PORTLAND - Researchers at Oregon Health and Science University (OHSU) have found that melatonin, a naturally occurring brain substance, can relieve the doldrums of winter depression, also known as seasonal affective disorder, or SAD. The study is publishing online this week in the Proceedings of the National Academy of Science.
The study was led by AlfredLewy, M.D., Ph.D., an internationally recognized pioneer in the study of circadian (24-hour) rhythm disturbances, such as those found in air travelers and shift workers, as well as in totally blind people.
Lewy and his colleagues in the OHSU Sleep and Mood Disorders Lab set out to test the hypothesis that circadian physiological rhythms become misaligned with the sleep/wake cycle during the short days of winter, causing some people to become depressed. Usually these rhythms track to the later dawn in winter, resulting in a circadian phase delay with respect to sleep similar to what happens flying westward. Some people appear to be tracking to the earlier dusk of winter, causing a similar amount of misalignment but in the phase-advance direction. Symptom severity in SAD patients correlated with the misalignment in either direction.
The treatment of choice for most SAD patients is bright light exposure, which causes phase advances when scheduled in the morning. Because patients know when they are exposed to bright light, however, there is a considerable placebo response associated with it. Melatonin can also cause phase advances, but it has to be taken in the afternoon. The Lewy team used afternoon melatonin to test if it was more antidepressant than melatonin taken in the morning, which causes phase delays.
The researchers randomly assigned 68 SAD patients to one of three treatment groups, taking placebo capsules or melatonin in the morning or afternoon for three weeks. After four years of study, they concluded that, similar to persistent jet lag, circadian misalignment is a major part of SAD.
Most patients, typically phase-delayed types or “night owls,” have misalignment that responded best to taking low-dose melatonin in the afternoon or evening. A longer-than-expected subgroup of SAD patients, phase-advanced types or “morning larks,” responded best to taking low-dose melatonin in the morning. Melatonin did not cause drowsiness, because the doses used were lower than what is usually taken at bedtime.
In addition to bright light exposure, another treatment may be in the offing once low-dose, sustained-release melatonin formulations become available. “However, people in the phase-advanced subgroup should use these treatments at different times of the day than the typically phase-delayed type of patient,” explained Lewy, adding that more research is needed.
Lewy is the Richard H. Phillips Professor of Biological Psychiatry, senior vice chairman of psychiatry, and director of the Sleep and Mood Disorders Lab, OHSU School of Medicine
Although it’s common to have the occasional sleepless night, insomnia is the lack of sleep on a regular basis.
Before starting any natural remedies, consult your doctor. Chronic insomnia can itself be a symptom of another condition, such as depression, heart disease, sleep apnea, lung disease, hot flashes, or diabetes, so it’s important to see a doctor if you are having trouble sleeping.
Natural Remedies for Insomnia
Here are fourteen natural remedies that are used to treat insomnia.
1) Valerian
Valerian (Valeriana officinalis) is a herb that has been long used as a remedy for insomnia. Today, it is an accepted over-the-counter insomnia remedy in Germany, France, Switzerland, Belgium, and Italy.
Exactly how valerian works in the body is still not well understood. Some studies suggest that like conventional sleeping pills, valerian may affect levels of the calming neurotransmitter GABA.
Unlike many other sleep medications, valerian is not believed to be addictive or cause grogginess in the morning. But valerian doesn’t work for everyone. And although studies in labs have been encouraging, clinical trials are still inconclusive.
Valerian is usually taken between an hour before bedtime. It takes about two to three weeks to work. It shouldn’t be used for more than three months at a time. Side effects of valerian may include mild indigestion, headache, palpitations, and dizziness. Although valerian tea and liquid extracts are available, most people don’t like the smell of valerian and prefer taking the capsule form.
Valerian shouldn’t be taken with many medications, especially those that depress the central nervous system, such as sedatives and antihistamines. Valerian shouldn’t be taken with alcohol, before or after surgery, or by people with liver disease. It should not be taken before driving or operating machinery. Consultation with a qualified health practitioner is recommended. For more information about valerian.
Melatonin
Melatonin is a popular remedy to help people fall asleep when the sleep/wake cycle has been disturbed, such as in shift workers or people who with jet lag.
