Insomnia: 

A “quick” overview of the many components to consider to get some good sleep  

by Dr. Alan Kadish

With the consistency of insomnia, for many of my patients, I’d like to suggest a non-toxic and self-help method to start the process of changing toward a more appropriate restful and restorative cycle. I want you to recognize that sleep is not an option, it’s a necessity for good health. You can live without food for a few days and still function, not so without sleep !

Sleep is a complex intermix of many considerations including light and darkness, temperature, comfort and spinal support, air flow and quality–along with changes occurring from our last meal and the body’s control of our blood sugar levels, coupled with control of our fluid intake prior to bedtime. We now have many more insights towards making changes. Never underestimate the seemingly small changes  you can make, as all of your inputs will be cumulative and many will be well worth the effort. 

We can easily start the process of maximizing a great place to sleep by following some simple preparations. This is a listing of the various areas to consider. 

Timing:

Light:

Sound:

Bedding:

Heat/Cooling:

Air Quality:

Supplements and Medications:

Chinese Medicine:

Acupressure:

Monitoring sleep:

  

Timing:

There is much to be said for having consistent times that we both prepare for bed and get to bed. The chaotic lifestyle is not one that bodes well for sleep quality. When you consider your or your child’s schedule, pick some clear and relatively easy to implement time frames. We need different amounts of sleep dependent on a host of factors. The literature is still very much debating the best methods to get achieve optimal sleep patterns. There are indications that we are doing a great disservice to our middle and high school student by scheduling classes early in the morning. Clearly as an adult with work responsibilities our flexibility is limited for most people. With that in mind, there appears to be a need for between 7-9 hours of sleep for most adults and more for early ages and possibly less for the elderly. Most of us have had enough time to find what works best. We may not be able to get that many hours or schedule ourselves to accommodate our situation, but getting as close as possible to the ideal should be our goal.

Hard and fast rules may not apply to anyone with an illness, a muscle or joint issue or a metabolic disturbance, so we need to keep this in mind when considering your optimal sleep scheduling. 

Naps for the younger group is almost a necessity and can be an excellent way to modulate the schedules of their parents so that everyone gets a good night’s sleep. There are those people who are the “night owls”. They actually have a different cycling of their brain chemistry. This subgroup may need to adapt to their brain’s function or slowly adapt using a number of available methods.

Many in the sleep industry are clear that if you find it takes more than ~30 minutes to initiate sleep, get up and start to unwind again, don’t persist and just lay in bed. We can develop a number of strategies to make the sleep transition easier and more healthful. Start by going through the listing of making a good bedroom environment. 

Light: 

The room should be completely dark and not have light leaks, as even small amounts can completely disrupt the brains ability to manufacture adequate melatonin levels and get proper signals to the brain. Dark shades or combinations of drapes and other window treatments are a must. For those who have used night-lights, a change to a very low wattage red bulb is a must. There are a number of colors that will give false signals to the brain and have us believing it’s time to awaken. Red light will keep the triggers below the threshold level. Even better is to use the light initially and then have it on a timer and extinguished during the majority of the evening. 

The bathroom light, commonly left on or turned on if you use the restroom during the evening, is a disaster. It’s the last thing you want to turn on as you will have effectively destroyed the sleep cycle in your brain. Once again, a small red light such as an LED light discretely placed to not shine in the eyes is a much better option and can still make certain that you can safely navigate the restroom. 

Speaking of disruption of a cycle, the use of the blue backlighting found in almost all electronic pads, computers and smart phone displays will effectively disturb a sleep cycle. Always try to pattern a break in the light intake of your eyes, before bed. Some practical ideas include the reading of a book with a backlit lower intensity lighting, listening to calming music or for some a light workout or a bath or shower with lower intensity light in the bathroom areas. These patterns will make for a much better means to sleep induction. 

Sound:

Although we all don’t have the luxury of sleeping in a totally quiet environment we can minimize noises. If you’re not certain that there are noises being made at night use your smartphone. Most smart phones have a recording option application either built in or available for free on the internet. You can leave it on record during the evening hours and then with a quick playback get an accurate idea of the noise that your home and neighbors create. 

Not all noise is bad when you think in terms of sleep. Consider the typical experience of someone who goes to the coast or a river and is lulled to sleep by the white noise of the natural environment. You can easily recreate this on a phone or pad as there are no lack of excellent applications available, for free. Use the timers or even consider leaving them on during the whole evening. If you prefer a fan or other repetitive sound, that too can be an excellent choice. 

