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Insomnia – The importance of sleep

Sleep is a pivotal part of our lives, impacting everything we do from the moment we wake up to the second we fall asleep. Sleeping is a function serving the purpose of rest and regeneration, where we recharge our minds and body to prepare us for the next day. It’s important for various physical and psychological factors including heart and circulatory systems, hormones, metabolism, immune systems, respiratory functions, emotional regulation and learning and memory consolidation. Adults need on average 7-9 hours of sleep a night to feel fully rested, with teenagers and children needing more. Not getting enough sleep can be extremely detrimental, just one night of restless sleep can make us feel anxious, worsen our concentration, affect our mood and create poor judgement. So, what happens if this persists?

Insomnia

Insomnia is a condition defined by trouble with sleep initiation, duration, consolidation, or quality, which happens despite sufficient opportunity for sleep and derives some form of impairment during the day. It is estimated that 10%-30% of the population suffers from Insomnia, with prevalence higher for older adults, females, and those with a mental or physical condition (Bhaskar et al 2016). There are different types of insomnia, including but not limited to: acute insomnia (short term), chronic insomnia (long term), primary insomnia, secondary insomnia (caused by other factors), maintenance insomnia (staying asleep), onset insomnia (falling asleep) and idiopathic insomnia (lifelong). Causes are limitless and can include things like depression, noise, uncomfortable environment, shift work, alcohol and many more. The consequences of insomnia are significant: it affects your quality of life, impairs work/school performance, home life, can cause depression, anxiety and can lead to serious incidents such as road accidents. We all know what it’s like to wake up feeling groggy after a restless sleep tossing and turning. But what can we do about it?

Treatments

When treating insomnia, healthcare professionals will suggest non-pharmacologic options first, avoiding drugs where possible, as they are usually a short-term treatment option. Currently, treatment options for insomnia include behavioural therapies such as cognitive behavioural therapy (CBT), which addresses underlying issues and sleep hygiene. CBT has been shown to have significant effectiveness in the treatment of insomnia, with various meta-analyses highlighting strong clinical improvements throughout various sleep associated outcomes (Rosenberg et al 2021). Mindfulness, meditation, relaxation therapies and even forehead cooling are amongst the other non-medicinal treatment options. These all contribute to a better night’s sleep, improvements in mood and anxiety and are associated with reduction in insomnia severity. (Rosenberg et al 2021). However, when behavioural options have failed, medications like benzodiazepines, sedatives, hypnotics or supplements such as melatonin and magnesium are used to help reduce insomnia severity. Sateia et al (2017) shows that many studies have demonstrated the effectiveness of hypnotics comparable to CBT. However, the results from CBT have been shown to last longer and are sustained compared to after discontinuation of medications. Research has mixed findings on the effect of melatonin with some studies finding no improvements in total sleep time, sleep latency or wake after sleep onset (Sateia et al 2017). Overall, non-pharmacologic options are shown to have good longevity and indicate good improvements for sleep, whereas pharmacologic treatments can act fast, but do not last after discontinuation and have more side effects.

TMS

Transcranial magnetic stimulation (TMS) shows promising results for the treatment of insomnia. Studies have suggested that treatment over the dorsolateral and dorsomedial prefrontal cortex might have significant improvements in insomnia severity. Oroz et al’s (2021) review from 20 studies using low and high frequency TMS revealed some subjective improvements in sleep quality after TMS, with one study finding it associated with anxiety improvement. Further, Lin et al (2023) found that after 10 sessions of low-frequency TMS, a reduction of duration of wake after sleep onset was observed in the experimental group and sleep efficiency increased. Though both studies did find significant placebo effects due to similarities between experimental and sham control. Despite this, low frequency TMS might offer a safe, non-invasive, and useful adjunctive therapy for insomnia.

