Insomnia

In a recent Canadian survey, 40 percent of people reported one or more symptoms of sleeping problems and almost 20 percent met the criteria for a diagnosis of insomnia. That’s a lot of sleepless nights!

If you are one of the millions who have trouble sleeping, you know how disruptive it can be. Poor sleep not only makes you feel unwell in the short term, but it may also have a major impact on your long-term health, including increasing the risk for several chronic diseases.

Acute versus chronic insomnia

Insomnia can be defined as either acute or chronic. Acute—also known as short-term—insomnia can last up to three weeks. Insomnia is considered chronic when there is trouble sleeping at least three nights a week for one month or longer.

Sleep apnea

A possible cause of insomnia, sleep apnea causes a person to briefly stop breathing while they sleep. Many people with this disorder do not even know they have it but will suffer daytime symptoms such as major fatigue, headaches, and problems concentrating. Someone sleeping next to them may notice that the person snores, seems to stop breathing now and then, or makes choking or gasping sounds several times throughout the night.

Sleep apnea can lead to serious health problems, discussed more below. The condition is more common in those who are overweight and is about twice as likely in men as in women.

Other causes

The list of potential causes of insomnia is very long and includes both emotional and physical triggers. Some of the most common causes include

• pain
• stress (related to work, family, or life)
• anxiety
• depression
• illness
• side effects of medication
• hormone imbalances (particularly for women)
• poor sleep habits (such as regularly changing bedtimes or shift work)

And still other people suffer from insomnia for unknown reasons, which are generally more challenging to treat.

Bad sleep, bad for your health

We all know that a poor night’s sleep can make us feel tired, grumpy, and generally unwell the next day. But research is increasingly linking chronic sleep problems to a number of other health issues.

Weight gain

Those sleeping fewer than five hours each night have been shown to have a higher average body mass index than those sleeping an average of seven to eight hours, with obesity risk being between 2.3 (women) and 3.7 (men) times higher. In children, inadequate sleep has been consistently linked to weight gain.

Diabetes
With lack of sleep linked to weight gain, and excess weight as a risk factor for diabetes, it is not surprising that poor sleep has been linked to a greater risk of diabetes. Poor sleep can challenge the body’s ability to metabolize sugar, increasing insulin resistance and leading to climbing blood sugar levels.

Researchers have found that chronic sleep loss prompts a decrease in insulin sensitivity as well as an increase in ghrelin, a hormone that stimulates the appetite. The result is greater hunger, along with an inability for the body to manage the extra carbohydrates. In one study, teenagers who were sleeping an average of less than eight hours a night consumed more fats and carbohydrates and were more than twice as likely to consume extra snacks as those who managed at least eight hours of sleep per night.

Depression
A review of 21 studies about sleep and mood found that nondepressed people who suffered from insomnia had twice the risk of developing depression compared to those without sleep problems. Sleep—or the lack thereof—appears to have a measurable impact on the brain’s ability to function normally. Researchers have shown that sleep deprivation affects the brain on more than one level, leading to an overall reduction in cognitive function.

Heart health
Chronic sleep problems can be bad for your heart. This is particularly the case for those with sleep apnea. The frequent pauses in breathing in sleep apnea cause drops in oxygen levels, which put a strain on the cardiovascular system and increase blood pressure. Sleep apnea has also been associated with an increased risk of stroke, arrhythmia (improper heart rhythm), and other cardiovascular concerns.

What to do?

The first step in treating insomnia is to assess the underlying cause(s). Your health care practitioner can work with you to look for common issues such as sleep apnea, hormone imbalances, or medication side effects. You may also be referred to a special sleep clinic for a more in-depth investigation.

Once causes have been determined, an appropriate treatment plan can be put together. Part of this plan can include nondrug options such as counselling and supplements.

Stress management and counselling

Stress and poor sleep habits can be a major cause of sleep disturbances for many people. A counsellor can be a great addition to your team if these are the major underlying causes of your sleep problems.

Supplements
There are many natural health products on the market that are promoted for sleep. Not all of these are appropriate for every case. Always consult your health care practitioner to help determine what products may be best for you. Listed below are two of the most well known.

Melatonin
Although not all cases of insomnia will be relieved by supplementing with this hormone, melatonin has been shown to benefit adults over age 50, people with jet lag, and those whose insomnia is associated with certain medications or medical conditions.

A small 2012 study showed encouraging results for the use of melatonin to treat insomnia resulting from beta blockers, a medication commonly prescribed for high blood pressure. Beta blockers can suppress the body’s natural production of melatonin. Melatonin supplementation of 2.5 mg a night over three weeks led to increased sleep time and less time taken to fall asleep.

In those over 55 years old, 2 mg of melatonin, taken one to two hours before bed, has been found to significantly improve sleep parameters including quality and length of sleep. In this population, there were no significant side effects, evidence of dependence on melatonin, withdrawal symptoms, or worsening of previous insomnia when melatonin was discontinued.

Chronic insomnia in individuals with an intellectual disability could also be helped by melatonin. Four weeks of treatment with melatonin produced improvements in falling asleep and duration of sleep and lessened instances of waking at night. Schizophrenic patients struggling with insomnia have also been found to benefit from melatonin, with 3 mg improving sleep as well as mood.

Valerian
This age-old herbal sleep remedy also has some clinical trial evidence to support its use. If you are a postmenopausal woman with trouble sleeping you may want to give valerian a try: four weeks of valerian extract improved sleep quality in 30 percent of women treated.

Adding a little hops to your valerian might be worth considering as well. Hops is perhaps best known for its use in beer, but it has also been used for centuries as part of herbal sleep medicines. The combination of valerian and hops has shown some positive results in at least one clinical trial.

Too many nights spent tossing and turning could not only be making you tired, but also be bad for your health in the long term. Talk to your health care practitioner about options available to help get you back to a better sleep.

Improving sleep success: Getting ready for bed

• Maintain a consistent sleep schedule: try to get to bed at about the same time on most nights.
• Avoid caffeine, large meals, sugary snacks, or other potentially sleep-disrupting food and drinks before bedtime.
• Schedule in some time to unwind before bed: relaxing, reading, meditating, or similar activities can help you de-stress after a long day.
• Exercise: regular exercise can help release stress and calm restlessness.
• Use sleep accessories: hot baths, lavender essential oil, calming music, your favourite slippers—whatever it is that gets you in the mood for sleep, include it as part of your regular bedtime ritual.

L-theanine:A lesser-known supplement for sleep

This amino acid is also worth considering for some cases of insomnia. L-theanine has a calming effect on the mind, which can make it especially helpful for those whose busy brains keep them from falling asleep. If you find it hard to unwind because you are anxious, restless, or constantly thinking, L-theanine could be worth a try.

Initial research has shown that L-theanine promotes relaxation of the mind without causing drowsiness and may have stress-reducing effects. In a 2011 study, L-theanine supplementation was even found to be helpful for improving sleep quality in children over the age of eight who have attention deficit hyperactivity disorder (ADHD).

Dosages are usually in the 200 to 400 mg range. L-theanine is also one of very few sleep aids that can be taken if you find yourself waking up too early, as it will not leave you feeling groggy the next morning.