Jacob Teitelbaum, MD
While browsing the old stacks at my medical school library, it was interesting to find an article in JAMA from about 140 years ago, which suggested that the average night’s sleep in the US was nine hours a night. Then lightbulbs were invented starting the decline to the current average 6-3/4 hours of sleep a night. Essentially a 30% pay cut for the human body.
For too little sleep not only contributes to fatigue and cognitive dysfunction, it also causes immune dysfunction, weight gain, premature aging, and contributes to chronic pain.
In addition to not making time for sleep, a host of other conditions are contributing to a worsening of sleep quality. Understanding these can dramatically improve a practitioner’s ability to help people get well.
Fibromyalgia and Chronic Fatigue Syndrome (FMS/CFS). This is a rising epidemic, which until recently crippled about 6 million Americans. With over 10% of people who had Covid developing post viral CFS/FMS, this number has now skyrocketed to over 16 million.
CFS/FMS reflects a human energy crisis, where dropping energy production essentially trips a circuit breaker. Called the hypothalamus, this small, almond-size major regulatory center in the brain controls sleep, hormonal, and autonomic function (POTS). When people come in complaining of non-restorative sleep, or difficulty falling and/or staying asleep, ask if they also have widespread pain and exhaustion. If so, they are likely to have fibromyalgia until proven otherwise.
A simple quiz (see step two at www.vitality101.com ) can screen for fibromyalgia, even that caused post Covid, using the American College of Rheumatology 2010 Amended Diagnostic Criteria. If present, my published randomized placebo-controlled study showed that 91% of people improved with an average 90% increase in quality of life by using the SHINE Protocol (optimizing Sleep, Hormones, Immunity, Nutrition, and Exercise Is Able; p<.0001 vs placebo). Step three at www.Vitality101.com is a free quiz which analyzes the person’s history, and even lab tests if available, to determine how to use the SHINE Protocol to optimize energy in each person, using a mix of natural and standard therapies.
If you miss the person’s fibromyalgia, the person will simply not have a good response to treatment. If you find it and give them the information to understand and correct it, you will have a very happy and appreciative patient.
Our recently published study https://www.mdpi.com/1424-8247/15/1/43/pdf showed that the unique herbal “Red Ginseng Energy” chewable tablets taken (1/2 to 2 chews – from EuroMedica) in the morning helped in 60% of people with greater than 50% decreased function. Not only did energy increase an average of 67%, but sleep also improved an average of 46%.
Periodic Leg Movement Disorder of Sleep (PLMDS)/restless leg syndrome. Research has shown that supplementing with iron helps decrease symptoms of PLMDS/restless leg syndrome if the person’s ferritin level is under 60. Supplementing with magnesium 200 mg at bedtime and optimizing thyroid function even if the thyroid blood tests are “normal” will also decrease restless legs in PLMDS and help sleep.
It is important to understand what the normal range means on a blood test. Generally, it has very little to do with health. It is derived by applying two standard deviations, which means that you take 100 people and the highest and lowest 2½% of the population are defined as abnormal. So a normal range for shoe sizes would be 6-13. This does not mean that any shoe size in that range will fit you, or that the person’s thyroid level is adequate for them if it is in the “normal” range. If they are tired, achy, weight gain, cold intolerant, have restless leg syndrome, unexplained infertility, constipation, or any two – three symptoms suggestive of low thyroid, with a free T4 in the lowest 25th percentile (a normal or even low TSH is extremely unreliable), a trial of thyroid hormone to see if they clinically improve is warranted.
Sleep Disordered Breathing. While treatment for sleep apnea is straightforward, Upper Airway Resistance Syndrome (UARS), and the causes behind its attendant nasal congestion, tend to still often be misunderstood in the standard medical community. In the absence of overt IgE mediated inhalant allergies, the most common cause of chronic nasal congestion and secondary UARS is fungal overgrowth in the sinuses. Two Mayo Clinic studies have now shown that this is the case for over 90% of chronic sinusitis. We have found that by giving the medication Diflucan 200 mg a day for six weeks plus the antifungal herbals and a prescription “Sinusitis Nose Spray” from ITC Pharmacy (888-349-5453), the nasal congestion and UARS often resolves after 6-10 weeks.
If fatigue and low blood pressure symptoms persist once the nasal congestion resolves, then the person will often also have the fibromyalgia or attendant chronic fatigue syndrome noted in paragraph one above and will need the SHINE Protocol approach to recover.
