Tag Archives: insomnia

Isoflavones reduce postmenopausal insomnia, hot flashes

In a past blog, Natural Medications (Herbs, Vitamins, and Supplements) for Menopausal Symptoms, I discussed the data supporting a trial of isoflavones in women with menopausal symptoms. However, there was not a lot of data. Now, Medscape is reporting, “Isoflavones may reduce insomnia symptoms” in postmenopausal women, according to a small study in the journal Menopause. Continue reading

Less Than 25% of Valerian Herbal Sleep Supplements Pass Tests For Quality

Long-time readers of this blog know of my admiration for ConsumerLab.com, a leading provider of consumer information and independent evaluations of natural medications (herbs, vitamins and supplements). In fact, I use their findings almost daily in my practice to recommend natural medications to my patients.

In its most recent evaluation of a natural medication, valerian, ConsumerLab found that MOST of the valerian herbal supplements tested contained less of the herb than expected and/or were contaminated with lead.

Valerian is a popular herbal sleep aid used by approximately 6% of the U.S. population. Valerian accounted for $68 million in sales in the U.S. in 2009, up 10% from the prior year, according to Nutrition Business Journal.

Among nine leading and best-selling products selected by ConsumerLab.com for review, only TWO passed testing.

Of the seven that failed, one contained no detectable key valerian compounds and four others had only 26.7% to 82.5% of amounts expected from ingredient listings.

One of these products was found to be contaminated with lead, as were two other products. These results were confirmed in independent laboratories. Lead is a heavy metal that can impair mental functioning and may affect blood pressure. The amounts of lead found in the products (which ranged up to 3.5 mcg of lead per daily serving) are not likely to cause toxicity alone, but it is best to avoid unnecessary lead exposure.

Lead contamination was found to be an issue in products consisting primarily of valerian root powder as opposed to valerian root extract. The extraction process removes heavy metals.

“Valerian may help some people with sleep problems, although the evidence is mixed,” said Tod Cooperman, M.D., President of ConsumerLab.com. “Unfortunately, it appears that many people may not be giving valerian a fair try because the brand they buy lacks the expected ingredient. And some brands unnecessarily increase one’s exposure to lead.”

ConsumerLab.com found similar problems in earlier reviews of valerian supplements in 2001, 2004, and 2006. Dr. Cooperman added, “If you use valerian, it would seem prudent to choose a product that passed ConsumerLab.com’s testing.”

The complete report is available here. The report includes results for ten products. ConsumerLab.com selected nine. One other product was tested at the request of its manufacturer through CL’s Voluntary Certification Program and is included for having passed testing.

Brands included are:

  • A. Vogel (Bioforce),
  • Bluebonnet,
  • CVS,
  • Douglas Laboratories,
  • Genestra (Seroyal),
  • Mason,
  • Nature’s Answer,
  • Shaklee,
  • Solaray, and
  • Solgar.

Another of my favorite Internet-based sites for information on natural medications, the Natural Medicines Comprehensive Database, rates valerian as POSSIBLY EFFECTIVE for insomnia. The Database says:

Most research shows that taking valerian orally reduces the time to sleep onset (sleep latency), and improves subjective sleep quality. The greatest benefit is usually seen in patients using 400-900 mg valerian extract up to 2 hours before bedtime.

Valerian does not relieve insomnia as fast as benzodiazepines. Continuous nightly use for several days to four weeks might be needed for significant effect.

Some research suggests that valerian is not as effective as temazepam (Restoril) or diphenhydramine (Benadryl) for causing sedation in elderly people.

Valerian is often used in combination with other sedative herbs. Taking a combination product containing valerian extract 187 mg plus hops extract 41.9 mg per tablet, two tablets at bedtime, seems to modestly improve subjective sleep measures including subjective sleep latency compared to placebo after 28 days of treatment; however it was not significantly better than placebo after only 14 days of treatment (15018). A combination of valerian with lemon balm might also improve the quality and quantity of sleep in healthy people.

Valerian also seems to improve the sleep quality of insomniacs who have recently withdrawn from benzodiazepines. After tapering the benzodiazepine over two weeks, 300 mg valerian extract in three divided daily doses might subjectively improve sleep quality.

