Originally published in Dr. Julian Whitaker's Health & Healing, Vol. 22, No. 12, December 2012
Quality sleep ranks high on the list of requisites for optimal health, but its significance is often overlooked. I know this not only as a physician, but from personal experience. I used to feel tired all the time. I had to drag myself out of bed, I'd sometimes nod off during the day, and more than once I caught myself drifting off while driving. However, because I always went to bed and got up at a reasonable time and rarely woke up during the night, I never attributed it to poor sleep.
About 12 years ago, at the request of my wife – who put up with my snoring but was disturbed by the increasing frequency of episodes when I appeared to stop breathing – I got tested for sleep apnea. In one hour, I had 69 attacks of apnea (spells when I stopped breathing for 10 seconds or longer). My oxygen level was low, and I got virtually no restorative REM sleep. No wonder I was groggy and fatigued!
I immediately began using a continuous positive airway pressure (CPAP) machine, a device worn at night that delivers a steady stream of air to keep the airways open. I couldn't believe how much it improved my quality of life. Some people complain that their CPAPs or APAPs (an automatic version of CPAP) are uncomfortable, and they do take some getting used to. But over the past 12 years, I've slept without mine only once, when I left it at home while traveling. I may occasionally forget to pack my toothbrush, but I never forget my CPAP because I am acutely aware of the tremendous benefits imparted by a good night's sleep.
A serious, common sleep disorder
A flood of research reveals links between sleep and a broad range of health concerns. In addition to making you tired and cranky, poor sleep can wreck your memory and mood, make you fat, raise your blood pressure and blood sugar, stress your immune system, and increase your risk of diabetes, stroke, heart attack, and dementia.
At the Whitaker Wellness Institute, if patients have any of these symptoms or disorders – or if they snore, a common sign of this condition – we evaluate them for sleep apnea. When I was tested 12 years ago, I had to spend a night in a sleep lab hooked up to all kinds of sensors and monitors. Now, we give patients a portable monitor to use in the comfort of their home or hotel room. Much less expensive and far more pleasant, this test is widely accepted as a reliable diagnostic tool.
It's shocking how many of our patients do have sleep apnea – an estimated 70 percent of those who are tested. But it's heartening to see how much better they feel once they adapt to CPAP/APAP.
Steer clear of drugs
Not all sleep issues, of course, are related to apnea. Run-of-the-mill insomnia affects an estimated one in four adults. Far too many of them turn to sleeping pills – more than 60 million prescriptions were filled in the US last year. All sleeping pills, both benzodiazepines (such as Xanax, Restoril, and Halcion) and the newer non-benzodiazepine sedative hypnotics (Ambien, Sonata, and Lunesta), have serious side effects. They include daytime drowsiness, cognitive impairment, balance problems, a strong potential for addiction – and according to a 2012 study, increased risk of death.
Researchers compared outcomes of 10,529 patients who had received prescriptions for sleeping pills and 23,676 others who had not been on these drugs. They found that taking as few as 18 pills a year more than tripled risk of death; 18–132 pills increased risk by 443 percent, and more than 132 by 532 percent. Furthermore, the latter group had a 35 percent increased risk of cancer.
Sleeping pills are approved only for short-term use, several days to a few weeks at most, but many patients take them night after night for months or years on end. What are their doctors thinking? Furthermore, these meds don't work that well. Studies show that the newer drugs, which can cost upwards of $8 per pill, may help sleep arrive 10–20 minutes faster and last about 30 minutes longer, but is that really worth all these risks – especially since we have far safer, equally effective options?
Nature's sleep aids
The best-studied natural sleep aid is melatonin, the "hormone of sleep." Melatonin's production in the pineal gland is cued by light – levels rise in the evening as darkness falls and ebb towards the morning. Today's plugged-in, lit-up world blurs the signals for melatonin synthesis, resulting in disturbances in our sleep-wake cycles. By restoring natural levels, supplemental melatonin not only enhances sleep, but it's a powerful antioxidant that protects against cancer and other diseases.
Another popular remedy for insomnia is valerian (Valeriana officinalis). This calming herb helps curb anxiety that leaves many tossing and turning. One recent study involved a group for whom sleeplessness is a common complaint: postmenopausal women. After four weeks of taking either a concentrated valerian extract or a placebo, 30 percent of the women in the valerian group had improvements in quality of sleep compared to just four percent in the placebo group.
L-theanine (from green tea), lemon balm, chamomile, and hops also relieve stress, induce relaxation, and facilitate sleep, as do acupuncture, reflexology, and massage. If none of these safe, drug-free approaches help, I suggest you talk to your doctor about Dilantin. In these stressful times, ruminating, busy minds underlie many a restless night. Low doses of Dilantin, a drug used primarily for seizure disorders, tone down the static and help banish the worrisome thoughts that keep us awake.
The balm of sleep
Sleep is serious stuff, and you need to do everything in your power to get a handle on any and all sleep issues. As the Irish proverb goes, "A good laugh and a long sleep are the best cures in the doctor's book."
- Talk to your doctor about getting tested for sleep apnea.
- Suggested doses of natural sleep aids are melatonin 1-6 mg (average 3 mg), valerian 500 mg, L-theanine 200 mg, lemon balm 300 mg, chamomile 300-400 mg, and hops 120 mg. Take 30-60 minutes before bedtime.
- The recommended dose of Dilantin is 100 mg at bedtime. Dilantin requires a prescription, and many physicians are unfamiliar with this low-dose, non-seizure use. To learn more, visit Dr. Whitaker's web site.
Kripke DF, et al. Hypnotics' association with mortality or cancer: a matched cohort study. BMJ Open. 2012 Feb 27;2(1):e000850. doi: 10.1136/bmjopen-2012-000850.
Taavoni S, et al. Effect of valerian on sleep quality in postmenopausal women: a randomized placebo-controlled clinical trial. Menopause. 2011 Sep;18(9):951–955.