Insomnia

While adequate sleep has sometimes been considered a luxury in past generations, more and more research is confirming that good night’s sleep is one of, or perhaps even the biggest factor in long term health.

Improper sleep can lead to symptoms like; daytime fatigue, irritability, difficulty concentrating, and impaired functioning in daily activities. It can caused by various factors including stress, anxiety, depression, medical conditions, medications, or lifestyle factors.

When sleep disturbances are pronounced and impact daily functioning, they are referred to clinically as Insomnia.

What Is Insomnia?

Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or both, despite having the opportunity for adequate sleep.

What are the different types of Insomnia?

Insomnia can be categorized as either Short-term or Chronic Insomnia, which is insomnia that persists for at least three nights a week for three months or more.

In addition to being short-term or chronic, Insomnia can be further categorized as Primary or Secondary

• Primary Insomnia: occurs without any underlying medical or psychiatric cause.
• Secondary Insomnia: is secondary to other medical or psychiatric conditions. Treating the underlying condition often helps improve sleep quality.

In addition to being acute or chronic and primary vs. secondary, Insomnia can be categorized in relation to the timing of the concern. Insomnia can be further categorized as Sleep Onset Insomnia, Sleep Maintenance Insomnia, and Late Insomnia.

• Sleep Onset Insomnia: this refers to difficulty falling asleep at the beginning of the night. This type of insomnia can be caused by factors such as stress, anxiety, or poor sleep hygiene.
• Sleep Maintenance Insomnia: this involves difficulty staying asleep throughout the night. This type of insomnia can be caused by various factors, including pain, discomfort, or underlying medical conditions.
• Late Insomnia: Also known as terminal insomnia or early morning awakening, late insomnia involves waking up earlier than desired and being unable to fall back asleep. This type of insomnia may be associated with depression, anxiety, or circadian rhythm disturbances.

Ensuring a good night’s sleep can be critical to both mental and physical health. If you or someone you know is suffering from insomnia, relief is not only possible but within reach, with the right interventions in place.

How Naturopathic Medicine Can Help:

A Naturopathic Doctor can help in the assessment and treatment of many different kinds of insomnia. In some states, like Washington, a Naturopathic Doctor can diagnose and treat many sleep disorders, while investigating the route biological drivers contributing to them. Depending on the individual, medication and a referral to a board-certified sleep medicine physician or psychologist may be indicated.

Along with the biological factors that play a role in insomnia, the Bio-Psycho-Social model can be an important framework to keep in mind when treating insomnia and many other mental and physical conditions.

Below are some examples of the implementation of the Bio-Psycho-Social Model in the treatment of Insomnia.

Biological Level in the Treatment of Insomnia:

Labs

Addressing the biological drivers of insomnia may include assessment for sleep apnea. As sleep apnea is a common contributor to insomnia, ruling it out with an at-home sleep study or referral to a sleep doctor can be an important place to start if sleep apnea is suspected.

Blood tests that are relevant in picking up secondary insomnia (insomnia due to another underlying health condition) include:

• Basic Metabolic Panel (BMP) or Comprehensive Metabolic Panel (CMP)
• Blood Glucose (Fasting Glucose or HbA1c)
• Lipid Profile
• Iron Studies
• Inflammatory markers such as CRP and ESR
• vitamin D levels

Diet

In addition to the types of food one consumes, the timing of food consumption can be critical when it comes to quality sleep.

A few dietary considerations in the treatment of insomnia are:

• Ruling out food sensitivities, a common trigger of insomnia
• Avoiding large meals or spicy foods within three hours before bed
• Avoiding drinking more than 4-8 ounces of fluids within 2 hours before bed
• Avoiding alcohol within 3 hours before bed
• Increasing protein intake and reducing consumption of food with added sugars and refined carbohydrates during the day, as blood sugar dysregulation is a common trigger for nighttime waking

Lifestyle

A few important lifestyle recommendations for sleep hygiene are:

• Waking up at more or less the same time each day
• Getting early morning light exposure from natural light or a blue or 10,000 lux bright light
• Exercising, even if it’s just a short walk, and ideally in the morning or afternoon
• The 3-2-1 Principle
  • No eating 3 hours before bed
  • No work 2 hours before bed
  • No screens 1 hour before bed

Nutritional Supplementation

In addition to a blood sugar balancing diet with adequate protein and lower added sugars and refined carbohydrates, many nutritional supplements have been shown to improve outcomes in insomnia.

Nutritional supplements that help with insomnia may include but are not limited to:

• Melatonin
• 5HTP
• Taurine
• Magnesium
• Others supplements including; ashwagandha, phosphorylated serine, L-theanine, or other calming herbs
• Calming teas that may include ingredients such as chamomile, lemon balm, or passionflower

When it comes to natural supplements, Naturopathic Doctors are the generally the best people to make recommendations. As Natural Products are not standardized the way pharmaceuticals are, and lots of conflicting information exists, it typically takes a qualified

professional to identify the correct quality supplement and ensure the right timing and dose for your needs.

Pharmaceutical interventions may also be required and can be prescribed by a Sleep Doctor, Psychiatrist, or in some cases, Naturopathic Physician.

Psychological level in the Treatment of Insomnia

Day time stress, as well as mental health concerns such as anxiety and depression, can have a profound effect on sleep.

Talking to a licensed therapist or counsellor and addressing daytime stressors can play an important part in the treatment of insomnia.

Cognitive Behavioral Therapy remains one of the most validated evidence based therapies to address insomnia at the psychological level.

In addition, some of the following sleep hygiene principles to lower psychological stress have been shown to be helpful:

• Writing concerns or worries in a journal before bed has been shown in research to lessen the time it takes to fall asleep
• Meditation, EFT (tapping), or hypnosis recordings for sleep can be helpful practices for sleep onset and maintenance
• Avoiding repeated negative judgments about your ability to fall or stay asleep and replacing those with positive self-talk including statements such as “I can fall asleep easily” or “relaxation comes easily to me” can be helpful in promoting quality sleep

Social Contributors in the Treatment of Insomnia

As with most health and mental health concerns, social factors may play a role in the development and treatment of insomnia.

Factors such as animals in the bed, children or infants who disrupt sleep, or sharing a bed with a partner with sleep issues, can all have an impact on sleep, which is important to consider.

Although it is not generally a norm in our culture, studies have shown that separate sleeping arrangements in couples where one or both partners have sleep issues, can improve both sleep along with sexual and relationship satisfaction. If you or your partner struggle with sleep, a separate bed may be something to consider.

In addition to sleeping arrangements, social factors like avoiding conflict before bed and low social and/or other stimuli before bed can be important factors in sleep hygiene.

What to do if you or someone you know is struggling with Insomnia:

If you or someone you care about is struggling with insomnia that interferes with daily functioning, and mental or physical health, reaching out for help can be a critical step in protecting long term health and quality of life.

In addition to implementing basic sleep hygiene practices like the ones listed above, booking a consult with a Naturopathic Physician with experience in sleep issues is a great place to start.

In addition to booking a consult, checking out reliable publications and books on sleep such as Matthew Walker’s ‘Why We Sleep’ can help in arming yourself with the knowledge you need to get your sleep and health on the right trajectory.

Disclaimer: The information provided in this article is intended for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.