Melatonin is a hormone found naturally in the body. The pineal gland in the brain makes serotonin which is then converted into melatonin at night when exposure to light decreases.
Melatonin is typically taken about 30 minutes before the desired bedtime. Some experts caution that melatonin should not be used by people with depression, schizophrenia, autoimmune diseases, and other serious illness. Pregnant and nursing women should not use melatonin.
The University of Alberta study examined 17 studies with 651 people and found no significant side effects when used for three months or less. The long-term effect of melatonin supplementation is not known. For more information about melatonin, read
3) Kava
Kava is an anti-anxiety herb that may be helpful for anxiety-related insomnia. However, the United States Food and Drug Administration (FDA) has issued an advisory to consumers about the potential risk of severe liver injury resulting from the use of dietary supplements containing kava. To date, there have been more than 25 reports of serious adverse effects from kava use in other countries, including four patients who required liver transplants. Learn more:
4) Relaxation Techniques
Relaxation techniques are one of the most effective ways to increase sleep time, fall asleep faster, and feel more rested in the morning. They require a minimum of 20 minutes before going to bed. There are many different techniques:
Visualization involves imagining a relaxing scene. You can try it in bed before falling asleep. Involve all your senses. If you’re imagining yourself on a tropical island, think of the way the warm breeze feels against your skin. Imagine the sweet scent of the flowers, look at the water and listen the waves–you get the picture. The more vivid the visualization and the more senses you involve, the more effective it will be.
Relaxation Response - A mind/body technique based on the principles of Transcendental Meditation.
Mindfulness - A type of meditation that essentially involves focusing on your mind on the present.
Yoga combines deep breathing, meditation, and stretching. A Harvard study found that daily yoga for eight weeks improved total sleep time, the time to fall asleep. If you’ve never tried yoga before, not to worry. There are many gentle yoga styles to choose from.
Progressive Muscle Relaxation is a promising natural remedy for sleep. If you’ve never tried a relaxation technique before, this technique is easy to learn and simple to master.
5) Diet
Cut out caffeine
Caffeine can have a pronounced effect on sleep, causing insomnia and restlessness. In addition to coffee, tea, and soft drinks, look for hidden sources of caffeine such as chocolate, cough and cold medicine, and other over-the-counter medicine.
Avoid sweets
Although sugar can give a burst of energy, it’s short-lived and can cause uneven blood sugar levels. This can disrupt sleep in the middle of the night as blood sugar levels fall.
Eat foods that help you sleep
Tryptophan is an amino acid that is a precursor to serotonin, which is then converted to melatonin. Carbohydrate snacks such whole grain crackers before bedtime may help to promote sleep. Just be sure to stay away from sweets.
Eat magnesium-rich foods
Magnesium is a natural sedative. Deficiency of magnesium can result in difficulty sleeping, constipation, muscle tremors or cramps, anxiety, irritability, and pain. It has also been use for people with restless leg syndrome.
Foods rich in magnesium are legumes and seeds, dark leafy green vegetables, wheat bran, almonds, cashews, blackstrap molasses, brewer’s yeast, and whole grains.
6) Aromatherapy
The scent of English lavender has long been used as a folk remedy to help people fall asleep.
Research is starting to confirm lavender’s sedative qualities. It’s been found to lengthen total sleep time, increase deep sleep, and make people feel refreshed. It appears to work better for women, possibly because women tend to have a more acute sense of smell.
The good thing about lavender is that it begins to work quickly. Try putting a lavender sachet under your pillow or place one to two drops of lavender essential oil in a handkerchief. Or add several drops of lavender oil to a bath — the drop in body temperature after a warm bath also helps with sleep.
Other aromatherapy oils believed to help with sleep are chamomile and ylang ylang.
7) Light
If you have trouble falling asleep at night, you may need more light in the morning.
Light exposure plays a key role in telling the body when to go to sleep and when to wake up. Try taking a walk first thing in the morning. Just be sure to wear sunscreen to protect your skin from ultraviolet rays.
On the other hand, if you find you’re waking up too early in the morning, you may need more light in the afternoon. Try taking a walk in the late afternoon.
Music
Gentle, slow music is another remedy that can help to improve sleep without medication.
Music has been found to improve sleep quality, decrease nightly wakenings, lengthen sleep time, and increase satisfaction with sleep.
