• Dr. Bill Rawls

    ABOUT BILL RAWLS, M.D.

    Dr. Rawls is a licensed medical doctor in North Carolina and a leading expert in integrative health. He has extensive training in alternative therapies, and is the Medical Director of Vital Plan, a holistic health and herbal supplement company in Raleigh, NC.

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Sleep Protocol

An Introduction to Sleep Health

There’s nothing worse than lying in bed at 1 o’clock in the morning with churning thoughts. No matter how hard you try, sleep will not come. Even worse is knowing that the next day is going to be miserable because of a bad night’s sleep.

Who wouldn’t want a safe and natural alternative to ease the mind into a relaxed state and allow normal sleep to occur?

However, natural doesn’t always equate with safe. Many sleep preparations contain herbs that have drug-like effects and can adversely affect liver function. And some products actually contain habituating drugs that are not regulated by the Food and Drug Administration (FDA).

Fortunately, for occasional sleeplessness, there are safe and effective natural options that actually work.

About Sleep

Every time you go to sleep, you are making a deposit into your health safety deposit box. This is a very stingy bank, however, and at least 7 to 8 hours of sleep are required out of every 24 hours to keep from depleting reserves.

If your body has been stressed, sleep is especially important because reserves are already low. Ironically, people who are the most stressed often find sleep especially hard to come by.

Because sleep is so important for normal health, it is worth every effort you can make to consistently get good sleep. The reward for the effort is feeling your very best and performing at your highest possible level — there’s nothing quite as good as sleep for promoting optimal wellbeing.

What Prevents Normal Sleep?

A few lucky people in the world seem to never experience difficulty sleeping, but most people will be touched by not sleeping well at some point in their lives. People who are naturally alert will have greater difficulty sleeping than most. For those people, just the thought of something stressful may keep them up at night.

Poor sleep is not actually a disease. Instead, it is a manifestation of neurotransmitter imbalances in the brain, most commonly occurring as a reaction to stressful situations. Stress disrupts hormone balance, and suppresses neurotransmitters in the brain that are necessary for sleep.

When stress becomes severe, poor sleep can be a nightly aggravation: the nervous system gets wound up, causing extreme tiredness and simultenous agitation that prevents sleep.

Beyond the day-to-day stress associated with modern life, the modern world is saturated with artificial light. Clinical studies have demonstrated that artificial light at night is associated with suppression of normal melatonin levels and disruption of normal sleep.

Many natural processes, including aging, can also adversely affect sleep. People tend to struggle more with sleep as they grow older. Menopause, a natural process, is almost always associated with disrupted sleep. Fortunately for most women, the disruptions caused by menopause gradually resolve and sleep does return to normal.

Sleep disturbances are common for individuals with suppressed immune systems. Though stress is a common culprit for occasional sleeplessness, inflamed brain and nerve tissues may also be a contributing factor. Numerous clinical studies have linked inflammatory markers of systemic inflammation in the body with sleep dysfunction. This may explain why poor sleep can occur with a chronic health condition, even when the body and mind are in a relaxed state.

Reversible Causes of Disrupted Sleep:

  • Artificial lighting and computer screens
  • Gastrointestinal issues (reflux, irritable bowel syndrome)
  • Working long hours
  • Rebound occasional sleeplessness from taking sleeping pills
  • Environmental factors (noise, light, bed partners)
  • Chronic discomfort
  • Stress and anxiety
  • Stimulants in food and drink (caffeine, sugar)
  • Working odd day/night shifts

Recommended Herbs for Occasional Sleeplessness

Three ingredients — bacopa, passionflower, and motherwort — stand out as being exceptional for promoting a calm state without side effects or toxicity. Used during the day, a relaxed state results. Taken before bedtime, that relaxed state allows for normal sleep.

Each ingredient offers slightly different properties. When combined, the effect is restoration of normal calm throughout the body, without drug-like effects or risk of dependence.

Unlike valerian and hops (commonly found in many sleep supplements), these ingredients do not pose the risk of causing liver damage or habituation.

Bacopa has long been used in traditional medicine in India for occasional sleeplessness and stress, and more recently it has been studied for optimizing cognitive function. In other words, bacopa is a sleep aid that helps you think better. It also protects the brain against the negative effects of not having sleep. Studies have shown that bacopa enhances mental clarity and focus in subjects ranging from college students to elderly individuals with mental decline.

Passionflower is derived from the leaves of a woody vine native to South America. It has long been revered for promoting a state of calm, but it is unique in also offering muscle-relaxing properties.

Motherwort is a calming herb also known for supporting cardiac function, particularly occasional palpitations associated with stress and hormonal fluctuations.

Pairing these three herbs with a few other natural sleep- and calm-promoting ingredients can be an even more powerful way to restore normal restful sleep, particularly if issues like stress, tension, and pain are contributing factors to keeping you up at night. On this list:

  • Tart Cherry Extract: Tart cherries are a natural source of the sleep-inducing hormone melatonin. The amount is low, but it’s enough to help support your circulating levels of melatonin and invite sleep when you consume the fruit before bed. Tart cherries are also rich in potent antioxidants that can help reduce inflammation and related pain.
  • Magnesium Glycinate: More than half of American adults don’t get enough magnesium, and shortfalls of this mineral have been associated with poor sleep quality in studies. Magnesium helps promote calm and relaxation, and magnesium glycinate is particularly easy to absorb, plus glycine is a calming amino acid.
  • Ashwagandha and L-theanine: Ashwagandha is a soothing adaptogen that can help you feel calm and carry on in the face of stress. It’s complemented by l-theanine, an amino acid found naturally in green tea that helps counter the excitatory effects of stress hormones and certain neurotransmitters in the brain.
  • CBD Oil: CBD (short for cannabidiol) from hemp, a natural plant compound with no euphoric effects, is gaining notoriety for its ability to help moderate pain, ease anxiety, and support normal sleep. Look for a full-spectrum hemp oil as opposed to a CBD-only isolate to get the benefits of all the cannabinoids and other plant compounds like terpenes in hemp.