There is also preliminary clinical research that suggests valerian also might help improve sleep in intellectually impaired children.

Not all evidence is positive. Some evidence suggests that valerian does not significantly improve insomnia compared to placebo.

Valerian does not relieve insomnia as fast as benzodiazepines (6480). Continuous nightly use for several days to four weeks might be needed for significant effect (6249,10209).
Some research suggests that valerian is not as effective as temazepam (Restoril) or diphenhydramine (Benadryl) for causing sedation in elderly people (10424).
Valerian is often used in combination with other sedative herbs. Taking a combination product containing valerian extract 187 mg plus hops extract 41.9 mg per tablet, two tablets at bedtime, seems to modestly improve subjective sleep measures including subjective sleep latency compared to placebo after 28 days of treatment; however it was not significantly better than placebo after only 14 days of treatment (15018). A combination of valerian with lemon balm might also improve the quality and quantity of sleep in healthy people (10423).
Valerian also seems to improve the sleep quality of insomniacs who have recently withdrawn from benzodiazepines. After tapering the benzodiazepine over two weeks, 300 mg valerian extract in three divided daily doses might subjectively improve sleep quality (8006).
There is also preliminary clinical research that suggests valerian also might help improve sleep in intellectually impaired children (10207).
Not all evidence is positive. Some evidence suggests that valerian does not significantly improve insomnia compared to placebo (15046).

The Natural Medicines Database also rates valerian as POSSIBLY SAFE “when used orally and appropriately, short-term. Clinical studies have reported safe use of valerian for medicinal purposes in over 12,000 patients in trials lasting up to 28 day.” However, “the safety of long-term use is unknown.”

So, for my patients with occasional insomnia, I simply print off the ConsumerLab.com list of valerian products that have passed quality testing and say, “Buy the least expensive one and don’t use it more than a month at a time.”

The three products on the current “approved” list include:

  • Bluebonnet Herbals Valerian Extract (1 vegetable capsule, 1 per day)
  • Shaklee® Gentle Sleep Complex (3 tablets, 3 per day)
  • Solgar® Standardized Valerian Root Extract (1 vegetable capsule, up to 3 per day)

Six doctor-recommended sleep aids

Tired of counting sheep? Consider one of these remedies for the possibility of getting a good night’s sleep when you have occasional insomnia. These tips were posted on Health.com and are from RealSimple.com:

1) Aromatherapy

Try it: When you’re drowsy but slightly tense.

How to use it: Massage a dab of aromatherapeutic balm or oil into the back of your neck and shoulders (and inhale deeply) before you hit the sack. Certain fragrances, including lavender and lemon balm, promote snooze-inducing relaxation, says Rubin Naiman, Ph.D., a sleep specialist at the Arizona Center for Integrative Medicine, in Tucson. (Try Dr. Andrew Weil for Origins Night Health Bedtime Balm, which contains lavender; $25, origins.com.)

Good to know: You don’t have to stick to traditional aromatherapeutic scents — any fragrance that makes you feel good can be calming, says Dr. Phyllis Zee, M.D., Ph.D., a professor of neurology and the director of the Sleep Disorders Center at Northwestern University, in Chicago.

2) Valerian tea

Try it: If you are getting a full night’s sleep but still feel tired in the a.m.

How to use it: Sip a brew made from the flowering plant an hour or so before bedtime. (Try the Republic of Tea Get Some Zzz’s; $10.50 for 36 bags, republicoftea.com.) Some studies have shown that valerian can help increase sleep quality (it’s packed with antioxidants, too). You may have to drink it for several nights in a row before it works, says Naiman.

Good to know: Valerian shouldn’t be taken for more than two weeks at a time, since prolonged use can lead to dependency. And it can interfere with some prescription medications, including cholesterol drugs, so check with your doctor before steeping.

3) GABA-enhanced drink

Try it: When your head is racing with worries.

How to use it: Down a shot of gamma-aminobutyric acid (GABA) right before bed. (Try Arizona P.M. Relax FastShot; $3, drinkarizona.com for stores.) “GABA, an amino acid found in your body, has been shown to quiet the mind when taken orally,” says Naiman.