9) Acupuncture
Acupuncture may help with insomnia. A University of Pittsburgh analysis concluded that acupuncture may be an effective treatment for insomnia. A preliminary study found that five weeks of acupuncture increase melatonin secretion in the evening and improved total sleep time.
10) Traditional Chinese Medicine
In traditional Chinese medicine, insomnia often stems from kidney energy weakness. This syndrome is not necessarily related to kidney disease in Western medicine. A few signs of kidney energy weakness are low back ache, tiredness and fatigue, and a burst of energy at about 11 pm in the evening. Women in menopause often experience this type of insomnia. People who are taking anti-estrogenic drugs such as tamoxifen also experience this type of insomnia, however, they should not take herbal combinations such as the herbal formula liu wei di huang that may increase estrogen levels.
11) Ayurvedic Medicine
In Ayurvedic medicine, insomnia is often associated with a vata imbalance. Vata regulates breathing and circulation. People with a vata imbalance often notice irritability, anxiety, and fear with insomnia. One Ayurvedic treatment is the application of oil on the head and feet. For the pitta type, room temperature coconut oil is used, for the vata type, warm sesame oil is applied, and for the kapha type, warm mustard oil is often applied.
12) Exercise
Lack of exercise can contribute to poor sleep. Muscle tension and stress build in the body. Exercise can promote deep sleep that night. However, intense exercise too close to bed can increase adrenaline levels, leading to insomnia.
13) Other Natural Remedies
For hot flashes, a thin, flat foam pillow insert, called a Chillow, can help to cool the head throughout the night.
Chamomile, hops, passionflower, lemon balm, and ashwagandha are other herbs that are often used for insomnia. Some people may find benefit from simply having a cup of chamomile tea one to two hours before going to bed. Chamomile can reduce anxiety, calm the digestive system, and relieve muscle tension.
14) FengShui
Feng shui, which originates in the Chinese philosophy of Taoism, instructs on how to arrange rooms, furniture, offices, houses, and other arrangements to maximize favorable energy flow throughout living spaces. Here are some recommendations that may help promote relaxing sleep:
Try not to have the bed in a corner of the room. The corners are where energy tends to be stagnant.
Avoid putting your bed next to a window. Energy can be drained this way.
The bed shouldn’t be positioned so that the soles of the feet, when lying face-up in bed, directly face the doorway.
When lying in bed, you should have full view of anyone coming in the door. If you can’t do this directly, hang a mirror to reflect the entranceway.
Try to avoid facing sharp corners from desks, bookcases, and other pieces of furniture.
Melatonin is a hormone that helps regulate sleep. It also appears to influence other hormones in the body. Melatonin supplements have become popular as natural sleep aids.
The amount of melatonin we produce is determined by how dark or light our surroundings are. Our eyes have specialized light-sensitive receptors that relay this message to a cluster of nerves in the brain called the suprachiasmatic nucleus, or SCN. The SCN sets our internal biological clock, also called our circadian rhythm, which regulates a variety of body functions including sleep.
Melatonin is made from an amino acid called tryptophan. When our surroundings are dark, the SCN tells the pineal gland to produce melatonin, which is thought to trigger sleep. Some melatonin is also made in the stomach and intestines.
Melatonin levels were originally thought to decline with age. Early reports said that a person’s melatonin levels peaked at age 20 and gradually decreased to 20% at age 80. This theory was used to explain why many older people have sleep difficulties. Melatonin supplements became marketed as a “youth hormone,” contributing to its rise in popularity. Recent evidence, however, suggests that melatonin levels don’t actually decline with age.
Why Do People Use Melatonin Supplements
Melatonin supplements are popular as natural sleep aids for the following sleep disorders:
* Jet Lag
Travel across time zones disrupts the circadian rhythm. Evidence suggests that melatonin supplements can decrease jet-lag symptoms, particularly in people traveling eastward and/or crossing five or more time zones. Melatonin has been found to lessen the time it takes to fall asleep, reduce daytime tiredness, and boost alertness during the day.
The best results occur when melatonin supplements are started on the day of travel and taken at the desired bedtime at the destination. It is usually taken for several days. Melatonin doesn’t work for everyone: Evidence suggests that approximately half of the people who take melatonin notice an improvement.
