4 Natural Solutions that Promote Calmful Sleep
By Anna O’Byrne and Laura Young, clinical research expert, Honours B.Sc., student of the Canadian College of Osteopathy
According to 2011 research conducted at Université Laval, sleep disorders affect 40% of adult Canadians (Science Daily, 2011). While only 13.4% of those surveyed displayed all symptoms required to diagnose insomnia, the full 40% experienced symptoms of insomnia at least three times a week (Science Daily, 2011).
What is Insomnia?
Insomnia is characterized by sleep onset delay and difficulty with sleep maintenance, including nocturnal wakefulness and waking earlier than planned (Science Daily, 2011).
The causes of insomnia are varied and include: poor sleep hygiene; existing psychiatric or medical conditions; certain substances; stress; and sleep disorders (Sleep Foundation, n.d.).
A number of sleep disorders are caused by circadian rhythm disruptions. The more common of these include: delayed sleep-wake phase disorder, shift work disturbances and travel-related jetlag (Sleep Education, 2017). What is now deemed ‘social jet lag’ occurs with “self-selected modifications to the natural light/dark cycle” and resultant variations between sleep time on weekdays and weekends (Swaminathan, Klerman, & Phillips, 2017).
Insomnia Effects and Treatment Options
Poor sleep and lack of sleep is associated with a range of psychological, psychiatric and medical conditions. Insomnia affects cognitive, emotional and social functioning (Misra & Sharma, 2017). A vast body of research exists investigating the relationship between poor sleep and health-related quality of life (Brevik et al., 2017).
Pharmacological treatments are considered less than ideal (Misra & Sharma, 2017). Most sleep inducers are sedatives and are often associated with addiction and other side effects (Rao, Ozeki, & Juneja, 2015).
Non-pharmacological treatments include, “stimulus control therapy, sleep restriction, relaxation, sleep hygiene and cognitive therapy” (Misra & Sharma, 2017). In the quest for safer, more effective insomnia solutions, we also look to alternative medicine.
Natural Supplements for Extra Sleep Support
Magnesium “plays a critical role in nerve transmission, cardiac excitability, neuromuscular conduction, muscular contraction, vasomotor tone, blood pressure” and more (Volpe, 2013).
As early as 1980, researchers demonstrated the effects of magnesium on sleep. In a polygraphic study of newborns, sleep behaviour positively correlated to serum magnesium levels. An increase in magnesium resulted in an increase of quiet sleep and a decrease in active sleep (Dralle & Bodeker, 1980).
More recently, Abbasi et al. (Abbasi et al., 2012) reported in a double-blind, randomized, placebo-controlled study of older patients with insomnia, that daily magnesium supplementation induced statistically significant increases in sleep time and sleep efficiency. A significant decrease in insomnia severity scores and sleep onset latency, among other positive indicators were further reported (Abbasi et al., 2012).
Magnesium is a GABA agonist (more on which, below) and plays “a key role in the regulation of sleep and endocrine systems” (Held et al., 2002). Held et al. investigated the effect of magnesium supplementation on age-related neuroendocrine and sleep EEG changes in a placebo-controlled, randomized cross-over study (Held et al., 2002). The results demonstrated that magnesium supplementation led to a significant increase in slow wave sleep and the results suggest that magnesium partially reverses sleep EEG and nocturnal neuroendocrine changes occurring during aging (Held et al., 2002).
“L-theanine (γ-glutamylethylamide) is an amino acid found primarily in the green tea plant” (White et al., 2016).
A 2016 study published in the journal, Nutrients, reported, “subjective stress response to a multitasking cognitive stressor, was significantly reduced one hour after administration of the L-theanine drink when compared to placebo” (White et al., 2016). In a 2017 review of acute psychoactive effects, L-theanine taken alone was found to improve self-reported relaxation, tension and calmness (Dietz & Dekker, 2017).
As a treatment for sleep disorders, according to a review published in the Journal of the American College of Nutrition in 2015, L-theanine is a “safe natural sleep aid” (Rao et al., 2015). It has been found to “promote relaxation without drowsiness,” and “unlike conventional sleep inducers, L-theanine is not a sedative but promotes good quality of sleep through anxiolysis.” (Rao et al., 2015).
Melatonin (N-acetyl-5-methoxy-tryptamine) is a chief secretory product of the pineal gland with a well-established relationship to sleep (Zhang et al., 2017). The production of melatonin is triggered by low-light conditions, and higher levels in the bloodstream encourage sleep (Sleep Foundation, n.d.). Circadian rhythms of melatonin are significantly delayed through exposure to artificial light at night (Cuesta, Boudreau, Cermakian, & Boivin, 2017).
