia. Serotonin is formed from the amino acid tryptophan. Many depressed individuals benefit from taking the metabolized form of tryptophan, 5-HTP. This can help provide the body with the building blocks of this important neurotransmitter. Those taking antidepressants such as selective serotonin reuptake inhibitors (SSRIs), should ask their physician before taking 5-HTP as it could increase serotonin levels too much. Taking vitamin B6 can also be helpful as it is a cofactor required in the synthesis of serotonin. Finally, a small dose of niacin may also be helpful. This is because niacin is also synthesized from tryptophan. Insuring that niacin levels are adequate can prevent the body from using tryptophan for its synthesis and allowing the tryptophan to be used to synthesize serotonin instead.
General Tips for Healthy Sleep
- Create and keep a sleep schedule. Go to bed and wake up at the same time each night.
- Have a relaxing bedtime ritual. Avoid bright lights, television, work, video games, Facebook.
- Avoid naps if you have trouble sleeping. While a nap may make the day feel easier, it may make it difficult to sleep at night.
- Exercise daily. Vigorous exercise is great, though even light exercise is better than none. Avoid exercising two hours before bedtime.
- Make your bedroom comfortable. Keep the bedroom a bit cooler—between 60 and 67 degrees. Keep the bedroom noise-free and dark.
- Purchase a comfortable mattress and pillows. If you have allergies, make sure the bedding is free of allergens.
- Manage your circadian rhythms. Keep your environment bright in the daytime and darker at night.
- Avoid alcohol, cigarettes, and heavy meals in the evening.
- Transition into bedtime. Find some time to wind down and get ready for bed.
- If you can’t sleep, go to another room and do something relaxing until you do feel tired.
Jessica Pizano is the owner of Fit to You, LLC, which offers clinical nutrition and nutrigenomic counseling, as well as personalized training programs. Her concentrations include genetics and nutrigenomics, general health and fitness, weight loss, food allergies/sensitivities, autoimmune disease, obesity intervention, and Pilates. She earned a master’s degree in human nutrition at the University of Bridgeport. She is a certified nutrition specialist through the Board for Certified Nutrition Specialists. She is continuing her studies at Maryland University of Integrative Health where she is pursuing a doctor of clinical nutrition and is also an adjunct faculty member teaching nutritional genomics. A certified personal trainer and a corrective exercise specialist through the National Academy of Sports Medicine, she is also certified in mat Pilates through PHI Pilates and earned her Clinical Exercise Specialist and Longevity Wellness Specialist through the American Council on Exercise. Currently, Jessica practices nutrition counseling, nutrigenomics, and personal training in her studio in Avon. She may be contacted at (860) 321-7234 or online at: www.fittoyouct.com.