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Could Pumpkin Seeds + Carbs = Better Sleep?

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Let’s begin with a caveat: no organic sleep aid on the market has been shown to cure insomnia.

But if you like warm, nonalcoholic, caffeine-free liquids, and if drinking a beverage is part of your evening routine, you might be interested in trying Zenbev Drink Mix. Its claim as a sleep aid and alternative treatment for insomnia is based on a study showing that food bars made from the same ingredients significantly reduced insomnia subjects’ time awake at night.

Here’s more information about it.

What Is Zenbev Drink Mix?

It’s made from pumpkin seeds that are cold-pressed to remove the oil and made into pumpkin seed flour. The flour is then combined with dextrose (the sugar found in plants), rice starch (a carbohydrate), and guar gum (a binder–thickener); flavored with chocolate or lemon; and sold as a powder, to be mixed with warm milk or warm water. It’s touted as promoting “a natural and healthy sleep.”

A Tryptophan–Carbohydrate Combination

Research suggests there may be grounds for this claim. Like other protein sources—turkey, fish, milk—pumpkin seeds are high in tryptophan, an essential amino acid. Tryptophan is a precursor to melatonin, a hormone secreted at night. Your melatonin levels start to rise a few hours before bedtime, which helps you fall and stay asleep. Tryptophan is also a precursor to serotonin, a neurotransmitter the body eventually converts into melatonin.

But tryptophan has to cross the blood–brain barrier to exert its sleep-inducing effects. It competes with other amino acids to cross that barrier, so a drink high in tryptophan alone would not have much effect on sleep.

Adding a carbohydrate to the mix might help. It would promote the release of insulin, inhibiting production of competing amino acids or diverting them into muscle. With less competition at the gate, more tryptophan would be expected to cross the blood–brain barrier and begin its conversion into serotonin and melatonin, in turn promoting sleep.

Effects on Sleep

To test the effects of the pumpkin seed–carbohydrate combination on sleep, Biosential, the company that makes Zenbev Drink Mix, set out to conduct a randomized controlled trial, enrolling 57 people with insomnia.

Forty-nine participants completed the 3-week study. Each week they were randomly administered 3 different food bars. One week, the food bars contained deoiled pumpkin seed flour mixed with carbohydrates. Another week, the food bars contained pharmaceutical-grade tryptophan mixed with carbohydrates. In another week, the food bars contained carbohydrate only.

The bars containing deoiled pumpkin seed and those containing pharmaceutical-grade tryptophan led to significant improvements in sleep, as reported by study participants. The bars made of carbohydrate alone led to some improvement, too.

Measured objectively, the pharmaceutical-grade tryptophan outperformed the deoiled pumpkin seed when it came to increasing sleep duration. But the bar containing the deoiled pumpkin seed-carbohydrate preparation was the only treatment to significantly cut down on wake time after sleep onset.

The Take-Away

Offering the results of a single trial as proof that a treatment works is better than offering no results at all. Yet the study would have to be repeated—with Zenbev Drink Mix instead of food bars—to substantiate the claim that this beverage can actually improve insomniacs’ sleep.

Still, enough evidence points to tryptophan’s helpful effect on sleep that Zenbev Drink Mix may be worth trying, especially if you’re looking for alternative treatments for insomnia and interested in exploring the idea that dietary changes might help. The product is sold in the United States, Canada, and Europe.

Tips for Better Sleep on the Road

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My husband and I are going on a road trip this summer and we won’t be staying at the Marriott. Not just because 4-star hotels are too expensive. Where we’re headed, we’ll be lucky to find a Super 8. More likely we’ll end up in budget motels with names like Willow the Wisp and All Tucked Inn.

Being the finicky sleeper that I am, I carry the potential for insomniac nights wherever I go. (But hey, a new study found that even good sleepers tend to sleep less soundly the first night they’re sleeping in an unfamiliar place. This is called “first-night effect.”) At least a dozen possible hazards can throw my sleep off track. Here’s what I do to boost my chances of getting better sleep on the road.

Noise Control

Noise is my No. 1 enemy when I’m staying overnight in budget motels. So, I

(1) Pack earplugs. Not just one set but two, in case one gets lost or left behind. I use silicone earplugs that mold to the shape of the ear and form an airtight seal. Some people prefer to mask noise at night. My sister uses a white noise machine. A friend of mine packs along a small fan.

(2) Open the conversation in the office by saying I’m looking for a room that’s QUIET. Then I choose the room strategically. I take one facing away from the road when possible. If plenty of rooms are available, I ask for one far away from others currently occupied. I don’t care if they think I’m a misanthrope. I can’t be nice to my fellow human beings after a night of rowdy partying in the room next door.

