Articles

Alternative Treatments for Insomnia

By Janna Gordon, RPh.

Almost every person experiences temporary lack of sleep or insomnia at some point in their lives. Insomnia is defined as a difficulty in falling asleep, maintaining sleep, or not feeling rested despite a sufficient opportunity to sleep. Many things can impact the quality of our sleep such as stress at work or at home, changing hormone levels seen in pregnancy and menopause, certain medical conditions (i.e., anxiety disorders, depression, chronic pain, GERD, incontinence, etc.) and some medications and natural supplements (i.e., stimulants, some antidepressants, thyroid supplements, ginseng, pseudoephedrine, etc.).

Insomnia occurs more often as we age, and is more common in women. Being divorced, separated, or widowed also can increase the occurrence of sleep disturbances. Common symptoms of insomnia include fatigue, irritability, decreases in mental clarity, as well as physical complaints such as headache, GI upset, and muscle fatigue.

Some sleep disturbances can be corrected with improved sleep habits such as:

- Regular bedtimes and awakenings
- Creating an environment to encourage sleep
- Establishing a routine of preparing to sleep
- Regular exercise
- Exposure to bright light within 5 minutes of waking for at least 30 minutes.

For those whom behavioral changes do not provide relief of insomnia and are concerned with the effects of commercial prescription sleep aids, the following therapies may be considered:

Melatonin is a natural substance secreted from the pineal gland and helps to regulate the sleep/wake cycle. Levels are found to decrease with age and in patients with depression and insomnia. Peak melatonin levels shift to an earlier or later time than is usual in menopausal women. While dosing recommendations vary, to induce sleep a 3mg dose taken 3-4 hours prior to bedtime is a good starting point. If 3mg is not effective, some suggest increasing to 5mg may improve results. An effective dose should not produce daytime fatigue or irritability. Adverse effects include daytime drowsiness (usually only experienced with high doses), headache and depression. Melatonin may interact with isoniazid, oral contraceptives, estrogen, hydralazine, loop diuretics, penicillamine, and theophylline. Sedatives and alcohol may produce additive effects.

Valerian Root is a natural substance that is often used as a sedative to induce sleep. It is thought to work by increasing amounts of the neurotransmitter, gamma aminobutyric acid (GABA). Products that increase the amount of GABA generally cause relaxing, anti-anxiety, or anticonvulsive effects in the body. A typical dose is 200-400mg prior to bedtime. Adverse effects seen with valerian root include headache, dizziness, pruritis, and gastrointestinal (GI) distress. There have also been some reports of hepatotoxicity with long term use and withdrawal syndrome. Additive effects may be seen with taken with barbiturates (i.e., Phenobarbital) or with benzodiazepines (i.e. alprozolam or triazolam). Valerian root should be discontinued 1 week prior to surgery as it may interact with anesthesia.

L-5-Hydroxytryptophan (L-5-HTP), an amino acid is a serotonin precursor and studies have found that depletion of serotonin results in insomnia. Serotonin metabolizes to melatonin. A dose of 50-100mg one to three times per day may help improve sleep. Adverse effects include weight loss, and mild-moderate GI distress. 5-HTP may interact with other sedatives, and with antidepressants.

Sleep Naturally is a combination product that contains a blend of herbals (valerian root, chamomile flower, passion flower, lemon balm, skullcap whole, catnip whole, hops whole, and ashwagandha root), L-5-HTP, magnesium, melatonin, niacin, vitamin b-6, and folic acid. These ingredients help with sleep through a variety of mechanisms, for example, folic acid aids in the production of vitamin b-6 and vitamin b-6 aids in the synthesis of melatonin and serotonin. Magnesium also plays a role in the production of melatonin. Niacin is said to help people relax and fall asleep faster. The dose suggested to help with sleep is 1 to 2 capsules with water 30 minutes prior to sleep.

Human Growth Hormone (HGH) or Trans-D Tropin, a growth hormone releasing hormone may also aid in producing a sounder sleep. HGH production peaks during adolescence, but begins to decline in our 20s. As we age, we continue to produce HGH usually in short bursts during deep sleep. Studies have shown there is a rise in HGH 4 ½ minutes after the onset of deep sleep. At this time it is unknown if this occurs with the sleep or causes the sleep, but it has been hypothesized that HGH administration can improve sleep quality. Trans-D Tropin(TM) is an analogue of Growth Hormone Releasing Hormone (GHRH) that stimulates the body's pituitary to produce and release more of its own HGH. It stimulates the body's production of HGH in a pulsatile manner at every application time during the day. Trans-D Tropin is a topical solution. At this time, there are no known drug interactions. Trans-D Tropin should not be used if you are pregnant or have a pituitary tumor.

For menopausal women, a common cause of sleep disturbance is hormone imbalance. Replacing the hormones estradiol and progesterone often eliminate all or the majority of sleep disturbances experienced by menopausal women. One of the pharmacists at Bellevue Pharmacy Solutions would be glad to assist you in making a recommendation to your physician for starting on compounded bioidentical hormones to help with your hormone induced insomnia as well as other menopausal symptoms.

Patients should be aware that all products suggested to help with sleep may cause daytime drowsiness and they should use the products with caution until they are familiar with their effects.