BY DR. PANCHAJANYA ‘PANCH’ PAUL, MD
The role of sleep in health was recognized since the earliest times. Unfortunately, there is a lot of confusion on sleep products and supplements. Although there are various sleep medications in the market, it is best to use them as the last resort for their highly addictive potential and long-term side effects.
The four commonly used sleep supplements are Magnesium, Melatonin, Tryptophan/5HTP, and GABA. For many patients, these can be too strong or less effective. Fortunately, there are numerous herbal products along with vitamins and minerals available for sleep.
Valerian Root: Ancient healing traditions like the Indian (Ayurveda), Chinese and Greek mention several herbs to help with sleep. Common among them (that have stood the test of time) are Valerian root, Passion flower, Lemon balm and Chamomile. Valerian increases the level of GABA in the brain. It can bring a sense of calm, relaxation and promote deep sleep at night. However, valerian can cause side effects like nausea, headaches, unrest and dizziness. Some people may react very strongly to valerian like a Xanax and valium, and develop hangover the next day, and a reduction in cognition. It is advisable not to drive or operate heavy machinery after taking valerian. Typical dose for insomnia is around 500 mg 1 hour before sleep.
Other Essential Herbs: Passionflower is another relaxing herb and is used in combination with Valerian root in many sleep aid formulations. It also helps with anxiety and relaxation. Lemon balm, is another ancient herb works that through the GABA. It has a soothing effect to the brain. It also improves memory along with sleep. Lemon balm essential oil is also used in aromatherapy. Chamomile is consumed as a tea to help with sleep. In addition, chamomile tea can also help in reducing inflammation, improving digestion, and relieving sore throat.
Amino Acids Glycine and Theanine: There are two amino acids that can bring rapid sleep onset. One is Glycine of animal source, and the other is Theanine derived from tea. Glycine is an amino acid produced by the body, and is an inhibitory neurotransmitter like GABA. It dilates the blood vessels, reduces the core body temperature, and prepares the body for sleep. Glycine also helps in day time wakefulness and reduces fatigue. Chief dietary sources of glycine are high protein foods like eggs and red meat. When taken as supplement, typical dosage is 1 to 3 grams 1 hour before sleep.
Theanine is derived as an extract tea. It is present in both black and green tea. Although tea is stimulating as it contains caffeine, L-theanine has a calming and sedative effect. Theanine also works if sleep problems are due to restless leg at night. The advantage of theanine is its rapid onset of action. It works by reducing anxiety and promotes sleep within 30 minutes of intake. Typical dose of theanine is 100 to 200 mg before bedtime.
Inositol: It is a B-vitamin that boosts the action of serotonin and has a natural calming effect on the body. It is useful if your sleep problems are due to anxiety and obsessive thoughts. A double blinded study found inositol as effective as fluvoxamine in reducing panic attacks and anxiety in patients. It is available in both powder ad tablet form. Powder form is preferred as you can go up on the dose. It is very safe and the dose ranges from 1 gram to 18 grams per day. The dose for insomnia is about 2 grams at night 2 hours before sleep. It is easily tolerated without side effects. Its effects are potentiated by taking it with choline or choline rich food like egg yolk and animal fat. In addition to brain function, inositol also helps with acne, menstrual problems, and metabolic problems. However, inositol takes some time to work, and you may have to take it at least a month before noticing its benefits.
B vitamins: Several B vitamins help in the regulation of sleep mainly by acting through the tryptophan-serotonin pathway. Niacin (B3) is mostly known for the disease pellagra caused by its deficiency which can cause dementia, dermatitis, diarrhea, insomnia and general weakness. Niacin is needed for every cell of the body. The exact way how niacin causes insomnia is unknown. Theoretically, we know that more than ninety percent of the tryptophan in the diet is used to make niacin. Thus, an adequate level of niacin in the body will free up more tryptophan for the serotonin and melatonin production. Another B vitamin called pyridoxine (B6) is needed in the conversion of tryptophan to serotonin. Women taking oral contraceptives or hormone replacement therapy may secrete more tryptophan metabolites in their urine and become deficient in B6. Supplementation with vitamin B6 can mitigate some of these problems. Vitamin B12, B9 (folate) and B6 deficiency can also cause restless leg syndrome leading to sleep problems. Since vitamin B is water soluble, there is less risk of side effects. I it may be a good idea to take a vitamin B supplement containing all the vitamin B types along with vitamin C for general wellbeing.
Vitamin D: The sunshine vitamin is a hormone that plays a vital role in immunity, cancer prevention, depression, bone health. Low levels of vitamin D are associated with increased sickness. Vitamin D supplementation in the morning can help with sleep. Vitamin D supplementation in the morning along with melatonin at night helps in the regulation of the circadian rhythm. Vitamin D levels are easier to check, and your primary care doctor can order it for you. Generally, levels over 60ng/ml is recommended. Based on your level, consider taking Vitamin D3 at a dose of 1000 IU to 5000 IU in the morning. However, whenever you take vitamin D t doses more than 1000 IU, always add Vitamin K2 200 mcg along with it to prevent calcium deposition in the blood vessels.
Probiotics: The healthy bacteria in our gut produces serotonin which is helpful in sleep. Without this tryptophan (which is the raw material for serotonin) cannot be converted into serotonin. If you have chronic constipation, chronic diarrhea or irregular bowel movement, you may have too many bad bacteria in your gut. Taking probiotic supplements can raise the level of good bacteria. You can also get probiotics from fermented food like yogurt, kefir, kombucha, sauerkraut, and kimchi.
Iron: Many people move their legs at night. This causes sleep problems to them as well as their partners. The medical term for it is Restless leg Syndrome (RLS). Iron deficiency is a common cause for RLS. Its good idea to check your iron levels if you move too much in the bed at night. Low iron levels can be treated by eating iron rich food like red meat, liver, eggs, and chicken. Most vegetarian sources are poor in iron, and addition of iron supplements will help. Also, remember to take adequate amounts of vitamin C as found in citrus fruits like orange and lemon juice to increase the iron absorption.
Ayurveda: The most studied herbs for mental ailments and insomnia are Ashwagandha, Brahmi, and Sankhapushpi. Ashwagandha, also called Withania somnifera reduces chronic stress by decreasing the blood cortisol or the stress hormone level. Ashwagandha is an energizing herb, which reduces anxiety, and relaxes the mind for sleep. Shankhapushpi is another brain rejuvenation herb which improves blood circulation and helps with insomnia. Brahmi, also called Bacopa, is a memory booster. Legend has it that the ancient seers used Brahmi to memorize all the Vedic knowledge which was orally transmitted over the generations. Brahmi is a brain tonic, and promotes healthy nerve function. It can also act as a tranquilizer and aid in sleep.
*Dr. Panch Paul, MD, ABIHM, ABPN, FAPA – is an American Board certified – Child, Adolescent, and Adult psychiatrist. Call 7704541252 to schedule an appointment with Dr. Paul.