(3) Check the appliances for potential noise. Does the refrigerator sound like a Mack truck? I’m out of there in a red-hot second. Does the A/C shut off with a loud judder? Same thing. And neighbors whose TV is blaring when I inspect the room are not necessarily going to want to turn it down.

Light Control

Budget motel rooms rarely come with lighting favorable to the sleep challenged. So, I

(4) Pack along an eye mask. My eye mask is lightweight and molds to my face so it blocks out light but isn’t too hot to wear.

(5) Pack a mini-flashlight. A middle-of-the-night trip to a bathroom with bright fluorescent lighting can sabotage my sleep for the rest of the night. A flashlight is the answer here. A night light can work, too—if you remember to pack it up in the morning.

Temperature Control

I’m sure to have insomnia if I feel too hot to sleep. So, I

(6) Check out the A/C to make sure it works and that I can control the thermostat. A/C whose only setting keeps the room in a deep freeze is just not good enough.

(7) Pack along a lightweight blanket. Bed linen at motels these days consists of sheets and a comforter or a quilted bedspread—which means I either freeze or boil. Yes, my body cools down at night. But to stay comfortable what I need is a lightweight blanket, not a so-called comforter.

Beyond insomnia, when traveling I have to think about my back. I’m sure to wake up with back pain if I sleep on a too-soft mattress. When I check out a room, I flop down on the bed to make sure the mattress is hard enough so I won’t wake up with back pain. (I pack along a knee pillow, too, so my spine stays straight when I’m sleeping and a basketball that serves as a prop for my back exercises.)

I guess I’m high maintenance traveler. Aren’t you glad you’re not coming on the trip?

The Insomnia/Perfectionism Connection

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Do you hold yourself to high (sometimes impossibly high) standards? Do you tend to be self-critical and cringe at making mistakes? Is it even difficult sometimes to take pleasure in your own hard-won achievements?

These are signs of perfectionism, and perfectionists are more susceptible to insomnia than people who can shrug off their mistakes.

The theory that perfectionism and other personality traits (such as neuroticism and internalization of negative feelings) are the main drivers of insomnia has not withstood the test of time. But the evidence for an association between perfectionism and insomnia remains fairly strong. Even so, a team of Swiss researchers has found that when they take stress, poor coping strategies, and poor emotion regulation into account, perfectionism’s role in explaining insomnia all but disappears. There’s a message here for those of us who want to improve our sleep.

Where Perfectionism Comes From

Like many personality traits, perfectionism appears to have both environmental and genetic components. “It is likely that a perfectionistic orientation develops over time, and family history may contribute to the development of perfectionism,” wrote Cal State University researchers David R. Hubbard and Gail E. Walton, who in 2012 reported interviewing 36 students about perfectionism and the motivation to achieve. Two aspects of experience differentiated the perfectionists from their nonperfectionist peers:

  1. The perfectionists felt pressure from their families to succeed.
  2. Their parents were overly critical of their mistakes when they were growing up.

But inherited genetic material may also make people more inclined to perfectionism. When researchers at Michigan State administered a series of tests to 292 young female adults in the Michigan State University Twin Registry, they found that both anxiety and maladaptive perfectionism (concern about mistakes and doubts about actions) were moderately heritable—on par with the heritability of general intelligence. A second twin study found that identical twins were more alike than fraternal twins in how much they idolized skinny celebrities—another sign of perfectionism.

A Relationship Between Perfectionism and Sleep

Chronic insomnia is attributable to a mix of factors: physiological and psychological, environmental and behavioral, inherited and learned. The dysfunctional processes underlying perfectionism (manifesting as doubts about abilities, concern about mistakes, and so forth) might be similar to those that underlie trouble sleeping, the Swiss researchers reasoned. So they gave a battery of pencil-and-paper tests to 346 college students to see what relationships would emerge.

Statistical analyses showed that perfectionistic traits were associated with trouble sleeping and the same daytime complaints of people with persistent insomnia: tiredness, reduced concentration, and low mood. But when perceived stress, poor coping strategies, low emotion regulation, and low mental toughness were factored into the equation, perfectionism’s contribution to sleep disturbance was nil. In other words, the researchers conclude, “It is not perfectionism per se, but rather the underlying psychological mechanisms that best explain the association between perfectionism and poor sleep.”

Why Is This Important?

Let’s assume you have insomnia. A therapist you’re working with thinks the problem is personality-related and sets out to address it by helping you modify your perfectionistic tendencies.

Changing personality traits originating in childhood and/or predisposed at birth is a real challenge. It might not be impossible to free yourself from a harsh inner critic that developed under the watchful eyes of Mom and Dad, yet the effort it would take—several months (if not years) of psychotherapy—would be great and the results, uncertain. As for improving your sleep, well, good luck there. Psychotherapy has never been found to be an effective treatment for insomnia.