Strategically-timed melatonin administration is indicated for the treatment of intrinsic circadian rhythm sleep-wake disorders (American Academy of Sleep Medicine et al., 2015). Melatonin, aside from phase-shifting these rhythms, “may have direct soporific effects, particularly at higher doses” (American Academy of Sleep Medicine et al., 2015). Studies suggest that timing of melatonin for these disorders is more important than dosing, at least insofar as the phase-shifting effects are concerned (American Academy of Sleep Medicine et al., 2015).
Randomized, double-blind clinical trials have demonstrated positive results with the use of melatonin for patients with primary insomnia aged ≥55 years (Lyseng-Williamson, 2012). Melatonin treatment demonstrated significant improvements relative to placebo in many sleep and daytime parameters, including: sleep quality and latency, morning alertness and health-related quality of life. Over the short and long-term, melatonin treatment was not associated with dependence, tolerance, rebound insomnia or withdrawal symptoms (Lyseng-Williamson, 2012). Similar positive results and positive carryover effects were reported in a study which investigated patients with insomnia related to chronic use of beta-blocker medications, which may suppress melatonin (Scheer et al., 2012).
Age is a consideration in use of melatonin, and as a supplement, it is currently indicated for ages 18 – 80 (Wade et al., 2011). Wade et al. evaluated the age limit for use of melatonin. The randomized, double-blind, placebo-controlled study revealed short and long-term efficacy of melatonin for patients aged 18-80 years who experienced insomnia, with particularly strong results for those aged 55 and over (Wade et al., 2011). In all age cohorts, sleep improvements were maintained over the long-term, with no signs of tolerance, no withdrawal symptoms or rebound insomnia. Most adverse events were mild with no significant differences in safety outcomes between the melatonin and placebo groups (Wade et al., 2011).
The use of melatonin for those under age 18 could be considered controversial, however, it may be indicated for individuals with certain conditions. Cortesi et al. (Cortesi, Giannoti, Sebastiani, Panunzi, & Valente, 2012) investigated melatonin and cognitive behavioural therapy for persistent insomnia presenting in children with autism. The study reported that melatonin was found to elicit significant improvements across all outcome measures including: sleep latency, total sleep time, wake after sleep onset and number of awakenings. Melatonin therapy reduced insomnia symptoms and was most effective in combination with cognitive-behavioural therapy (Cortesi et al., 2012).
Gamma-aminobutyric Acid (GABA)
GABA is the chief inhibitory neurotransmitter in the brain (Watanabe, Maemura, Kanbara, Tamayama, & Hayasaki, 2002). It is synthesized in the brain via a process that converts glutamate, an excitatory neurotransmitter, into an inhibitory neurotransmitter (Petroff, 2002; Schousboe & Waagepetersen, 2007).
Marketed as an amino acid supplement, GABA is purported to relax the nervous system and reduce anxiety. The research on GABA for sleep is preliminary but promising. Studies have reported a close association between sleep and the GABAergic system (Held et al., 2002).
Two studies published in the journal, Biofactors, demonstrated the natural relaxant and anti-anxiety effects on humans of orally administrated γ-Aminobutyric acid (GABA). The first study evaluated the effect of GABA intake via electroencephalograms (EEG), and showed that GABA significantly increased alpha waves and decreased beta waves compared to water or L-theanine. The researchers concluded GABA not only induces relaxation but also reduces anxiety (Abdou et al., 2006).
Meverhoff et al. (Meverhoff, Mon, Metzler, & Neylan, 2014) investigated cortical GABA and glutamate in posttraumatic stress disorder (PTSD). Self-reported sleep quality revealed a correlation between poor sleep quality and GABA levels. Those with PTSD had lower cortical GABA levels, higher depressive, anxiety and insomnia scores (Meverhoff et al., 2014).
Studies suggest that non-pharmacological products may significantly reduce symptoms of insomnia, with high levels of safety. Various clinical studies have demonstrated the efficacy of magnesium, l-theanine, melatonin and GABA in improving sleep quality.
Abbasi, B., Kimiagar, M., Sadeghniiat, K., Shirazi, M., Hedayati, M., & Rashidkhani, B. (2012). The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. The Official Journal of Isfahan University of Medical Sciences, 17(12), 1161–1169.
Abdou, M. A., Higashiguchi, S., Horie, K., Kim, M., Hatta, H., & Yokogoshi, H. (2006). Relaxation and immunity enhancement effects of gamma-aminobutyric acid (GABA) administration in humans. BioFactors, 201–208.