Good to know: Certain foods, including brown rice, bananas, and mackerel, contain GABA. Consuming them during the day may help you sleep better at night.

4) Melatonin supplement

Try it: If you don’t feel tired until way past bedtime.

How to use it: Take a three-milligram tablet 15 to 20 minutes before bed. (Try GNC Melatonin 3; $5 for 60 tablets, gnc.com.) Your brain makes this neurohormone naturally to “tell the body that it’s time for sleep,” says Naiman. “But many people have suppressed melatonin production because they’re overexposed to light in the evening.” Naiman has been using it nightly for 20 years.

Good to know: Consult with your doctor before taking melatonin. It is not recommended for pregnant women, women trying to conceive, children, and adolescent boys (it can affect testosterone levels in maturing males).

5) Over-the-counter sleeping pill

Try it: When you’re going through a short period of sleeplessness, like during a stressful time at work.

How to use it: At bedtime, take two tablets that contain diphenhydramine, an antihistamine that makes you feel sleepy (research shows that an excess of histamine in the body may cause insomnia). “The less often you take these pills, the better,” says Dr. Lisa Shives, M.D., a sleep specialist in Evanston, Illinois. “You can build up a tolerance, and then they won’t work as well.” (Try Unisom SleepGels; $10 for 32 gel tabs, at drugstores.) Note: Never mix alcohol and sleeping pills.

Good to know: “The older you are, the slower you metabolize this type of drug,” says Shives. That means you may experience lingering sleepiness in the morning.

6) Prescription medication

Try it: When insomnia becomes a chronic problem.

How to use it: Work with your doctor to figure out which medication is best for you. Shives’s favorite is Rozerem (rozerem.com). It acts on the melatonin receptors in the brain that help you fall and stay asleep (other aids act only as a sedative). However, only Lunesta (eszopiclone) and Silenor (doxepin) are approved by the FDA for long-term use. Take a tablet about 30 minutes before bed.

Good to know: Finding the right medication may require trial and error: Some can make you more wired and awake. Side effects are common, says Shives, and range from the annoying (headaches, grogginess) to the serious, like unconscious nighttime binge eating and driving. Pregnant women may want to avoid these aids, even though they have not been proven to be dangerous.

Insomnia is considered chronic when it lasts most nights for a few weeks or more. This longer-term condition deserves professional attention, says Tom Roth, Ph.D., head of the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit. If you’re unsure about whether you have chronic insomnia, Roth suggests looking at it like a headache. “If it goes on day after day and nothing you do makes it go away, then you should see a doctor,” he says. “Ask yourself: Do you know the cause?”

Tart Cherry Juice (Sour Cherry): What Are The Facts?

Tart cherry juice is now becoming a popular drink for everything from heart disease, insomnia, and muscle pain to preventing cancer.

It’s in commercial products such as Cheribundi Tru Cherry Tart Cherry Juice, Nature Blessed Cherry Juice, and others.

Tart cherry juice contains antioxidants including vitamin C, vitamin E, kaempferol, and quercetin.

In addition, the juice has anti-inflammatory effects and might reduce markers of muscle damage after exercise. According to The Review of Natural Products by Facts and Comparisons (St. Louis, MO: Wolters Kluwer Co., 1999), “A preliminary study suggests that compounds found in the sour cherry may have anti-inflammatory effects that are ten times stronger than aspirin but without aspirin’s side effects.”

Tart cherry juice is also a natural source of melatonin. Some people are using it to improve sleep. According to the experts at the Natural Medicines Comprehensive Database, “Drinking two 8 ounce servings daily for 14 days might modestly improve some measures of sleep in older adults.”

They add that according to one study: “A specific juice blended from whole Montmorency tart cherries and apple juice has been used (Tru Cherry Cheribundi, CherryPharm, Inc., USA). More evidence is needed to rate sour cherry for this use.” Tru Cherry has about 120 calories per 8 ounce serving.

According to another publication, the melatonin content seems to vary between different varieties of sour cherry. Montomorency cherries contain about 13 ng of melatonin per gram of fruit, and Balaton cherries contain about 2 ng per gram.

The NMCD tells us physicians, “Explain to patients that this is promising, but very preliminary.”

