Disordered sleep is, in my opinion, a major underlying process that perpetuates fatigue and pain. For most people, it is optimal to get eight to nine hours of solid, deep sleep every night.
A hundred years ago, the average American got nine hours of sleep a night. Anthropologists tell us that 5,000 years ago, people spent the entire night sleeping. When the sun went down, it was dark, boring and dangerous outside, so people went to bed. When the sun came up, they woke up. Since the average time from sunset to sunrise is 12 hours, people got 11 or 12 hours sleep. Then candles came along and people began to stay up later. Light bulbs were next, then radio, TV and computers. We're now down to an average of 6 ¾ hours of sleep a night, and this is simply not adequate to allow proper tissue repair.
Some people get inadequate sleep because of poor sleep hygiene, often occurring because pain keeps them awake. Others have insomnia because the sleep center in the brain (called the hypothalamus) is suppressed, as occurs in fibromyalgia.
A 2001 poll conducted by the National Sleep Foundation of over 1,000 adults found that 58% of Americans had sleep difficulties. This was an increase from 51% the year before. 15% of Americans use a prescription or over-the-counter sleep aid. In addition, those who got less than 6 hours sleep a night reported more stress, anger, sadness and were (of course) more tired than those who got more sleep. The survey also found that only 30% of people reported getting the recommended 8 hours of sleep a night, down from 38% the year before. The overall average amount of sleep also decreased to under 7 hours.
In a recent blog post we talked about the possible role of adenosine in helping sleep, and a study looking at adenosine in fibromyalgia is currently underway.
There are a number of natural alternatives that have been proven to help you fall asleep and stay asleep. Let's take a look at them.
Natural Sleep Aids
There are a number of natural alternatives that can help you fall asleep and stay asleep. Let's take a look at them.
- Special herbal formulations can provide a combination of natural ingredients that are known to promote better sleep. These include herbals such as theanine, wild lettuce, Jamaican dogwood, hops, passionflower and valerian. A blend like this is the best way to start. You'll usually see the effect of a given dose on sleep the first night you take it, although the effectiveness increases with continued use. (Revitalizing Sleep Formula and Sleep Tonight!, both from Enzymatic Therapy, are excellent choices for this.) If after trying this for a couple of weeks you're still not sleeping well, consider adding the items below.
- Magnesium (75-250 mg) and calcium (600 mg) at bedtime can also help sleep. (Jigsaw Health's Jigsaw Magnesium w/SRT™ is an excellent magnesium supplement.)
- 5-HTP (Hydroxy L-Tryptophan) is what your body uses to make serotonin, a neurotransmitter that helps improve the quality of sleep and can decrease levels of substance P, your body's pain messenger (200-400 mg a night). 5-HTP may also help you lose weight. The one caution I give is that if you are taking other therapies that increase serotonin (anti-depressants like Prozac, St. John's Wort, Ultram, Desyrel, etc.), then you should not take more than 200 mg daily of 5-HTP. It takes 6 to 12 weeks to see the full effect of 5-HTP, and you should be aware that it is more expensive than the other items described here. (Pro Health makes a good 5-HTP product.)
- Melatonin is a hormone produced by the pineal gland. Although it is natural and available over the counter, this does not mean that it is without risk. My concern with any hormone is that although it might be quite safe when used within the body's normal range, I worry about toxicity when people take more than the body would normally make. For most people, all it takes to restore melatonin to normal levels is 1/2 mg a day. The usual dose you find in stores, however, is 3 mg, which is 6 to 10 times the dose that most people need. Except for a small subset of people, who likely have trouble absorbing it properly, the 1/2 mg dose is every bit as effective for sleep as higher doses.
Good Sleep Hygiene
Here are some tips to help you sleep better just based on your behavior:
- Don't consume alcohol near bedtime.
- Don't consume any caffeine after 4:00 P.M.
- Don't use your bed for problem solving or doing work.
- Take a hot bath before bed.
- Keep your bedroom cool.
- If your partner snores, sleep in a separate bedroom (after tucking in or being tucked in by your partner) or get a good pair of earplugs and use them. The wax plugs that mold to the shape of the ear are often the best ones.
- If you frequently wake up to urinate during the night, do not drink a lot of fluids near bedtime.
- Put your bedroom clock out of arm's reach and facing away from you so you can't see it. Looking at the clock frequently aggravates sleep problems and is frustrating.
- Have a light snack just before bedtime. Hunger and hypoglycemia cause insomnia in all animals, and humans are no exception. For your snack, eat foods high in the amino acid tryptophan, such as milk and turkey, which promotes good sleep.
Although I much prefer trying natural alternatives before prescription medications, you may find this isn't enough and you need the medications. But even if you do, keep in mind that including natural aids can still be very helpful and over time may decrease your need for the meds (and thereby reducing potential side effects from meds). You may find that after a while all you need are the natural alternatives. Whatever therapies you use, though, it's important that they not only increase the duration of sleep but also maintain or improve the deep stage 3 and stage 4 sleep. Unfortunately, many sleeping pills in common use (Dalmane, Halcion, and Valium) may actually worsen the quality of sleep by increasing the amount of light stage sleep (especially stage 2) and decreasing the deep stages of sleep even further.
The bottom line is that you want to make sure that the therapies and medications you use leave you feeling better the next day, not worse.
Jacob Teitelbaum, M.D. is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of four research studies on their treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.