Monthly Archives: November 2009

PMS and Sleep

Women of all ages experience sleep changes in response to hormone fluctuations. Today let’s look at the sleep of women during their monthly menstrual cycle.

In 1998, the Sleep in America poll by the National Sleep Foundation was all about women’s sleep. Almost 50% of women reported that symptoms such as bloating, headaches, cramps, and breast tenderness interfere with their sleep 2-3 days each month.

Other women report being more sleepy just before their period. This is when progesterone levels are dropping rapidly. One woman shared with me that she needs to sleep an extra hour for the four nights before and during her period. This has been so consistent that she now puts the extra sleep time into her calendar so she can continue to function well on those days. She notices that when she does schedule extra sleep for that week she is less moody, irritable and emotional, has more energy, and can think more clearly.

If you struggle with PMS symptoms, see if getting more sleep helps you maintain a good quality of life during that time. Write to let me know what effect it has for you.

Tryptophan for sleep: Truth or Turkey?

Many stories abound about how the tryptophan in turkey or a glass of milk before bed will help you sleep.  Is this true or not?  Let’s look at the information.

Tryptophan is an amino acid found in foods.  Many amino acids combine to make a protein.  These proteins are then digested and broken down into the amino acids.  Amino acids are carried by the blood throughout the body.  When we think about sleep, the important organ is the brain.  There is a “blood-brain barrier,”  which substances in the blood need to be transported across.  Tryptophan uses the same transporter as several other amino acids.  If those amino acids are in the blood at the same time, they will compete with tryptophan, so less tryptophan will cross into the brain.

Why is tryptophan relevant to sleep?

Several of the neurotransmitters (brain chemicals) of sleep rely on tryptophan for their production.  Among these are serotonin and melatonin.  Melatonin has been discussed in other blog posts here.  Increasing tryptophan by taking tryptophan supplements does help treat insomnia.  These supplements provide higher doses of tryptophan than can be found in food.  Cottage cheese has the most tryptophan per serving, at 400mg tryptophan in 1 cup.  A 3oz serving of turkey provides 283mg of trytophan, and 1 cup of milk 110mg.

Does the tryptophan in our Thanksgiving turkey help sleep?

Thinking about the tryptophan basics we first discussed above, the tryptophan in turkey probably doesn’t help you sleep.  This is because there are other amino acids in the turkey, some of which may compete with tryptophan to be taken into the brain.  That said, enjoy the sleepy reverie that often follows the Thanksgiving feast!

Your Cortisol Rhythm and Sleep

Cortisol is an intrinsic hormone we all have. It is secreted by the adrenal glands on a regular daily basis.  There is a daily fluctuation in levels, called it’s circadian rhythm.  Cortisol should be low at night while we sleep.  It rapidly rises in the early morning, helping us have the energy to start our day.  Cortisol also can increase due to acute stress, such as an auto accident, or can be chronically elevated due to a chronic stressor.  It is thought that after long periods of chronic stress the adrenal glands get fatigued, so that cortisol is abnormally low.  Cortisol is typically elevated in depression, and low in Chronic Fatigue Syndrome (CFS).

So how does our cortisol levels affect our sleep? 

Cortisol is a wake-promoting hormone, so it can contribute to insomnia when it is high.  In my naturopathic sleep medicine practice we evaluate cortisol when the patient reports high stress levels and difficulty sleeping in the middle of the night.  Salivary cortisol levels are typically tested at four time points throughout a day – 7am, noon, 4pm and midnight.  The patients results are then compared to the normal profile. 

What will help normalize cortisol levels?

Many nutrients are needed by the adrenal glands to function well.  These include vitamins C, B6, and zinc and magnesium.  Some botanical medicines will also support adrenal function.  When the 24 hour cortisol profile is abnormal, supplements are typically recommended for 3 months, then levels are re-tested.  As always, it is equally (or more) important to address the underlying reason that the cortisol has gotten out of balance.  Behavioral approaches to decreasing stress include deep breathing, progressive muscle relaxation, good diet with avoidance of caffeine and alcohol, and good relationships.  If you suspect your cortisol levels may be affecting your ability to sleep consult with a physician for evaluation and treatment if necessary.

For more information about Naturopathic Sleep Medicine go to

Sleep Related Movement Disorders

Do you know someone who twitches their leg all night?   Or someone who feels like they just have to move their legs in the evening, or when sitting in a cramped theater?   Chances are, they may be suffering from a movement disorder.

What are Movement Disorders?

It is normal to move some during sleep, to change position, or have a few rhythmic movements.  In Sleep Related Movement Disorders a person moves part of their body involuntarily.   When these movements are associated with sleep disturbance or impaired daytime functioning they are classified as a disorder.   Commonly the arms or legs move, but in some cases the whole body is involved, as in Sleep Related Rhythmic Movement Disorder.   Tooth grinding at night, called Bruxism, is another movement disorder.   Let’s touch on the most common disorders.