Targeting the psychological mechanisms underlying chronic insomnia directly would be a faster, more effective approach to improving sleep, the researchers conclude, particularly in insomnia sufferers with perfectionistic tendencies. Cognitive-behavioral therapy for insomnia (CBT-I) does this. Its cognitive restructuring component is aimed at dismantling the mental and emotional underpinnings of persistent insomnia. So CBT-I is a better treatment option than psychotherapy if your goal is better, sounder sleep.

What’s That Antidepressant Doing to Your Sleep?

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Most—but not all—antidepressants tend to suppress and/or delay REM sleep (the stage associated with dreaming). This can be helpful for people with depression.

It’s not necessarily helpful for people with insomnia. In fact, REM sleep irregularities may be a causal factor in insomnia. So it pays to know a bit more about antidepressants if you’re taking them now or before you head down that path.

Antidepressants are the third most commonly taken medication in the United States today, prescribed for depression and health problems such as insomnia, pain, anxiety, headaches, and digestive disorders. Most—but not all—antidepressants tend to suppress and/or delay REM sleep (the stage associated with dreaming). This can help people with depression.

It’s not necessarily helpful for people with insomnia—or for people who might be inclined to sleep problems if pushed in the wrong direction. There’s mounting evidence that REM sleep irregularities may actually be a causal factor in insomnia. So it’s worthwhile knowing about the REM and other sleep effects of antidepressants if you’re taking them now or before you head down that path.

IMPORTANCE OF REM SLEEP

Intact, sufficient REM sleep has many benefits. They include the enhancement and consolidation of learned tasks and skills in long-term memory and the regulation of emotion.

Fragmented REM sleep, in contrast, may lead to the inadequate processing of emotion and then to hyperarousal, in turn giving rise to insomnia. Loss of the final REM period, a phenomenon identified in some “short sleepers” (often defined as those who sleep less than 5 hours a night), may increase your appetite and make you more vulnerable to weight gain and obesity.

In short, reduced or compromised REM sleep is not something you generally want.

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (AND RELATIVES)

SSRIs are widely prescribed because they’re effective for depression and have relatively few major side effects. But as a class, they tend to suppress REM sleep. (They may also bring about changes in the frequency, intensity, and content of your dreams.) They also tend to delay the onset of sleep and increase awakenings and arousals at night, reducing sleep efficiency.

If you have both depression and insomnia, it’s probably best to steer clear of SSRIs. But here’s a caveat. SSRIs and other drugs that act on the serotonin system (which is very complex) are known to have different sleep–wake effects on different people. Trying out a drug like fluoxetine (Prozac) may be the only way to ascertain for sure how it will affect your sleep.

The story is basically the same for serotonin and norepinephrine reuptake inhibitors (SNRIs). Drugs such as duloxetine (Cymbalta) and venlafaxine (Effexor XR) markedly suppress REM sleep and tend to disrupt sleep continuity.

TRICYCLIC ANTIDEPRESSANTS

TCAs aren’t prescribed as often as SSRIs because they tend to cause more side effects. However, like SSRIs, most TCAs (except trimipramine) markedly suppress REM sleep. Also, TCAs like desipramine and protriptyline give rise to increased norepinephrine, which tends to promote wakefulness rather than sleep. In studies of desipramine, the drug degraded the sleep of people with depression by extending sleep onset latency, decreasing sleep efficiency, and increasing their number of awakenings at night.

Most TCAs are not sleep-friendly. However, low-dose amitriptyline is known to have sedative effects and is sometimes prescribed for people with depression and insomnia.

Low-dose doxepin has been shown to have sedative effects as well, blocking secretion of histamine, a neurotransmitter associated with wakefulness. Sold today as Silenor, it’s the only antidepressant approved by the FDA for the treatment of insomnia. Clinical trials suggest that Silenor is effective in treating sleep maintenance insomnia but not insomnia that occurs at the beginning of the night.

ATYPICAL ANTIDEPRESSANTS

Some antidepressants are atypical in that they don’t fit neatly into any category. Although not approved for the treatment of insomnia (the requisite trials were never conducted), low-dose trazodone (Desyrel) and mirtazapine (Remeron) are often prescribed for people with insomnia because of their sedative effects. Unlike most antidepressants, these drugs have not been found to markedly suppress REM sleep. And the results of a very few studies suggest that they may help people fall asleep more quickly and sleep more deeply.

If you’re taking an antidepressant now (for whatever reason) and you think it may be interfering with your sleep, talk about it with your doctor. And if you’re having sleep problems and considering an antidepressant, be selective about the one you use.

