Insomnia and Sleep Disorders
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As we have seen on the previous page about hormonal insufficiency and the circadian rhythm, insomnia can have a very damaging effect on a person's health over a period of weeks, months and years. If you have not read this page, please do so before reading on.

'In mammals and birds the measurement of eye movement during sleep is used to divide sleep into the two broad types of Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM) or "Non-REM" sleep. Each type has a distinct set of associated physiological, neurological and psychological features.

Sleep proceeds in cycles of REM and the four stages of NREM, the order normally being:

Stages 1 -> 2 -> 3 -> 4 -> 3 -> 2 -> REM.

In humans this cycle is on average 90 to 110 minutes, with a greater amount of stages 3 and 4 early in the night and more REM later in the night. Each phase may have a distinct physiological function. Drugs such as sleeping pills and alcoholic beverages can suppress certain stages of sleep [i.e. more likely to have stage 1 shallow sleep, and less deep sleep and less REM sleep] (see Sleep deprivation). This can result in a sleep that exhibits loss of consciousness but does not fulfill its physiological functions. Allan Rechtschaffen and Anthony Kales originally outlined the criteria for identifying the stages of sleep in 1968. The American Academy of Sleep Medicine (AASM) updated the staging rules in 2007.

Criteria for REM sleep include not only rapid eye movements but also a rapid low voltage electroencephalogram EEG. In mammals, at least, low muscle tone is also seen. Most memorable dreaming occurs in this stage. NREM accounts for 75Ð80% of total sleep time in normal human adults. In NREM sleep, there is relatively little dreaming. Non-REM encompasses four stages; stages 1 and 2 are considered 'light sleep', and 3 and 4 'deep sleep' or slow-wave sleep, SWS. They are differentiated solely by using EEG, unlike REM sleep which is characterized by observable rapid eye movements and relative absence of muscle tone. In non-REM sleep there are often limb movements, and parasomnias such as sleepwalking may occur. A cyclical alternating pattern may sometimes be observed during a stage.

NREM consists of four stages according to the 2007 AASM standards:

- During Stage N1 the brain transitions from alpha waves (having a frequency of 8 to 13 Hz, common to people who are awake) to theta waves (with a frequency of 4 to 7 Hz). This stage is sometimes referred to as somnolence, or "drowsy sleep". Associated with the onset of sleep during N1 may be sudden twitches and hypnic jerks also known as positive myoclonus. Some people may also experience hypnagogic hallucinations during this stage, which can be troublesome to them. During N1 the subject loses some muscle tone and most conscious awareness of the external environment.

- Stage N2, is characterized by "sleep spindles" (12 to 16 Hz) and "K-complexes." During this stage, muscular activity as measured by electromyography (EMG) decreases and conscious awareness of the external environment disappears. This stage occupies 45 to 55% of total sleep.

- In Stage N3, the delta waves (0.5 to 4 Hz), also called delta rhythms, make up less than 50% of the total wave-patterns. This is considered part of deep or slow-wave sleep (SWS) and appears to function primarily as a transition into stage N4. This is the stage in which night terrors, bedwetting, sleepwalking and sleep-talking occur.

- In Stage N4, delta-waves make up more than 50% of the wave-patterns. Stages N3 and N4 are the deepest forms of sleep; N4 is effectively a deeper version of N3, in which the deep-sleep characteristics, such as delta-waves, are more pronounced. As of new AASM guidelines, the distinction between stage 3 and stage 4 sleep is inconsequential; both may be considered delta sleep or slow wave sleep. Therefore, in order to make the scoring guidelines more precise, a recent ruling by the AASM discontinued stage four sleep (N4) and left only stage N3 to describe delta sleep.

Both REM sleep and NREM sleep stages 3 and 4 are homeostatically driven; that is, a person or animal selectively deprived of one of these stages will rebound once uninhibited sleep is allowed. This finding suggests that both types of sleep are essential.

