Insomnia Archives

Jul

2023

What to Do about Hot Flashes in Menopause

By Ray Schilling | Hormones, Insomnia, Menopause

This article is regarding what to do about hot flashes in menopause. It is important to realize that 80% of women who transition to menopause develop hot flashes and night sweats. Notably, this happens between 45 years and 55 years for most women. Another key point, two methods to fight menopause are non-hormonal methods including a new FDA approved drug and estrogen/progesterone therapy to replace missing hormones. Below I am reviewing both methods.

Non-hormonal methods to fight hot flashes

June 7, 2023 CNN published a review article about non-hormonal methods to fight hot flashes. In the article health professionals pointed out that there are a number of steps that the menopausal woman can take to lower the number and intensity of hot flashes. Indeed, menopausal symptoms include not only hot flashes, but also chills, night sweats, sleep problems, mood changes, vaginal dryness and pain during sex. It is important to realize that some women are not good candidates for hormone therapy, because they have a family history of estrogen-dependent cancers, cardiovascular disease, stroke, blood clotting disorders, deep vein thrombosis and chronic liver disease. The North American Menopausal Society just published the 2023 update to their recommendations for non-hormone therapy of menopause.

A new drug blocking hot flashes and night sweats

In this recommendation a new FDA approved drug is included. The pharmacological name is fezolinetant, the brand name is Veozah. To point out, this drug targets the neural activity in the brain that causes hot flashes and night sweats. It binds to the NK3 receptor, which regulates body temperature. The end result is a block of the KNDy (pronounced “candy”) neurons in the brain. To emphasize, these consist of kisspeptin, neurokinin B and dynorphin. The initials led to the abbreviation of the KNDy neurons (pronounced “candy”). To explain, the most common side effects are nausea and headaches. The only other medications that the FDA recognizes as effective for hot flushes and night sweats are low dose SSRI antidepressants.

Other recommendations of the 2023 non-hormone therapy of menopause update

By all means, triggers like caffeine and alcohol overconsumption and smoking should be avoided. Weight loss and cognitive therapy are reducing hot flashes. Clinical hypnosis is also effective as a treatment, as is Gabapentin. Specifically, a low-fat, plant-based diet and a half-cup of cooked soybeans per day led to a 88% reduction in moderate to severe vasomotor symptoms (hot flashes). Researchers compare this to a group with no dietary changes over 12 weeks.

Despite all of these measure menopausal women on hormone replacement did feel a lot more improvement.

Hormone replacement with estrogen and progesterone

Before we discuss this further a quick review of the Women’s Health Initiative in 2002 is necessary. This was a large study that showed that on Premarin and Progestin, two synthetic hormone products, women came down with breast cancer, heart attacks, stroke, and thromboembolic events. They were using the synthetic drugs conjugated equine estrogen and medroxyprogesterone acetate. The reason these women had to suffer these side effects was because their physicians insisted in using hormones from drug companies rather than compounded bioidentical hormones. But these synthetic hormones were not pure hormones; they were adulterated with side chains. These side chains made the synthetic hormones not fit the body’s hormone receptors. And this is the reason why the synthetic hormones created chaos in form of breast cancer, strokes and heart attacks.

European trials regarding bioidentical hormone treatment

However, studies in Europe showed over many years that hormone replacement with bioidentical estrogen and progesterone creams from compounding pharmacies have no deleterious side effects, but replace the action of the missing hormones in menopause. Women lose their hot flashes and night sweats, regain their previous energy and sleep again through the night. Here is a link what the Mayo Clinic recommends to treat menopause.

Present day recommendation from regenerative physicians

The key about hormone replacement after menopause is to balance estrogen replacement with bioidentical progesterone. The ratio of the two hormones needs to be about 200:1 (or higher) for progesterone versus estrogen. Estradiol, which is the main estrogen in women is a mild carcinogen when not properly balanced with progesterone. By having higher progesterone dosages for hormone replacement, the body is protected from cancer and other side effects. Dr. John Lee years ago coined the term “estrogen dominance”. He also recommended the ratio of 200:1 of progesterone versus estrogen to balance the two hormones. A postmenopausal woman can apply a bioidentical BiEst cream (estrogen) to her skin and combine this with a bioidentical progesterone cream. Alternatively, she may prefer to take oral progesterone (Prometrium) 100 or 200 mg at bedtime. These tablets consist of crystallized bioidentical progesterone. None of this will cause cancer or other detrimental conditions.

What to Do about Hot Flashes in Menopause

Conclusion

Recently a publication describes a new drug that helps with hot flashes. The pharmacological name is fezolinetant, the brand name is Veozah. It blocks special neurons in the brain that are responsible for hot flashes. But possible side effects of this drug are nausea and headaches. Contrary to this there is no side effect with bioidentical hormone replacement when the physician balances the concentration of estrogen and progesterone. In this case the hormone balance prior to menopause simply returns. In this case her hot flashes and other menopausal symptoms simply stop. Anti-aging physicians in Europe have shown decades ago that the described combination of BiEst and Prometrium is safe, contrary to the synthetic drugs that were used in the Women’s Health Initiative where women died from heart attacks, breast cancer and blood clots.

Apr

2023

Help with Menopausal Symptoms

By Ray Schilling | blood test, Diabetes, diet, Inflammation, Insomnia, irregular periods, Menopause, Nutrition, sleep

At the 30^th A4M Conference mid-December Dr. Anna Cabeca lectured about “Help with menopausal symptoms”. A4M stands for “Conference of the American Academy of Anti-Aging Medicine”. It is a yearly event at the Sand Conference Center of the Venetian Palace in Las Vegas. The following is a summary of the very detailed lecture by Dr. Anna Cabeca.

Definition of postmenopausal symptoms

Dr. Cabeca’s detailed title for her lecture was: “Menopause: Hot flashes, brain fog and vaginal dryness; 3 symptoms women don’t have to experience.” The first thing to remember is this detailed list of symptoms of menopause:

Hormones are disbalanced
Unusual behaviors and moodiness
Gaining weight (accumulating fat)
Tiredness
Loss of willpower
Sleep disturbance: can’t sleep or sleeps all the time
Brain fog and memory problems
Lost your “edge”
No sex drive
Aging rapidly
Hair loss
Thyroid problems
Hysterectomy (to remedy excessive periods)

Hormone changes with menopause

To clarify, there are major hormone changes with menopause as follows. To explain, at the age of 35 progesterone suddenly experiences a major reduction, which completes by the age of 45. In contrast, estrogen levels remain high until the age of 40 when it, too is reduced to background activity by the age of 50. In fact, at this point estrogen production is still more than progesterone synthesis. This is the basis of what is called estrogen dominance.

In general, symptoms of estrogen dominance are: PMS, hot flashes, night sweats, mood swings, weight gain, vaginal dryness, brain fog, irregular periods, less libido, missing or increased periods, bone loss and sleep disturbance.

To emphasize, the production of male hormones, DHEA and testosterone, slows down around the age of 30 and reaches a low plateau around the age of 45. This explains, for example, the lack of sex drive mentioned above. In addition, it is also partially responsible for brain fog, tiredness, hair loss and unusual behaviors and moodiness.