American Academy of Sleep Medicine, Auger, R. R., Burgess, H. J., Emens, J. S., Deriy, L. V., Thomas, S. M., & Sharkey, K. M. (2015). Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015. Journal of Clinical Sleep Medicine, 11(10), 1199–1236. http://doi.org/10.5664/jcsm.5100
Brevik, E. J., Lundervold, A. J., Halmøy, A., Posserud, M. B., Instanes, J. T., Bjorvatn, B., & Haavik, J. (2017). Prevalence and clinical correlates of insomnia in adults with attention-deficit hyperactivity disorder. Acta Psychiatrica Scandinavica. http://doi.org/doi: 10.1111/acps.12756
Cortesi, F., Giannotti, F., Sebastiani, T., Panunzi, S., & Valente, D. (2012). Controlled-release melatonin, singly and combined with cognitive behavioural therapy, for persistent insomnia in children with autism spectrum disorders: a randomized placebo-controlled trial. Journal of Sleep Research, 21(6), 700–709. http://doi.org/10.1111/j.1365-2869.2012.01021.x
Cuesta, M., Boudreau, P., Cermakian, N., & Boivin, D. B. (2017). Skin Temperature Rhythms in Humans Respond to Changes in the Timing of Sleep and Light. Journal of Biological Rhythms.
Dietz, C., & Dekker, M. (2017). Effect of Green Tea Phytochemicals on Mood and Cognition. Current Pharmaceutical Design.
Dralle, D., & Bodeker, R. H. (1980). Serum magnesium level and sleep behavior of newborn infants. European Journal of Pediatrics, 134(3), 239–243.
Held, K., Antonijevic, I. A., Kunzel, H., Uhr, M., Wetter, T. C., Golly, I. C., et al. (2002). Oral Mg(2+) supplementation reverses age-related neuroendocrine and sleep EEG changes in humans. Pharmacosychiatry, 35(4), 135–143.
Lyseng-Williamson, K. A. (2012). Melatonin prolonged release: in the treatment of insomnia in patients aged ≥55 yrs. Drugs & Aging, 29(11), 911–923.
Meverhoff, D., Mon, A., Metzler, T., & Neylan, T. C. (2014). Cortical gamma-aminobutyric acid and glutamate in posttraumatic stress disorder and their relationships to self-reported sleep quality. Sleep, 37(5), 893–900.
Misra, A., & Sharma, P. K. (2017). Pharmacotherapy of Insomnia and Current Updates. J Assoc Physicians India, 65(4), 43–47.
Petroff, O. A. (2002). GABA and glutamate in the human brain. Neuroscientist, 8(6), 562–573.
Rao, T. P., Ozeki, M., & Juneja, L. R. (2015). In Search of a Safe Natural Sleep Aid. The Journal of the American College of Nutrition, 34(5), 436–437.
Scheer, F. A. J. L., Morris, C. J., Garcia, J. I., Smales, C., Kelly, E. E., Marks, J., et al. (2012). Repeated Melatonin Supplementation Improves Sleep in Hypertensive Patients Treated with Beta-Blockers: A Randomized Controlled Trial. Sleep, 35(10), 1395–1402. http://doi.org/10.5665/sleep.2122
Schousboe, A., & Waagepetersen, H. (2007). GABA: homeostatic and pharmacological aspects. Progress in Brain Research, 9–19.
Sleep Foundation: Sleep Disorders. (n.d.). www.sleepfoundation.org. Retrieved June 7, 2017.
Science Daily: Sleep disorders affect 40 percent of Canadians. (2011, September 8). www.sciencedaily.com. Retrieved June 9, 2017.
Sleep Education: Delayed Sleep-Wake Phase – Overview & Facts. (2017). www.sleepeducation.org. Retrieved June 7, 2017.
Swaminathan, K., Klerman, E. B., & Phillips, A. (2017). Are Individual Differences in Sleep and Circadian Timing Amplified by Use of Artificial Light Sources? Journal of Biolo, 32(2), 165–176. http://doi.org/doi: 10.1177/0748730417699310
Volpe, S. L. (2013). Magnesium in disease prevention and overall health. Advanced Nutrition, 4(3), 378S–83S.
Wade, A. G., Crawford, G., Ford, I., McConnachie, A., Nir, T., Laudon, M., & Zisapel, N. (2011). Prolonged release melatonin in the treatment of primary insomnia: evaluation of the age cut-off for short- and long-term response. Current Medical Research and Opinion, 27(1), 87–98.
Watanabe, M., Maemura, K., Kanbara, K., Tamayama, T., & Hayasaki, H. (2002). GABA and GABA receptors in the central nervous system and other organs. International Review of Cytology, 213, 1–47.
White, D. J., de Klerk, S., Woods, W., Gondalia, S., Noonan, C., & Scholey, A. B. (2016). Anti-Stress, Behavioural and Magnetoencephalography Effects of an L-Theanine-Based Nutrient Drink: A Randomised, Double-Blind, Placebo-Controlled, Crossover Trial. Nutrients, 8(1).
Zhang, L., Guo, H. L., Zhang, H. Q., Xu, T. Q., He, B., Wang, Z. H., et al. (2017). Melatonin prevents sleep deprivation-associated anxiety-like behavior in rats: role of oxidative stress and balance between GABAergic and glutamatergic transmission. American Journa of Translation Research, 9(5), 2231–2242.