Sleep timing is controlled by the circadian clock, by homeostasis and, in humans, by willed behavior. The circadian clock, an inner time-keeping, temperature-fluctuating, enzyme-controlling device, works in tandem with adenosine, a neurotransmitter which inhibits many of the bodily processes that are associated with wakefulness. Adenosine is created over the course of the day; high levels of adenosine lead to sleepiness. In diurnal animals, sleepiness occurs as the circadian element causes the release of the hormone melatonin and a gradual decrease in core body temperature. The timing is affected by one's chronotype. It is the circadian rhythm which determines the ideal timing of a correctly structured and restorative sleep episode.

Homeostatic sleep propensity, the need for sleep as a function of the amount of time elapsed since the last adequate sleep episode, is also important and must be balanced against the circadian element for satisfactory sleep. Along with corresponding messages from the circadian clock, this tells the body it needs to sleep.[6] Sleep offset, awakening, is primarily determined by circadian rhythm. A normal person who regularly awakens at an early hour will generally not be able to sleep much later than the person's normal waking time, even if moderately sleep deprived.

Clearly the ideal and healthiest type of sleep a person can have is to sleep very deeply, and not be woken by sounds or by the need to urinate. Even when the bladder is full, this should not interrupt the ideal night's sleep. Upon waking, one may or may not need to urinate a large amount. Clearly any deviation from this reflects worse sleep quality, for example waking once during the night to urinate, and either shallow sleep or shorter periods of deep, regenerative sleep, perhaps reflecting minor hormonal or mineral/vitamin deficiencies.

In the USA, in a 2002 survey, approximately 58% of adults exhibited symptoms of insomnia a few nights a week or more. With CFS patients, this is more chronic, but the root problems of insomnia are present in much of the population, to perhaps a lesser extent.

Insomnia varies from person to person, but in general, those suffering from CFS may well have no serious problems getting to sleep, but the act of staying asleep all night is nearly impossible. A common pattern is to wake up after 2 or 3 hours, after which subsequent blocks of 1-2 hours sleep are harder to achieve. A pattern of waking up every hour may well occur during the night or in severe cases, after the intial block of sleep, the person is completely unable to get back to sleep again. This is usually a result of a drop in melatonin levels during the night. Because of low melatonin levels and too high stress hormone levels in the body during the night, the slightest amount of urine in the bladder may be enough to wake the person from sleep, even if it is not necessary to urinate yet. If a person has had too much stress or overdone things during the day, the body may well not stop producing cortisol and other stress hormones and prevent the person from getting any sleep whatsoever that night or until the early hours of the morning.

Sleep is a biological necessity and we do much of our bodily repair and mitochondrial recovery during deep sleep. If one is not sleeping well, one can take as many supplements as one wants, but is unlikely to see significant progress until one starts to get at least some level of regular sleep each night, and perhaps daytime naps to supplement this if necessary.

As well as the lack of serotonin and inability to relax at night, and the underproduction of melatonin and the over production of cortisol during the night, the lack of water retention can also be problematic, waking the person at regular intervals during the night to urinate.

Magnesium and P5P deficiencies are also contributary factors, and supplementing these nutrients in the diet can assist in restoring proper sleep in the medium term. Also, stimulating the endocrine system as discussed on the previous page will help to restore normal sleeping patterns and energy and ability to cope with stress during the day.

Taking a 5-HTP, L-Theanine and/or a Melatonin supplement may greatly help your sleeping pattern and help you to stay asleep, or at least get back to sleep quickly if you wake up. 5-HTP is the body's natural precursor to seratonin. Between 50mg and 400mg of 5-HTP may help. The dosage depends on the body's deficiency of serotonin and also ability to convert 5-HTP to serotonin.

