Insomnia is the most prevalent sleep disorder and affects a large proportion of the population on a situational, recurrent or chronic basis.[i] An estimated one third of a general population presents at least one form of insomnia and 6% to 10% meet criteria for an insomnia disorder.[ii] Prescription ‘sleeping pills’ (or sedative hypnotics) are associated with numerous side effects and according to available evidence, the risks of chronic hypnotic use outweigh the benefits.[iii] Thankfully, various natural alternatives are available.

Lifestyle and diet

There are several aspects of our lifestyle and diet that can be modified to improve sleep quality. For example, studies show that exercise improves sleep quality, mood and quality of life among older adults with insomnia, and improving sleep may encourage exercise participation.[iv] According to a multiethnic study published in Sleep in 2018, a Mediterranean style diet was associated with adequate sleep duration, less insomnia symptoms and less likely to have insomnia accompanied by short sleep among the participants.[v] The use of light emitting electronic devices before bedtime may contribute to or exacerbate sleep problems. Exposure to blue wavelength light from these devices may affect sleep by suppressing melatonin and causing neurophysiologic arousal.[vi]

Nutritional supplements

Several nutritional supplements have clinically and scientifically proven records of safe and effective use in the management of insomnia and sleep disturbances. Here are some of the best documented options.

• Melatonin

Melatonin supplementation is probably one of the most popular natural remedies for insomnia. Melatonin is a physiological hormone produced by the pineal gland and involved in controlling our circadian rhythms. It is used exogenously as a supplement in the treatment of primary and secondary sleep disorders.[vii] In a review published in 2017 in Neurological Research, melatonin was shown to synchronize the circadian rhythms, and improve the onset, duration and quality of sleep. Additionally, it was well tolerated and had no obvious short or long term adverse effects. The researchers concluded that melatonin offers an alternative treatment to the currently available pharmaceutical therapies for sleep disorders with significantly less side effects.[viii]

Melatonin can be especially helpful for shift workers. In a study involving workers who took three milligrams of melatonin, the results showed that they were able to fall asleep more quickly and spend more time sleeping each cycle.[ix]

• 5-Hydroxytryptophan

Serotonin, which is produced in the body, is known as a neurotransmitter; this means it is responsible for sending messages between nerve cells. In the central nervous system (CNS), serotonin levels have been implicated in the regulation of sleep, depression, anxiety, aggression, appetite, temperature, sexual behaviour and pain sensation. 5-Hydroxytryptophan (5-HTP) is the intermediate metabolite of the essential amino acid L-tryptophan (LT) in the biosynthesis of serotonin. Serotonin can be converted to melatonin.

 5-HTP is well absorbed from an oral dose, with about 70% ending up in the bloodstream. It easily crosses the blood-brain barrier and effectively increases CNS synthesis of serotonin.[x] Therapeutic administration of 5-HTP has been shown to be effective in treating a wide variety of conditions, including depression, fibromyalgia, binge eating associated with obesity, chronic headaches and insomnia.[xi]

• B Vitamins Complex

The B vitamins represent a group of eight essential water soluble vitamins that work closely in concert at a cellular level and which are essential for every aspect of brain function.[xii] For example, vitamin B6 is involved in converting LT/5-HTP to serotonin. A deficiency in vitamin B6 may limit the amount of serotonin in the body, potentially leading to disturbed sleep patterns and insomnia. According to a February 2016 review in the journal Nutrients, a deficiency of vitamin B6 has been linked to and disturbed sleep, irritability, emotional disturbances and confusion among other effects.[xiii]

In terms of supplementation, pyridoxal 5`phosphate (P5P) is a highly bioavailable, active coenzyme form of vitamin B6. Since all the B vitamins are closely interrelated and vitamin B6 deficiency typically occurs alongside other B vitamin deficiencies, a B vitamin complex supplement may be the best choice. Scientific evidence suggests that supplementation with the entire B group of vitamins is a more rational approach than selecting one, two or three compounds from this sub-group of vitamins.[xiv]

• Passiflora incarnata L

Commonly referred to as “passionflower”, Passiflora incarnata L., consists of approximately 400 species in Brazil, other parts of the tropical Americas, Asia, and Australia. Its fruit and flower contain components such as tannins, coumarin alkaloids, flavonoids, tyrosine and glycine.[xv] Traditionally, passionflower is a plant that has been used to treat insomnia. Several studies have shown clinically relevant benefits of Passiflora incarnata L. for insomnia treatment.[xvi] It may be of particular interest during the perimenopausal period since it has been shown effective in the treatment of early menopausal symptoms such as insomnia, vasomotor symptoms, depression, anger or headaches.[xvii] The plant has a good safety profile, and no side effects have been reported in the literature.

