On March 17, 2011, Dr. Brad Jacobs, MD, and Chair of Pharmaca’s Integrative Health Advisory Board, held a webinar to talk about the problem of sleeplessness—which affects more than 40 million people—and its integrative solutions.
"On average we feel that people should be sleeping at least 7-8 hours, some people prefer 9 hours per night, on a regular basis,” Dr. Jacobs says. While this was possible 100 years ago, too much external and internal stimuli keep us from that amount of sleep. “Today we're a bit more disrupted, so the hours of sleep have really gone down."
Insomnia is characterized by difficulty getting to sleep, staying asleep or waking too early, or even just getting poor quality sleep. This problem usually worsens as we age, and up to 50% of the elderly experience insomnia, with women experiencing it more often than men.
But there are other causes, too: medical conditions such as hyperthyroidism, heart disease and neurological disorders; stimulants such as caffeine and alcohol; and even prescription drugs such as bronchodilators, decongestants and some anti-depressants. “A lot of medications can cause sleep problems,” Dr. Jacobs says. “Often medical doctors don't realize that."
And the consequences of not getting enough sleep can be drastic. Dr. Jacobs says that even if you just feel tired and grumpy, you may not know that sleeplessness can also lead to cognitive problems, decreased performance and productivity in the work place, even accidents and injuries.
“We think it actually accelerates a lot of health issues related to age,” Dr. Jacobs says. But it also affects health issues not related to age, including your endocrine system, carbohydrate metabolism, glucose tolerance, cortisol levels, and the activity of your sympathetic nervous system. “Our body is very well designed to deal with acute stress,” he says. “But the consequences of chronic stress are quite devastating.” Chronic diseases such as high cholesterol, cardiac disease, even cancer, can be dramatically affected when you have sleep debt, he says.
The good news is that now there is much research being done on sleep problems, and there are a variety of ways to tackle the issue. "In my experience, the vast majority of sleep problems are related to lifestyle and medications,” Dr. Jacobs says.
Above anything else, he recommends the “non-drug” solutions, which include the following lifestyle changes:
Set bedroom rules. Reserve the bedroom for sleep and sex. That means no work, no television, no emotional conversations right before bed. "There are a lot of things people do in the bedroom that really should be done in other parts of the home," says Dr. Jacobs. Set rules with yourself, your partner, your family.
Set solid sleep patterns. The body develops a circadian rhythm, so if you’re constantly switching your sleeping and waking times, it will have trouble getting good sleep. Dr. Jacobs adds that naps can be helpful. "I recommend that people experiment with naps,” he says. “But if you're going to nap, nap routinely so that your body gets accustomed to it."
Exercise! It's not only important for your body, your mental state and your spirit, Dr. Jacobs says, it's also important as a stress reliever. Decreasing that stress makes it easier for your mind to unwind when it comes time to go to sleep.
Eat the right foods. Too much sugar can keep you up, as can big meals that are still being digested. Pay attention to foods like dairy that can cause gas. Opt instead for small snacks or warm tea.
Create the right environment. Because of our circadian rhythm, darkness is especially important for good sleep. Dr. Jacobs recommends doubling up on drapery, or using an eyepad filled with lavender or other calming herbs. If you live in an urban environment, consider a white noise device to blur out specific noises, or earplugs.
Control external stimuli. If you have difficulty falling asleep, don't read or watch television for long periods of time, since those things can get you “wound up” and engaged. If you can't fall asleep after 15-20 minutes, get up, leave the bedroom and do calming activities until you're feeling sleepy enough to head back to bed. Activities might include breathing techniques, prayer, yoga or meditation, which help engage the mind in a calming, focused way.
If you're worrying too much, have a pad of paper near the bed to unload it from your mind. “Worry about it sometime in the future, not in the current moment,” Dr. Jacobs says.
Try Mindfulness-Based Cognitive Therapy. “Research has shown it to be better than drugs, even long term,” Dr. Jacobs says. This mindfulness-based practice helps change the repeated pattern of negative thinking that keeps us from falling to sleep, replacing it with new positive thoughts. The practice includes breathing exercises, encouraging the person to let negative thoughts pass through like clouds instead of holding onto them.
In addition to these lifestyles changes, the following supplements and medications can be helpful.
Melatonin: Dr. Jacobs says that 1-3 mg of melatonin, about 30 minutes before sleep, can really help. Though we don’t know the effects of taking it for the long term, he feels that it’s most effective when taken as needed, such as for jet lag or just when you have trouble sleeping a night or two each week.
Valerian: This herb is pretty well-tolerated by most people, says Dr. Jacobs. Find a formula that includes at least .3% of valerenic acid, and take 30-60 minutes before sleep.
5-HTP: A precursor to serotonin, Dr. Jacobs says many people sleep well with 200-300 mg daily.
Herbal formulas: There are a variety of different herbs that can help calm the mind and enhance sleep, including hops, lemon balm and chamomile. Look for formulas that combine a number of these different herbs.
Prescription medications: In general, Dr. Jacobs only recommends prescriptions such as Lunesta and Ambien as short-term solutions as you get on your way to modifying your lifestyle. While they can help, they can also evoke some serious side effects. Dr. Jacobs’ final advice? Know that you’re not alone in your sleeplessness. Recognize that as you age, sleep patterns do change,” he says. “It's not abnormal. Just adjust to it accordingly."