Perimenopause and menopause increase risk for diabetes

By all means, there is a clear relationship between age and the risk of developing diabetes in both males and females. But it must be remembered that the hormone weaknesses in combination with weight increases can also trigger diabetes.

Head-to-toe patient work-up

There are two parts to a patient’s work-up, a thorough assessment and a patient’s education.

The patient’s assessment includes:

Energy, mind, spirit
Hormone balance
Inflammation
Assessment of diet and nutritional intervention
Gastrointestinal health and digestion
Detoxification
Structural investigation

Surely, another key point is that patient education is important to be successful in the multiple step intervention to normalize the metabolism, shed excessive weight and help the patient to refocus.

Comments to the patient’s assessment

Indeed, the display of energy in a patient is closely related to hormone balance. Notably, when hormones are measured and they are out of balance, this usually explains the multiple symptoms. It is important to realize that inflammation is measured with the high-sensitivity CRP blood test. This test measures the level of inflammation. Initially, the level may be 30, but with weight loss it often normalizes with values of 2 or 3. At the same time weight loss stabilizes blood sugar (indicated by an initially high, but later normalizing hemoglobin A1C) and diabetes can completely disappear. Frequently, an analysis of the diet often shows that the patient is eating too much sugar and starchy foods.

Faulty nutrition, heavy metals and osteoporosis

In addition, many patients also eat too much meat and processed meat products, which leads to elevated cholesterol and triglycerides. Also, introducing more vegetables and fruit reduces lipids in the blood. Certainly, patients’ blood tests often show high levels of heavy metals like mercury, lead and cadmium. This can be chelated out with intravenous EDTA. Often 6 treatments at weekly intervals will rid the body of these toxins from pollution and the consumption of fish that has high mercury content.

Structural investigation of the bone with bone density measurements can diagnose osteoporosis. An initial remedy for this is supplementation with 5000 IU of vitamin D3 and vitamin K2 200 micrograms daily.

Low carb diet can help rebalance body metabolism

People who are overweight or obese get metabolic changes in their blood that physicians call metabolic syndrome. It raises blood pressure, often leads to elevation of cholesterol, triglycerides and blood sugars and also causes inflammation. A diet like the Mediterranean diet can help stabilize the metabolism. Dr. Anna Cabeca recommended a ketogenic diet, but from my reading a Mediterranean diet will achieve the same. In addition, a ketogenic diet carries a higher risk of heart attacks and strokes. For this reason I cannot recommend a ketogenic diet. The end result is an improvement of organ function, improvement of blood tests and less reliance on medications. Our body simply performs and functions better.

Fasting improves mitochondrial health

Mitochondria are small particles inside the plasma of all the body cells. Their functioning is essential for our energy and for cell metabolism in all of our organs. The energy, which is produced by the mitochondria is stored in a small molecule, called adenosine triphosphate or ATP. I discussed earlier that heavy metals must be removed from the body by chelation therapy. One known effect of heavy metals is the poisoning of mitochondria. A person who has high blood levels of heavy metals in the body complaints of low energy and brain fog. After several intravenous chelation treatments, the energy returns and the brain fog disappears.

The fasting mimicking diet of Dr. Valter Longo is another tool to reactivate mitochondria.

Bioidentical hormone replacement

Many postmenopausal women require some help with regard to their hormonal balance. There are doctors who specialize in this area. They order a baseline panel of hormones. If there is a lack of progesterone, they order bioidentical hormone replacement, a hormone cream that the patient applies herself to the forearm or abdomen. Hormone saliva tests must show a ratio between progesterone and estrogen of 200 to 1 or higher. Many women have too much estrogen in their system relative to progesterone. By balancing this hormone ratio, the risk of getting cancer from estrogen that is not in balance experiences a significant reduction. The patient will also feel more energy and sleep better.

Help with Menopausal Symptoms

Conclusion

Menopause does not have to be the dreaded time in a woman’s life, when her periods stop. With a bit of attention to her nutrition, her hormone balance and other symptoms the physician can help her experience none of the symptoms. It will require some hormone and other blood tests. It may also require some detoxification with intravenous EDTA infusions. At the end that postmenopausal patient will feel energy again, clear up her foggy brain and sleep better. In addition, the woman will regain her sex drive and feel more energy. The physician treats estrogen dominance by adding progesterone cream supplementation. This also assist with regard to sleeping better.

It does take the effort to have all the necessary blood tests and saliva tests to establish deficiencies. A physician who has experience in anti-aging medicine will be of important help to bring a menopausal patient back on the road to wellness.

Mar

2023

Hormone Imbalance can Impact Health

By Ray Schilling | birth control pill, Hormones, Insomnia, irregular periods, lifestyle, mitochondria, sleep, stress

Dr. Erika Schwartz spoke at the 30^th Anti-Aging Conference in Las Vegas about “hormone imbalance can impact health”. The talk was scheduled early in the morning on Dec. 10, 2022. She pointed out that when hormones are in balance people have energy, they sleep well, they have normal sexual functioning and they are fertile. But in contrast, when hormones are not in balance, their weight goes up, they suffer from fatigue, depression, and anxiety. In addition, they often have skin and hair changes, changes in menstrual regularity, acne, infertility and decrease in libido. Finally, they may have problems in building muscle mass, women develop vaginal dryness and men erectile dysfunction. However, people also can develop autoimmune conditions and various cancers.

Symptoms of hormone imbalance at various ages

Teens

Most importantly, acne is an embarrassing, but common symptom. Depression, PMS, mood swings and headaches are also very common. By the same token, weight gain occurs frequently from faulty diets (fast food, lack of vegetables and fruit and sugary soda drinks).

The twenties and thirties

The birth control pill interferes with the normal function of LH and FSH resulting in lack of ovulation and infertility. Other symptoms are bloating, constipation, weight changes, libido changes and postpartum depression.

The forties and fifties

Mood changes and irritability, weight problems, menstrual changes, and changes in sexual desire are typical for this age group.

The sixties and over

Hot flashes are common in this age group, but they can start in women from the age of 50 onwards. Other symptoms are night sweats, insomnia, skin and muscle changes. Many diseases of the aging occur like diabetes, arthritis, cardiovascular disease, dementia, degenerative and autoimmune diseases.

Diagnosis of hormone imbalance

The doctor takes a detailed history about exposure to environmental pollutants, the birth control pill in women and medications. In addition, the doctor wants to know whether the patient consumed meat from animals that were treated with antibiotics. Next the physician inquires about physical changes, symptoms of hirsutism, menstrual

irregularities and infertility. There are three steps to diagnosing hormone imbalances:

Listen to the patient and inquire about the subjects just mentioned.
Order extensive laboratory tests including hormone levels.
Review all of the medications and supplements the patient is taking.

How do hormone imbalances affect our bodies? They affect our mental health, our sleep, brain function, libido, energy, weight, digestion (leaky gut), joints and the immune system.