Does Insomnia Carry a Social Stigma?

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My aunt and uncle from LA recently visited me here in Ann Arbor. I spent a fair amount of time with them when I lived on the West Coast, and over the years we’ve had lots of intimate conversations. They’d read my book, The Savvy Insomniac, and the first thing they said about it was this:

“We never knew you had such a problem with insomnia.” Implied was a question: Why didn’t you ever mention it to us?

I was actually surprised to find out I hadn’t spoken about my sleep problem with these family members. I answered as truthfully as I could:

“There’s a stigma attached to insomnia,” I said, or something to that effect. “I didn’t use to say much about my trouble sleeping. I didn’t want people making assumptions about me, like I had big psychological problems or I was making a mountain out of a molehill, or something like that.”

A Pervasive Social Stigma

Part of what motivated me to study insomnia was the social stigma I felt was attached to it. I wanted to understand where it came from and why it’s so enduring.

Other insomnia sufferers also perceive this stigma. A number I’ve spoken with feel that family and friends don’t understand what it’s like to struggle with persistent insomnia, and that they make negative judgments about people who have it (or they would judge us poorly if they knew). So we end up keeping the complaint to ourselves . . . and feeling like we’ve got to tough it out on our own rather than reaching out for help.

Still other insomnia sufferers say they have no reservations about discussing their sleep problem, adding that the normal reaction they get is sympathy. I overheard a sleep therapist say there was no stigma attached to insomnia, and I wondered if the stigma was finally dying out.

But recent studies exploring the experience of insomnia suggest the stigma persists. Of 24 insomnia patients interviewed at the University of North Texas, “38 percent of the sample directly admitted to feeling stigmatized about their problem sleeping,” and “more discussed it indirectly in terms of isolation and feeling different.”

Do You Feel This Way?

These testimonials are taken from the study above and from similar studies conducted in Scotland and Pittsburgh. See if they reflect a part of your experience with insomnia:

  • “I felt like it was . . . a disgrace? Like why am I weak and why can I not get over this? It’s a thing you feel a little bit guilty about. You know, I am tough and strong and I can do this myself. That was one reason I waited [to look for help].”
  • “I feel embarrassed even to discuss about my sleeplessness, why I’m so tired, why I’m dull, why I’m not performing maybe to my friends’ expectations . . . to the world, it is a problem you can sort out.”
  • “When I tell my family I have it, they all laugh. They say I need to see a psychiatrist. I thought I was nuts. . . . [Even now] I can’t really talk about it with anyone except my doctor.”
  • “Other people think you’re a freak” . . . “a liar” . . . “a hypochondriac.”
  • “People might see that some days I do okay but not most days. . . . I think they wonder if I’m faking when I talk about how hard things are.”

Beyond Embarrassment and Isolation

This sense of being misunderstood, and the shame and isolation that can take root in those of us who suffer insomnia, is apparently fairly common. These feelings and attitudes get serious treatment in The Savvy Insomniac. The overall aim is to encourage people to move beyond them and see persistent insomnia as a serious health problem deserving of attention.

For now, in case you’re resigned to carrying on as a poor sleeper, keep these things in mind: chronic insomnia compromises day-to-day functioning and long-term health. Avoid mentioning it to friends and family if you must–but do continue to look out for help.

Are you guarded about discussing your sleep problem with others? If so, why?

Q&A: Start Sleep Restriction Right for Best Results

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Recently I’ve heard from a handful of people starting out with sleep restriction therapy (SRT), a treatment for insomnia. All were in a similar predicament. Here’s what Jenny wrote:

‘I’m on Day 4 of SRT and it isn’t going well. I finally had an appointment with a sleep therapist last week. He talked to me about SRT and gave me a 7-hour sleep window, from 11 p.m. to 6 a.m. My usual bedtime is 9:30 so I had some apprehensions. But I started 4 days ago.

Since then I haven’t slept more than 3 hours a night. It’s really hard for me to stay up till 11, and then when I get in bed I’m wide awake! In the morning I’m so tired I can hardly keep my eyes open! Is this normal? I’m afraid I may be a treatment failure. Any advice?’

FIRST FEW WEEKS OF TREATMENT

The first few weeks of SRT are not much fun. Your time in bed is cut short at night and naps are not allowed. It can be hard to figure out what to do during the extra hours you’re up. In the daytime you may feel sleep deprived: exhausted, cranky, off your game.

Is this normal?

Research suggests it’s not abnormal. Results of a study of 16 insomniacs in the UK showed that while their sleep was greatly improved following SRT, during the first few weeks of treatment, they were sleep deprived. Like Jane Fonda said: no pain, no gain!