Bedding:

This is a subject that is a book let alone a paper on to itself. Most of us are poisoning ourselves by utilizing conventional bedding, which by law has to be treated with fireproofing agents. Most of this chemical group have been banded by the Europeans years ago and in only 2 states, as of the time of this article’s writing, are also partially controlled and limited. (Washington and Vermont) This is one area where a few extra dollars spent pays back in good health dividends. I will include specifics for the PBDE family of fireproofing agents as well as those of the other components, adhesives and moldicides all commonly found in your mattresses, in another article.

If you consider that we spend on average approximately 1/3 of our lifetime in a bed and for your youngster close to a 1/3 or more of their hours per day, this is a major input to our health. There are a number of choices that make sense and can truly impact your child’s health. Consider a latex, not memory foam or some other petrochemical derived foam product or an organic cotton spring-based mattress. For a full discussion of the options and how to purchase a bed at a reasonable price please speak to our staff or myself. 

Remember we haven’t even started the conversation regarding the other person potentially disturbing your sleep, if they move or change other circumstances.

Heat/Cooling:

Finding the correct level of heat and cooling is a matter of providing a draft free air circulation while maintaining a slightly cool environment. It may take redirecting a vent or moving some furniture. Maintaining good consistent temperatures can be achieved with many of the newer thermostats.

Consider turning down the temperature a few degrees during the evening hours. Experiment with how your child’s bed appears in the morning, before they’re up and about. Are the covers still on the bed/child or is the child hugging the blankets or under same ? Admittedly the covers can be arranged for any number of reasons but it should give you a starting point to adjust the temperature to the best levels. 

Air Quality: 

Having clear properly humidified air to breath is obviously important all the time for everyone. When we sleep our metabolic levels change along with our breathing patterns. A clean, from the perspective of particulates and chemicals, environment will be a much more healthful situation and can be the key to a good night’s sleep.

Remember to not use harsh toxic cleaning agents and have the minimum of chemicals off gassing in the bedroom. This can also include a list of often forgotten materials including: marker pens, makeup, magazines with odors, toys with fragrances and off gassing plastic products (shower vinyl curtains). 

We want to make certain that no mold issues are present. If food products are consumed in the room it’s another potential source of a problem. It’s worth a quick look with a flashlight under the sink if there is an attached bathroom to the bedroom. Also look at the cleaning agents that you have in the general vicinity.

Bleaches, bottles of alcohol, fragrances and a host of other common products should be eliminated. These so called sealed closed bottles all outgas and the chemicals can be found in small to moderate concentrations in the air, including in the next room. 

Dusty environments are also a consideration. Have you checked under the bed for dust bunnies or see a coating on the shelves ? We want to minimize any irritation of the lungs that can cause a cough or other sleep interrupting process. Dusting a room only moves the dust to other lower areas, ie the carpet or floor. To clean a room use a damp cloth or better yet use a vacuum that exits the air outside, such as a built in vacuum cleaning system or as an alternative use a HEPA vacuum cleaning system. For more on this subject please see the article on cleaning your home.

Dependent on your location we should also consider the moisture levels in your home and bedroom. Optimal levels are in the low 40%. You can easily know what’s present by using a combination temperature/humidity meter, easily obtained online or at your local store for ~10 $. New monitors attach to your phone wirelessly and can give you a whole days worth of information. Leave it in the bedroom and check periodically. A dry throat or mold because of too much moisture will disturb anyone’s sleep. 

Supplements and Medications:  

I would very much like to suggest that the use of prescription medications should NOT be utilized until all and every other option has been exhaustively tried. All of the prescription products have significant downsides and interrupt good sleep cycles. 

Our initial intent is to mimic the light cycle our bodies have been programed to expect. We produce more melatonin when the lights go on and much less when the lights go out. 

Melatonin is probably one of my favorite champions among the natural, inexpensive and non-toxic choices. The dosage range is anywhere from .5 mg to 3 mg’s and can easily be administered as the tablets dissolve under the tongue and don’t have much, if any, taste. There are some caveats to the use of this supplement. Always be alert to the next day’s awakening when you start using the product. If there is a drowsiness or sleepiness more than without the use of the supplement, you’re probably using too large a dose of the product and should try a bit less. Interestingly for some patients the lower dosages have been more effective. Melatonin should of the

We have a number of approaches for getting the sleep cycle induced via natural means. Two products, 5-hydroxytryptophan and the precursor tryptophan are found naturally in our bodies and can be supplemented effectively to increase melatonin production. Curiously the highest concentration of naturally occurring tryptophan is found in pumpkin seeds. In my practice, I have found a number of excellent powdered sources that can be mixed with a small amount of fluid and work within a very short time frame. Other amino acids, such as GABA and inositol can be also employed and have a very positive sleep response. Often times we may use a combination product as there is a synergy between the B vitamins and the amino acids. 

