Good mind and body health depends on getting good sleep. Stress, anxiety, aging, shift work, erratic sleep schedules and health problems can all lead to sleep troubles. Outside of the over-the-counter or prescription medications, here are some other integrative treatments for insomnia to get a good night’s sleep!
Melatonin is a natural substance that is directly responsible for maintaining the circadian rhythm. It is available in an over-the-counter supplementation in doses between 1-10 mg (Lexicomp Drug Reference, 2020) and can be taken three hours prior to bedtime. Supplementation with magnesium has also been found to be helpful in the treatment of sleep disorders due to its key role in the regulation of melatonin.
In an article by Ji (2017), there appears to be a link between iron levels and sleep, particularly in the younger population. In older people, magnesium may one of the more important supplements to monitor with regards to sleep. For all age groups, the evidence suggests a link between sleep and iron, zinc, and magnesium levels. In addition, vitamin B12 is linked to daytime alertness. Some research also suggests that vitamin B12 has a direct link to sleep as well. These micronutrient are not only linked to helping promote sleep but also in maintaining sleep.
Ashwaganda, a lesser known adaptogen that grows naturally in South and Central Asia, Africa, Indian, Pakistan and the Middle East, offers therapeutic benefits similar to gamma-aminobutyric acid (GABA). Described as the“Queen of Ayurveda” by Wadhwa, et al. (2016), ashwaganda’s latin name, Withania somnifera, “sonmifera”, means sleep-inducer which lends to its extensive use as a stress remedy throughout history. More recently, Deshpande, et al. (2020) published a randomized, double-blind, placebo-controlled trial of 150 people who reported frequent episodes of non-restorative sleep. Subjects were given 120 mg of ashwagandha extract once a day for six weeks and were found to have improved quality of sleep without any reports of adverse effects.
Stahl’s Essential Psychopharmacology (2013) describes a few non-pharmacologic behavioral interventions to aid sleep promotion.
- Relaxation training (i.e. breathing techniques, toe-to-head progressive relaxation)
- Stimulus control therapy (get out of bed if unable to get back to sleep)
- Cognitive behavioral therapy (reduce automatic negative thoughts about sleep)
- Practicing consistent sleep hygiene (go to sleep and wake up at the same time every day)
- Sleep restriction therapy (No Naps – to increase the drive for sleep at the appropriate time)
In addition to behavioral interventions, other basic and novel suggestions are:
- Make the bedroom a haven for sleep and sex only.
- Limit caffeine intake at least four hours prior to sleep (use an herbal tea, such as chamomile tea, for a nighttime drink instead)
- Positional support during sleep may reduce potential risks related to sleep apnea and gastric reflux. (Side-note: Sleep study may be needed to rule out obstructive sleep apnea (OSA), central sleep apnea or other sleep disruption. Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Risk factors for OSA include male gender, obesity and age. OSA is most common between young adulthood and age 70. Treatment of underlying OSA with proper positive airway pressure would be an appropriate intervention before the addition of medications.)
- Ensure that light is blocked adequately in the bedroom or use an eye mask to help reset wake-sleep cycles for shift workers.
- Bright light therapy(BLT):
- Evening BLT phase delays circadian parameters and sleep-wake cycle
- Shift workers can be completely re-entrained with bright light intermittently for 20 minutes during night
- Use ear plugs to help avoid loud auditory disruptions
- Try a “white noise” machine to blunt environmental noise.
- Listen to music at particular frequencies that sync with the brain waves of healthy sleep, i.e. delta waves helps to improve sleep quality (Gao, et al.,2020)
- Use meditation, calming music, reading before bed, etc.
- No TV in the bedroom, limit screen time before sleep.
- Lower the temperature of the bedroom
- Try a weighted blanket for warmth and anxiety relief.
The use of Autonomous Sensory Meridian Response (ASMR).
Public awareness of ASMR as a means to promote sleep and relaxation has increased in the last few years. ASMR videos are made in various forms to promote relaxation. Poerio, et al., (2010) reported that people who experience the effects of ASMR describe it as a head-to-toe tingling sensations in response to a variety of “audio-visual triggers such as whispering, tapping, and hand movements”. In addition to promoting sleep and relaxation, ASMR helps combat stress and anxiety, and increase feelings of connectedness. Two recent studies tested the physical and emotional responses to ASMR. The results indicated that ASMR videos helped to regulate emotions and had some physically therapeutic effects, such as reducing heart rate, that were comparable to therapeutic music-based stress reduction. The effects were found to be greater than those seen during mindfulness interventions for anxiety. They note, however, that ASMR only affects certain people who are capable of experiencing ASMR and that the mechanism by which people experience ASMR is not fully understood.
Deshpande, A., Irani, N., Balkrishnan, R., & Benny, I. R. (2020). A randomized, double blind, placebo controlled study to evaluate the effects of ashwagandha (Withania somnifera) extract on sleep quality in healthy adults. Sleep Medicine. doi:10.1016/j.sleep.2020.03.012
Gao, D., Long, S., Yang, H., Cheng, Y., Guo, S., Yu, Y., Liu, T., Lu, J., &, Yao, D. (2020). SWS brain- wave music may improve the quality of sleep: An EEG study. Frontiers in Neuroscience, 14. doi:10.3389/fnins.2020.00067
Institute for Natural Medicine. (n.d.). How do naturopathic doctors treat insomnia and other illness? Retrieved from https://naturemed.org/faq/how-do-naturopathic-doctors-treat-insomnia-and-other-sleep-problems/
Ji, X., Grandner, M. A., & Liu, J. (2017). The relationship between micronutrient status and sleeppatterns: a systematic review. Public Health and Nutrition, 687-701 .
Poerio, G. L., Blakey, E., Hostler, T. J., & Veltri, T. (2018). More than a feeling: Autonomous sensory meridian response (ASMR) is characterized by reliable changes in affect and physiology. PLOS ONE, 13(6), e0196645. https://doi.org/10.1371/journal.pone.0196645.
Sleep Foundation.Org. (2020). Insomnia: Treatment. Retrieved from https://www.sleepfoundation.org/insomnia/treatment
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. (4th ed., pp. 444-470). Cambridge University Press.
Wadhwa, R., Konar, A., & Kaul, S. C. (2016). Nootropic potential of Ashwagandha leaves: Beyond traditional root extracts. Neurochemistry International, 95, 109-118. doi:10.1016/j.neuint.2015.09.001