Getting your zzzz’s
Monday, 28 January 2019
Sleep is optimal to our health. During sleep, the body is in an anabolic state - basically when in energy conservation, tissue repair and growth take over. The body temperature falls, growth hormone is secreted and immune cell production is increased - ahh – why we get that cold or flu when we’ve been burning the candle too much!
Insomnia, however, is another beast entirely and is defined as a disorder where people have extreme difficulty in getting to sleep or staying asleep for long enough to feel refreshed the next morning. It’s a common problem thought to affect around one in every three people in the UK – 1 in three!!
While there are numerous and varied reasons for sleep disturbances, a common denominator is physical, emotional or mental stress to the nervous system. This beautiful infographic, adapted from Guilliams, T. The Role of Stress and the HPA Axis in Chronic Disease Management. Point Institute, 2015 shows all the components that we encounter, that the brain perceives as stress. Once this message has been received, a chain of hormonal cascades are set in motion and insomnia can be one of the symptoms.
Women over the age of 50 ( that’s me!) struggle with insomnia more as there is such a shift in our sex hormones. Progesterone, which is made predominantly by the ovaries, placenta, and then the adrenal glands. has a calming, sedative effect that promotes good sleep via GABA receptors; therefore, as progesterone drops when we cease menstruation there is a correlation to newer levels of anxiety (or things seem to just annoy you faster) both the quality and quantity of sleep is compromised.
To understand how progesterone impacts mood and sleep, it is important to note that progesterone is, to high-degree, metabolized (broken down) to allopregnanolone (ALLO on the stress infographic) which can cross the blood-brain barrier and act as an agonist on the GABA-A receptor complex in the brain eliciting calming effects.
GABA also helps to balance anxiety and stress by acting like a bouncer on the door at a nightclub, curbing the release of Master adrenaline and Master noradrenaline, the hormones responsible for the stress surge. Without GABA's (the bouncer) modulatory activity in the adrenals, adrenaline and noradrenaline release would become like a drunken brawl in that night club having multiple metabolic knock-on effects like insomnia, anxiety and pain. Yes - pain…. The drug Gabapentin, which raises GABA levels uses this mechanism to blunt the stress response at the level of the adrenal gland and is commonly used for neuropathic pain.
From a Functional Nutritional perspective, I like using nutraceuticals nutraceuticals that have been shown to calm these catecholamines (adrenaline & noradrenaline), which I’ve listed at the end, and in this product aptly named CatecholaCalm
The gut (you knew I’d come to this!!!) is also saturated in GABA receptors of all types, and certain species and strains of Lactobacillus and Bifidobacterium have been documented to produce, GABA https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769009/
Thereby these strains positively influence the central nervous system, via the vagus nerve. So supporting the gut microbiome to grow these species and strains makes perfect sense. Here we are talking about prebiotics and prebiotic type foods, which are a special kind of fibre which acts like fertiliser for the ‘good’ bacteria in our gut to grow. This gained a lot of media coverage in 2017 when Dr Michael Mosley was researching his documentary The Truth About: Sleep in 2017.
The particular fibre that was used by Michael Mosley was inulin. This can be taken as a supplement as Michael Mosley did, and I’ve shown you a product here. But the broader message is that fibres, plants and their polyphenols best build diversity! Jerusalem artichokes, onions, garlic, leeks and asparagus are the main food sources of inulin (not great for SIBO - but that’s another post!).
Falling oestrogen can also trigger vasomotor symptoms such as hot flushes, rapid heart rate, and stress. These changes cause frequent nighttime awakenings, making sleep quality really poor. Complicating matters even more, melatonin – the hormone that puts us to sleep and keeps us sleeping – is significantly reduced during menopause, in addition to the normal decline in endogenous melatonin secretion known to occur as both sexes age.
Thus we can see that any imbalance or stress (as per the infographic above) in this interconnected system may lead to sleep disturbances. So what to do while working with a practitioner on underlying causes?
Broadly there are two areas: Sleep hygiene and lifestyle changes are necessary for managing stress and insomnia, and then certain herbs and Nutraceuticals can also be an integral part of a support plan.
Firstly let’s discuss Healthy Sleep Habits.
Allowing the body to adequately prepare for sleep is important. The brain begins releasing melatonin approximately two hours before it assumes sleep, to calm and relax the body, which promotes uninterrupted sleep. Even though melatonin production decreases with age, taking measures to preserve and support its production can be beneficial. I love to read before turning out the lights (not a medical paper or article on inflammatory cytokines! - but a good novel). Reading books, rather anything off an electronic device is so key as the blue light emitted from electronic devices cancels the effects and reduces the production of melatonin. While light of any kind can suppress the secretion of melatonin, blue light at night does so more powerfully. Harvard Researchers and their colleagues conducted an experiment comparing the effects of 6.5 hours of exposure to blue light to exposure to green light of comparable brightness. The blue light suppresses melatonin for about twice as long as the green light and shifted circadian rhythms by twice as much (3 hours vs. 1.5 hours) – convinced now?
The Sleep Council UK have these wonderful Nodcasts (what a great name) if you are more of an auditory being https://sleepcouncil.org.uk/nodcasts/
Other sleep promoting rituals that help lower the stress response are, a warm bath with magnesium salts and promotes better sleep. Alternatively, orally taking magnesium (in either a Glycinate or malate form) can help relax muscles and encourage better rest. Finally, it is important to sleep in a dark room, void of lights, and distracting pets (that jump up on the bed at 2am!- Pepper!!), to support optimal melatonin production and uninterrupted sleep.
Secondly, there are a number of Botanicals and Nutriceuticals that can help to promote sleep:
Nervines are the botanical world's answer to insomnia, with actions that have a beneficial, and sometimes tonic effect on the nervous system. Some of the herbs promote relaxation supporting a natural sleep, while nourish and restore balance to the nervous system. While nervines act primarily on the nervous system there is a close interface with the adrenal glands. So nervines can also be a key component of adrenal support formulations.
Chamomile is well-known and commonly used for anxiety and insomnia. Having carminative properties, the herb is often used to settle the stomach in bouts of indigestion or gastritis.
The flavonoid constituents of chamomile, have demonstrated anti-anxiety and slight sedative activity without muscle relaxant effects in mice, likely due to modulating the GABA A receptor.
Lemon balm has a long tradition as a tonic remedy, its uses include insomnia, anxiety, GI complaints and menstrual cramps. A 2011 pilot trial summarized the lemon balm extract as demonstrating a significant improvement in anxiety manifestations and associated symptoms and insomnia. After 15 days of treatment, insomnia was reduced by 42%. In a study assessing a herbal combination for sleep disruption accompanying menopause, 100 women were evaluated. Half were given placebo and half were given a remedy containing both lemon balm and valerian. The intervention group revealed a significant improvement in their sleep quality compared to the placebo group.
The California poppy, a specific indication of the poppy, has been used as a sedative and hypnotic (sleep promoter) for children where there is "over-excitability and sleeplessness." Another study showed a key alkaloidal constituent, chelerythrine, acting as an inhibitor to pain neurons in the spinal cord, significantly reducing nociceptive responses.
This amino acid found in tea leaves increases the levels of GABA, serotonin, and dopamine – calming neurotransmitters in the brain that regulate emotions, mood, concentration, alertness, sleep, and energy.
If you call my clinic or pop in I can recommend a blend suitable to you.
By following some of these tips I hope this helps you to get some extra healing zzzzzzs in!