For many of our children the growth cycle and their diet restrictions places a higher demand for some minerals. Principally, but not exclusively, the levels of magnesium and calcium can be found to be less than optimal. Often I will use a powdered format mixed with some fluid at dinner time or pre-bed time to assist in meeting the demand of a growing body. Both of these minerals have multiple forms with most of the over-the-counter products in the less expensive format that results in less absorption. Always remember that it’s not what you place in your mouth that counts. It’s what reaches the cells that matters. This combination of minerals has the ability to relax the overall muscle tone and is integral with numerous metabolic processes that are essential for proper overall function of our systems. 

I would be remiss if I didn’t include the various teas and other herbal products that I have found to work well. I am a fan of chamomile tea. This is an age old remedy that stands the test of time and should be considered for anyone. 

In the area of herbal products I am a bit more reserved due to the issue of the quality, quantity of active ingredients, contaminants and excipients all considerations with those who are sensitive, especially the ASD patients. This is not to say that they cannot be used, however since we have such a large group of other means to get our children to sleep, I will utilize the herbal approaches as a later consideration.  

Chinese Medicine: 

Other helpful ways to stimulate sleep includes the use of acupressure. This is a simple way to both interact with your child, calm them pre-bedtime and actually has a medicinal input that can result in amazing responses. 

In the practice of (TCM) Traditional Chinese Medicine there are specific meridians that come into play as we go through the day. This is known as the Chinese clock. A good description regarding the clock and sleep can be had at: http://thepowerof4-paula.blogspot.com/2010/09/keep-your-gallbladder.html 

Here are some recommended acupuncture/acupressure points for sleep. Please appreciate that to more specifically address your child’s need a well versed Acupuncturist is the best resource.

Acupressure 

Start with the wrist, lower leg and back acupressure points first. Apply mild to moderate pressure using only a single finger and after a while you will notice that there is a specific sensation or response both you and your child will notice, when at the pressure point. Keep in mind that the intent is not to create any level of pain, but rather a mild stimulation. You will note that the level of pressure needed may vary dependent on a host of factors, so always start gently and progressively apply more input. You may need to hold the spot for as few as a number of seconds or even minutes. With some practice you will feel a difference as the energy changes and you should remain focused on the changes your child is noting. 

To locate a specific acupressure point go to this site: Qi-Journal.com They have an easy to locate specific picture for you to reference where the point is well documented with a flashing red dot.

I would recommend that you print a couple of copies of the chart and have your child work with you to tell you or indicate how they feel at each of the points. Marking the chart will give you an easy way to create a pre-bedtime segway toward better sleep. 

Some of the common points to use are Heart 7 and Spleen 6 are very common starting points and can be used along with Urinary Bladder points 10, 17, 18, and 23.  Try this combination initially and then consider adding one point more at the next session, if needed. 

Start with CF 15, Conception Vessel 14, Liver 14, Liver 13, Kidney 16, Stomach 27, Conception Vessel 4, Kidney 1. 

If person is tired, anemic, add: Urinary Bladder 20, Urinary Bladder 15, Urinary Bladder 17 and Spleen 1. 

If anxiety, nervousness or anger are part of the pre-bedtime experience consider adding these points: Urinary Bladder 18, Urinary Bladder 19, Gall Bladder 12. 

If your child has been dealing with digestion issues you might want to consider adding these two additional points: ST 36, Urinary Bladder 21.

For more on acupressure points and a bit more regarding the art of choosing points go to: Traditional Chinese Medicine for Sleep/Insomnia  

Monitoring Sleep: 

If you’re unsure of the quality of your sleep an excellent aid is an application known as: Sleep Cycle

It’s easy to use and can give you indications of how deep and consistent the nights sleep really was in detail. This free application is very highly recommended. I also understand that another application, SleepBot  is another similar app to consider.

It goes without saying that the issues of apnea, where one has a restricted or disturbed change in their respiration when they sleep is a subject for extensive discussion. It’s impossible to maintain proper brain function when your oxygen level drops below a level of adequate  oxygen saturation. I will endeavour to post an article specifically on this subject.

 

If you’ve read this whole article you will undoubtedly appreciate why it’s important to have us evaluate the whole picture. Sleep is not an option it’s a necessity for good health. Please see us for assistance with your insomnia, there are options.

Copyright Center of Health™ 5/2014  For permission to reprint this article, please contact the author.

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Dr. Kadish is an unusual physician often referred to as a "doctor detective". His expertise is the evaluation and treatment of complex disorders, typically after other physicians have been stumped, is renowned. He provides care for all family members and has additional training in autistic spectrum disorders and chronic complex diseases.