It’s estimated that up to 50% of people suffer from insomnia occasionally, and about 10% have chronic insomnia. There are a lot of reasons that can cause insomnia, from stress to medical conditions to external factors such as excessive noise. Yet, the most conditioned response from people whenever they can’t fall asleep is to take a sleeping pill. Unfortunately, this is not the best solution for most people.

In Search of the Best Sleep Remedy

Prescriptions for sleeping pills are at record volumes (56 million in 2008). In times of either emotional or financial stress, symptoms of insomnia rise, and so do prescriptions for sleeping pills. But how effective are they? A recent study funded by the National Institutes of Health (NIH) in 2005 showed that sleeping pills decreased the time it took to fall asleep by 18 minutes, and increased total sleep time by 28 minutes per night, on average. Pharmaceutical company funded studies show much more optimistic results, but there’s definitely a wide range of opinions within the sleep community regarding effectiveness of prescription sleep aids. Not to mention the various known side effects such as daytime drowsiness, sleep walking and sleep eating. Also, as with many studies, many people in the placebo arm also had significantly improved results.

In my experience with patients, sleeping pills are a hit or miss. The results vary depending on the individual. It’s safe to say that some people are much more susceptible than others without very many side effects. The same goes for the various natural supplements, herbs and remedies that are recommended, such as warm milk, L-theanine, valerian and melatonin. Regardless of whether or not there’s scientific evidence over which one works or doesn’t work, if it works for you, you can keep taking it, as long as there are no major side effects. Preferably, you should take a non-prescription medication, as they tend to have less side effects. The one exception is the over the counter sleep aid ingredient, diphenhydramine, which is the main ingredient in Benadryl. It’s also included alone or in combination with many other brand names. This ingredient is a strong antihistamine (used for allergies) that also can make you drowsy. Some elderly who use it have experienced  mental status changes as well as other various side effects. 

There have been many studies using melatonin. Melatonin is a natural hormone that your body produces more of as you fall asleep. Darkness causes melatonin to increase and sunlight stimulates receptors in your eyes that cause it to drop. Results for the use of melatonin as a sleep aid have generally been positive, but somewhat conflicting. Ramelteon is a recently introduced melatonin-like chemical that stimulates melatonin receptors in the brain. Results show that, in general, although it does help, it’s not as effective the standard sleep aids. 

Another recent study showed that valerian was not better than placebo in treating insomnia. This contradicts a number of my patients that swear by valerian. Again, studies report statistical averages, which lumps together people who respond with people that don’t. 

Simple Steps to Resolve Insomnia

For most people, practicing routine beneficial sleep habits is all you’ll need to avoid taking pills or medications. Setting aside at least 30 minutes to wind down and do something relaxing is one way. Avoiding anything stimulating (such as playing video games, surfing the internet, checking email, or even exercising) can help you fall asleep faster. 

Everyone has different sleep needs, so don’t stress if you can’t get 8 hours of sleep. People need anywhere from 6-8 hours of sleep to function normally. It’s also important to get out of bed within 30 minutes every morning, even on the weekends. Try to get outdoors and get exposed to sunlight. This helps to strengthen your sleep clock. 

If you’re not drowsy within 30 minutes of getting into bed, get out and do something that’s quiet and relaxing, until you feel drowsy. Try to reduce the total time in bed to match the total time you actually sleep. If you’re tired during the day, try taking a short nap in the mid to late afternoon. 

Try practicing relaxation techniques and breathing exercises such as meditation or yoga, especially before going to bed. Use the bed for sleep and sex only—don’t read, watch TV, or work on your computer while in bed. 

Lastly, don’t exercise too close to bedtime. Leave about 2-3 hours after exercising before going to bed. Elevation of core body temperature will keep you from falling asleep. As body temperature drops, you’ll feel more drowsy.

Various practitioners will tout one natural herb or supplement as being helpful for insomnia, but as I’ve pointed out previously, not everyone will benefit significantly. However, even if it works, as long as you’re not treating what’s causing your insomnia, it’s definitely going to come back. In some cases, there may be an underlying medical condition that could be presenting as insomnia. Many people with insomnia, for instance, actually have obstructive sleep apnea.  That’s why taking a pill, although it seems like the path of least resistance, will only worsen the situation in the long run.

