Don’t Let Insomnia Spoil the Summer

Do you experience a sudden onset of insomnia at about this time every year? Not much is written on seasonal insomnia that occurs in warm weather. Yet I’m convinced it’s a real phenomenon since my posts on summer insomnia get lots of traffic starting in May.

Here’s updated information—and speculation—on what could be causing the problem and how to get a better night’s sleep.

Waking up too early caused by bright summer sunriseDo you experience a sudden onset of insomnia at about this time every year? Not much is written on seasonal insomnia that occurs in warm weather. Yet I’m convinced it’s a real phenomenon since my posts on summer insomnia get lots of traffic starting in May.

Here’s updated information—and speculation—on what could be causing the problem and how to get a better night’s sleep.

Excessive Heat and Light

Late spring and summer are the hottest, lightest times of the year, and excessive heat and light are not very conducive to sleep.

In humans, core body temperature fluctuates by about 1.5 degrees Fahrenheit every day. Sleep is most likely to occur when core body temperature is falling (at night) and at its low point (some two hours before you typically wake up). Some research suggests that impaired thermoregulation may be a factor in insomnia, that sometimes you may simply be too hot to fall asleep. If so, a bedroom that’s too hot may exacerbate that problem, interfering with your body’s ability to cool down.

Light, too, can interfere with sleep. It does so by blocking secretion of melatonin, a hormone typically secreted at night. Exposure to bright light late in the evening or early in the morning—a phenomenon more likely to occur in months around the summer solstice—may keep you from sleeping as long as you’d like.

Other Possible Challenges to Sleep in the Summer

Swedish researchers have found that people with environmental intolerances to things like noise and pungent chemicals are more prone to insomnia than people without these intolerances. Depending on where you live, sleeping with open windows in the warm weather—if it leads to more noise or bad odors in the bedroom—could interfere with sleep.

Finally, new research conducted at Poznan University of Medical Sciences found that medical students in Poland had higher levels of circulating cortisol—a stress hormone—in the summer than in the winter. This is a preliminary result, and whether it can be confirmed or will hold true for the general population is unknown. Yet if humans do have higher levels of cortisol in the summer than in the winter, this, too, could have a negative effect on sleep.

Sleep Better in the Hot Weather

Climate control is the answer to many environmental triggers of insomnia in the spring and summer. Yet not everyone has air conditioning. If at night you’re too hot to sleep, take care to cool your sleeping quarters down in advance:

  • In the daytime, keep window shades and curtains closed to block out heat from the sun.
  • Later in the evening, use a window fan (facing outward) to draw cool air through the house. Open and close windows strategically so the bedroom is cool by the time you’re ready to sleep.
  • If your bedroom is on an upper floor that simply won’t cool down, sleep on a makeshift bed downstairs.

If keeping windows open at night exposes you to too much outside noise, block it out with silicone ear plugs or high-tech ear plugs, or mask it with white or pink noise using a small fan, a white noise machine, or SleepPhones.

Manage Your Exposure to Sunlight

Daily exposure to bright light helps keep sleep regular—but not if the exposure comes early in the morning or at night. Sunlight that awakens you at 5 a.m. or keeps you up past your normal bedtime may shorten your summer nights, depriving you of the full amount of sleep you need. If you’re sensitive to light,

  • Install light-blocking shades, curtains, and skylight covers on bedroom windows.
  • Purchase a lightweight eye mask for use during sleep.
  • Wear sunglasses if you’re outside in the evening.
  • At home, lower shades and curtains by 8:30 or 9 p.m. even if it’s still light outside, and start your bedtime routine at the same time as you do in other seasons.
  • Avoid devices with a screens in the hour leading up to bedtime.

Reduce Stress

If circulating stress hormones are an issue during the summertime (or if for any reason you’re feeling stress), then kicking back and relaxing, typical in the summer, is not necessarily going to be a dependable path to sound sleep. To reduce stress and sleep better, find a way to make regular aerobic exercise part of your day despite the heat:

  • Do the outdoor sport of your choice—walking, jogging, bicycling—early in the morning or early in the evening. Mall-walking may not be very sexy, but it sure beats walking in 100-degree heat.
  • Buy a seasonal membership in a gym or recreation center, where you can work out in air conditioning.
  • Take up swimming.