Two clinical examples about hormone imbalances

Dr. Schwartz gave two clinical examples showing how correction of hormone imbalances led to normalization of the hormone imbalance.

Example 1

A 17-year-old female complained about acne in her face, had no periods, was fatigued and had migraine headaches. She was in senior high school and wanted to look and feel better before graduation. Her periods started at age 12, but were irregular. Her physician started her on the birth control pill at age 14. Within one year she stopped having any periods and also started getting hyperpigmentation in her face. Dr. Schwartz noted that she had no allergies and that she did not take any supplements. She took Estarylla (ethinyl estradiol/ norgestimate), a BCP formulation and Excedrin for migraines. Her ferritin level was 12 (11 to 307 micrograms per liter is normal for women). TSH was 5.16 (normal now 0.5-2.5). This meant she was borderline iron deficient and also mildly hypothyroid.

Diagnosis and treatment plan

Dr. Schwartz diagnosed a hormone imbalance. The treatment schedule consisted of stopping the BCP, start a low dose 30 mg NP thyroid in the morning. In addition, the doctor prescribed adrenal support pills and low-dose iron pills with vitamin C. The doctor also addressed lifestyle and self-awareness issues with the patient. 4 months later she was seen again and had regular periods, no more migraines and she felt more energy. The face pigmentation was gone and she felt great.

Example 2

A 42-year-old woman presented to Dr. Schwartz with psoriatic arthritis, weight gain, problems sleeping, brain fog and irregular periods. Her last menstrual period was 6 months ago. Her doctor had recently placed her on a statin drug and put her on the BCP Mirena. This is a progestagen releasing IUD placed in the uterine cavity, which was given to her in an attempt to regulate her periods. She was divorced and a mother of 3 children. At work she was a business partner in a high stress law firm. Personally, she was trying to date, but has been unsuccessful so far. She would like to lose weight and gain more energy. What she was hoping for was that her doctor address her overall health.

Medication and blood tests

She did not have any allergies. Her medications consisted of Rosuvastatin 10 mg daily and Mirena for the last year. As supplements she took Turmeric. Blood tests showed that her hemoglobin A1C was 5.7, the vitamin D blood level was 17 ng/mL (very low). The TSH level measured 1.29 (in the normal range). Estradiol blood level was in the lower range, progesterone level the same. Finally, her testosterone level was low as well. The other blood tests were all normal.

Diagnosis for this patient and treatment plan

Dr. Schwartz diagnosed hormone imbalance due to natural and environmental factors.

She ordered Mirena to be removed and to stop Rosuvastatin. Instead, she started the patient on vitamin ADK ( a mix of vitamin A, vitamin D and vitamin K)– 5000 IU daily. She also started her on Omega3 1000mg daily. In addition, she discussed a well-balanced diet, regular exercise and sleep issues (7-8 hours every night) with her.

Hormone replacements

As blood tests showed a low estradiol level, she started her on Estrogel, a form of estrogen. She also started her on progesterone tablets (Prometrium) 100 mg at bedtime as well. This keeps progesterone and estrogens balanced. As her testosterone was on the low side, she started her on Testosterone cypionate 100 mg/ml (0.4 cc per injection) intramuscularly once a month. Dr. Schwartz also started adrenal support, 2 capsules in the morning. Further she was told to start 3 capsules of NMN (Nicotinamide Mononucleotide Supplements) daily and 5 units of Semaglutide subcutaneously weekly. The latter medication helps the pancreas to release the right amount of insulin when blood sugar levels are high.

Follow-up at 6 months

The doctor reassessed he patient after 6 months. She had developed increased self-awareness. She lost 30 pounds and she slept for 7.5 hours most nights. Her energy level has increased and she improved her dietary choices. She had started regular work-outs. Overall she was now happier at work and at home with her children. She feels now more like an age of 25, and she has been starting to date.

General remarks about hormone imbalance

When hormones are in balance, we are healthy. Hormones can get out of balance at any age; the examples above involved 17 and 42 year old patients. Keep in mind that it is impossible to have optimal health without balanced hormones. Dr. Schwartz said that the more pieces of the puzzle you address, the more likely you are going to truly help improve quality and quantity of life. Lifestyle factors that must be addressed are:

Diet
Exercise
Stress Management
Sleep
Breathing
Mitochondrial and cellular integrity

Hormone Imbalance can Impact Health

Conclusion

Hormone imbalances occur frequently when our lifestyle factors are slipping. Often untoward side effects of medication are also contributing to the hormone imbalance. The holistic doctor takes a thorough history, examines and takes blood tests including key hormone tests. When imbalances of hormones are detected, this has to be addressed with supplements and hormone replacements. At the end the hormones balance each other and the patients’ abnormal symptoms disappear. It only takes a few weeks before the patient will feel normal again.

Nov

2022

Lack of Sleep Harms the Immune System and Causes Inflammation

By Ray Schilling | Cardiovascular disease, depression, Diabetes, Heart Disease, Inflammation, Insomnia, sleep, Sleep apnea

A research group from Boston, MA and New York, NY found that a lack of sleep harms the immune system and causes inflammation. This was summarized in this CNN article.

Specifically, they first conducted experiments with a mouse model. They studied the effects of sleep disruption and sleep deprivation and could later confirm identical changes in man. The observation was that a lack of sleep caused the hematopoietic cells in the bone marrow to proliferate, but the cell diversity was less than in people with normal sleep patterns. The same pattern of bone marrow proliferation was present in mice. This research was published Sept. 21, 2022 in the Journal of Experimental Medicine.

Chronic sleep deficit

A chronic sleep deficit caused chronic inflammation and eventually autoimmune diseases. Again, this was a pattern present in both the mouse model and in humans. Next the researchers observed what happened with sleep recovery. In the past it was assumed that with sleep recovery all of the physical changes from sleep deprivation would disappear. However, the opposite was true: both in mice and in humans the bone marrow stimulation and the lack of cell diversity persisted.

In the mouse model the researchers could show that there were permanent epigenetic changes, which were caused by sleep deprivation. The same is true with humans, but this is more difficult to show than in the mouse model. The researchers came to the conclusion that sleep deprivation stimulates bone marrow maturation, but restricts the clonal differentiation. In doing so the body initiates inflammation, which becomes chronic even with sleep restoration.

Human sleep studies

There were 14 volunteers that were the test subjects. One group was the normal sleep control. The other group underwent chronic sleep deprivation. Each group did this for 6 weeks. There was a 4-to-6-week washout period. Following this the previous normal sleep group started a 6-week sleep deprivation program. On the other hand, the prior sleep-deprived group switched to 6 weeks of normal sleep. All of the participants had daily late afternoon blood tests.

There are many sleep disruptions, which cause a sleep deficit

In modern life sleep gets disrupted in many ways. There can be sleep fragmentation, sleep restriction, jet lag, obstructive sleep apnea (OSA), and insomnia.

People with these conditions often oscillate between these various types. They may have a few days of normal sleep, but then have sleep deprivation again for a few days. Every time they have sleep deprivation the bone marrow enhances hematopoietic activity. Normally there is a high leukocyte number in the blood at the end of the day and in the morning a lower leukocyte count. But with sleep deprivation there is a high monocyte count in the blood that stays high even when subjects switch back to a normal sleep pattern.

