BY DR. PANCH PAUL, MD*
As most of us spend a large chunk of our time indoors perusing sedentary jobs- sleep problems are on rise across the globe. Sleep deprivation can mimic, trigger and exacerbate psychiatric conditions. Poor sleep will cause poor attention and focus the next day mimicking Attention deficit hyperactivity disorder (ADHD). The good news is- restful sleep will promote brain healing and alleviate the symptoms of depression, anxiety, bipolar, ADHD and psychosis.
Unfortunately treating insomnia is not easy. All conventional prescription sleep medications come with adverse effects if used in the long run. Commonly prescribed medications of the benzodiazepine class like Valium and Xanax are highly addictive and increases the risk of memory loss and dementia. Other class of medication like Ambien, Lunesta are reported to cause sleep-walking, behavioral changes, and cognitive problems. Off-label medications for sleep like Seroquel and Remeron increases body weight, blood cholesterol, and blood pressure. Antihistaminic medications like Trazodone, Doxepin, Vistaril are safe in the short term, but patients can develop tolerance requiring even higher doses. New promising drugs like Belsomra is a welcome addition, but its long-term effects are unclear. While the search for a magic prescription sleep pill goes on, let us examine what natural remedies are available for sleep. Here is a list of four sleep supplements I often use:
Magnesium is a vital mineral and plays a role in more than 300 cellular processes in the body. Magnesium deficiency is becoming a serious health hazard as around 50 percent or half of the American population may be getting inadequate magnesium in their diet. Magnesium is essential for all muscle function including those of the heart. Magnesium deficiency will cause restlessness, anxiety and sleep problems. Our modern living is to blame for this. Magnesium is an anti-stress mineral. When we experience stress, the body loses magnesium. The more the food is processed, the magnesium is lost. Intensive agricultural practices like use of fertilizers, pesticides and other chemicals also deplete the magnesium in the soil. Thus, it becomes crucial to take magnesium as a dietary supplement to balance this loss.
Luckily, magnesium is a safe mineral with no serious side effects. If you take more magnesium that your body needs, it will pass through stool, and you will experience diarrhea. There are various forms of magnesium available in the market. All forms, other than magnesium oxide will work. The best is Magnesium L-Threonate, which is the most bioavailable form of magnesium, and has the highest absorption in the brain. However, it is expensive. Standard dose is 2000 mg 1 hour before sleep. Magnesium Taurate is another excellent form of magnesium used mostly for cardiovascular health and heart problems. It can be used at a dose between 150 and 300 mg. Magnesium Glycinate also contains glycine in addition to magnesium which promotes sleep. You can start at 200 mg bedtime, and increase to 400 mg as needed. Magnesium Citrate, another commonly used form, is available both as a tablet and powder. For tablet, you can start at 150 mg, and increase till 400 mg as needed. The powder form, (which I personally prefer) is available as Natural Vitality Natural Calm Anti-Stress Magnesium Drink. Take 1 to 2 tea spoons in water before sleep. Stay away from Magnesium Oxide which is inexpensive, and works the least. It is poorly absorbed and mostly lost in stool, resulting in diarrhea. Magnesium Oxide has medicinal use as a short-term laxative, as it relieves constipation. Also, it is a good antacid, and can be used for acid reflux. However, it cannot be used to correct magnesium deficiency in the body, and is ineffective as a sleep aid.
Melatonin: Melatonin is a hormone which is secreted by pituitary gland when we are exposed to darkness. It is a very powerful antioxidant and helps in the recovery and healing of the brain. It is important not to expose yourself with bright light from the computers, smart phones and television. Remember, melatonin cannot work, unless your eyes are exposed to darkness for at least an hour. Darkness stimulates the posterior pituitary to secrete melatonin. As melatonin level rises, we feel sleepier. Bright light suppresses melatonin, and amongst the light waves, blue light causes the maximum suppression of melatonin. So, if you must work on screen at night, use blue light blocking eye glasses, and turn your screen into night mode for night work.
Melatonin is useful for those who have irregular sleeping hours. It will help those who travel frequently and suffer from jet lags and sleep problem due to change in time zones. Melatonin decreases the time for the onset of sleep. Melatonin can be taken from a dose of 1 mg to a maximum of 5 mg on a regular basis.
Although safe, melatonin can adversely react with many hormones in the body. First, although no negative feedback loop has been identified, there remains a theoretical risk of getting dependent on the outside melatonin, which could lead to the body stopping its own secretion. Secondly, melatonin suppresses sex hormones, and can delay puberty in children. Also, sudden stoppage of melatonin in children can lead to precocious puberty. Other side effects are headache, dizziness, nausea and drowsiness.
Serotonin Precursors: Serotonin is an important neurotransmitter in the brain playing a crucial role in mood, anxiety, stress and sleep. Many of the antidepressants work by rebalancing the serotonin pathway. For example, Prozac increases serotonin levels in the brain by decreasing its absorption inside cells, thus making more serotonin available in the synapses.