For now, tart cherry juice likely does no harm and may help some folks with insomnia and may be worth a try to prevent muscle aches after exercise.

Strategies for Getting a Good Night’s Sleep

Here’s some excellent information on avoiding insomnia and getting a good night’s sleep using common-sense sleep hygiene. It’s from my friends at the Natural Medicines Comprehensive Database. However, I find that many of my patients are not aware of some (or even most) of this information. So, here’s to a good night’s sleep for each of you.

What Is Insomnia?

Insomnia is a common complaint. Some symptoms of insomnia are difficulty falling asleep, difficulty staying asleep, and difficulty with early morning awakening.

Sometimes insomnia only lasts for a short time and can be easily managed. Persistent insomnia is more troublesome and can affect work, school, social relationships, and health.

Many conditions are associated with insomnia such as depression, anxiety, allergies, and pain. Much of the time insomnia is simply the result of poor sleep habits.

How Is Insomnia Treated?

Insomnia treatment in adults may include use of an over-the-counter medication or, in other cases, use of a prescription sedative.

Over-the-counter sleep medications (diphenhydramine [Benadryl]) may worsen insomnia in children.

It is important to determine the cause of insomnia before treatment begins. Maintaining a sleep diary for one to two weeks is a good way to start. Keeping track of sleep times, caffeine and alcohol ingestion, etc. may provide clues as to the cause of insomnia.

Behavioral changes are often all that’s needed to improve sleep. By maintaining good sleep habits (sleep hygiene) the need for medication may be avoided. In children, ensure a regular sleep schedule and calming bedtime routine.

PRINCIPLES OF SLEEP HYGIENE

  • Stick to a regular sleep schedule—even on weekends.
  • Exercise regularly—avoid exercise in the late evening.
  • Go to bed only when sleepy.
  • Put your worries away when you go to bed.
  • Do something relaxing and enjoyable before bedtime.
  • Make your bedroom quiet and comfortable.
  • Avoid large meals just before bedtime.
  • Use your bedroom only for sleep and sexual activity.
  • If you cannot sleep within 15 to 20 minutes get up and go to another room. Return to bed only when drowsy.
  • Remove the clock from eyesight.
  • Do not nap during the day. If you must nap, limit it to 30 minutes in the early afternoon.
  • Avoid alcohol, nicotine, and caffeine use.
  • Avoid frequent use of sedatives.
  • Schedule outdoor time at the same time each day.
  • Have your pharmacist check your medications for potential sleep effects.
  • Avoid bright lights (e.g. from TV, computers, video games) before bed.

Adapted from Jermain DM. Sleep disorders. PSAP. 1995:139-154.

What If Nondrug Treatment Fails?

If you or your child are still having difficulty getting a good night’s sleep, you should talk to your pharmacist or other healthcare provider. The cause of your insomnia will need to be determined and a medication may be needed.

Even if medication is used for insomnia, sleep hygiene principles should still be followed and can provide added benefit.

Tai chi helps older adults get good night’s sleep

Reuters Health is reporting a study in the journal Sleep that found that regular practice of tai chi, a Westernized version of the ancient Chinese martial art of tai chi, can help older people rest easier at night. Nearly two-thirds of people who learned the slow, gentle tai chi moves experienced significant improvements in sleep quality, compared to about one-third of those who participated in health education sessions that included information on how to get a better night’s rest.

My Take? Continue reading

Better Sleepers Are ‘Successful Agers’

 

HealthDay News is reporting a study showing that normal sleep is associated with healthy aging. Researchers at the University of California, San Diego assessed 2,226 women aged 60 and older and found increased severity of sleep disturbances predicted lower self-rated successful aging and a greater difference between perceived and actual age. Continue reading

Sleep a Necessity, Not a Luxury

HealthDay News reports that as the pace of life gets faster and faster, and people try to cram more and more into every minute of the day.

Before Thomas Edison invented the light bulb in 1880, people slept an average of 10 hours a night. These days, Americans average 6.9 hours of sleep on weeknights and 7.5 hours a night on weekends, according to the National Sleep Foundation.

But lack of sleep affects a person in one of two ways. Continue reading