Do you have trouble sleeping? You are not alone! About one-third of adults in America regularly sleep less than 7 hours a night. That’s bad enough. But a majority of us (about 70%) have trouble sleeping once in a while. 1 Sleep is crucial for overall health, and in particular, brain health. This epidemic of sleep deficiency is a contributing factor in a number of chronic diseases and can cause daytime fatigue, difficulty concentrating, mood swings, learning ability and can even cause serious accidents.
We don’t fully understand everything that happens when you sleep but we have now learned about a number of ways that sleep rejuvenates your brain. Your brain is a complex mixture of neurons, supportive cells, blood vessels and the cerebrospinal fluid (CSF) drainage system. When you go into deep non-REM sleep, not only are your thoughts and memories sorted and stored, but your brain cells and blood vessels shift a bit to allow more cerebrospinal fluid drainage to occur. This causes a cleansing effect. The day’s activity can cause oxidative stress and inflammation, but when the CSF flows through the brain, it is like your brain is taking a bath and toxins are removed. I like to call it a “reset”. Similar to how you turn your computer off and on again when it isn’t working properly, your brain sometimes needs to be reset. This is what happens when you go into deep sleep throughout the night and get more than 7 hours of sleep. You wake up with energy, focus and a good mood. This is how your brain is supposed to work!
There are many reasons for sleep difficulties. The most common is stress or anxiety, but inflammation, blood sugar instability and hormonal imbalances do contribute. The other factor you cannot afford to ignore is your lifestyle habits. Sleep hygiene is so very important. For example, you cannot watch suspenseful movies late at night or be active on social media (exposing your eyes to blue light) late at night and then expect your brain to go to sleep easily!
Good sleep hygiene is a foundation for optimal sleep:
- Keep a regular sleep schedule, whether it’s a workday or not.
- Do not do stressful work in the evening.
- Dim the lights in the house 2 hours prior to bedtime.
- Turn off all screens 2 hours prior to bedtime. (TV, tablet, computer and phone). This is not easy, but can be very helpful.
- No screens in the bedroom. Charge your phone in another room so alerts do not disturb you.
- Keep your bedroom cool, dark and quiet. (turn down your thermostat – winter or summer – to no more than 68)
- Do not eat a large meal close to bedtime.
- No caffeine after 2 PM.
- Avoid alcohol. You may fall asleep a little quicker but alcohol disrupts your sleep cycle and causes poor quality sleep that is non-restorative.
- Exercise regularly but not within 6 hours of bedtime.
- If you do not fall asleep within 20 minutes of going to bed, get up and do a quiet activity such as reading. Use your bed only for sleep and sex.
I can’t sleep! What can I do?
Before we discuss supplements, first consider a few things:
- If you have daytime fatigue, please discuss with your practitioner whether you should have a sleep study done. Obstructive sleep apnea (OSA) is epidemic and often silent. Many people with OSA have no idea they have it and they do not realize how absolutely crucial it is that it is identified and treated. If your sleep cycles are constantly being interrupted all night long by hypoxia (a drop in oxygen), you will never feel energetic during the day. Home sleep studies are a very easy way to find out if this is an issue for you.
- When women transition through menopause, sleep disruption is common. Bioidentical hormones can often help your sleep quality, but they usually need to be used in conjunction with good sleep hygiene and supplements.
Long-term prescription medications can lead to negative side effects. Supplements are a safe & effective option!
There are many supplements available to improve sleep. They typically have a number of ingredients in them that work together. Common ingredients include melatonin, GABA, theanine, valerian, magnesium, lemon balm, 5HTP, and passionflower.
Quality matters! Any company can make a supplement for sleep, but the best supplements are made by companies that use high quality ingredients and produce a pharmaceutical grade product. Therefore, you often get what you pay for.
Everyone’s brain is unique. Therefore, what works for you may not work for someone else. This simply requires that you try different products until you find a product that works for you. The process may take some time, but it will pay off!
Here is a list of my favorite products for sleep. You can purchase any of them in the office, and most are also available on Fullscript (click here to purchase).
- Alpha-Theta Ultra PM (Biotics Research)
- Alpha GABA PM (Neuroscience)
- Insomnitol (Designs for Health)
- Liposomal Tranquinox Deep (NuMedica)
- Melatonin SRT (Designs for Health)
- CBD Synergies (Quicksilver Scientific)
Several thoughts: the Alpha-Theta Ultra PM and Alpha GABA PM are both very popular. You take 1 or 2 at bedtime and they work quite well. The Tranquinox Deep is a new product that is also proving itself very effective. It is a liposomal liquid, and the dose is 6 pumps under the tongue at bedtime. However, some people do not need the full dose, so you can customize your dose to exactly what you need. Also, some people will use several pumps in the middle of the night if they wake up. It is quite useful for use during the night. The last product, CBD Synergies, is a liposomal full spectrum, low THC hemp product. It is a blend of hemp, melatonin, and botanicals that all work together for sleep. Research on CBD is beginning to show benefits on sleep2 so it is worth a try, as long as you use a high quality,
organically grown hemp CBD product. Quicksilver is one of the best.
In summary, do everything you can do with your daily routines and lifestyle habits to increase your chance of getting a good night’s sleep. Work with your provider to address any medical issues that may be playing a part. Then start trying supplements. Once you find what works, it is OK to take it every night for awhile to re-train your brain to sleep well. Do not play the game of “should I take it or not?” Just take it every night to completely eliminate that stress. After awhile, you can try to wean down your dose if desired. But botanical ingredients are not at all bad for you, as long as the product is from a high quality company. Also, remember: melatonin is a bioidentical hormone! You are simply restoring a natural, optimal level of that hormone. There is absolutely nothing wrong with taking one of these natural products indefinitely.
Long term use of prescription medications such as Ambien®, Ativan® and the like have been associated with an increase in the risk for dementia in a few studies.3 This has not been definitively proven, but it is concerning. We do know that these types of sleeping pills affect your sleep cycles in an unnatural way, so your sleep is not quite as restorative as natural sleep. So clearly, that is not a good long-term option. But the natural sleep supplements have no long term risks. So give them a try.
- You are not alone! Many of us have had sleep issues.
- Do all that you can with your lifestyle habits.
- Start trying high quality sleep supplements to find one that works.
“True silence is the rest of the mind, and is to the spirit what sleep is to the body, nourishment and refreshment.” —William Penn
- Shannon, S., Lewis, N., Lee, H., Hughes, S., Cannabidiol in Anxiety and Sleep: A Large Case Series, The Permanente Journal, 2019. 23: 18-41.
- Zhong, G., Wang, Y., Zhang, Y., Zhao, Y., Association between Benzodiazepine Use and Dementia: A Meta-Analysis, PLOS ONE, May 27, 2
Gretchen Reis, M.D. is an esteemed physician specializing in bioidentical hormone therapy and the Medical Director of Integrity Wellness MD. Dr. Reis is passionate about medicine and her patients, working in partnership with each patient as she helps them discover optimal wellness.