THE WEEK BEFORE RESTRICTION BEGINS

Jenny’s experience of the first few days of SRT is not so unusual. But nowhere in her email—or in the others I received—was there any mention of having kept a sleep diary* during the week before treatment. Also, all 4 I heard from were starting SRT with rather generous sleep windows: 6.5, 7, and even 8 hours in bed. Yet they didn’t say how those sleep windows were established.

Maybe sleep diaries were kept—and the writers just didn’t mention them. Or maybe a therapist determined, based on a clinical interview, that starting out with a generous sleep window was the best way to treat insomnia in that particular person. (See my blog on paradoxical insomnia for more on this.)

But I suspect that at least some who wrote had plunged right in to sleep restriction without filling out a sleep diary the week before and that their sleep windows were set arbitrarily. This can make the first week of sleep restriction even rockier than it needs to be—and might lead people to think the treatment is failing and quit.

HOW MUCH DO YOU SLEEP?

To set your sleep window (time allowed in bed) at the start of SRT, you need to know how much sleep you’re getting from night to night. Maybe you have a pretty good idea of that already. In reality, though, most insomnia sufferers are not very good at estimating sleep duration.

Keeping a sleep diary during the week before treatment won’t necessarily make your estimate more accurate—but it might. By noting in the diary how many times you wake up each night, how long the wake-ups last, and the variability in your sleep from night to night, you might get a more realistic read on the average number of hours you sleep.

LOOK BEFORE YOU LEAP

Regardless of whether keeping the diary clues you in to anything you didn’t already know, the results are an indication of how much your time in bed should be restricted at the start of sleep restriction:

  • You discover you’re a 6-hour sleeper? Start SRT with a 6-hour sleep window.
  • You’re sleeping 5 hours 15 minutes a night? Start with a 5.25-hour sleep window.
  • There’s one exception: most sleep experts (but not all) recommend starting SRT with nothing less than a 5-hour sleep window. So 4-hour sleepers are usually advised to start with a 5-hour window.

If you start with a too-small sleep window, you’ll wind up very sleep deprived. But if your sleep window is too generous (as I suspect may have been the case for Jenny and the others who wrote in), you’re likely to continue with the same broken sleep pattern you’ve known from before. This could sour you on sleep restriction even before you’re off the ground.

So keep a sleep diary for a week before starting SRT and set your sleep window accordingly. It’s the quickest path to success.

* Download this sleep diary from the National Sleep Foundation and make several copies for use during SRT.

What was your experience like during the first week of sleep restriction therapy?

Paradoxical Insomnia: What It Is & How It’s Treated

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Do you normally get just an hour or two of sleep? Are there nights when you don’t sleep at all?

You may have paradoxical insomniaAn overnight sleep study would confirm the diagnosis. Despite your perception of getting very little sleep, your electroencephalogram (EEG)—the graphic record of your brain waves produced during an overnight sleep study—would indicate that you were actually sleeping a 6.5- to 8-hour night.

This sleep disorder seems to be fairly common. About 9 to 40 percent of the people diagnosed with insomnia are estimated to have it. Despite its prevalence, the whys and wherefores remain largely unknown. But researchers have made a little headway in recent years, and here’s what they say now.

Is There Really Anything Wrong?

Formerly called pseudoinsomnia and more recently sleep state misperception, the sleep of people with paradoxical insomnia looks similar to normal sleep in a conventional sleep study. In fact, the EEG of a person with paradoxical insomnia can look identical to the EEG of a normal sleeper. Doctors used to tell their patients that nothing was wrong.

But people with paradoxical insomnia do have grounds for complaint, and scientists are now a little closer to understanding why. In a 1997 study, Michael Bonnet and Donna Arand reported that compared with normal sleepers, people with paradoxical insomnia (1) were more confused, tense, depressed, and angry, and (2) had a significantly increased 24-hour metabolic rate. This is suggestive of hyperarousal, a characteristic of people with insomnia.

Subjective vs. Objective Insomnia

Paradoxical insomnia, also called subjective insomnia, differs from objective insomnia—the type that’s more familiar. Compared with paradoxical insomniacs, objective insomniacs

  • sleep significantly fewer hours, as recorded on the EEG
  • tend to be less inaccurate at estimating total sleep time
  • may have psychological and physiological symptoms that are more severe.

In a 2002 study, Andrew Krystal and colleagues presented an in-depth analysis of brain wave patterns that shed light on more differences. Compared with objective insomniacs, paradoxical insomniacs

  • had less delta wave activity during sleep (delta waves are the predominant waveform in deep sleep, the restorative stuff). The lower the delta activity, the greater the discrepancy between the total sleep time recorded on the EEG and the sleep time estimated by the patient.
  • experienced more alpha, beta, and sigma wave activity during sleep—brain waves commonly associated with arousal, perception, and thinking. This suggests that people with paradoxical insomnia are prone to perceiving and possibly even processing information when they sleep.