Epigenetic effect of sleep deprivation on bone marrow cells

The authors found that sleep deprivation affects the genetic control of hematopoietic cells in the bone marrow. They called this the epigenetic effect of sleep deprivation. This is responsible for the evening leukocyte response, the monocytosis and the tendency for autoimmune diseases. They summed this up by saying: “Our findings support the hypothesis that periods of poor sleep, even if followed by sleep recovery, have sustained consequences on immunological health.”

Lack of sleep harms the immune system and causes inflammation says the literature

There is ample evidence that a lack of sleep causes cardiovascular disease, diabetes, depression and more frequent infections. Healthy sleep is important when you want to age well without complications. But enough sleep is also necessary to prevent obesity, diabetes and cardiovascular disease. Experts consider getting enough high-quality sleep as essential as a balanced diet and regular exercise.

Lack of Sleep Harms Immune System and Causes Inflammation

Conclusion

So far, most researchers believed that when you miss some sleep for a few nights that a afternoon nap or a few nights of longer sleep would compensate for the sleep deficit with no sequelae. Think again, because new research from a group in Boston, MA and New York, NY found that lack of sleep harms the immune system and causes inflammation permanently. Sleep deprivation stimulates the bone marrow cells to multiply and causing proliferation of monocytes, called monocytosis as well. Despite afternoon naps and recovery sleep this condition remains and can lead to autoimmune diseases. All this was unknown up to now. Our bone marrow cells need regular sleep hours to stay diversified and to optimally fight infections in the body. This prevents autoimmune diseases and keeps our defenses against viral diseases strong.

Jul

2022

Can Surgery Help with Snoring?

By Ray Schilling | Insomnia, sleep, Sleep apnea

Snoring is a common problem in people, and so the question is: can surgery help with snoring? About 25% of adults snore regularly, 45% snore occasionally. You are more likely to snore when you are overweight. Other factors are being a middle-aged or older male or a postmenopausal woman. Over the last decades various surgical procedures were in development in an attempt to cure snoring.

Obstructive sleep apnea

A person with obstructive sleep apnea has a problem of a relaxed rooftop in the mouth, where the uvula drops down. At the same time the tongue is falling backwards and together with the relaxed rooftop this leads to intermittent obstruction of the airway. The end result is loud snoring, which can lead to intermittent cessation of breathing. A positive pressure device is a common remedy for this condition, which keeps the airway open during your sleep. It is called continuous positive airway pressure (CPAP). However, this system is somewhat noisy, and about 50% of patients find it disturbing and cannot tolerate it. Many patients prefer a surgical, permanent solution.

Classification of snoring

Most snorers have primary snoring. Among these patients there is a minority who stop breathing periodically, which lowers the blood oxygen content. The patient awakes from this and tightens the muscles in the palatine-pharyngeal area and then breathes normally again for a while. These patients have obstructive sleep apnea (OSA). However, when deeper sleep is reached in OSA patients the cycle repeats itself. A clinical test how to distinguish between primary snoring and OAS is a polysomnography study, which also goes by the name of a sleep study.

Uvulopalatopharyngoplasty

This sounds like a tongue twister! In lay terms it is a surgical procedure which removes the uvula and the adjacent tissues of the palate and throat walls. There are side effects like swallowing problems, throat changes and the permanent feeling of a foreign body in the throat. Since the original design several modifications were introduced, which reduce the side effects of this procedure, but do not entirely eliminate them.

Somnoplasty or radiofrequency ablation

For patients with primary snoring, who do not have OSA a new procedure utilizes low levels of radiofrequency heat energy to create finely controlled localized burns in the lining of the soft tissues of the palate. This tightens the palate tissue and avoids the vibrations that cause snoring. The procedure can be done in the office setting under local anesthetic. It takes only about 30 minutes. When researchers compared pre-treatment scores with scores after three years following two ablation radiofrequency treatments there was a significant reduction of the snoring activity. Somnoplasty is another name for the FDA approved ablation radiofrequency treatment. This treatment works well for patients with primary snoring, but is not so successful for patients with OSA.

Maxillomandibular advancement (MMA)

The physician orders this fairly invasive surgery for patients with OSA who cannot tolerate continuous positive airway pressure. The goal of the surgery is to remove the two obstruction points where the patient chokes at night. This occurs most often behind the palate and behind the tongue. MMA was introduced more than 35 years ago. On the plus side, the success rate is about 90%. The minus side is the fact that it is major invasive surgery where the surgeon moves both the upper and lower jaws forward opening up the two choke points in the back. The surgery lasts about 6 hours and it takes approximately 6 weeks for it to heal.

Hypoglossal nerve stimulation

An alternative for patients with moderate to severe OSA is the use of hypoglossal nerve stimulation. Patients with OSA have a weakness in the muscle tone of the muscles that push the tongue forward. When they fall asleep the tongue tends to fall backwards obstructing the airways. This can be remedied with the use of hypoglossal nerve stimulation that stimulates the muscles that push the tongue forward.

Results with hypoglossal nerve stimulation devices were encouraging, as more than 80% of patients with OAS who had this device inserted had a successful treatment outcome. 4 years later, in the same patients there was still effectiveness of the hypoglossal nerve stimulator and the improvement in quality of life remained the same.

Can Surgery Help with Snoring?

Conclusion

There are several procedures that can help patients with primary snoring or patients with an obstructive sleep apnea (OSA). For patients with primary snoring, who do not have OSA a new procedure utilizes low levels of radiofrequency heat energy to create finely controlled localized burns in the lining of the soft tissues of the palate. This tightens the palate tissue and avoids the vibrations that cause snoring. In patients with obstructive sleep apnea a continuous positive airway pressure device (CPAP) is a common remedy for this condition, which keeps the airway open during their sleep. But only about 50% of patients tolerate this procedure.

More surgical procedures

The uvulopalatopharyngoplasty can help a certain number of patients. Here the ear/nose/throat surgeon removes the uvula and the adjacent tissues of the palate and throat walls. The surgeon does this under general anaesthesia, and patients will take about two weeks to fully recover. Another more invasive procedure is the maxillomandibular advancement (MMA). The goal of the surgery is to remove the two obstruction points where the patient chokes at night. This occurs most often behind the palate and behind the tongue. The surgical procedure is in use for more than 35 years and the success rate is about 90%. However the surgery will take several hours, and recovery of the patient will take about 6 weeks.

Jan

2022

Sleep Training to Prevent Insomnia and Depression

By Ray Schilling | depression, Insomnia, sleep

A new study describes that sleep training to prevent insomnia and depression is desirable. Notably, the study published in JAMA Psychiatry took 291 people age 60 years and older and followed them for three years. In this case half the participants received treatment with sleep training, the other half treatment with cognitive behavioral therapy. The other half was the control who received sleep education therapy from a public health educator. It is important to realize that both groups received 120 minutes weekly group sessions for two months. That is to say, following training of 2 months the subjects were followed for 36 months. It must be remembered that they completed monthly questionnaires to monitor for depression and insomnia. At the end of the study almost 1/3 of the cognitive behavioral group still were free of insomnia.