Additional Tips for Improving Sleep

  • Adjust the thermostat: Your body must purge the heat that builds up during the day before your brain can initiate sleep. Turning down the thermostat and sleeping in a room that’s in the range of 65℉ to 72℉ will promote a better night’s rest. Be sure to have extra covers handy, however, as your body continues to cool down during the night.
  • Get a sleep test: If your partner reports that you snore excessively, you may have sleep apnea. See a neurologist or visit a sleep center for testing.
  • Build up sleep pressure: The more active you are during the day, the more your brain builds up a substance called adenosine, which promotes sleep. Being active also lowers adrenaline, your primary stress hormone. Avoid vigorous exercise after 8pm, however, except for relaxing routines such as yoga or qigong. The gentle relaxing movements of qigong are perfect for promoting a relaxed state before going to bed.
  • Take a warm bath before bedtime: Warm water is both soothing and relaxing. A hot bath also dilates blood vessels in your skin, which will help you purge heat once you’re out of the water.
  • Avoid excessive light stimulation: Use low lights and turn off televisions and especially computer screens after 8pm. This will help stimulate natural melatonin levels. Always sleep in a very dark room. If you work an odd shift, use darkening shades to completely darken the room where you sleep.
  • Avoid blue light computer screens: Blue light suppresses melatonin and keeps your brain alert. If you read from a tablet, make sure it’s one that allows reading without blue light, or download an app for removing blue light from the screen. There are several programs available for download; a popular one is f.lux.
  • Sleep on a comfortable mattress: “Memory foam” mattresses or tops are especially conducive to a good night’s sleep and allow for sleeping on your side. Sleeping on your back encourages sleep apnea, while stomach sleeping can result in back and neck pain.
  • Limit noise pollution: Try to limit noise like outside traffic, snoring bed partners or restless pets. Consider obtaining an electronic device that produces “white noise” to drown out surrounding sounds. A HEPA air filter unit by the bedside is a great option.
  • Isolate yourself: Be aware that your bed partner may be keeping you awake. Movement and snoring from a person or pet in the room may be contributing to trouble sleeping. Consider sleeping in an isolated location until your sleep quality improves.
  • Learn how to turn off your brain: Become a master of simple breathing and relaxation exercises. There are almost unlimited options for accomplishing this goal, but if you want to overcome occasional sleeplessness, consider it essential.

When to Call Your Doctor

When occasional sleeplessness becomes a nightmare of nighttime wakefulness, it’s time to see your doctor. Before you go, however, you should know something about medical therapy options that may be offered.

If trouble sleeping is severe and unrelenting, medications can play an important role in breaking a vicious cycle. That being said, potential side effects associated with drug therapy and the potential for habituation and dependence must be respected.

It should also be noted that certain medications can actually cause occasional sleeplessness. Selective serotonin reuptake inhibitors (including Prozac, Zoloft, Effexor, and Wellbutrin), taken for anxiety and depression, are notorious for disrupting sleep in certain individuals.

Consult with your physician if you experience:

  • Chronic sleeplessness
  • Restless legs
  • Sleep apnea (commonly associated with excessive weight)
  • Chronic pain
  • Habituation to sleep medications

 

REFERENCES:
1. Zhang et al, Differentiating Nonrestorative Sleep from Nocturnal Insomnia Symptoms: Demographic, Clinical, Inflammatory, and Functional Correlates, Sleep. 2013 May 1; 36(5): 671–679.
2. Irwin, Olmstead, Carol, Sleep Disturbance, Sleep Duration, and Inflammation: A Systematic Review and Meta-Analysis of Cohort Studies and Experimental Sleep Deprivation, Biol Psychiatry, June 2015, in press
3. Cappuccio, D’Elia, Strazzullo, Miller, Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies, Sleep. 2010 May;33(5):585-92.
4. Kline, et al, Sleep Hygiene Behaviors Among Midlife Women with Insomnia or Sleep-Disordered Breathing: The SWAN Sleep Study, J Womens Health (Larchmt). 2014 Nov 1; 23(11): 894–903.
5. Lee et al, Cytokine Polymorphisms are Associated with Poor Sleep Maintenance in Adults Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome, Sleep. 2014 Mar 1; 37(3): 453–463.
6. Hall et al, Association between Sleep Duration and Mortality Is Mediated by Markers of Inflammation and Health in Older Adults: The Health, Aging and Body Composition Study, Sleep. 2015 Feb 1; 38(2): 189–195.
7. Drake et al, Stress and Sleep Reactivity: A Prospective Investigation of the Stress-Diathesis Model of Insomnia, Sleep. 2014 Aug 1; 37(8): 1295–1304.
8. Pillai et al, Moderators and mediators of the relationship between stress and insomnia: stressor chronicity, cognitive intrusion, and coping, Sleep. 2014 Jul 1;37(7):1199-208.
9. Bittencourt et al, Chronobiological disorders: current and prevalent conditions, J Occup Rehabil. 2010 Mar;20(1):21-32.
10. Bjorvatn, Pallesen, A practical approach to circadian rhythm sleep disorders, Sleep Med Rev. 2009 Feb;13(1):47-60.

Statements on this website have not been evaluated by the Food and Drug Administration. Always consult a qualified healthcare provider before making changes to your healthcare regimen.