Conclusion Insomnia and sleep disorders are widespread and can have different origins. However, natural, safe and effective management of the various aspects of sleep quality are readily available. A comprehensive approach including lifestyle modifications, correction of potential underlying nutritional deficiencies and the addition of proven, herbal support can make all the difference! Some combination, quality, natural products formulations can deliver results and a good night sleep from the first night of supplementation!

References:

[i] Morin CM, Benca R. Chronic insomnia. Lancet 2012; 379(9821): 1129-41. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60750-2/fulltext

[ii] Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Medicine Reviews 2002; 6(2): 97-111 https://pubmed.ncbi.nlm.nih.gov/12531146/

[iii] Kripke DF. Risks of Chronic Hypnotic Use. In: Madame Curie Bioscience Database [Internet]. Austin (TX): Landes Bioscience; 2000-2013. Available from: https://www.ncbi.nlm.nih.gov/books/NBK6630/

[iv] Baron KG, Reid KJ, Zee PC. Exercise to improve sleep in insomnia: exploration of the bidirectional effects. J Clin Sleep Med. 2013;9(8):819-824. Published 2013 Aug 15. doi:10.5664/jcsm.2930 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716674/

[v] Castro-Diehl C, Wood AC, Redline S, et al. Mediterranean diet pattern and sleep duration and insomnia symptoms in the Multi-Ethnic Study of Atherosclerosis. Sleep. 2018;41(11):zsy158. doi:10.1093/sleep/zsy158 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231522/

[vi] Shechter A, Kim EW, St-Onge MP, Westwood AJ. Blocking nocturnal blue light for insomnia: A randomized controlled trial. J Psychiatr Res. 2018;96:196-202. doi:10.1016/j.jpsychires.2017.10.015 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703049/

[vii] Auld F, Maschauer EL, Morrison I, Skene DJ, Riha RL. Evidence for the efficacy of melatonin in the treatment of primary adult sleep disorders. Sleep Med Rev. 2017 Aug;34:10-22. doi: 10.1016/j.smrv.2016.06.005. Epub 2016 Jul 20. PMID: 28648359. https://pubmed.ncbi.nlm.nih.gov/28648359/

[viii] Xie Z, Chen F, Li WA, Geng X, Li C, Meng X, Feng Y, Liu W, Yu F. A review of sleep disorders and melatonin. Neurol Res. 2017 Jun;39(6):559-565. doi: 10.1080/01616412.2017.1315864. Epub 2017 May 1. PMID: 28460563. https://pubmed.ncbi.nlm.nih.gov/28460563/

[ix] Sadeghniiat-Haghighi K, Bahrami H, Aminian O, Meysami A, Khajeh-Mehrizi A. Melatonin therapy in shift workers with difficulty falling asleep: A randomized, double-blind, placebo-controlled crossover field study. Work. 2016 Sep 27;55(1):225-230. doi: 10.3233/WOR-162376. PMID: 27612057. https://pubmed.ncbi.nlm.nih.gov/27612057/

[x] Magnussen I, Jensen TS, Rand JH, Van Woert MH. Plasma accumulation of metabolism of orally administered single dose L-5- hydroxytryptophan in man. Acta Pharmacol Toxicol 1981;49:184-189.

[xi] Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Altern Med Rev. 1998 Aug;3(4):271-80. PMID: 9727088. https://pubmed.ncbi.nlm.nih.gov/9727088/

[xii] Kennedy DO. B Vitamins and the Brain: Mechanisms, Dose and Efficacy–A Review. Nutrients. 2016;8(2):68. Published 2016 Jan 27. doi:10.3390/nu8020068 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772032/

[xiii] Kennedy DO. B Vitamins and the Brain: Mechanisms, Dose and Efficacy–A Review. Nutrients. 2016;8(2):68. Published 2016 Jan 27. doi:10.3390/nu8020068 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772032/

[xiv] Kennedy DO. B Vitamins and the Brain: Mechanisms, Dose and Efficacy–A Review. Nutrients. 2016;8(2):68. Published 2016 Jan 27. doi:10.3390/nu8020068 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772032/

[xv] Moerman DE. Native American ethnobotany. Portland, OR: Timber Press; 1998

[xvi] Kim M, Lim HS, Lee HH, Kim TH. Role Identification of Passiflora Incarnata Linnaeus: A Mini Review. J Menopausal Med. 2017;23(3):156-159. doi:10.6118/jmm.2017.23.3.156 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770524/#B3

[xvii] Fahami F., Asali Z., Aslani A., Fathizadeh N. A comparative study on the effects of Hypericum Perforatum and passion flower on the menopausal symptoms of women referring to Isfahan city health care centers. Iran. J. Nurs. Midwifery Res. 2010;15:202–207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3203277/