Most people have experienced periods of poor sleep and know how intrusive sleeplessness can be on daily functioning. Common symptoms of poor sleep are fatigue, irritability, forgetfulness, difficulty learning and maintaining focus, lack of motivation, increased appetite, and feeling overly moody or emotional. Left unattended, poor sleep can create serious physical and mental illness. When taking an accounting of one’s overall health, sleep must be an important factor to consider or it will be difficult to identify other health issues that are not causally related.
It is now clear that chronic poor sleep is directly associated with poor mental health and mental health issues are inversely associated with insomnia symptoms (Kaneita et al., 2007). As mental health clinicians, it is important that a client’s sleep history and current sleep status be a part of a comprehensive treatment strategy. Treating symptoms of mental health without addressing underlying sleep issues can be a futile and frustrating endeavor. Early life trauma, a trauma in general, and chronic stress are known factors for disrupting sleep cycles but poor sleep can inversely impact symptoms of these mental health issues. Multiple studies also show that reduced sleep duration and poor sleep quality predicted greater depression, anxiety, and externalizing symptoms over time. This can be especially harmful to adolescents and children where adjustment, behavior, and learning difficulties can be reciprocally related to sleep problems (Kelly & El-Sheikh, 2014). Additionally, chronic insomnia is also a risk factor for a variety of significant health problems, such as cardiovascular disease, diabetes, and obesity, as well as bad mood and cognitive dysfunction (Guadagna, Barattini, Rosu, & Ferini-Strambi, 2020). Sleep disturbances are also a moderate risk factor for suicide (Pigeon & Bishop, 2020).
It is believed that the most common type of sleep disorder is circadian rhythm sleep disorder (CRSD), which is characterized by the misalignment of the desired sleep phase to one’s internal circadian rhythm or internal sleep-wake rhythm clock. Bright light treatment and melatonin administration are the treatments of choice for circadian rhythm sleep disorder. However, if those do not work, there may be other factors disrupting the sleep-wake cycle. Note: Melatonin is a hormone and contains no relaxation or sedative properties. Melatonin, which is naturally produced from the pineal gland in darkness at night or available in many foods, when taken as a supplement, is used to help reset one’s natural sleep-wake cycle (circadian rhythm). Also, because it is a hormone, it is not recommended for children and should only be used for adolescents on a short-term basis (Armour & Paton, 2004).
Since there are many reasons for possible sleep disturbances, it is a good idea for anyone trying to get better sleep to try many methods or combine several methods simultaneously. Also note that even though recommended supplements are commonly used, have little to no side effects and have empirically supported data regarding efficiency, you should check with your doctor before taking, especially if you are taking other medications.
The chart below contains lifestyle and nutritional recommendations for insomnia and other sleep-related disorders. It is important to remember that most health professionals do not support the use of benzodiazepines for sleep. The side effects are too severe, the benefits to productive sleep are minimal, and there is a high risk of addiction associated with the use of benzodiazepines (Guadagna et al., 2020).
| Life-Style Recommendations | Nutrition & Supplement Recommendations |
| Reserve the bedroom for sleep. Create a relaxing peaceful environment in the bedroom. Keep the room cool and wear comfortable clothes (or no clothes) for sleep. | Reduce stimulants. No coffee, tea, or caffeine after 2PM. |
| Sleep in complete darkness and in a cool room. | Small snack before bed may help with waking up in the middle of the night due to lower blood glucose levels. Best snack is high in protein and carbohydrates and low sugar (i.e. apple with peanut butter, yogurt with granola, hard boiled egg). |
| Keep a regular sleep schedule. | Foods like bananas, nuts, whole gains, cottage cheese, and cherries, berries, prunes, raisins, plum, carrots, sweet potatoes, and many forms of protein are all great food choices for dinner to help promote good sleep. Many of these foods contain melatonin. |