The control group who received sleep education therapy initially showed no longer any

improvement. In other words, the initial progress did not last with sleep education only. The study was also published in CNN.

Results about rates of depression

Those subjects of the cognitive behavioral therapy group who had a sustained remission of their insomnia disorder had a rate of 82.6% less depression. This was in comparison to the subjects who did not sustain their treatment against insomnia. Dr. Pim Cuijpers commented that the results of the study show “a completely new and innovative way” of tackling the growing problem of depression. Dr. Cuijpers is a professor of Clinical Psychology at the Free University of Amsterdam.

A brief background about depression in older patients

Depression is common in people above the age of 60. About 30-50% of this age group develop depression. Part of this could be that older people often do not get enough sleep as middle-age or younger adults do. Melatonin production declines with older age and this may play a role in insomnia of older people. On the other hand, one of the major symptoms of depression is a lack of sleep. It seems that a lack of REM sleep, the deep sleep that makes us dream, is responsible for both troubles, sleeping (insomnia) and depression.

Cognitive behavioral therapy administered by a therapist is effective for insomnia

It is important that a therapist administers the cognitive behavioral therapy. There are recordings available online that provide cognitive therapy, but they are not individualised. Dr. Irwin said: “That’s why CBT-I is so effective in person, because the therapist is helping that individual navigate and negotiate with themselves — and it can be really hard work,” Irwin added. “I believe that’s also why CBT-I apps or online tools often don’t work — people get frustrated, disappointed or angry at themselves, and they basically stop the work.”

The rationale for cognitive behavioral therapy (CBT)

CBT for insomnia has five components: Stimulus control, sleep restriction, sleep hygiene, relaxation and cognitive behavioral therapy. Researchers gave the program the name CBT-I. Sleep hygiene and relaxation involve these sleeping habits: going to bed at the same time every day, eliminating noise and blue light from electronic devices. Also, you want to keep your bedroom cool, take warm baths and do yoga for relaxation.

Stimulus control and sleep restriction

Stimulus control involves getting out of bed, if you can’t sleep. Dr. Irvin said: “Most people stay in bed, fretting about not falling asleep, which then turns the bed into a negative space. Instead, people are taught to get up after 10 minutes of tossing and turning, do quiet, non-stimulating activities, and not to come back to bed until they are sleepy.” Sleep restriction means that a person lies in bed only to sleep plus 30 minutes. It is a way to make people with insomnia get out of bed instead of lying there awake.

Cognitive behavioral therapy

Cognitive behavioral therapy disrupts irrational thoughts and beliefs about sleep. Patients with insomnia often think “I can never sleep” or “I might die if I don’t sleep tonight.” A therapist has training to help the patient find a way back to a more realistic mindset. Eventually the patient accepts the bed as a welcoming place.

Cognitive behavioral therapy is effective in preventing depression

Dr. Irwin pointed out that chronic insomnia often leads to depression. A dangerous consequence of depression can be preoccupation with suicide. A certain percentage of patients with depression in any age group want to kill themselves. This is where cognitive behavioral therapy can intervene and make a huge difference. As mentioned earlier almost 1/3 of patients who received cognitive behavioral therapy for two months retained their normal sleep pattern. It was among this group that 82.6% had no depression compared to a control group. These are very important statistics. Dr. Irwin said: “We have shown that we can actually target insomnia with cognitive behavior therapy and prevent depression from occurring”.

Sleep Training to Prevent Insomnia and Depression

Conclusion

A new study in JAMA Psychiatry describes that sleep training to prevent insomnia and depression is feasible. Sleep researchers used cognitive behavioral therapy sessions for two months on subjects who suffered from insomnia. The treatment group had profound effects with respect to improving insomnia and depression. Almost 1/3 of subjects treated with cognitive behavioral therapy returned to a normal sleeping pattern. And this subgroup of patients had 82.6% less depression. The lead author, Dr. Irwin thinks that cognitive behavioral therapy could become the new way of how to treat and prevent depression.

Nov

2021

How to Fall Asleep Quicker

By Ray Schilling | alcohol, Circadian rhythm, Diabetes, Insomnia, melatonin, Pain, sleep, Sleep apnea

Early October 2021 CNN had an article about how to fall asleep quicker. Most people take 15 to 20 minutes to fall asleep.

Sleep environment

It is important to arrange a sleep environment where you can sleep well. This includes bedroom darkening and keeping the room temperature of 60 to 67 degrees Fahrenheit (15 to 20 degrees Celsius). Make sure your bed is comfortable and use your bedroom only for sleeping and sex. Do not read in the bedroom, keep your cell phone in another room and do not have a TV or computer in the bedroom. These produce blue light, which stimulates your brain. This is exactly what you do not want to have in your bedroom.

Normal sleep duration for different ages

There are always exceptions to rules. In this case there is a rare gene that allows the carrier to sleep only 5 hours at night and still have normal energy during the day. It is called short sleep gene.

Here are the hours of sleep that everybody else needs every night in different age groups:

Adults: 7-8 hours
School-age children: 12 hours
Teenagers: 8-10 hours

If you get the proper hours of sleep, but you are still tired during the day, you may have a lack of quality of sleep. Older people often have to go to the bathroom several times during the night. As it takes some time to reach the deepest level of sleep at night (REM sleep) older people often miss significant amounts of REM sleep during which they dream. The end result is a lack of energy during the day.

Conditions that interrupt your sleep

There are some medical conditions that can interfere with a good night’s sleep. Obstructive sleep apnea is one such condition that 25 million Americans have. A person with this kind of condition snores, gasps, chokes or stops breathing periodically during the course of the night. Restless leg syndrome is another condition, which interferes with a restful, deep sleep. Other conditions are chronic pain, heart disease, diabetes, asthma and gastroesophageal reflux. Medication can affect sleep depth as well.

Falling asleep naturally

Despite many studies it is not clear why some people have no problem falling asleep while others find it difficult. Taking 10 to 20 minutes of falling asleep is normal. If you cannot fall asleep after 20 minutes of trying, go to a dim room and do something calming until you feel drowsy again. Then return to your bed. Follow the same procedure, if you wake up in the middle of the night and you have difficulties falling asleep again. Deep breathing, yoga and meditation are proven remedies to pipe down and help you to fall asleep.

Monitoring sleep at a sleep clinic

A sleep study can be very helpful in diagnosing sleep disturbances. The sleep expert measures several body functions simultaneously. These are heart rate, air flow, blood oxygen level, breathing rate, brain wave activity, muscle movements and eye movements. During a night sleep study, a polysomnogram records all these body functions automatically. The finding helps the sleep expert to diagnose and treat the sleep disturbance.

Self-help supplements for insomnia

My regular sleep supplement every night is 3 mg of melatonin.

Sometimes this is not enough, because I watched an exciting movie or I wrote too much for Quora online. When I can’t fall asleep within 30 minutes, I take a capsule of 500 mg of valerian root. I would say that this helps in 95% of the nights to fall asleep.