Feel free to email me at FatigueDoc@Gmail.com for free treatment tools and articles on effective treatment of CFS, fibromyalgia, and long Covid. Please note if you are a health practitioner versus somebody with the condition.
For those with insomnia, it is important to divide them into those who have difficulty with sleep onset versus maintaining sleep. From a complementary medicine point of view, common causes for difficulty with sleep onset include:
- Adrenal cortisol levels are too high at bedtime. Most people run morning cortisol levels of about 18 mcg/dL. This needs to come down under 2 µg/dl for people to be able to initiate sleep. A simple way to tell is to ask the person if their mind is wide awake at bedtime. Alternatively, a salivary cortisol level can be done at bedtime. Simply giving phosphatidylserine 100-300 mg 1-2 hours before bedtime will usually take care of this problem.
Often the same people will find that their blood sugar drops during the night, causing them to wake up (sometimes with a sweat) around 2 AM. Simply giving a 1 ounce protein snack at bedtime, such as a hard-boiled egg or some cheese or meat, can be helpful. This middle of the night drop in blood sugar may be accentuated with the phosphatidylserine, which is why I start with a lower dose and work up every few days to see what works best.
All of these are manifestations of adrenal fatigue and loss of circadian rhythm. So these people will usually get irritable when hungry (“hangry”) during the day as well as they get drops in blood sugar from low cortisol. I find that increasing salt, decreasing sugar, and using a simple supplement called Adrenaplex (EuroMedica) each morning can dramatically improve their lives. It also decreases the mood shifts and is much cheaper than a divorce lawyer or marriage counseling!
- Just like children need a quiet time routine to settle down in the evening and ease in to sleep, adults are no different. It is unreasonable to expect the body to shift from sympathetic to parasympathetic mode without this.
Once these two have been addressed, along with other sleep hygiene issues, natural remedies can be used to help people both initiate and maintain sleep. I begin with Melatonin 10 mg from EuroMedica. I use this specific one not only because of the quality, but especially because it is sustained release. Otherwise, people will fall asleep and wake up after a few hours. Unable to fall back asleep.
Then I add herbals if needed. Some of the most effective herbal mixes for sleep are the following:
- Anxiocalm (by EuroMedica). This is basically a cannabinoid concentrated from parts of the echinacea plant. It can be especially helpful if anxiety disrupts sleep. Other cannabinoids can also be very helpful.
- The Revitalizing Sleep Formula (only in the retail line from Enzymatic Therapy). This mix of six herbs can be remarkably helpful and increases in effect over six weeks. It is a mix of valerian, passionflower, 5 HTP, theanine, lemon balm, and hops. These have been shown to be helpful in numerous studies.
- 20-30% of Americans suffer with chronic pain, and this is a major cause of disrupted sleep, not to mention overall misery. The herbal mix Curaphen 1 to 2 caps three times a day (from EuroMedica) is remarkably effective for pain. Although it can start to work quickly, it does take six weeks to see the full effect. It is compatible with other pain medications. It is a mix of a unique highly absorbed curcumin, Boswellia, DLPA, and nattokinase. I have found it to be a pain relief miracle for people. And as the pain goes, they’re often finally able to sleep and heal.
All four of these are compatible with any other sleep medications and can be used together as well. As with any herbal, caution should be used when combining them with Coumadin.
By using the best of standard and complementary therapies, you’ll find that people can have their restorative sleep–restored!
NOTE: you can email me at FatigueDoc@gmail.com for free information sheets and effective treatment tools for CFS, fibromyalgia, and long Covid. Please note if you are a health practitioner, have the condition, or both.
Published November 4, 2023
About the Author
Jacob Teitelbaum, MD, is one of the most frequently quoted integrative medical authorities in the world. He is the author of the best-selling From Fatigued to Fantastic!, Pain Free, 1,2,3!, The Complete Guide to Beating Sugar Addiction, Real Cause Real Cure, The Fatigue and Fibromyalgia Solution, and the popular free Smart Phone app Cures A-Z. He is the lead author of four studies on effective treatment for fibromyalgia and chronic fatigue syndrome, and a study on effective treatment of autism using NAET. Dr. Teitelbaum appears often as a guest on news and talk shows nationwide, including Good Morning America, Oprah & Friends, CNN, and FoxNewsHealth. Learn more at www.Vitality101.com .