A woman recently wrote me wondering if the allergies she normally experiences late in April could trigger seasonal insomnia. I couldn’t find any information on this. But insomnia that routinely occurs at certain times of year is probably triggered by environmental or situational factors. Figuring out what the triggers are is the first step to finding a remedy.

Anniversary Book Giveaway Marks Change in Blog

It’s time for a couple of announcements: The Savvy Insomniac came out four years ago today and we’re giving away 10 copies of the book to mark the occasion. Read on to find out how to get one yourself!

Announcement No. 2: I’ve been blogging weekly about insomnia for five years and now, starting in October, I’ll be posting once a month. I’m as committed as ever to offering news and perspective on issues related to sleep and insomnia. But other projects are calling and taking more time.

Here are the giveaway details. After that, a summary of popular blog topics you’ll hear more about in the future.

Still blogging about insomnia—now, once a month

It’s time for a couple of announcements: The Savvy Insomniac came out four years ago today and we’re giving away 10 copies of the book to mark the occasion. Read on to find out how to get one yourself!

Announcement No. 2: I’ve been blogging weekly about insomnia for five years and now, starting in October, I’ll be posting once a month. I’m as committed as ever to offering news and perspective on issues related to sleep and insomnia. But other projects are calling and taking more time.

Here are the giveaway details. After that, a summary of popular blog topics you’ll hear more about in the future.

Book Giveaway

First, heartfelt thanks to those of you who follow my blog. It’s one thing to visit a website now and then but quite another to sign up for news from a blogger who posts a 600- to 800-word story every week! Your interest in insomnia and insomnia treatments must be as deep and personal as mine.

For all the blogging I’ve done about sleep and insomnia, though, The Savvy Insomniac is the best and most comprehensive writing I’ve done on the subject. Anyone living in the US who hasn’t got a copy and wants one can use the contact form to let me know. The first 10 people who contact me with a question about sleep or insomnia (something you wonder about but haven’t found much information about) will get a copy of The Savvy Insomniac free of charge.

Don’t forget to include your mailing address. Overseas shipping rates are so exorbitant that I can’t ship books abroad. But inexpensive e-books continue to be available through Amazon and other online booksellers.

Here, now, are the blog topics most popular with Savvy Insomniac readers. Count on hearing more about them in the months ahead.

Insomnia Relief in the Form of a Pill

Sleeping pills don’t get great press these days, but they have great interest for Savvy Insomniac readers. Posts about Belsomra, the newest sleeping pill approved for the treatment of insomnia, consistently get the most views. Belsomra acts as a sedative by blocking transmission of orexin, a neurochemical that promotes arousal. Other orexin-blocking sleeping pills are in the works. I’ll write about them if and when they’re approved by the FDA.

Posts about sedating antidepressants are also popular. Since many sleeping pills have undesirable side effects, persistent insomnia is sometimes treated with low doses of a sedating antidepressant. Doxepin has been approved as Silenor for treatment of sleep maintenance insomnia. The others (trazodone, mirtazapine, amitriptyline) have not been sanctioned by the FDA as effective for insomnia. They do, however, have sedative properties.

Melatonin supplements are also of high interest to readers, especially in timed-release formulations. But melatonin is not a sleeping pill. Its usefulness lies in its ability to shift the timing of sleep. Melatonin is sometimes recommended to night owls whose daytime schedules make it necessary to go to sleep earlier than they would following their natural inclinations. It also helps lessen jet lag.

Insomnia: What’s Your Flavor?

Posts on the different types of insomnia are the next most visited category. Since the underlying causes of insomnia disorder remain unknown, insomnia is usually classified based on the symptoms people report.

Psychophysiologic (or psychophysiological) insomnia is the most common insomnia diagnosis given to those of us who report trouble sleeping at night and daytime impairments. Symptoms are both physiological (bodily tension and warmth, for example) and psychological (anxiety about sleep). Cognitive behavioral therapy (CBT) is now the first-line treatment for psychophysiologic insomnia.

A diagnosis of paradoxical insomnia may be made following a sleep study showing a large discrepancy between how much time a person reports sleeping and how much sleep is recorded on the polysomnogram (the test in the sleep lab). Treatment options vary and there’s no clear consensus on which works best.

Sleep Restriction for Insomnia Relief

Sleep restriction therapy comes in for a close third topic of interest to Savvy Insomniac readers. Offered as part of CBT-I or as a standalone therapy, sleep restriction has been found in research to improve several aspects of sleep.