If you currently rely on sleeping pills every night to help you fall asleep, or you feel tired and lethargic no matter what steps you take, then it’s time to see a doctor about your insomnia problem. 

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Cognitive Behavioral Therapy or CBT is a drug free therapy that has been effective in treating many people with insomnia.  Click here to find out how you can access the download to my interview, How to Beat Insomnia Without Medications, with Dr. Gregg Jacobs, the leading authority on the treatment of insomnia and the first to develop a drug-free program for insomnia proven more effective than sleeping pills.
 

As the obesity numbers keep climbing, everyone wants to eat less and to exercise more. This is great if you’re able to exercise moderation and common sense. But if you’re already sick and your frame of reference is unhealthy to begin with, it’s difficult to know when enough is enough. 

Just as those with anorexia diet excessively to cover up their faulty body image, some people with sleep breathing problems like upper airway resistance syndrome (UARS), or obstructive sleep apnea (OSA), abuse exercise as a means to cope with the lethargy created by their chronic sleep deprivation.

Addicted to Exercise

A lot of patients I see with UARS and OSA become exercise junkies in the same way that people who don’t sleep enough become coffee addicts. Rather than consume substances to give them a "high", these exercise addicts crave the endorphin fix they get while working out to overcome the constant fatigue they feel from not getting the quality sleep they need. Many of them admit that If they miss even one day of working out, they’ll get agitated, moody, and sometimes downright catatonic. 

For these people, exercise or any physical activity is a coping mechanism for the constant energy drain they feel. The problem is, like any drug, too much exercise, if it’s used to deter them from taking care of their underlying sleep breathing problem, will manifest later into health complications that no amount of exercise may be able to cure. 

What’s Your Sleep Position?

Obviously, not everyone who exercise excessively do so to compensate for an underlying sleep breathing problem. One quick and simple way I use to discern who is and who is not susceptible to having a sleep breathing problem is to ask whether or not they can or like to sleep on their backs. You see, those with sleep breathing problems can only sleep on their sides or more commonly their stomachs. The reason being, that they’ll have difficulty breathing when they’re sleeping otherwise. 

To summarize, my sleep-breathing paradigm proposes that all modern humans have difficulty breathing at night to various degrees due to our unique upper airway anatomy. The voice box is located underneath the tongue, as opposed to animals, where the voice box is located behind the tongue. This location of the voice box under the tongue is necessary for complex speech and language. But this is also what makes our airway vulnerable and unprotected, making us more prone to having the various breathing and swallowing problems that we, as modern humans have. 

What’s worse, it’s thought that due to a radical change in our diets (highly processed foods and refined sugars) over the past century, our jaws are getting narrower and we have more dental crowding. Furthermore, dentists have stated that introduction of bottle-feeding to infants can aggravate dental crowding and malocclusion, which makes everything much worse. All these factors aren’t the only reason for everyone’s sleep problems, but they are problematic if your anatomy is already predisposed. 

So what does breathing have to do with sleep quality? There are two components to this issue: When lying flat on your back, your tongue falls back partially, due to gravity. This narrows the breathing passageway behind your tongue to various degrees. As you fall asleep, the deeper level of sleep you enter, the more your muscles relax, and at a certain point, your tongue can fall back and obstruct your breathing. The more narrow your airway (due to smaller jaws or inflammation due to a cold or allergies), the more likely you’ll stop breathing and wake up to turn over. When you were young, you tossed and turned and eventually figured out that you can sleep much better when sleeping on your side or stomach. The problem is that even on your side or stomach, it’s never perfect, and you’re not able to get deep, efficient sleep, no matter how long you sleep.

Sleep Among Athletes

It’s also not too surprising that many personal trainers and fitness professionals have very similar features: Almost invariably they prefer to sleep only on their sides or stomachs. The same can be said about bodybuilders—a personal trainer/natural body builder friend of mine told me that almost every one in her gym snores. Snoring, incidentally, is a very common trait amongst those who have OSA or UARS. 