Natural remedies

Some natural remedies might offer relief from sleep issues, these include valerian root, magnesium, chamomile tea and tryptophan. Valerian root is an herbal supplement in the form of tea or capsules which has been suggested to help improve sleep and reduce anxiety and is thought to affect levels of gamma-aminobutyric acid (GABA), which has a calming effect (Summer and Singh 2023). Magnesium is a natural mineral shown to have positive effects on sleep, improving sleep efficiency and sleep time (Arab et al 2022). Chamomile tea is an essential oil thought to produce a calming effect by reducing muscle tension and anxiety and thereby improving sleep (Hieu et al 2019). Tryptophan is a natural occurring amnio acid found in certain foods such as milk, fish, turkey and peanuts, it is a building block for serotonin which is converted to melatonin, and therefore is important in mood, anxiety and sleep. Sutanto et al (2022) found improvements in sleep quality after tryptophan supplementation. It is important to note always doing your own research if you’re thinking about taking supplements and to consult your doctor to ensure taking it safely.

Lifestyle Changes

Below are some easy and quick lifestyle changes that you can make to improve the quality of your sleep.

  • Getting direct sunlight exposure in the mornings for < 10 minutes.
  • Commit to a regular sleep schedule, waking up and going to bed at the same time.
  • Create a cool, dark, quiet and comfortable environment in your bedroom.
  • Avoid blue lights an hour before bed, so don’t go on your phone or watch TV.
  • Create a relaxing bedtime routine (meditation, reading, stretching).
  • Exercise regularly and earlier in the day.
  • Avoid alcohol nicotine and caffeine a few hours before bed.

Written by our Bristol practitioner, Carmen.

References

  1. Arab, A., Rafie, N., Amani, R. and Shirani, F. (2022). The role of magnesium in sleep health: A systematic review of available literature. Biological Trace Element Research, [online] 201(1). doi:https://doi.org/10.1007/s12011-022-03162-1.
  2. Bhaskar S, Hemavathy D, Prasad S. (2016) Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Family Med Prim Care. 5(4):780-784. doi: 10.4103/2249-4863.201153. PMID: 28348990; PMCID: PMC5353813.
  3. Hieu TH, Dibas M, Surya dila KA, et al.(2019) Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials. Phytother Res;33(6):1604-1615. doi:10.1002/ptr.6349
  4. Lin, Wei-Chena,b,c; Chen, Mu-Honga,b,c; Liou, Ying-Jaya,b; Tu, Pei-Chia,b,d; Chang, Wen-Hanb; Bai, Ya-Meia,b; Li, Cheng-Taa,b,c; Tsai, Shih-Jena,b,c; Hong, Chen-Jeea,b,c; Su, Tung-Pinga,b,c,d,e,*. (2023) Effect of low-frequency repetitive transcranial magnetic stimulation as adjunctive treatment for insomnia patients under hypnotics: A randomized, double-blind, sham-controlled study. Journal of the Chinese Medical Association 86(6):p 606-613. | DOI: 10.1097/JCMA.0000000000000924
  5. Oroz, R., Kung, S., Croarkin, P. E., & Cheung, J. (2021). Transcranial magnetic stimulation therapeutic applications on sleep and insomnia: a review. Sleep Science and Practice, 5(1), 1-10.
  6. Rosenberg R, Citrome L, Drake CL. (2021) Advances in the Treatment of Chronic Insomnia: A Narrative Review of New Nonpharmacologic and Pharmacologic Therapies. Neuropsychiatr Dis Treat. 17:2549-2566. doi: 10.2147/NDT.S297504. PMID: 34393484; PMCID: PMC8354724.
  7. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. (2017) Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 15;13(2):307-349. doi: 10.5664/jcsm.6470. PMID: 27998379; PMCID: PMC5263087.
  8. Summer J. and Singh A. (2023). Valerian Root: Sleep Benefits and Side Effects. Sleep Foundation [online] Available at: https://www.sleepfoundation.org/sleep-aids/valerian-root.
  9. Sutanto CN, Loh WW, Kim JE. (2022) The impact of tryptophan supplementation on sleep quality: a systematic review, meta-analysis, and meta-regression. Nutr Rev. 80(2):306–316. doi:10.1093/nutrit/nuab027