Its appeal to readers of this blog may have to do with the sheer number of posts I’ve written on the topic (10) and the fact that it worked so well for me. Combined with daily exercise, sleep restriction helped me regularize my sleep and overcome my sleep anxiety. Invaluable gains, to me.

Seasonal Insomnia

Insomnia that varies seasonally is another topic that draws lots of readers. Environmental factors that occur in the spring and summer—too much light and too much heat—can easily interfere with falling and staying asleep.

Insomnia that starts in the fall and continues through the winter may be driven by other environmental factors. Lack of sunlight or other bright light is usually the culprit. Lack of vitamin D may be another factor. Expect to see an update on this topic coming fairly soon.

Don’t see a topic that interests you here? Use the contact form to ask a question about a topic that does interest you, and receive a free copy of The Savvy Insomniac.

And here’s a last request: please like and share blog posts you feel are helpful on Facebook, Twitter, and other social media. This will help The Savvy Insomniac blog remain discoverable to other insomnia sufferers looking for a better night’s rest.

Sleeping Pills: Too Risky, or a Red-State, Blue-State Affair?

How do people with insomnia feel about sleeping pills?

Attitudes toward sleep medications differ from one American to the next, and between Americans and Australians, it turns out. Here’s a brief comparison that I hope will start a conversation.

Sleeping pills are viewed differently in Australia and the USHow do people with insomnia feel about sleeping pills?

Among 51 insomnia sufferers interviewed by Australian researchers in Sydney, both users and non-users of sleeping pills (or sleeping tablets) held negative views of sleep medications.

When I asked this same question of the 90-odd American insomniacs I interviewed for my book, the response was more divided. Some people viewed prescription sleeping pills as harmful and said they’d never use them. Others felt their sleep medications were helpful and would not want to give them up. Here’s what I wrote:

Poll the sleepless about sleeping pills, and you come up with . . . a red-state, blue-state affair. In one camp are the pill abstainers . . . and in the other, insomniacs who’d sooner dump their iPhones than part with their pills.

Pro or con, attitudes about sleeping pills are often strongly held. Following is a brief comparison of Australian and American attitudes that I hope will start a conversation.

Safety vs. Effectiveness

Both the Australians and the Americans felt that pharmaceutical sleep aids were stronger and more effective at putting people to sleep than over-the-counter (OTC) sleep aids or “natural” sleep aids such as valerian or melatonin.

But most Australians said they didn’t like taking sleep medication. They expressed a definite preference for natural products based on the notion that natural products were gentler on the body and had fewer harmful effects. In the majority view, safety concerns outweighed concerns about sleeping tablets’ effectiveness.

“I’ll take something that isn’t as effective so it doesn’t have any negative consequences,” said a man quoted in the Australian study.

A woman, comparing how she felt about taking the sleeping pill temazepam (Restoril) with how she felt about about the prospect of taking melatonin, said this: “I felt it’s a more natural remedy than the temazepam. So I think I was less stressed about taking it.”

But the Australians were divided as to whether prescription or OTC medication was the safer option. Some thought OTC sleep aids (medications containing diphenhydramine, such as Benadryl and Tylenol PM in the United States) were safer because they were available without a prescription and therefore less potent and apt to have fewer side effects. Others felt the safer alternative was to go with a prescription medication recommended by a doctor who was familiar with one’s individual medical needs and could supervise the process.

Among Americans, a Split

About half of the insomniacs I interviewed felt they needed medication to get a good night’s sleep and were mainly concerned about medications’ effectiveness. Jane M. wrote the following comment on one of my earlier blogs. It epitomizes the feelings of insomniacs who were satisfied with the sleeping pills they were using, having decided the benefits outweighed concern about risks.

“I was first prescribed Ambien many years ago, and don’t think I could have continued my work life this long without it. I sleep soundly eight hours every night, wake up with lots of energy, and have always wanted to meet the discoverer of the formula to thank him or her.

“My gratitude is deeply felt. My mother, who died in 1983, sat up half the night for years. I think there are genetic issues, hormone issues, aging issues . . . I could walk 20 miles a day and I still wouldn’t be able to fall asleep. Some people have asked, ‘What if you become addicted?’ to which my answer has always been ‘So what?’ I am addicted to sleep, good health, and a strong work ethic. Ambien has made it all possible for me into my mid-70s.”