Overall, then, the sleep of people with paradoxical insomnia tends to be light and characterized by hypervigilance. Scientists are not sure if this sleep disorder is simply a way station en route to objective insomnia or a completely different kettle of fish.

Treatment of Paradoxical Insomnia

There is no standard treatment for people with paradoxical insomnia. Drug-free behavioral therapies such as sleep restriction and stimulus control may not help.

If physiological hyperarousal is the main problem for insomniacs in this group, one way to address it would be through physical training. Daily aerobic exercise—and possibly the daily practice of yoga, tai chi, or qi gong—would cut down on arousal and likely promote sounder sleep.

On the other hand, a team of Italian researchers thinks the problem is mainly perceptual. These patients “may have a sort of agnosia [a partial or total inability to recognize something by use of the senses] of their sleep,” they conclude.

Investigators at The University of Alabama treated four paradoxical insomnia patients with a kind of “sleep education.” After behavioral therapies failed to help, a specialist talked to each patient about sleep and sleep staging. Together, they looked at the patient’s EEG, watched a video of the patient sleeping, and noted differences between the recording of sleep and patient perceptions. After receiving the information, 2 of the 4 patients reported falling asleep much more quickly and sleeping a lot longer.

Ralph Downey, a sleep specialist at Loma Linda Sleep Center, conducts therapy sessions for people with paradoxical insomnia in a sleep lab. Each time a patient falls asleep, she’s awakened and asked whether she thinks she’s asleep or awake. After repeated awakenings, the patient develops the ability to recognize the bodily cues that accompany sleep. Her perception of sleep becomes much closer to that recorded on her EEG.

Michael Schwartz, whose SleepQ app I reviewed last fall, believes that the same thing can be accomplished with a smart phone and an app costing just $4.99.

If you found this information helpful and/or interesting, please like and share on social media sites. Thank you!

Cerêve Sleep Device Approved for Treatment of Insomnia

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Would you wear a cap at night if it helped you fall asleep faster?

You may soon have the opportunity: the cap, a medical device for the treatment of insomnia, has received approval from the FDA, clearing the way for it to come to market.

“We are thrilled that the FDA has cleared the Cerêve Sleep System for treating people with insomnia,” sleep specialist and company founder Eric Nofzinger was quoted as saying in a press release. “The Cerêve System offers a clinically proven and safe alternative to pills, with the potential to help millions of Americans get to sleep fast.”

A Novel Insomnia Therapy

It isn’t just any old cap. This cap, made of soft plastic, comes with a software-controlled bedside device that continuously pumps fluid to a pad that rests against your forehead and cools the brain. You wear it all night.

I found out about the cap and the cooling process—called frontal cerebral thermal transfer—at a conference on sleep and sleep disorders in 2011. My first reaction was disbelief. Really? I said to myself. Now they’re proposing to cure my insomnia by sticking an ice pack on my brain? No way!

Despite my skepticism, I showed up for a poster session where Nofzinger was talking about results of clinical trials conducted on insomniacs who used the device at night. Patients responded positively, he said. “They describe it as sort of like a spa treatment.”

But what did wearing a cooling cap have to do with insomnia? I asked him. What was the relationship between the two?

“Insomniacs have too much metabolic activity in the frontal cortex,” Nofzinger said. “It’s very soothing to be able to settle that brain activity” by cooling the frontal region of the brain. “It’s as if your grandmother put a washcloth on your forehead.”

Something cold against my forehead sounded unappealing, I told him. I can’t sleep when I’m cold.

The temperature can be adjusted within a comfortable range of coolness, was Nofzinger’s response.

Origin of the Concept

Formerly, Nofzinger directed the Sleep Neuroimaging Research Program at the University of Pittsburgh School of Medicine. He and his colleagues studied neural activity in the human brain. What they knew from past studies was that the brains of normal sleepers are largely quiet at night: there’s not much metabolizing of glucose. But in functional brain imaging studies of insomnia patients, the researchers saw something different.

In insomniacs at night, quite a bit of glucose was being metabolized in certain areas of the brain, especially the frontal cortex (the part responsible for thinking, planning, and other executive functions). Excessive activity in the frontal cortex might be a biomarker of the hyperarousal believed to underlie insomnia, and decreasing this activity by gently cooling the frontal lobe might lead to sounder sleep.