| Avoid blue light from electronic devices at least 2 hours before sleep or use blue light blocking glasses. | Skip the white bread, refined pasta, and sugary, baked goods, which may reduce serotonin levels and impair sleep. |
| Incorporate relaxation techniques into nightly rituals. Multiple relaxation techniques are available, such as progressive body relaxation, breathing techniques, some yoga poses, guided visualization, meditation. | Because hypoglycemia (low blood glucose) can be an underlying cause for insomnia, a glucose tolerance factor supplement could be helpful. Glucose tolerance factor supplements contain chromium which research has shown to act like insulin to help balance blood sugar (Abdollahi, et al., 2013). |
| Avoid aerobic exercise after 4 or 5PM. | Magnesium sulfate (Epsom salt) baths are relaxing and soothing before bedtime. Magnesium is an essential mineral that is involved in more than 300 different enzyme-related reactions in the body’s cells. Magnesium baths relax the muscles or soothe the joints. People with low magnesium often experience restless sleep or waking frequently during the night so taking a magnesium glycinate supplement can also help with sleep. |
| Use white-noise machine or sleep with a fan. | Three supplements are common for supporting better sleep, valerian, hop, and passionflower. All have been tested and found helpful in many cases (Maroo, Hazra, & Das, 2013). These supplements can be tried individually, or a better approach may be to find a supplement that combines them, of which there are several on the market. |
| Give yourself some time, about 30 minutes, to “wind-down” where you are not being stimulated by electronics or television drama/violence or news. | Lactium, a hydrolysed milk protein that acts on the calming GABA neurotransmitter, is a supplement that has shown clinically significant results in promoting effective sleep (Kim et al., 2019). Recommended dose is 300mg. A compound supplement called LZComplex3 that include magnesium, hops, sour date and B6 also has shown promising results for sleep, although the dosage for lactium is quite small. |
| Commit to releasing worries or anxieties before sleep. Designate a specific time to worry and plan before bed and then put them aside and with intent, put your brain in “off” mode. | Drinking soothing teas before bed has helped many to wind down and relax and help with sleep. Recommended teas for relaxation/sleep are chamomile, valerian, passionflower, and kava. |
References
Abdollahi M, et al. (2013). Effect of chromium on glucose and lipid profiles in patients with type 2 diabetes; a meta-analysis review of randomized trials. J Pharm Pharm Sci, 16(1), 99-114.
Armour, D., & Paton, C. (2004). Melatonin in the treatment of insomnia in children and adolescents. Psychiatric Bulletin, 28(6), 222-224. https://doi.org/10.1192/pb.28.6.222
Goldman, L. (2020). Listen to Your Body Clock. Prevention, 72(4), 64–71.
Guadagna, S., Barattini, D. F., Rosu, S., & Ferini-Strambi, L. (2020). Plant Extracts for Sleep Disturbances: A Systematic Review…Vitafoods 2019 in Geneva. Evidence-Based Complementary & Alternative Medicine (ECAM), 1–9. https://doi.org/10.1155/2020/3792390
Kaneita Y, Ohida T, Osaki Y, et al. (2007). Association between mental health status and sleep status among adolescents in Japan: a nationwide cross-sectional survey. The Journal of Clinical Psychiatry, 8(9), 1426-1435. DOI: 10.4088/jcp.v68n0916
Kelly, R. J., & El-Sheikh, M. (2014). Reciprocal Relations between Children’s Sleep and Their Adjustment over Time. Developmental Psychology, 50(4), 1137–1147.
Kim, H. J., Kim, J., Lee, S., Kim, B., Kwon, E., Lee, J. E., Chun, M. Y., Lee, C. Y., Boulier, A., Oh, S., & Lee, H. W. (2019). A Double-Blind, Randomized, Placebo-Controlled Crossover Clinical Study of the Effects of Alpha-s1 Casein Hydrolysate on Sleep Disturbance. Nutrients, 11(7), 1466. https://doi.org/10.3390/nu11071466
Maroo, N., Hazra, A., & Das, T. (2013). Efficacy and safety of a polyherbal sedative-hypnotic formulation NSF-3 in primary insomnia in comparison to zolpidem: a randomized controlled trial. Indian journal of pharmacology, 45(1), 34–39. https://doi.org/10.4103/0253-7613.106432
Pigeon, W. R., & Bishop, T. M. (2020). The Strong Relationship Between Sleep and Suicide. Psychiatric Times, 4, 8–9.
Rémi, J., Pollmächer, T., Spiegelhalder, K., Trenkwalder, C., & Young, P. (2019). Sleep-Related Disorders in Neurology and Psychiatry. Deutsches Aerzteblatt International, 116(41), 681–688. https://doi.org/10.3238/arztebl.2019.0681