Some Americans Concerned About Risks

The other half of my respondents voiced reservations about sleeping pills, similar to the Australians. Their reasons were mixed. Some did not think of insomnia as a medical problem, preferring to address it through changes in lifestyle or psychotherapy rather than with drugs.

Other insomniacs shied away from using sleeping pills because of negative feelings about medication overall and about prescription hypnotics in particular. Still others felt they simply couldn’t tolerate such potent medication.

“I can’t take any hardcore pharmaceuticals,” an insomniac told me. “A mild antidepressant, that’s something I’d consider. But I’m afraid of sleeping pills.”

Unlike the Australians, few of the American insomniacs I spoke with had anything good to say about so-called natural sleep aids—herbal teas, melatonin, lavender. Based on my interviews, I would venture to suggest that here in the United States, the concept of the natural sleep aid does not have the strongly positive connotation it has in Australia.

But some Americans said they got relief from insomnia using OTC sleep aids like Benadryl and Unisom, which they felt were likely to be gentler and less harmful than prescription pharmaceuticals.

Accounting for Attitudinal Differences

The differences (and similarities) spelled out here may not be representative of Australians and Americans overall. The sample sizes are small, and the years when the interviews were conducted were different (2013–2014 for the Australian study; 2004–2008 for my book). Physician prescribing patterns and the public health information patients receive about insomnia and sleeping pills may be different as well.

But my point is not to make an evidence-based claim about attitudes in Australia and the United States. Rather, I’m interested in knowing how readers of this blog feel about sleeping pills, OTC sleep medications, and “natural” complementary sleep aids, and why.

Please take a minute to comment below, and like and share on social media. Thank you!

Could Pumpkin Seeds + Carbs = Better Sleep?

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. Here’s more information about it.

Insomnia sufferers may want to try a sleep aid called Zenbev Drink Mix, made from pumpkin seedsLet’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 carbohydrate. Another week, the food bars contained pharmaceutical-grade tryptophan mixed with carbohydrate. 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.

Can Heavy Use of Computers Cause Insomnia?

I spend most workdays at the computer. Then I spend an hour or more of leisure time surfing the web and answering emails later in the day. And I wonder: does my heavy computer use—mostly work related—increase my susceptibility to insomnia?

A recent article on the relationship between sleep problems and computer use at work and during leisure time offers insight into that. Here’s the scoop:

Insomnia can be the result of heavy computer use at nightI spend most workdays at the computer. I start at 6:30 in the morning and finish about 7 hours later when my brain runs out of steam. It’s not unusual to spend some or most of the workday on the computer, according to statistics from the Organisation for Economic Cooperation and Development. In 2012, some 64% of working Americans were using computers at work.

In addition to my work-related computer use, I spend an hour or more of leisure time surfing the web and answering emails later in the day. And I wonder: does my heavy computer use increase my susceptibility to insomnia?

A recent article on the relationship between sleep problems and computer use at work and during leisure time offers insight into that. Here’s the scoop:

A Relationship Between Computer Use and Sleep

The researchers took their data from the 2010 Danish Work Environment Cohort Study, a series of questionnaires used to assess the work environment and health and habits of the general working population of Denmark every 5 years. Respondents included 7,883 currently employed wage earners in every major occupation. All worked during the daytime.

The researchers analyzed information about workers’ average weekly computer use at work and their use of computers during leisure time, presumed to occur in the evening. They also used information about workers’ sleep, assessed with questions taken from the Bergen Insomnia Scale. In addition, they took into account several factors that can affect people’s sleep: body mass index and chronic health conditions, for example; work conditions, such as demands made of workers and their influence at work; and workers’ level of physical activity on the job and during leisure time.

Sleep Effects of Computer Use at Work

Even after investigators controlled for all the variables, their results showed no relationship between work-related use of the computer in the daytime and the soundness and quality of workers’ sleep at night. So I guess I can’t blame my insomnia on my 7 or 8 hours of screen time!

(Take note, though: excessive screen time is known to have other harmful effects, including eye strain, dry eyes, and blurred vision. Also, the heavy use of blue light-emitting devices with screens may have more serious long-term effects such as the earlier formation of cataracts and macular degeneration.)