Melatonin is the hormone that causes a person to feel tired and fall asleep and stay asleep. 3mg to 9mg of Melatonin may also be useful. Some people only require 1mg or a fraction of an mg, so start off with a very low dose and build up slowly and carefully. Both supplements are best taken 1-2 hours before going to bed. For those who cannot get back to sleep at all after waking up the first time, additional doses of melatonin and 5-HTP during the night may help the person get back to sleep again. For example, perhaps taking 3mg to 6mg of Melatonin and 100mg of 5-HTP every 3-4 hours. Alternatively you may wish to try a slow release or sustained release melatonin supplement, like Jarrow Formulas Melatonin Sustain. Or perhaps take one regular melatonin supplement and one sustained release melatonin supplement when going to bed (perhaps together with the 5-HTP and/or L-Theanine), so that some melatonin is immediately available and the rest will become available during the night. Of course some sustained release tablets have a two stage release system already so perhaps there is no need to do this. There are other permutations and options. Be careful however if you are already taking sleep pills and consult your doctor to ensure that there are no contraindications with mixing both. You may wish to try to phase out your sleeping pills and phase in non-habit forming and less harmful alteratives, as mentioned above, and see what happens. Experiment yourself and take a note of your normal pattern of sleep/waking cycles, and at what time you feel you cannot easily get back to sleep, taking the minimum additional melatonin and 5-HTP necessary to do the job and get you back to sleep again.

One should be very careful regarding the dosages of melatonin and serotonin. Please see the Neurotransmitter Supplementation section of the Adrenal page for more information.

Remember that not all supplements are alike in their quality and effectiveness for you. Ideally your consultant would establish which brand works best for you kinesiologically. Otherwise, you could try a reputable brand such as Vital Nutrients. There are slow-release Melatonin supplements, which may help, but my experience is that they still don't provide sufficient Melatonin throughout the entire night.

Melatonin, L-Theanine and 5-HTP are not miracle cures for sleep, they are symptom alleviators, and will assist you to get to sleep and stay asleep for longer, and increase your ability to get back to sleep. They will not 'cure' the underlying conditions that cause your insomnia. They are merely safely plugging holes in the body's underproduction of specific hormones. To cure the endocrine problems that cause insomnia, you have to actively stimulate the endocrine system and overcome one's nutritional element and vitamin deficiencies. This is examined in on the previous page.

I have myself noticed that on some nights when I am very tired, I forget to take any Melatonin or 5-HTP, and sleep just like normal, whereas on other nights when I have deliberately not taken these sleep aids, have not managed to fall sleep at all. Whilst there are different factors at play on each occasion, and it is hard to notice a definite pattern, this may be something you wish to experiment with, to ascertain whether you really do need to take these or not; and if so, when.

Please note that an adaptogenic herb or adrenal supplement taken during the morning and/or early afternoon each day may help to regulate the production of adrenal/stress hormones so that more are produced as and when required during the day, so that they are not still being produced at night when one wants to be asleep. As well as giving the person more energy, such herbs or supplements can also ensure better sleep.

A number of herbs can be taken prior to going to bed to assist in falling asleep, as they can promote relaxation. Such herbs include Valerian (Valeriana officinalis) root extract, Passionflower (Passiflora incarnata) leaf and flow extract, Hops (Humulus lupulus) flower extract, wild lettuce (lactuca virosa) leaf extract (found in some adrenal supplements also) and Jamaican Dogwood (Piscidia piscipula) root extract etc. Products may include Enzymatic Therapy (Fatigued to Fantastic)'s Revitalizing Sleep Formula or the common product Kalms (which also contains sugar!) I have used such formulations in the past, and whilst they indeed did help with relaxation and better quality of sleep, being herbs, they also have energetic qualities (c/f TCM, hot and cold energy), and as a result, when used regularly for months or years, may severely upset the body's energetic system. I personally felt like I had a constant background sense of malaise, like a 'wall' of some kind, and this disappeared immediately he stopped taking Kalms (having taken them continuously for 2-3 years or so). So whilst herbs can help, they should not be used for extended periods in BlackSpy's opinion.

Other than the biochemical problems highlighted above, there are a number of free of charge things that a person suffering from sleep disorders can do to assist his or her condition. These are listed below. Try them and see what works for you.

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