Testing the Device

Once the device was created, it had to be tested for safety and efficacy on insomnia patients. The first two studies were small and the main results were as follows:

  • The devices reduced brain metabolism during sleep, especially in the frontal cortex.
  • They also reduced participants’ core body temperature (also favorable to sleep).
  • The cooler the setting, the greater was the benefit.
  • Worn all night at the coolest setting, the devices enabled insomnia patients to get to sleep as quickly and sleep as efficiently as normal sleepers.

A third much larger clinical trial—randomized and placebo-controlled—was conducted with funding from the National Institutes of Health. The caps were found to reduce the time it took insomniacs to reach Stage 1 and Stage 2 sleep, effectively helping them fall asleep faster. Regarding safety, Cerêve Sleep System was classified by the FDA as a novel, low-risk device.

Now that the FDA has granted its approval, what remains to be done is to ramp up production and roll out a marketing campaign. These things always take more time than you’d like them to, but as of now Cerêve expects to launch the product in the second half of 2017.

Does this sleeping cap sound like something that might help your sleep? Why or why not?

Can Insomnia Be Caused by Dietary Supplements?

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I’ve written about common medications that can cause insomnia. But less is known about the side effects of supplements. They’re unregulated in the United States and not required to undergo rigorous testing.

But investigators at ConsumerLab, after reviewing the results of tests that have been conducted, say there’s evidence that 6 supplements may interfere with sleep. Here’s a summary of the findings:

I subscribe to a newsletter from ConsumerLab, a watchdog company that tests and reviews dietary supplements. Last week a question in the newsletter caught my eye:

“Could my CoQ10 supplement be causing my insomnia?”

I’ve written about common medications that can cause insomnia. But less is known about the side effects of supplements. They’re unregulated in the United States and not required to undergo rigorous testing. But investigators at ConsumerLab, after reviewing the results of tests that have been conducted, say there’s evidence that 6 supplements may interfere with sleep. Here’s a summary of the findings:

COQ10

Coenzyme Q10, or ubiquinone, is an antioxidant compound that cells use to produce energy. The body usually manufactures enough CoQ10 on its own, and small amounts can be gotten from beef and chicken. But CoQ10 production may fall off with age or because of heart disease. CoQ10 supplements are used for congestive heart failure and to reduce the risk of heart problems after a heart attack. They may also lessen the muscle pain associated with taking statin drugs and help to prevent migraines.

The typical daily dose is 100 to 300 mg. Yet taken in the evening, doses of 100 mg and higher reportedly cause mild insomnia in some people. Doses of 300 mg taken in the daytime may also interfere with sleep.

ST. JOHN’S WORT

The leaves, flowers, and stem of this herbaceous plant are used to treat major depression of mild to moderate severity. Two chemicals found in St. John’s wort–hypericin and hyperforin—are believed to be responsible for the herb’s antidepressant effects. They act on chemical messengers in the nervous system that regulate mood.

The typical dose varies depending on whether the product is made from an extract or the whole herb and how much hypericin or hyperforin it contains. Stomach upset is the most common side effect. Rarer side effects include anxiety, fatigue, and insomnia.

CHROMIUM

This essential trace mineral is important for insulin function and helps move glucose from the bloodstream into cells for use as energy. The body needs just a little bit, and because chromium is found in so many foods—from meat and potatoes to whole-grain bread and fresh fruit—most people get enough in their daily diet. Adequate intake for adults is low: 20 to 45 micrograms (mcg) daily.

Chromium helps decrease fasting blood glucose levels and regulate insulin. Chromium deficiency is associated with type 2 diabetes, and people with diabetes may be prescribed two 500-mcg tablets daily. However, doses of 200 to 400 mcg daily have caused insomnia and sleep disturbance in some users.

DHEA

Dehydroepiandrosterone (try to pronounce that one!) is a hormone produced by the adrenal glands that the body converts into other steroidal hormones such as estrogen and testosterone. DHEA production peaks when we’re in our 20s and declines with age. Dietary supplements—which are manufactured from chemicals in soybeans and wild yams (DHEA cannot be gotten directly by eating these foods)—are believed to have anti-aging effects. For example, DHEA may improve bone density, skin elasticity, and mood.

The prescribed dose varies widely. Rare cases of insomnia have been reported with daily use.

GARLIC

Garlic in its various forms—whole, powdered, and liquid—has been shown in studies to lower serum total cholesterol by 4 to 5 percent. So it’s used to lower cholesterol and may slow the progress of atherosclerosis.

Garlic is believed to be safe even at high doses. But some people taking high doses have experienced insomnia as a side effect.

POLICOSANOL

Policosanol is a cholesterol-lowering supplement made from sugarcane, beeswax wheat germ, or rice bran wax. Some studies show it helps prevent heart disease.