Sleep Effects of Computer Use During Leisure Time

Light or moderate use of the computer during leisure time had no effect on workers’ sleep at night. But workers who spent 30 or more hours a week (that’s an average of between 4 and 5 hours a day) on the computer in their free time were almost twice as likely to have severe sleep problems as those whose leisure-time computer use was more limited—even after adjusting for all the confounders listed above.

Other studies have shown that, used at night, computers and other devices with screens interfere with sleep. The usual explanation is that the light they emit blocks secretion of the hormone melatonin, thereby delaying sleep onset. The psychological arousal associated computer gaming, use of social media, and/or working at night to meet tight deadlines might also contribute to the sleep problems of those who spend lots of time on the computer at night.

But the take-away here, the authors conclude, is that any negative effect of light from the computer screen on sleep is relatively short lasting. It’s heavy use of computers at night that might cause you to experience insomnia—not being married to the computer during the day.

How many hours a day do you spend on the computer? Have you noticed it affects your sleep?

Tart Cherries: Helpful to Sleep but Harder to Find?

First, the good news: a small body of research suggests that tart cherry juice holds promise as an alternative treatment for insomnia, especially in older adults.

Now for the bad news: tart cherry juice, already pricey, is set to become pricier still as growers weigh whether to give up on cherries and plant apple trees instead. Here’s more on the benefits of tart cherry juice for sleep and why it may soon become scarce.

Insomnia, alternative treatment tart cherry juice not so plentifulFirst, the good news: a small body of research suggests that tart cherry juice holds promise as an alternative treatment for insomnia, especially in older adults.

Now for the bad news: tart cherry juice, already pricey, is set to become pricier still as growers weigh whether to give up on cherries and plant apple trees instead. Here’s more on the benefits of tart cherry juice for sleep and why it may soon become scarce.

Sleep Benefits of Tart Cherry Juice

A handful of studies conducted on the effects of tart, or Montmorency, cherry juice on sleep suggest it may be helpful for people with insomnia:

  • It may help you sleep longer. In a randomized controlled trial (RCT) published in 2012, drinking tart cherry juice concentrate mixed with 8 oz. of water twice daily for 7 days increased the total sleep time of 20 healthy volunteers by an average of 39 minutes.
  • Seven older adults with insomnia slept over an hour longer after 2 weeks of drinking 8 oz. of tart cherry juice twice a day. Results of a randomized crossover trial presented at the 2014 meeting of the American Society of Nutrition (still unpublished) showed that participants’ total sleep time increased by an average of 84 minutes.
  • Tart cherry juice may cut down on nighttime wake-ups and improve sleep quality. In an RCT published in 2010, drinking 8 oz. of tart cherry juice twice daily for 2 weeks significantly cut down on wake-ups and insomnia severity in 15 older adults with sleep maintenance insomnia.
  • The same twice-daily regimen of tart cherry juice had similar effects on the sleep of 30 healthy young, middle-aged, and older adults in a study published in 2013. Older participants’ sleep improved the most.

The evidence is not conclusive: these studies were small and only two looked specifically at the effects of tart cherry juice on people with insomnia. Still, unless you dislike or can’t tolerate tart cherries, drinking tart cherry juice twice a day is worth consideration as an alternative treatment for persistent insomnia.

Melatonin and Tryptophan-Enhancing Effects

Montmorency cherries are rich in melatonin, a sleep-friendly hormone secreted by the pineal gland at night. Melatonin production often falls off as people age, and lower levels of endogenous melatonin can make it harder to get to sleep and stay asleep at night. Tart cherry juice may exert its soporific effects mainly by increasing levels of melatonin at night.

Another mechanism by which tart cherry juice may benefit sleep can be found in the effect it has on tryptophan. Tryptophan is an amino acid humans need but cannot produce themselves, so it must be gotten in food. Tryptophan is a precursor to both melatonin and serotonin, a neurotransmitter important to sleep. Researchers who conducted the 2014 study found that tart cherry juice inhibited the degradation of tryptophan, thereby making more of it available for serotonin synthesis.

The sleep benefits of Montmorency cherry juice may be due to both its melatonin and tryptophan-enhancing effects.

