Insomnia is a sleep disorder that includes trouble falling asleep staying asleep or waking too early which can result in daytime impairment. Insomnia is a common problem that often occurs along with other diseases or emotional states thus many clinicians and researchers consider it a sign of a deeper underlying condition. It can also however exist without other medical or mental health issues and in these cases it is termed primary insomnia. Insomnia affects up to 10% of the population although my feeling is that it is much higher. Chronically it can increase the risk of and may lead to a variety of emotional and somatic conditions such as increased mortality and depression.

The Causes Are Many

Causes of insomnia are varied and numerous including issues such as hormone imbalances sleep hygiene mental and emotional disorders and drug use (legal or otherwise) including alcohol and caffeine. And as mentioned in a previous two part blog on melatonin as we age and certainly for those over 55 hormone synthesis across the board significantly declines. Melatonin the chief neurohormone responsible for sleep induction is another casualty with its decreased production adversely affecting sleep quality and quantity. In the elderly melatonin supplementation makes clinical sense and may be a first line of defense against insomnia in this population.

While the pituitary gland secretes melatonin it also produces another neurohormone called adrenocorticotropic hormone (ACTH) which acts on the adrenal cortex to produce cortisol. As part of the HPA axis which includes the hypothalamus this gland relationship is integral to proper sleep physiology. Elevated levels of corticotrophin releasing hormone (CRH) the hormone that acts to encourage the release of ACTH has been shown to disturb sleep causing primary insomnia. Additionally cortisol being the stress hormone has an inverse relationship with melatonin where high and inappropriate nighttime secretion of cortisol can suppress normal secretion of melatonin again adversely affecting normal sleep patterns.

Obviously a clinical attempt to lower nighttime cortisol production could prove beneficial in rebalancing sleep cycles. Compounds such as ashwagandha and phosphatidylserine have been used as therapeutic agents to help modulate and encourage proper cortisol secretion.

Tumor necrosis factor (TNF) is a cytokine involved in the inflammatory response and therefore plays a key role in the regulation of immunity. But unbeknownst to me this important compound also plays a role in sleep regulation. TNF-beta synthesis has been shown to induce non-rapid-eye-movement sleep while its depletion inhibits rapid-eye-movement sleep. Specifically TNF is a fatigue-inducing cytokine that under normal physiological states is released at night helping to provoke sleep. However chronic insomnia can dysregulate TNF's proper secretion and actually reverse appropriate release increasing it during the day.  This manifests as daytime fatigue.

Weight gain may be associated with insomnia as the production of the hormones leptin and ghrelin two compounds involved in energy metabolism appetite and satiety are also affected in chronic insomniacs.

Like inflammation oxidative stress may also be considered an initiating factor in the pathogenesis of insomnia as cell phone use highly oxidative to the brain has been associated with a disruption in specific sleep cycles.

Sleep Support

Aromatherapy is an interesting therapeutic tool that has been shown to be successful in certain insomniacs especially the use of lavender oil. It can act as a mild sedative while positively affecting stage two and REM sleep cycles.

Valerian root is a popular herb that is commonly used as an anxiolytic mild sedative and calming agent while showing great promise in insomnia including offering potential help for post-menopausal women who are notorious for experiencing the frustrating symptoms of insomnia.

Finally napping has been shown to not only help rejuvenate those that are sleep-deprived but to also help encourage a resetting of cortisol release back to normal cycles.

The scientific literature is quite clear regarding the relationship between good quality sleep and optimal health and how the long term effects of poor sleep can dramatically undermine overall health and increase all cause mortality. Establishing healthy sleep habits can be an aspect of our lives that many times may go unattended.

Michael Fuhrman D.C.