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Avoid Sleep Hypnotics Like the Plague
Regular use of sleeping pills, prescription sleep hypnotics, are linked to making you die prematurely from diverse causes.52 Even taking less than 18 sleep hypnotics in one single year has been linked to dying prematurely from all-cause mortality.53 By the way, the authors of this study pointed out that this was the 19th scientific investigation linking sleep hypnotics to premature death. This means that the link between taking sleeping pills and decreasing your time on earth is well established! The sleeping pill fix is not worth it. If you take them, use them for the shortest time possible while you fix the root issues causing your insomnia.
Also, these meds are habit forming. Plus, they lose their effectiveness over time as the brain builds up tolerance.
Sometimes doctors say that since sleeping pills are dangerous why not take allergy antihistamine drugs as they cause less dangerous drowsiness. Not true. Antihistamine meds block acetylcholine, which lubes neurotransmitters and is crucial for memory. The use of antihistamines, either pharmaceutical or over-the-counter, is now reproducibly linked to increased risk of cognitive decline and dementias54 as well as premature death and increased risk of cancer.55
For every three years on regular use of antihistamines, the increased risk of dementias increases significantly. Stay away!
Sleep medications can cause other issues. More car accidents. Poorer job performance. Addiction. When you try to stop taking these meds, you get "rebound-worsened insomnia,"56 which makes them very difficult to stop. And…you risk late night atypical behaviors or food binges that you can't even remember when you wake up the next morning.
You Gotta Laugh
I love the scene in Grace and Frankie where Jane Fonda (Grace) gathers up her courage and energy to break up with her beau when he comes down at night to raid the fridge. But the next morning he acts like it never happened.
Lily Tomlin (Frankie) queries to Jane, "Did you break up in English? Was he even in the room?"
But the truth comes out – it was an Ambien break-up!
Now Jane Fonda has to break up with him again when the Ambien is out of his bloodstream, and he is vertical and conscious.
I have had some patients admit to me that when on Ambien, they wake up in the morning to 10 empty tuna cans strewn throughout the kitchen and a mouth that tastes of fish!
Too Much Sleep Isn't Better
Both excessive longer and shorter sleep hours are associated with increased mortality.57 Sleeping more than you need, it turns out, can be just as detrimental as sleeping too little. Just like Goldilocks, you need to find the optimal "just right" amount of sleep that works best for you.
- Eat less junk foods, especially high glycemic ones that spike your blood insulin. Excessive blood sugar and insulin levels ding sleep.
- Drink less alcohol and limit caffeine intake.
- Limit IT exposure before bed and during sleep. Many people are sleeping with their phones under their covers or on their nightstands. This can disrupt sleep58 as the blue light that comes off screens mimics the light of full daylight. This can disrupt sleep as well as promote insulin resistance and keep you fat!
- Get regular exercise. Especially outside. Or work out at a gym, but stand outside in front of the gym for a bit of time to get sunlight, even on cloudy days. Or just look outside the window and let the vision of nature inside your body/mind and spirit.
- Try to find your most sleep-promoting mattress. Science now shows that many memory foam mattresses and pillows outgas dangerous solvents. For years. When will the bad news stop?
- Sleep in as a dark room as possible. Excess artificial light emitted from lights on in the bathroom or from street lights, televisions, monitors, smartphones and other devices can suppress melatonin production and sleep quality. Some very sensitive and ill people even need to "turn off" their electronics several hours before bed to start winding their brain and nervous systems down adequately to achieve restorative sleep.
Keep in mind, though; this may not be truth for all. There was a book by an anthropologist (it's out of print now and I can't find the name) who traveled the world assessing cultural differences in sleep. Some indigenous tribes did well sleeping with full light, chickens in the room, and 15 people on top of each other. Perhaps they did not have the constant barrage of electromagnetic fields that US towns and citizens now have.
- Clean up. Creating orderly spaces in your bedroom and home reduces cortisol levels, which then soothes spirits and sleep.
- Resolve your emotions as best as you can. Unhealthy emotions make for unhealthy sleep, and vice versa. Emotional house-cleaning soothes spirits and sleep.
- Don't eat before bed, for most of us. It takes approximately three hours for your stomach to empty after a meal. Thus, it's an ideal practice to stop eating at least three hours before bed. Part of insomnia is the American habit of snacking while lying down in front of the TV late at night. But we are all different. Some people sleep better with a light snack before bed, one that is high in protein but low in refined carbs.
- Deal with grinding your teeth. Sleep is harmed by bruxism (teeth grinding). The combination of insomnia and tooth grinding is considered a primary sleep-related movement disorder.59 Bruxism can be helped by mouth guards, and sometimes by identifying and avoiding intolerant foods. Adverse food reactions can cause any ongoing issue. Food is powerful!
- Getting up to pee. Drinking excess fluid before bed may cause you to wake up in the middle of the night to urinate and this then disrupts your sleep cycle. If you don't drink too much before bed, yet you wake up to pee, this suggests cortisol dysregulation. Appropriate lower nighttime levels of cortisol are supposed to keep you sound asleep, even if your bladder starts to fill up. Some people with severe adrenal fatigue and cortisol dysregulation have to wake up many times during the night to urinate and suffer with severe sleep issues. Fluid intake, adrenal health, and cortisol issues all overlap in affecting urination and ability to achieve deep restorative sleep.