Professional football players also have a much higher incidence of obstructive sleep apnea. About 1/3 of all linemen were found to have mild or moderate sleep apnea. Many people assume that this is due to the abnormally thick necks that many football players have. However, it’s not only the fat in the neck—it’s also the muscle mass that impinges on the soft tissues of the upper airway. So in theory, the more muscle bulk you have in your neck, the more breathing problems you’ll have while sleeping, and therefore more fatigue to cope with. This in turn, makes you work all that much harder than let’s say, someone else who may not be sleep deprived, to get the same level of intensity.  It’s hard to say which came first, the sleep breathing problem, or the intense work outs, but once it’s started, it ends up being a self-perpetuating vicious cycle. 

Sleeplessness Can Aggravate Injuries

As a long time track and field enthusiast, I know how important it is to eat right and exercise–especially as you get older. Running helped invigorate me after being cloistered for days studying for finals during medical school, and it still helps me maintain my health while balancing the demands of my work and family. Yet, there are times when I’ve let the running take control. This often happens when I’m outpaced by someone in my age group, or when I’m coping with a stressful event. During these times, I’d often train to the point of illness or injury—at which point, I’m temporarily unable to do the one thing that keeps me healthy and sane.

In this way, if you’re an exercise junky, you’re also more prone to having injuries. It’s like that saying: "The higher you climb, the harder you fall." Unfortunately, once injured, it becomes all that much harder to gain the momentum back. What often occurs is common trap for any athlete but much worse if you have UARS or OSA. The sudden lack of activity can cause you to eat more due to increased levels of stress from increased sleep deprivation. As you gain weight, your upper airway narrows even further, leading to worse deep sleep quality. Another scenario that can happen is if you injure your neck or shoulder. This will prevent you from being able to sleep on your side or stomach, which again, aggravates the vicious cycle.

What I just described may seem a little far fetched, but if you are prone to constant fatigue, snore, or have any other chronic health problems like chronic sinusitis, nasal congestion, throat problems, then the sleep breathing paradigm can potentially explain and help you avoid the various health complications you may experience down the road. One way to see where you’re headed is to look at your parents. More often than not, one or both your parents may snore heavily, and in many cases will have one or more of the complications of untreated obstructive sleep apnea: depression, anxiety, diabetes, hypertension, heart disease, heart attack or stroke. 

The best way for you to stay healthy and fit is to eat well, exercise, and most importantly, to sleep better.
 
 

I was wondering if you are aware of any link to birth defects or other issues in babies of mothers with undiagnosed sleep apnea? I have only been diagnosed lately at the age of 47, but my first child who’s 22 was born with a cleft lip, has asthma + is waiting for an operation for a deviated septum. My son, who’s 13, is waiting to see a specialist as his hearing is very bad in one ear, he has a permanent stuffy nose and also has learning problems (border-line dyslexia). When my daughter was born with the cleft lip her orthodontist asked me several times if I could think of any occasion during my pregnancy where there could have been a lack of oxygen to the placenta. At the time I couldn’t, but I didn’t know then that I had sleep apnea.

Many thanks for your time.
Kath (UK)

A:  It’s interesting that you ask that question, as a recent study reported that women with OSA had a much higher incidence of children with neural tube defects. There are a number of other studies linking sleep-breathing problems with perinatal complications. One study revealed that snoring alone during pregnancy was associated with much lower Apgar scores at birth. I’m not aware of any association between sleep apnea during pregnancy and cleft lip or palate problems, but I wouldn’t be surprised if there is a link. We also know that sleep apnea is most likely a major aggravator for pre-eclampsia during pregnancy.
 
I think your family history is a combination of hereditary risk factors as well an pregnancy-related sleep apnea complications. Unfortunately, there’s no easy way of proving cause and effect. The various problems that your children suffer from could be related to hereditary factors, since you already know that you sleep apnea. There are also external environmental factors that may contribute as well, such as bottle-feeding and the child’s diet. Needless to say, oxygen deprivation during pregnancy is not good for the developing baby.