Clinical doses range from 10 to 40 mg daily. But subjects have reported a wide range of side effects, including insomnia and daytime sleepiness.

Have you used any of these supplements? If so, did they interfere with your sleep?

Lifelong Insomnia? Don’t Give Up on It Yet

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Have you had insomnia all your life? Have your parents said you were a poor sleeper even as a baby?

Trouble sleeping that starts early in life is called idiopathic insomnia. If insomnia is still the black box of sleep disorders, then idiopathic insomnia is the little black box inside the black box.

Here’s what is known about the disorder and options for management.

What Is Idiopathic Insomnia?

Idiopathic insomnia begins in childhood, sometimes at or soon after birth. Trouble falling or staying asleep or reduced sleep duration is pretty much a nightly affair regardless of situational changes. The disorder is uncommon, affecting less than 1% of the population.

There is no identifiable cause. The presumption is that idiopathic insomnia is driven mainly by biological factors, and at least some of them are probably inherited. Abnormalities in the circadian system or the homeostatic process may be involved and/or there may be a problem in the circuitry controlling sleep and waking in the brain.

A Chronic Sleep Disorder, but How Well Defined?

Idiopathic insomnia is a chronic sleep disorder with familiar insomnia symptoms:

  • Trouble falling or staying asleep, or sleeping long enough, for more than 3 months despite adequate sleep opportunity
  • Daytime distress and impairment, including reduced stamina, low mood, and trouble thinking and learning

Research on the defining features of idiopathic insomnia is mixed. On one hand are a few studies showing significant differences between people with idiopathic insomnia (IdI) and those with psychophysiological insomnia (PI), the garden-variety insomnia that typically develops later in adolescence or adulthood. PI is often triggered by a stressful event; situational factors do not figure in IdI. PI is said to persist mainly due to psychological and behavioral factors that develop in response to poor sleep: conditioned arousal in bed, poor sleep hygiene (going to bed early to catch up on sleep, for example), and anxiety about sleep. Psychological factors are less typical in IdI.

On the other hand is research showing no major differences between PI and IdI when assessed by polysomnography (the overnight test in the sleep lab) or by self-report of psychological symptoms. Research suggests that arousal levels are higher among people with IdI than in people with other kinds of insomnia, though, leading some sleep experts to speculate that IdI is simply a more severe manifestation of PI.

What Can Be Done?

Without scientific certainty about the causes of IdI or whether the disorder is distinct from other kinds of insomnia, IdI is best treated on a case-by-case basis by a sleep specialist. Following are options for treatment.

Especially if a person with IdI has misconceptions and/or anxiety about sleep,

  • Cognitive behavioral therapy for insomnia (CBT-I) may help. CBT-I typically consists of two behavioral components—stimulus control therapy and sleep restriction therapy—and a cognitive component designed to decrease psychological barriers to sleep. Sometimes just changing your attitude about sleep can bring about demonstrable sleep improvements.
  • Acceptance and commitment therapy (ACT) may help. ACT focuses on building mindfulness skills so that, rather than trying to suppress, manage, and control emotional experiences, people develop psychological flexibility and learn to behave in ways that reflect their values and increase well-being. This approach, too, can change the way you feel about sleep and in the process improve your sleep.

If round-the-clock hyperarousal is driving IdI, then therapies designed to decrease arousal may help.

  • Regular, moderate-to-vigorous exercise—activities such as aerobics, calisthenics, biking, running, and weight-lifting—has been shown in recent studies to increase total sleep time and decrease levels of cortisol (a stress hormone).
  • Yoga, too, has been shown to decrease feelings of arousal and promote stress tolerance.

Medication for Idiopathic Insomnia

The issue of sleeping pills for chronic insomnia is increasingly fraught. Many drugs approved for the treatment of insomnia, taken nightly over time, may degrade sleep quality and result in alarming side effects, especially in older adults.

That said, while the medication prescribed for IDI is usually a benzodiazepine or a Z-drug such as zolpidem or eszopiclone, a second pharmacological approach, according to a paper by Michael Perlis and Philip Gehrman, involves use of a melatonin agonist such as ramelteon (Rozerem). No studies of the effects of this sleeping pill on the sleep of adults with IdI have been conducted. But in two studies of children aged 6 to 12 years with chronic idiopathic childhood sleep-onset insomnia, melatonin put them to sleep significantly sooner—by 1 hour.

If you’re contemplating managing lifelong insomnia with drugs, get some professional advice. This is one place where you really need the help of a specialist knowledgeable in the medical treatment of chronic insomnia.

At what age did your trouble sleeping start? What kinds of treatments—if any—have helped?