- Regular wind-down routines help signal your mind and body that it's time for sleep. Even changing your sheets more often can contribute to a healthier sleep and be part of this ritual. If I were super wealthy, I'd have someone change my sheets nightly!
- Mindfulness. I often suggest mindfulness exercises to my patients. I am seeing more and more patients, especially women, who are so chaotic during the day that they have abandoned congruency with their bodies and can't turn off their minds during sleep. If they do achieve hours of sleep, those hours still seem less restorative. Most of my patients are already rushing to fit in yoga, meditation, or workouts (so oxymoronic), so I recommend unique focused exercises that I learned while living with Swami Satchitananda at Yogaville East in the 1970s. Acupuncture is also a physical way to achieve more physiologic and emotional balance that contributes to better sleep.60
- A message from your deeper self… is your sleep issue trying to tell you something? Persistent sleep problems may be flashing red lights on your physiological dashboard saying that something is off in your life that needs attention and healing. If true for you, try to gently fix these issues. Put some intention and/or prayer onto these issues to inform your higher self that they need recovery. Sometimes repeating healing affirmations or requesting guidance (by repeating a simple inquiry over and over again) – before falling asleep – helps your unconscious take over and heal ongoing woes while you count sheep. You may be surprised to wake up to obvious restorative answers!
Sleep Performance Anxiety… Go to Bed Without It
We tell patients you "must" have eight hours of sleep or your toes will fall off. But some tribes around the world sleep for four hours, wake up and dine and party, and then go back to sleep for four hours, and are healthy and happy. My mother lived to 96 years of age and was never ill till her early 90s. She had infinite energy and only slept four hours a night. So did Einstein.
Even though practitioners make recommendations, everything ultimately has to be individualized to you… even sleep.
Maybe you do better on less sleep than the average bear. I used to sleep four or five hours a night, like my mother, and did great. But once I had a kidney removed, those short beneficial sleep nights were a thing of the past. I then had to sleep more and sleep better to have happier tomorrows. Need for optimal hours of sleep morphs with your personal life circumstances. Tune in and try to sense how many hours of sleep work best for you. You may need more hours of sleep when healing from illness or moving through tragedy than when all of your hours are humming healthfully.
The healthiest body is one you listen to.
If All Else Fails…Gabapentin
I had a number of patients that tried everything but still couldn't sleep, and thus were miserable. I did my geeky thing and sleuthed the peer review literature. Science-based articles showed that the old-time safe medication, gabapentin,61 lubes the sleep pathways to "retrain" the brain for healthier sleep. This is an off-label use of this medication that is typically used to treat nerve root pain. But it's an amazing helper for some people with severe non-responsive insomnia.
Gabapentin, 100 to 300 mg, taken one-half hour before bed for a few months helps brain cells retrain themselves for a good night's sleep. I've been recommending this for about a decade. It is not 100 percent foolproof. One patient told me it made her more jittery and less able to sleep. But most start sleeping that very night.
Presently, many medical sleep centers are recommending gabapentin because it's so effective for so many insomniacs.
Remember, integrative medicine is a combination of both sides of the healing coin. It's okay to use drugs for a while when they work, and you can eventually get off them once your brain has re-learned to sleep deep. After using gabapentin for four to nine months, you'll start responding to simple melatonin and magnesium one-half hour prior to bedtime, when before these didn't work. You need to slowly taper off this medication. Adding more magnesium helps you do so in a shorter period of time.62
Don't use this medication if you have kidney disease without working with a physician in-the-know.
May the therapeutic sleep force be with you!
- If you want me to help you with your sleep issues, contact me via my consult section at drlindseyberkson.com.
- Check out my podcast on sleep at Dr. Berkson's Best Health Radio.
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Devaki Lindsey Berkson, DC, has been in practice in functional medicine, with an emphasis on nutrition, hormones, intimacy, and digestion, for decades. Dr. Berkson is professor for higher board certification programs for medical professionals to become functional practitioners, such as A4M and PCCA. Dr. Berkson was a scholar at a hormone think-tank at Tulane, published original research with the University of Texas Medical School at Houston, and is a research fellow with Health Sciences Collegium. Dr. Berkson has been asked to be on a panel for the symposium "Functional Medicine is Coming" to the entire hospital staff at Houston Memorial Hospital this summer in 2019.
Dr. Berkson wrote the first gut, mind, nutrition book published by Wiley (Healthy Digestion the Natural Way) and one of the first books on hormone-altering-chemicals (Hormone Deception. Dr. Berkson's newest book, Sexy Brain, presents the newest health issue (environmental castration) and how to protect our intimacy and brain.
Dr. Berkson consults around the world with patients and their docs. She has a very popular podcast, Dr. Berkson's Best Health Radio, along with Berkson Blog at DrLindseyBerkson.com.