* Shift Work
Although night shift work also disrupts the circadian rhythm, the evidence that melatonin can improve sleep after night shift work is less solid. It also hasn’t been found to improve alertness during shift work. More research is necessary.
* Insomnia in Older Adults
A number of studies have found that melatonin supplements taken between half an hour and two hours prior to the desired bedtime can shorten the time it takes older adults to fall asleep. It isn’t clear, however, whether melatonin can help people stay asleep.
* General Sleep Improvement
Melatonin appears to lessen the time it takes to fall asleep, promote sleepiness, and lengthen sleep time when taken by healthy people. Most studies have been small and short in duration, so more research is needed.
* Delayed Sleep Phase Syndrome
Delayed sleep phase syndrome is a circadian rhythm disorder. People have trouble falling asleep until late at night and then have difficulty waking in the morning. Melatonin may help establish a regular sleep-wake cycle.
* Sleep Problems in Children with Neuro-Psychiatric Disorders
There have been a number of well-designed studies and case reports on the use of melatonin in children with neuro-psychiatric disorders that result in sleep difficulties, such as autism, psychiatric disorders, visual impairment, or epilepsy. The studies conducted so far suggest that melatonin can shorten the time to fall asleep and lengthen sleep duration.
Additional Uses
Although the evidence is unclear, melatonin has been studied for the following conditions:
* Cancer
Melatonin has been studied for cancer, primarily using lab animals and human cells in test tubes. Although results have been promising, there isn’t enough evidence to determine whether melatonin is safe or effective, and whether or not it might decrease the effectiveness of cancer therapies.
* Withdrawal From Benzodiazepine Medications
There is some evidence that melatonin may help ease the withdrawal symptoms in people who are decreasing their use of benzodiazepine drugs, often used for sleep disorders and anxiety.
* Sleep Problems due to Specific Conditions
Preliminary evidence suggests that melatonin may improve sleep for people with specific conditions such as Alzheimer’s disease, Parkinson’s disease, bipolar disorder, attention deficit hyperactivity disorder (ADHD), and diabetes.
* Electromagnetic Field Exposure
There is a theory that low-frequency electromagnetic fields (such as those in household appliances) may disrupt melatonin levels. Overall, studies with humans haven’t supported this theory.
Melatonin Side Effects and Safety Concerns
Melatonin is generally considered safe when used short-term and within the recommended dosages. There is no research on the long-term effects of melatonin supplements, particularly in higher doses.
Some experts consider the doses commonly found in melatonin supplements, 3 to 5 milligrams, to be far too high and say that amounts in the range of 0.1 to 0.5 milligrams are more reasonable.
Melatonin side effects may include drowsiness, dizziness, confusion, headache, irritability, vivid dreams, and a temporary reduction in attention and balance. People shouldn’t drive or use machinery for several hours after taking melatonin. Melatonin may cause abdominal cramps, nausea, and vomiting, lower blood pressure, and rarely, hallucinations or paranoia.
Melatonin may increase the risk of blood clotting, so it should not be used by people using warfarin (Coumadin), other medications that influence blood clotting, or by people with clotting disorders.
Melatonin Side Effects and Safety Concerns, cont’d
Melatonin influences the production of other hormones. It could theoretically interfere with normal sexual development, so it shouldn’t be used by children unless they are under the supervision of a healthcare provider. For the same reason, it shouldn’t be used by women who are trying to conceive or by pregnant or nursing women. Increased male breast size and reduced sperm count have also been reported. Melatonin may also affect insulin levels.
Melatonin can influence immune function and it’s not known how it affects people with autoimmune conditions such as multiple sclerosis, psoriasis, Crohn’s disease, rheumatoid arthritis, lupus, and type 1 diabetes.
Melatonin supplements may worsen the symptoms in people with depression, so people with depression should only use melatonin under the supervision of a health care provider. Melatonin is broken down by the liver, so people with liver disease should avoid melatonin.
Possible Drug Interactions
Melatonin may interact with the following drugs:
* High blood pressure medication
* Drugs that suppress the immune system, such as cyclosporine
* Antidepressant medication
* Corticosteroids (used for inflammatory conditions such as arthritis)
* Benzodiazepines, such as diazepam (Valium), and other drugs that cause sedation
* Herbs that cause sleepiness or drowsiness, such as kava kava and valerian
Music