Climate Change and Market Forces

But some fruit growers are now on the verge of abandoning cherry orchards and planting apple trees instead. Two factors are behind the change, according to an Interlochen Public Radio report last week:

  1. Most of the nation’s tart cherries are grown in northern Michigan, where almost the entire cherry crop was lost in 2012 due to an early spring followed by over 2 weeks of below-freezing temperatures. Cherry trees planted in Michigan are actually shipped from nurseries in the Pacific Northwest. Extreme weather events there have killed off thousands of cherry saplings. Michigan orchardists who want to continue producing cherries now can’t buy enough young cherry trees to replenish aging stock.
  2. Also, the demand for apples is on the rise, and growers are planting high-density varieties so they can plant many more trees per acre of land. Commercial nurseries are now struggling to keep pace with the demand for apple trees. Nursery owners may decide that planting for small specialty crops like cherries just isn’t worth it any more.

Now back to trouble sleeping: if you find that tart cherry juice helps you sleep, you’d be wise to stock up on it now.

Timed-Release Melatonin for Insomnia

A friend recently called to talk about insomnia. Her problem, she said, was that she couldn’t sleep past 3 a.m. Her doctor recommended taking melatonin and she wanted to know what I thought of this advice.

If you’ve got the type of insomnia where you wake up too early or too frequently (sleep maintenance insomnia), you may be interested in this update.

Timed-release melatonin may help people who awaken too early or too frequentlyA friend recently called to talk about insomnia. Her problem, she said, was that she couldn’t sleep past 3 a.m. Her doctor recommended taking melatonin and she wanted to know what I thought of this advice. Coincidentally, last week ConsumerLab, a company that tests and reviews dietary supplements, published a review of melatonin supplements.

If you’ve got the type of insomnia where you wake up too early or too frequently (sleep maintenance insomnia), you may be interested in this update.

Hormone and Supplement

The melatonin found in supplements is chemically identical to the sleep-friendly hormone produced at night in the brain’s pineal gland. Secretion of melatonin begins about 2 hours before bedtime and continues through the night, falling off at wake-up time.

Melatonin supplements are thought to be quite safe. They can help night owls fall asleep at an earlier hour. Timed right, supplements can also ease jet lag. But as a treatment for people with sleep maintenance insomnia, melatonin supplements often come up short.

Melatonin and Aging

Melatonin production often falls off as people age. This may occur because of degeneration of neurons in the circadian system or partial calcification of the pineal gland. The resulting low levels of melatonin make it harder to get sound, restorative sleep.

In theory, supplementary melatonin should take care of the problem. The reality is that often it doesn’t. One reason is that the melatonin in most over-the-counter supplements is fast acting. It reaches its maximum strength and is metabolized by the body quickly. The half-life of most melatonin supplements is quite short: 20 to 45 minutes. (Half-life refers to the time it takes for a dose of a drug in the blood plasma to decrease by half.) Compare this to the 5-7-hour half-life of Lunesta, the top-selling prescription sleeping pill in 2013.

Taken before bedtime, most melatonin supplements lose potency too quickly to help users sleep through the night.

Timed-Release Melatonin Supplements

The answer to this problem may lie in some type of timed-release formulation of melatonin. Circadin is one such drug. It’s available by prescription for adults 55 and older in several countries outside the United States. The drug has a half-life of 3.5–4 hours, so it’s longer lasting than most melatonin supplements sold over-the-counter. Clinical trials suggest that compared with placebo, Circadin improves the sleep quality and morning alertness of older adults with insomnia. (Apparently, the trial results are not convincing enough for the drug to gain approval in the US.)

ConsumerLab’s review of melatonin supplements acquainted me with timed-release formulations now sold over-the-counter in the US. Here are some examples:

  • Natrol Melatonin Time Release (1, 3, 5, and 10 mg, advertised as released over 8 hours)
  • Source Naturals Timed-Release Melatonin (2 and 3 mg, advertised as released over 6 hours)
  • Life Extension 6 Hour Timed Release Melatonin (300 and 750 mcg and 3 mg, advertised as released over 6 hours)

No spokesperson I reached at these companies was able to explain exactly what sort of testing was done to establish the 6- and 8-hour release times. Unlike pharmaceutical companies, manufacturers of dietary supplements do not have to conduct clinical trials or obtain approval for their products from the US Food and Drug Administration. Supplement makers are essentially allowed to police themselves, required only to gather enough evidence to show that their products are safe and that claims they make about them are not untrue or misleading. (ConsumerLab did not test the timed-release feature of these drugs.) How long the melatonin in these products will remain active in your body, and how likely the supplements are to improve your sleep quality or reduce your nighttime wake-ups, is impossible to know.