1. Relaxing Rituals to Rest Easy

In Chinese Medicine, nighttime is yin time—or, simply, when the body takes care of itself instead of your desires.  Proper sleep is required for your body to repair itself and regenerate. To reach deep, restful sleep, your spirit and heart must be calm. Excessive worry, anxiety, and depression can all disturb the spirit and activate the mind—making it near impossible to fall asleep and stay asleep. Rituals to sooth your spirit and induce a sleep response before bed include soaking your feet in Epson salts for 15 minutes, writing all of your thoughts in a journal to get them out of your head, and practicing relaxation before bed, like the Stress Release meditation below.

2. When Food Disturbs Sleep

When you eat late, you wake up tired. Your body will be busy digesting your dinner while you are trying to sleep, so you won’t feel rested in the morning. Do not eat anything for at least three hours before bedtime.  Also, cut back on eating bacon, cheese, chocolate, ham, potatoes, tomatoes, and sausage, especially before bed. These foods contain tyramine, which inhibits neurochemicals like norepinephrine and can cause insomnia. And, of course if you have sleep problems, caffeine should be cut out.

Eat for sleep! Try eating more grains at dinner; carbohydrates tend to make people sleepy. Another snooze snack is a warm cup of milk; because milk is rich in the amino acid tryptophan, it can sometimes aid in deep sleep. Mix in natural vanilla flavoring for a soothing snack. Or if you prefer, eat 1 cup of natural yogurt an hour before bedtime.

3. A Peaceful Place for Sleep

Your sleeping environment makes a huge difference to the quality of your sleep. Do everything you can to create a quiet and cozy atmosphere. Ideally, your bedroom should be located in the quietest area of your home. Keep the décor minimal. Lighting should be dim and any music that is played should be soothing. Research has found that lavender, vanilla, and green apple are among the best scents to help lower anxiety and induce sleep, making these smells a good choice for a scented candle or heated essential oil. Try to limit your pets to outside of the bedroom because their movements will keep with your body from fully relaxing into deep R. E. M. sleep. As much as possible, your bedroom should be only for sleep.

4. Exercise Enables Sleep

People with regular exercise routines often sleep better and have fewer incidents of insomnia than those don’t get regular physical activity. Exercise promotes sleep and improves sleep quality by altering brain chemistry. Exercising moderately for 20 to 30 minutes three times a day, combined with meditation or tai chi in the evening, will not only help you fall and stay asleep, but will also increase the amount of time you spend in R.E.M. sleep. In fact, for some people, exercise alone is enough to overcome sleep problems. Exercise in the morning or afternoon, but do not exercise for at least two hours before bed.

5. Herbs to Sleep Tight

A calming tea before bedtime can ensure a good night’s sleep. Drink valerian or passionflower (or passiflora) tea before bedtime every night for one month. Simply steep 1 to 2 tablespoons of the dried herbs in one cup of hot water and drink just before bed.

Or look for one with the traditional Chinese herbs zizyphus or jujube seed, bamboo shavings, and oyster shell, which soothe the mind and spirit. 

You might also try Calm-Fort/Sleep formula with useful herbs like lily bulbs, polygala and turmeric that help manage stress and calm the spirit while relieving restlessness and insomnia.

6. A Sleep-Friendly Meditation

I had one patient with insomnia who also felt anxious and even a little depressed. In addition to acupuncture and herbal therapies, I decided to teach her a stress release meditation that she could do before bedtime to help with her anxiety. I am happy to report that she is now sleeping like a baby.

Try this Stress Release meditation, which works for the majority of my patients who have sleeping problems:

Sit comfortably or lie down on your back.  Slow your respiration to deep, abdominal breathing.  Utter the word “calm” in your mind with every exhalation. Focus on relaxing each area of your body in sequence, from the top of your head to your toes.

Starting with the top of your head, inhale and then exhale while visualizing your scalp muscles relaxing.  Say “calm” in your mind.  Repeat this with each body part as you move down through all body parts, front, back, and sides, in succession: your face, throat, chest, arms, stomach, abdomen, thighs, knees, legs, ankles, until finally you reach your feet.  When you’ve relaxed your feet, visualize all the tension in your body leaving through your toes as dark smoke. Practice this for at least 15 minutes before bedtime. 

It will have you sleeping in no time. If you do better with meditative visualizations that are narrated, try my Stress Release CD.

