My Protocol for Insomnia in Adults by HealthMasters Naturopath Kevin Tresize ND
This treatment summary is provided as information for patients of HealthMasters Naturopath Kevin Tresize ND as part of a treatment plan. The information is to assist patients with understanding of their treatment plan. It is important to note that this is a summary only and is intended to assist with discussion between practitioner and patient as part of consultations.
Core Treatment for Insomnia in Adults
1. Address disturbed neurobiology and primary drivers:
Assess neurobiology with Mood and Stress Questionnaire
Address neurobiology with Stress Less Program
2. Restore healthy sleeping patterns:
California Poppy and Passionflower for Sleep (Metagenics NeuroCalm Sleep) - 2 tablets in evening or 1 tablet in afternoon plus 2 tablets 1-2 hours before bed
If slow sleep onset (cannot get to sleep):
Hydroxytryptophan Complex (Metagenics Proxan) - 1 capsule at dinner and 1 capsule at bedtime
If maintenance insomnia (waking through night):
Neurological Support (Metagenics NeuroPro) - 4-8 g daily
3. Specific magnesium formula to reduce cortisol and catecholamine secretion, support GABA activity, decrease glutamate activity and reduce muscular tension, all which supports sleep.
Magnesium Alkalising Combination for Stress (CalmX) - Add 2 level scoops to 200 mL of water twice daily.
4. Support GABA activity to quieten nervous hyperactivity
Herbal Support for Hyper HPA and Stress (NeuroCalm) - 2 tablets 2-4 times daily
GABA (Metagenics GABA) - 250 mg (1 tsp) – 500 mg (2 tsps) before bed
OR if anxious, hyper-sensitive (teary) with light sleep
Ginseng Complex for Emotional Resilience (Metagenics Resilian) - 3 capsules twice daily
5. If insomnia is associated with pain or other central nervous hypersensitivity
GABA (Metagenics GABA) - 250 mg (1 tsp) – 500 mg (2 tsps) before bed
Meta Mag-Magnesium Bisglycinate, Corydalis and California Poppy for Pain (Metagenics PainX) - Add 2 level scoops to 200 mL of water before bed
6. If with disrupted circadian rhythm
See Circadian Rhythm Reset Protocol and Circadian Hygiene Review
Definition of Insomnia
Insomnia is defined as the persistent difficulty or the inability to fall and/or stay asleep. This condition may have no apparent aetiology (cause), but is often a symptom of an underlying medical or psychological condition. Insomnia is generally not considered a disease, but rather a symptom of other pathologies (e.g., anxiety, depression or pain). Ongoing sleep impairment interferes with normal daytime function. The amount of sleep required by adults is slightly longer than 8 hours. Insomnia is classified as chronic if it persists for 4 weeks or longer. There are two common types of insomnia:
- Delayed sleep onset (i.e., difficulty getting to sleep) – possibly associated with serotonin deficiency.
- Frequent awakenings and/or early morning arousal (i.e., difficulty staying asleep) – possibly associated with dopamine imbalances.
Aetiology / Risk factors
Major causative factors and risk factors that can contribute to the incidence of insomnia in adults include the following:
- Psychiatric and neurologic disorders: stress, anxiety, depression, bipolar disorder, dementia, Parkinson's disease, restless leg syndrome, post-traumatic stress disorder.
- Medical problems that can cause insomnia: asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, cancer, chronic pain.
- Sleep disorders that can cause insomnia: sleep apnoea, narcolepsy, restless legs syndrome.
- Substance abuse: caffeine, alcohol, recreational drugs, long-term sedative use, stimulants; nicotine can cause restlessness, while quitting smoking can cause transient insomnia.
- Disruption of circadian rhythms: shift work; travel across time zones; visual loss; circadian rhythms— regulated, in part, by release of endogenous melatonin.
- Menopause: insomnia is present in 30% to 40% of menopausal women. It may be due to hot flashes and night sweats, anxiety, and/or change in progesterone levels.
- Hormonal fluctuations: hypercortisolaemia; hyperthyroidism; hypoprogesteronaemia – progesterone promotes sleep.
- Advanced age: normal decrease in depth, length, and continuity of sleep. Many factors are responsible for age-related insomnia, including the biological changes of ageing, existence of underlying medical conditions, increased sensitivity to environmental factors, more medications leading to greater potential for side effects, neurologic disorders that may cause confusion and disorientation, increased likelihood of depression, anxiety, and grief.
- Certain medications: decongestants and bronchodilators, and beta-blockers may lead to a variety of sleep disorders including mild, transient insomnia.
- Other: high fat diet, lack of exercise, food sensitivities and blood sugar disorders have all been linked to insomnia.
Signs and Symptoms
The consequences of lack of sleep, particularly when prolonged, include
- Decreased concentration and diminished memory
- Daytime drowsiness and impaired functioning / task performance
- Less enjoyment of activities and social interaction
- Increased likelihood of alcohol and other substance abuse
- Irritability and mood disorders
- Waking unrefreshed in the morning, or insomnia despite feeling tired.
Anticipatory anxiety; insomnia can become a vicious cycle with bed and bedtime coming to represent restlessness and anxiety.
Diet and Lifestyle
Sleep hygiene can be defined as controlling “behavioural and environmental factors that precede sleep and may interfere with sleep. Cultivating the following habits are essential to optimise sleep hygiene: Personal habits:
- Fix a bed time and awakening time, including on weekends and vacations.
- Avoid napping during the day
- Avoid alcohol 4-6 hours before bedtime
- Avoid caffeine 4-6 hours before bedtime
- Avoid heavy, spicy or sugary foods 4-6 hours before bed
- Exercise regularly, but not right before bed Sleeping environment:
- Use comfortable bedding
- Find a comfortable temperature setting for sleeping and keep the room well ventilated
- Block out all distracting noise and light
- Reserve the bed for sleep and sex Getting ready for bed:
- Try a light snack before bed
- Don’t take your worries to bed
- Establish a pre-sleep ritual
- Get into your favourite sleeping position
If waking through the night and sleep is not resumed within 15-20 minutes, recommend getting up and leaving the bedroom, reading, having a light snack, quiet activity or taking a bath. Do not perform challenging or engaging activity such as office work or housework. Do not watch television, which is very engaging and not recommended in the bedroom, whereas radio is less engaging, and may comfort some people to help sleep.
- Physical factors may upset sleep, including arthritis, acid reflux, menstruation, headaches and hot flushes. It is important to address these separately.
- Physiological and mental health problems like depression, anxiety and stress. In some cases maintaining sleep may be the only sign of depression
- Investigate side effects of medications.
- Sleep medications may be prescribed short-term to improve sleep patterns.
- Consider cognitive-behavioural therapies and other mind/body techniques.
- Acupuncture and acupressure have been shown to help resolve insomnia.
- Timed exposures to bright light (at least 2000 lux) can change the sleep-wake cycle and may be beneficial for treating circadian rhythm sleep disorders such as delayed sleep phase syndrome, jet lag, and sleeplessness caused by night shift work.
- Exposure to late afternoon sun, which stimulates release of endogenous melatonin: melatonin does not induce sleep but it does help regulate the circadian rhythm.
- Avoiding looking at the clock, which promotes anxiety.