If for some reason I still can’t fall asleep, I use 25 drops of Passion Flower Extract: I find that this is very reliable and puts me to sleep within 15 to 20 minutes of taking it. This way I am avoiding prescription narcotics and I am not getting addicted to benzodiazepines. The last step (Passion Flower Extract) I require only once or twice a month. The chemical in the Passion Flower Extract is very similar to benzodiazepines, which means you don’t want to take this every night or your system could get addicted to it.

How to Fall Asleep Quicker

Conclusion

Falling asleep is something we all can learn. It starts with a quiet and relaxing bedroom ambience. We need to allow for enough sleep duration. Adults need 7 to 8 hours of sleep, children and youth more. Deep breathing, yoga and meditation are proven remedies to prepare you to fall asleep easier. When all fails there are a number of self-help supplements you can take to help you ease into sleep. If you still have problems falling asleep a sleep study can be very helpful in diagnosing sleep disturbances. In a sleep clinic your heart rate, air flow, blood oxygen level, breathing rate, brain wave activity, muscle movements and eye movements are recorded with a polysomnogram. The doctor from the sleep clinic can formulate the diagnosis of the sleep disorder and help you overcome any identified problems.

The subchapter “Self-help supplements for insomnia” was published by me earlier here.

Jun

2021

Being A Morning Person Can Prevent Depression

By Ray Schilling | Anxiety, Cancer, Cardiovascular disease, Circadian rhythm, coffee, depression, Gastrointestinal Disease, heart attack, Insomnia, Lung Disease, Mortality, neurological disease, telomeres

A British study concluded that being a morning person can prevent depression. It was reviewed also in CNN. The study used sleep data from 85,000 UK participants in the Great Britain Biobank Study. They wore wrist activity monitors that provided sleep data. Researchers compared the sleep data with the self-reported mood changes. They found that if the sleep pattern is misaligned with the circadian rhythm, those who are night owls are at a higher risk of developing mood disorders. The controls were those who were morning persons. They were not affected by the misalignment effect.

Normal sleep pattern

Natural sleep habit or the circadian rhythm starts between 10 PM and 11 PM and continues for 7 to 8 hours. Your hormones are replenished during your sleep. This helps your body’s hormones and the immune system to restore itself overnight.

“The health problems associated with being a night owl are likely a result of being a night owl living in a morning person’s world, which leads to disruption in their body’s circadian rhythms”. This is what sleep specialist Kristen Knutson said. She is an associate professor of neurology and preventive medicine at Northwestern University Feinberg School of Medicine.

Reclaim your natural sleep habit

The key is to learn to live within your circadian rhythm pattern. Caffeine is a powerful stimulant and will stop you from falling asleep. For this reason, it is best to avoid caffeine-containing beverages. If you cannot live without your favourite cup of java, switch to the decaffeinated version. Stop using LED lights (from TV, computers, tablets or smartphones) 2 hours prior to your bedtime. Use dark curtains and enjoy a comfortable bed. Maybe read that thriller, earlier in the day instead of making it your bedtime story. And do yourself a favour: you do not need the eleven o’clock news on TV! They will probably stop you from falling asleep. Go to sleep between 10PM and 11PM.

Children can have problems with sleep disturbances and depression

Another study published March 22, 2021 in the Jama Network showed that depression had an association with sleep disturbances in youth and children.

A meta-analysis of 16 publications looked at depression and disturbed sleep. It showed that depression was 1.5-fold higher in sleep disturbed youths/children compared to controls with a normal sleep pattern.

Other studies re. being a morning person can prevent depression

Another study with Dr. Knutson as the lead author appeared in 2018. The authors found that various health conditions, mood disorders and mortality were on the increase the more the sleep rhythm deviated from the circadian rhythm. Morning persons were protected from this effect. But night shift workers and night owls were at a higher risk of disease. Specifically, they found the following associations for evening types.

Evening types compared to morning types had a 1.94-fold risk of psychological disorders
The risk of diabetes was 1.30-fold for evening types
Neurological disorders had a 1.25-fold risk in evening types
Gastrointestinal/abdominal disorders occurred 1.23-fold more often in evening types
respiratory disorders were 1.22-fold more common in evening types
Evening types had a 10% increased risk of all-cause mortality

The researchers concluded that externally imposed timing of work and social activities has potentially serious health consequences.

Circadian misalignment responsible for disease

Dr. Knutson also said: “Circadian misalignment could also lead to inadequate sleep duration and quality, which could also impair mood and exacerbate mood disorders.”

In other words, circadian misalignment to circadian rhythm problems. This can cause mood disturbances, but eventually lead to the diseases listed above.

Evidence of health risks in night shifts workers

The medical literature is full of examples that the health of night shift workers is significantly affected by circadian misalignment. Here are a few examples.

1.Here is a random selection to illustrate the health risks of night shifts workers. A study from 2015 examined the sleep patterns of 315 shift nurses and health care workers in Iranian teaching hospitals. They found that 83.2% suffered from poor sleep and half of them had moderate to excessive sleepiness when they were awake.

2.This South Korean study examined 244 male workers, aged 20 to 39 in a manufacturing plant. Researchers compared blood tests from daytime workers to blood tests from night shift workers. They also obtained inflammatory markers like the C-reactive protein and leukocyte counts. Night shift workers had significantly higher values. The investigators concluded that shift workers have increased inflammatory markers. This is a sign of a higher risk of developing cardiovascular disease in the future.

Higher mortality and higher cancer risk in nighttime workers

3. A Swedish study found that white-collar shift workers had a 2.6-fold higher mortality over a control group of daytime white-collar workers.

4. Another study compared night workers in the age group of 45 to 54 with daytime workers and found a 1.47-fold higher mortality rate in the night shift workers.

5.In a study from China 25,377 participants were part of a study that investigated cancer risk in males with more than 20 years of night shift work. They had a 2.03-fold increased risk to develop cancer compared to males working day shifts. Women with night shift work in this study showed no effect with regard to cancer development.

Healthy telomeres with healthy sleep pattern

It is true that you can suffer multiple health problems, as all of your hormones depend on the resetting during your deepest sleep between 2AM and 4AM triggered by the nighttime melatonin response. Even your telomeres, the caps of chromosomes in every cell get shortened from too much stress and too little sleep.

One example of such a study comes from Milan, Italy. https://oem.bmj.com/content/75/Suppl_2/A480.1

In this 2018 study researchers compared 46 nurses who had worked in night shifts with 51 nurses working day shifts. Among the night shift workers breast cancer was common, but not among day workers.

Shortened telomeres, hypomethylation of BRC1 gene and p53 gene

In the night shift nurses from Milan there was hypomethylation of the breast cancer gene BRC1. There was also hypomethylation of the general cancer gene p53. At the same time significant telomere shortening occurred in night shift nurses who had worked night shifts for more than 15 years. This likely all worked together in causing night nurses to develop breast cancer more frequently.