I hope you find the ways to resting easy and waking up refreshed!

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Dr. Maoshing Ni is a doctor of Chinese medicine and an authority in the field of Anti-Aging Medicine. Known simply as ‘Dr. Mao’ to his patients, he has lectured internationally on various topics including women’s health, sleep medicine, longevity medicine, diet and nutrition, herbal therapy, stress management, meditation, lifestyle enhancement, and much more. Click here for more information on Dr. Mao or to access his interview with Dr. Park, 10 Tips for Better Sleep: A Chinese Medicine Doctor’s Perspective.
 

Having just passed my 42nd birthday, I’ve come to terms with the fact that this was bound to happen eventually. I’ve said again and again that all modern humans are susceptible to breathing problems while sleeping, and I’m no exception. The only comfort I take is the fact that I did undergo a sleep study many years ago to see what it was like, and it revealed an AHI of 1, which is considered "within normal limits."  It did show that I had some mild disruptions in my deep sleep stages. I suspect it may creep up slowly as I get older. Fortunately, my weight has not changed—if anything, it’s gone down since I began running regularly. 

More recently, I’ve been sleeping well, and my energy level is pretty good, despite that fact that our 5 month old has been up at night repeatedly due to teething.

There’s now even more reason for me to follow the advice I give to my patients: don’t eat late, exercise regularly, keep your nose clear, and don’t sleep on your back. The one thing I’ll have to work on is to try sleeping more on my side since that brief obstructive episode happened while I was on my back. I’ll keep you posted.

The reason for bringing this up is that today, I feel great all of a sudden. The only difference that I can think of is that the sun shined in New York City for the first time in days, maybe even over one week. We’ve had either rain or overcast weather most of June. 

I realize now that I was probably suffering from a mild case of seasonal affective disorder (SAD), which affects susceptible people who either don’t get enough sunlight or during the winter season, when there’s much less sunlight. I didn’t think I could have this, but I guess things change as you get older.

For prolonged cases of SAD, bright light therapy is one way to treating this condition. Another way is to spend more time outdoors, even with the overcast skies. 

How many of you were also under the weather this past week?

Although napping without REM sleep resulted in slightly better test scores, naps that included REM sleep resulted in close to a 40% improvement over pre-nap scores.

This study is interesting in that we know that most of our REM sleep is in the second 1/2 of the night. If you’re only getting the bare minimum 5 hours, you’ll get enough of the non-REM deep sleep stage, but you’re probably missing out on most of your REM time. 

Plus, if you have a sleep-breathing problem, REM sleep is most commonly the time when you’re most likely to stop breathing and wake up. This will prevent you from staying in REM sleep, and more likely to have strange dreams or nightmares (since you’re waking up while dreaming). 

Even more reason to prioritize your sleep time.

Not all snoring is dangerous, but a significant number of snorers will have undiagnosed obstructive sleep apnea. Recent studies highlight the seriousness untreated sleep apnea. One study showed that untreated apnea patients experience similar changes in brain biochemistry as people who are having a stroke or are dying. Even moderate degrees of oxygen deprivation was found to have profound effects. The abstract can be found here.

Another study showed that untreated sleep apnea patients have higher blood viscosity, meaning that their blood is literally thicker than normal. This, coupled with increased inflammation that’s seen in sleep apnea, makes small vessels in the brain more likely to clot.

Numerous other imaging studies report finding multiple small areas of damage in different areas of the brain in people with untreated obstructive sleep apnea.

Studies in young children found that even very mild degrees of obstructive sleep apnea can lead to cognitive changes and maybe even permanent neurologic injury. 

These type of studies go on and on. While we can’t screen everyone who snores for obstructive sleep apnea, if you have any of the potential complications of sleep apnea (such as depression, anxiety, high blood pressure, or heart disease) or if there’s a strong family history of snoring with cardiovascular diseases, there’s good reason to get checked for sleep apnea. 

The reason I bring up this issue at all is that once in a while, I’ll see a relatively young patient (in his or her 30s or 40s) who had a stroke. Not too surprisingly, they all snore heavily. If you know anyone that had a stroke at a relatively young age, at least consider the possibility.