Prescription drugs are more powerful in increasing the serotonin levels as they are designed to cross the blood brain barrier. We can also increase serotonin levels in the brain by eating food rich in tryptophan (turkey, egg, cheese) which is a precursor for serotonin. The good bacteria in your gut (probiotics) convert tryptophan into 5 hydroxytryptophan (5HTP), which in turn is converted to serotonin, and finally serotonin is converted to melatonin. Hence, directly taking Tryptophan and 5HTP supplements (which are the raw materials for serotonin) can raise the serotonin levels in the body. However, 90% of the serotonin is made in the gut, and is used by the nerves of the gut, and very little can cross the blood brain barrier. These may not be enough for treating severe depression or debilitating anxiety; but may be enough for treating sleep problems. Thus, taking either tryptophan or 5TP will help in sleep. Now, which one to choose? Both have their merits and demerits.
Tryptophan is safer, as any excess amount is used by the body to make the vitamin Niacin. But this also makes it slower to work, as only 1 percent of tryptophan is available to make serotonin. 5HTP supplements work quicker and are more powerful, as they are directly converted into serotonin using Magnesium, Zinc, Vitamin C, Vitamin B6. However, both tryptophan and 5HTP should not be taken together, nor combined with any other drug or supplement which increases serotonin levels in the body. Also, people with a cyclical mood disorder like bipolar should never take 5HTP or Tryptophan in isolation, as it may trigger a manic episode. On the other hand, those with a purely depressive or anxiety disorders may notice improvement in symptoms with 5HTP and Tryptophan. The typical dose of Tryptophan for sleep is L- tryptophan 500 mg to 1000 mg. Typical dose for 5HTP is 50 mg to 200 mg 1-hour before sleep.
GABA: GABA stands for Gamma-aminobutyric acid. It is an inhibitory neurotransmitter to the brain. GABA can be taken as a dietary supplement. It acts through the same GABA receptor as Xanax, Valium, and Alcohol does. GABA supplements are used for anxiety, stress, and sleep. GABA can be useful for those who have been using alcohol for a long time before sleep, and now want to come off alcohol, but are unable to fall sleep.
Gabapentin, a prescription drug that increases GABA level is the brain, is also used to treat alcohol addiction. For those habituated on Xanax, and Valium- GABA can be healthier substitute. But GABA has a dark side. GABA is a brain depressant. GABA can also inhibit frontal lobe which is the site for learning and memory. Thus, it may be unsuitable for students, and elderly with memory problems. Additionally, GABA can cause disinhibition. Many parents have reported that their children have become more aggressive, violent and disruptive on GABA. Hence, GABA is not for all and needs careful monitoring. GABA is readily available in health stores. Usually comes at a dose of around 700 mg. 1 tablet per day to a maximum of 2 tablet per day is the recommended dose for most brands. GABA should be taken on an empty stomach for better absorption. Ideally, take them 2 hours after meals, and 1 hour before sleep for best results. Regular GABA supplements however does not easily cross the blood brain barrier. This makes them less potent. Phenibut, a structural analogue to GABA, crosses the blood brain barrier. Phenibut is used as a prescription drug in Eastern Europe and Russia. It is available online in US and is unregulated. One popular sleep aid, called KAVINACE contains Phenibut, Taurine, and Vitamin B6. However, beware that Phenibut has an addictive potential, and, can be abused as a recreational drug to get high.
In summary, supplements are an important tool in the treatment for insomnia, along with lifestyle changes, behavioral therapy and medications. The supplements are not regulated by the Federal Drug Administration as stringently as it does for the prescription medications. Thus, doses and efficacy may vary. I have mentioned standard doses in this article. Always follow the manufacturer’s recommendations as listed on the bottle under your doctor’s guidance. As a rule, always start at the lowest dose and gradually go up, and never exceed the maximum recommended dose unless your physician says so.
Sleep supplements work better if taken 1 hour before sleep. Avoid driving, or operating heavy machinery after taking them. There are many supplement brands in the market. The ones that I use for my patients are BrainMD, Jarrows, Designs for health, Pure Encapsulations, Thorne research, Mercola, and Zhou. Secondly, beware of the Side-effects of supplements. There is a common misconception, that all supplements are natural and are free of side effects. This is false. Anything that can have a positive effect in the body, can also have a negative effect. All supplements have side effects, a cursory google search will bring out a list of them. The key is to use the right kind of supplement for the right person at the right dosage. Many supplements can cross react with other medications or supplements that you may be taking. Do your research, and understand the risks and benefits. When in doubt, consult health professionals. Good luck and sleep deep!
*Dr. Panchajanya Paul, MD, ABIHM, ABPN, FAPA – is an American Board certified – Child, Adolescent, and Adult psychiatrist. He is a diplomat of the American Board of Integrative and Holistic Medicine, and a Fellow of the American Psychiatric Association. He holds adjunct faculty position at Emory University School of Medicine; University of Georgia, and University of Central Florida School of Medicine. He sees patient at the Amen Clinic and the Georgia Behavioral Health.