Shortened telomeres mean a shortened life span. The reason for this is that people with shortened telomeres develop heart attacks, strokes and cancer. This is what shortens the life span. How do we avoid this risk? Go back to healthy sleep habits. As mentioned above it is best to start going to sleep between 10PM and 11PM and sleep for 7 to 8 hours. Night owls delay going to sleep by 2 to 3 hours.

Being A Morning Person Can Prevent Depression (click image to enlarge)

Conclusion

A publication in Molecular Psychiatry demonstrated that evening person (night owls) are more likely to develop depression. This is in comparison to morning persons. As discussed, other researchers showed that evening persons also can develop diabetes and neurological disorders. In addition, respiratory disorders and gastrointestinal disorders are more common in night owls as well. When it comes to mortality, evening persons have a 10% increase of mortality over morning persons. There is a large body of literature regarding diseases of night shift workers. Night Shift work is perhaps the most extreme example of a circadian misalignment. It leads to poor sleep, inflammation in the body, increased cancer risk and higher mortality compared to day shift workers.

Prevent telomere shortening

Even the telomeres get shortened in night owls and night shift workers. We can prevent problems like these by going to bed in time and sleeping according to our circadian rhythm. If you had a poor night’s sleep, make up for it with the help of an afternoon nap. Do not sleep all afternoon though; half an hour or one hour will be enough. Even a short, restful nap after coming home from work can restore your feeling of wellness.

Jan

2021

Melatonin Is More Than a Sleeping Aid

By Ray Schilling | Alzheimer’s disease, Anti-aging medicine, Autism, autoimmune disease, Cancer, Cardiovascular disease, Circadian rhythm, Dementia, Diabetes, Health, heart attack, Heart Disease, Hormones, immune system, Inflammation, Insomnia, melatonin, Menopause, mitochondria, Multiple sclerosis, neurological disease, Osteoporosis, Parkinson’s disease, sleep, Stroke

Notably, the January 2021 issue of the Life Extension magazine informs you that melatonin is more than a sleeping aid. It contains an interview between Dr. Roman Rozencwaig and a Life Extension (LE) magazine reporter. It must be remembered that Dr. Rozencwaig dedicated much of his career to the healing effects of melatonin. Another keypoint is that in 1987 Dr. Rozencwaig published a paper together with two other researchers. Specifically, it showed that melatonin production by the pineal gland declines in older age. Markedly, they stated that this is the reason why people age and why diseases of aging develop. Another key point is that Dr. Rozencwaig also stated that taking oral melatonin can promote a healthier life.

Melatonin deficiency causing aging and various illnesses

With the aging process the pineal gland calcifies and melatonin production is steadily declining. Surely, along with this is a deterioration of the circadian hormone rhythm. Meanwhile, the neuroendocrine system in the brain gets disorganized. Accordingly, this causes various diseases to occur. To emphasize, Dr. Rozencwaig says that a proper balance between melatonin and neurotransmitters is what we need to maintain health and longevity. As a result, a daily intake of melatonin supports healthy aging and longevity.

The many clinical effects of melatonin

Oral melatonin tablets help you to fall asleep easier, particularly the population that is older than 60 years.

But besides that, melatonin has many other clinical effects.

Melatonin improves immunity, which improves resistance against infections. It helps also in cancer prevention
Melatonin maintains the circadian hormone rhythm by synchronizing pituitary and hypothalamic hormone production
It protects the brain and may prevent Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, autism, and others
Melatonin modulates anti-inflammatory cytokinins in different diseases

Dr. Rozencwaig mentioned that melatonin slows down the aging process. There are multiple intertwining reasons for this.

Melatonin’s actions against the aging process

Melatonin regulates gene expression. This means that some signs and symptoms of aging can be reversed through genetic switches
Because melatonin regulates the immune response, the body is more protected against viral, bacterial and parasitic infections
Melatonin helps to overcome chronic inflammation that produces cytokines
Melatonin is also liver-protective through stimulation of an enzyme (AMPK). This enzyme regulates cellular metabolism.
There are other processes that melatonin is involved in: energy metabolism by protection and restoration of mitochondria.
Melatonin protects against osteoporosis by balancing and regulating bone formation versus bone loss.

More actions of melatonin

An important function of melatonin is the stimulation of antioxidant enzymes like glutathione peroxidase and superoxide dismutase (SOD)
Melatonin regulates sirtuins, which are proteins that maintain cellular health. They protect you from obesity, type 2 diabetes, cancer, heart attacks and strokes, dementia and more
As already mentioned, melatonin is a neuroprotective agent and may prevent Alzheimer’s and dementia
Melatonin stimulates apoptosis of cancer cells.
Oral health and melatonin are related. Melatonin suppresses herpes infections and periodontal disease. Melatonin prevents oral cancers to a certain degree. In addition, dental implants survive better when melatonin is present in saliva.

Prevention of cognitive decline

Dr. Rozencwaig mentioned that melatonin stops much of the cognitive decline of aging. To achieve this the following processes take place.

Melatonin improves the sleeping pattern and increases the amount of REM sleep.
During sleep melatonin removes toxic amyloid and tau proteins. We know that with Alzheimer’s disease these are the proteins that accumulate in the brain.
Melatonin improves myelination of white matter in the brain. This prevents brain atrophy of old age.
The brain is metabolically very active and produces toxic free radicals. But melatonin is a strong antioxidant dealing with free radicals. Melatonin can cross the blood brain barrier and stimulates enzyme production to eliminate toxic reactive oxygen species.
Chronic inflammation also increases with age, but melatonin deals with this condition in the brain.
Here are 3 subtypes of melatonin receptors. The body integrates the multitude of actions of melatonin with the help of these receptors.

Melatonin Is More Than a Sleeping Aid

Conclusion

Melatonin is a powerful antioxidant that has many other useful protective qualities as explained. The body integrates various functions like anti-aging, anti-free radical activity, neuroprotection in the brain and more. Melatonin even synchronizes pituitary and hypothalamic hormone production. This helps to integrate the effect of melatonin, which benefits the body in many ways. Melatonin prevents Parkinson’s and Alzheimer’s disease, multiple sclerosis, autism, obesity, type 2 diabetes, cancer, heart attacks, strokes and dementia. Melatonin production deteriorates from the age of about 60 onwards. It is important to supplement with melatonin at nighttime from that age on. Usually, you only need small amounts of melatonin, between 1mg and 3 mg at bedtime. This prevents most of the serious diseases of old age, stimulates your immune system and lets you age gracefully.

Nov

2018

When you are sleepless

By Ray Schilling | andropause, Anxiety, Drugs, Insomnia, Menopause, Mortality, sleep, stress, telomeres, testosterone

You are not alone when you are sleepless. Insomnia is a widespread problem in society.

Previous review of the topic of insomnia

I have reviewed the topic of insomnia before in a blog.