Still, people with sleep maintenance insomnia who decide to try a melatonin supplement are probably better off with a timed-release product than the immediate-release type.

Dosing

Even low-dose melatonin supplements (0.1–0.5 mg) contain a lot more melatonin than humans produce naturally. So taking higher doses (2–10 mg) may leave you feeling groggy in the morning. This is especially true for older adults, who process drugs more slowly.

Starting with a low dose seems like a smart idea.

Have you tried a timed-release melatonin supplement? If so, did it help you sleep, and did you notice any negative effects?

Insomnia Advice Can Miss the Mark

People sometimes offer advice when they hear about my insomnia. Their suggestions are not always helpful.

In fact, I used to feel impatient with–and occasionally hurt by—comments that to my ears sounded judgmental or attitudes toward insomnia that I felt were just plain wrong. The comments were well meaning, but that didn’t make them easier to tolerate. Here are a few that put me off and what I think about them now.

Advice about insomnia can hurt rather than helpPeople sometimes offer advice when they hear about my insomnia. Their suggestions are not always helpful.

In fact, I used to feel impatient with–and occasionally hurt by—comments that to my ears sounded judgmental or attitudes toward insomnia that I felt were just plain wrong. The comments were well meaning, but that didn’t make them easier to tolerate. Here are a few that put me off and what I think about them now.

There must be a part of you that doesn’t want to sleep.

No doubt this suggestion was meant to be insightful, but I found it exasperating. The idea that there might be a twin self lurking inside me that wanted to stay awake (to do what? force myself to read when my eyes could barely focus? play another round of Internet solitaire?)—just how crazy did that make me sound?

Normal sleepers may assume that people who have insomnia actually want to remain awake because of a belief that sleep can be regulated voluntarily. This belief is fairly common, and some people do seem to have quite a bit of control over their sleep. I once knew a woman who could will herself to take a 10-minute cat nap whenever and wherever she pleased. And what about the lucky ones that drop right off in their seats even before the plane is finished boarding?

Sleep is more complicated for people with insomnia. Yes, there are habits and attitudes we can adopt to avoid sleep problems and we should do this. Yet wanting sleep is not always enough to make it happen–any more than a person with asthma can breathe easily on command.

Something has to be causing your sleep problem. Maybe it’s time you went to a therapist to figure it out.

The suggestion that insomnia was a symptom of a larger psychological problem was dismaying. I doubted very much that an unresolved internal conflict was driving my insomnia–that, despite my years of psychotherapy, a dark secret buried in my unconscious was keeping me awake. Or that I was actually deriving some benefit from insomnia (the sympathy of friends, for example) and this was keeping it alive.

A general practitioner actually made the above suggestion to me not 10 years ago. Obviously he hadn’t read Harvard sleep scientist Gregg D. Jacobs’ book, Say Goodnight to Insomnia, in which Jacobs writes, “There is not one scientific study demonstrating that psychotherapy is effective in treating chronic insomnia.”

Theories about the psychological origins of insomnia were predominant for most of the twentieth century, though, so it’s not so surprising that people—even some doctors—put stock in them still. These days, people who study chronic insomnia say the disorder develops due to many factors: biological, situational, behavioral, and attitudinal. As for the suggestion that a therapist could help me “figure it out,” well, all the world’s sleep scientists haven’t been able definitively to do that yet. So a lone psychologist would surely come up short.

Have you tried melatonin/valerian/yoga/warm milk?

It still surprises me when people offer suggestions like these as though they were novel ideas. I know people are only trying to be helpful and that it’s curmudgeonly of me to complain. But anyone who hasn’t heard of these insomnia remedies has never been on the Internet or read a magazine!

These sleep aids remain popular because sometimes they work: Night owls, for example, can use melatonin successfully to shift their sleep to an earlier hour. Valerian taken nightly has been shown in some studies to improve sleep. The daily practice of yoga reduces arousal and builds resilience to stress, which will have a positive effect on sleep. Milk contains the sleep-friendly amino acid tryptophan. Combined with a complex carbohydrate, it makes a good bedtime snack.

But a person with chronic insomnia has probably been there and done that, not to mention experimenting with a raft of other sleep aids. Sometimes I think we could do with a few more expressions of sympathy and a little less “helpful” advice.

What suggestions have people made about your sleep problem that annoyed you?