Restless Legs Syndrome (RLS)

5-10% of Americans are thought to suffer from this disorder.   There is an irresistible urge to move the legs or feet, often accompanied by an uncomfortable or painful feeling deep in the legs.   RLS is usually worse in the evening or in cramped places like airplanes, and is better with movement or in the morning.   These symptoms can make it difficult to fall asleep at the beginning of the night, or return to sleep after awakening.   Restless Legs Syndrome tends to run in families.   RLS can be associated with iron deficiency, and for some people treating the iron deficiency will resolve their symptoms.

Periodic Limb Movement Disorder (PLMD)

About 80-90% of patients who have RLS have Periodic Limb Movements of Sleep.   These are repetitive, stereotypical movements of the lower extremity which may be as subtle as flexing the big toe.   These movements will disrupt sleep by causing brief awakenings that break up the normal sleep cycle, causing less restorative sleep.   Patients frequently will be unaware of these movements, it is only during the overnight sleep study that it is diagnosed.   Patients will however be aware of being fatigued during the day, and also have higher rates of depression, and attention deficit.

Because these disorders on our daytime health and well-being they need to be taken seriously and effectively treated.   Since people are unaware that these movements occur, please bring it to your bedpartners’ attention if they are moving excessively in his sleep.   Who knows, you just might be able to get a better nights sleep too!





The Winter Holidays and Acute Insomnia

The winter holidays can be filled with fun activities, celebrations with friends and family, and snow sports.  But holidays can also be stressful as we both maintain our regular responsibilities and prepare for the additional activities.  This year many people are also concerned about the recent economic downturn.  The combination of the holidays and economic concerns can lead to acute insomnia, the topic for today.

What is Acute Insomnia?

Acute insomnia is the inability to fall asleep within 30 minutes, or spending more than 30 minutes awake in the middle of the night.  Acute insomnia is a completely normal response to life events, and something we will all experience periodically.  It becomes chronic when it has persisted for more than a month.  Although it is normal in times of extra activity or worry, there are still habits we can put in place to help us get the sleep we need to feel good.

Healthy Sleep Habits during the Holidays

Below are several ideas to keep you sleeping well during the holidays.  Remember the effects of insufficient sleep that we’ve talked about in other posts, such as having emotional ups and downs, difficulty concentrating, poor manual dexterity, and fatigue.  Getting enough sleep allows us to really enjoy this season more fully.

– Plan a little time (20 to 40 minutes) to wind down before you get into bed.  This will allow you to fall asleep more quickly.  Spend this time doing something you enjoy that does not involve bright light like TV or computers.

– If your thoughts start to spin once you get into bed, start the habit of journaling.  The goal here is to put your thoughts to bed before you put yourself to bed.  Spend 10-15 minutes (no more) every day putting those thoughts down on paper a couple hours before bedtime.  Then if they arise during the night, tell yourself gently but firmly “I’ve thought about that already, and I’ll have time to think about that tomorrow.  Now is the time to rest.”  Although this sounds simple, it is amazingly effective.

– If you are going to stay up late for a party, plan to start the following day a little later, or slower.  Another option is to take an afternoon nap before your late night.  Don’t take a nap if you will be going to bed at your regular time, as it will make it more difficult to fall asleep.

– If there are regular tasks you do that can be suspended or rescheduled until after your holiday plans, consider doing it.  This will help preserve the time you need for sleep.

– Remember that drowsy driving can be as dangerous as drunk driving, so plan accordingly.

Melatonin, the Sleep Hormone

You have probably heard of melatonin, one of our bodies’ endogenous hormones. Today we’ll talk about natural melatonin cycles, how melatonin relates to health, and also how melatonin is taken as a supplement.

Your Natural Melatonin Cycle
Melatonin is a hormone produced by the pineal gland. It also acts as a neurotransmitter. In dim light conditions melatonin levels will start to rise about 2 hours before your habitual bedtime, and peak about 2 hours afterwards. This increase is partly responsible for tired feelings before bedtime. It will decline during the night and be at very low levels during the day. Melatonin is suppressed by bright light, such as sunshine.

People who are either “larks” or “owls,” have a melatonin rhythm that is different from the norm. This causes them either to get sleepy much earlier in the day – “larks”, or much later than usual – “owls.” An example is found during puberty in teenagers whose melatonin rhythm shifts later, causing their sleep and wake times to shift later.

Uses of Melatonin
Melatonin can be taken as a supplement to improve sleep. In the past, higher doses (5-10mg) were used like a pharmaceutical drug, and some people experienced a hang-over effect the next morning. Newer research has shown that much lower doses (.3-3mg), which are in line with the levels naturally found in the body, are just as effective.

– Precisely timed melatonin can be used to shift the habitual sleep time for those people who are “owls” or “larks.” Exposure to bright light can also be used to shift sleep times as it will suppress melatonin.
– Melatonin can be used by travelers to reduce jet-lag symptoms. It is especially effective when used in combination with a well-thought out sleep schedule, bright light exposure and limiting light with sunglasses.
– Melatonin can be a gentle aid in promoting sleep for those who have sleep onset insomnia. There are also time-released formulas for people who have difficulty staying asleep through the night.

You can always take advantage of your endogenous melatonin rhythm by going to bed at approximately the same time each night, and getting bright light exposure in the morning. This is one way to naturally keep your sleep healthy!