Briefly I pointed out that in some people there is a mutation of the gene that controls the circadian sleep rhythm. It is called the CRY1mutation. Some people have sleep disturbances from working night shifts. I mentioned the blue light of electronics that is produced by the TV screens or computer screens. The more you are exposed to it, the more it stimulates the brain to produce serotonin. This undermines the melatonin production, and as a result the person finds it extremely difficult to fall asleep. Children playing with i-phones, tablets or watching children’s programs on television can have sleep disturbances from the blue light. Blue has the frequency that over stimulates the brain and interferes with melatonin production. Drug and alcohol abuse can also interfere with the normal circadian sleep rhythm and cause insomnia.

Hormone factors of insomnia

For natural sleep to occur, we need melatonin which the pineal gland releases in the evening. It initiates and maintains sleep during the night. The natural opponent of melatonin is cortisol, the stress hormone, from the adrenal glands. Both hormones need to be in balance to allow you to sleep normally. Shortly before we wake up in the morning melatonin production goes down and cortisol production is up. Cortisol levels are low at night and high during the day. So it is cortisol that keeps us going throughout the day. But an excess of cortisol from chronic stress can also interfere with falling asleep and sleeping through the night.

Stress and insomnia

When we feel stressed, cortisol production goes way up. This has consequences regarding our sleep pattern. It can interfere with falling asleep, causes us to wake up from a deep sleep in the middle of the night and can give us problems falling asleep again. Chronic stress exposure leads to high cortisol production by the adrenal glands, which in turn will lower melatonin and cause sleep disturbances. Older people (above the age of 50) have very little melatonin production left, as there is an age-related decline of melatonin production. The melatonin production is highest in younger years and lowest in older age.

What to do when you are sleepless

There are several over-the-counter remedies, which in combination can be quite effective.

Melatonin for when you are sleepless

Melatonin (3 mg at bedtime) is a good start to see what it does for your sleeplessness. Taking a small amount of melatonin at bedtime we can re-establish the balance between cortisol and melatonin, which helps the circadian hormone rhythm and sleep pattern to come back. Some people wake up in the middle of the night and find it difficult to fall asleep again. If this happens at 3 AM, a good remedy at this time is to take another 3 mg of melatonin. Melatonin stays in the system for about 4 hours. Light during the day de-activates the effect, when light hits the retinas upon opening your eyes. You should not exceed 6 mg of total melatonin overnight. Otherwise it will interfere with the balance of cortisol and melatonin, lowering cortisol levels, which would rob you of energy during the day.

Phosphorylated serine (Seriphos)

A supplement that is freely available in the US (but not in Canada) consists of a simple amino acid. As this link shows (second item in the link) phosphorylated serine Seriphos) helps to down-regulate cortisol levels (lowering them). This means that melatonin gets the upper hand and you can sleep again.

The dosage for phosphorylated serine (Seriphos) varies from person to person, but will be in the range of 1000 mg to 3000 mg in the evening. After about 30 days the circadian rhythm may have recovered and you can stop the Seriphos. A one-day pause is required once a month for resetting the hormone receptors. Should you still have problems sleeping, you can continue with it for another month and pause again for a day. Seriphos has very few side effects.

Valerian root capsules

Another useful sleep aid is valerian root (as capsules). 500 mg to 1000 mg will help you to relax. It does not have the side effect of feeling groggy the next morning.

Other considerations when you are sleepless

Hormone problems like thyroid abnormalities (too much or too little thyroid hormones) are issues that your doctor has to investigate. Women in menopause often have sleep disturbances due to a lack of estrogen and progesterone. A knowledgeable healthcare professional is able to take care of that by prescribing bioidentical hormone creams.

When men approach andropause (the equivalent of menopause in women), they lose testosterone production. This can cause insomnia. The doctor can verify the hormone loss by a blood test. Replacement with either bioidentical testosterone cream or injections will rebalance testosterone levels. Insomnia may disappear. It is essential not to overdose testosterone, as this can also cause insomnia.

Sleep lab for when you are sleepless

When home remedies do not help, it may be time to check into one of the sleep labs to diagnose the kind of sleep disorder you are suffering from. Here is an overview what is happening there.

Essentially you get hooked up to monitors and are encouraged to just sleep as you would normally do. The physician in charge of the lab will later explain to you what the monitors showed, and tell you what type of sleep. According to the findings your doctor will recommend what measures are appropriate to remedy the situation.

Treatment for insomnia when over-the-counter remedies fail

Short acting benzodiazepams

When anxiety is not a problem, but only insomnia is (falling asleep or staying asleep) lorazepam 1 mg (Ativan) or temazepam 10 mg (Restoril) are shorter acting benzodiazepams that will help. It is not a permanent but a short “emergency break” for intermittent use, so that the GABA benzodiazepine receptors have time to recover. Otherwise, with continuous use tolerance would set in. This means higher and higher doses of the sleep medication would be necessary to achieve the same effect. Another non-benzodiazepine is Zolpidem 5 mg (Ambien). Even though this medication is not a benzodiazepine, it works on stimulating the same GABA benzodiazepine receptors.

Longer acting benzodiazepams combined with antidepressant Trazodone

For several years the combination of a small amount of the longer acting benzodiazepams, clonazepam (Rivotril) at 0.5 mg combined with a small amount of the anti-depressant trazodone (Oleptro or Desyrel) at 50 mg at bedtime has been has been in use quite successfully.

But there is a concern of drowsiness caused by Rivotril as this link shows.

Trazodone, which is an antidepressant has a sleep cycle restoring effect at low doses and has less side effects, because it is used at ¼ the dose for a full-blown depression. Males are often complaining that it reduces their sex drive, and it may cause erectile dysfunction.

Clonazepam side effects

Rivotril was originally in use to control epileptic seizures and anxiety. The combination therapy for sleep disorders uses Rivotril at ¼ of the regular dose. Although it is good as a sleep aid, it has a long half-life and stays in the system well into the next day. This may present as sleepiness and cause falls in elderly patients because of clouded attention. Replacement by one of the medium long acting benzodiazepams could be the solution. A drug pause for 1 day will help to reset the GABA benzodiazepine receptors and prevent tolerance from happening. Knowing all those effects and side effects it is wiser to reserve the use of these medication strictly when everything else has failed!

When you are sleepless

Conclusion

As I mentioned before, you are not alone when you are sleepless. Insomnia can present as having problems to fall asleep, but it may present in others as a problem in the middle of the night waking up and having problems going back to sleep again.

I described non-conventional methods to help you to sleep using melatonin, Seriphos and valerian root capsules. If this fails, a sleep lab investigation may be necessary to get to the bottom of your insomnia problem. Physicians often prescribe short acting benzodiazepams like lorazepam (Ativan) and temazepam 10 mg (Restoril).

Other possibilities to treat insomnia

There are other possibilities to treat insomnia, with a combination of a low-dose antidepressant (trazodone, brand name Oleptro in the US) and low-dose anti-seizure and anti-anxiety drug clonazepam (Klonopin or Rivotril). Anxiety can often be a big component in insomnia and this treats both. On the other hand, anxiety is a separate problem, which needs professional treatment. There can be side effects of sleepiness from clonazepam and men complain of a lack of sex drive and erectile dysfunction from trazodone. Help is available when you are sleepless. But you need professional help to work on the problem and find the solution.

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