Why You Can't Sleep

Insomnia. It happens to almost everyone at some point. We can power through occasional and brief episodes. But those prolonged and recurring episodes can just about ruin your day...every day. If you can’t sleep, here are some possible reasons why.

Something Is Bothering You

Whether you realize it or not, something may be on your mind that’s interfering with your sleep. This is true whether you’re having a hard time falling asleep or you’re waking up at 3am and unable to fall back asleep. You may have gotten so used to this source of stress that you don’t realize it’s bothering you. This could be a change at work, a change in your financial situation, an upcoming visit from someone you don’t like, worry about a mysterious symptom you or your loved one is experiencing, ongoing marital problems, feeling lonely or bored in life - the list of possible options is endless and unique to your experiences. Mental health issues like clinical depression and anxiety are also associated with insomnia.

Your Hormones

The hormonal shifts that happen with menopause and perimenopause can interfere with sleep. Abnormal thyroid levels can also have a dramatic impact on sleep. In some cases, testing can help determine if hormones are playing a role in your insomnia. Birth control pills and hormonal IUDs may also interfere with sleep. Testing in these situations is more complicated as results may be skewed because of the hormonal influence of the birth control. Please do not change your prescription medications without consulting your doctor.

Nutritional Deficiencies And Supplements

Nutritional deficiencies like iron deficiency and low vitamin d have been associated with poor sleep. On the flip side, taking certain nutritional supplements or herbal remedies before bed can worsen sleep. One example of this is a B-complex. Many B vitamins can increase energy and can interfere with sleep if taken too close to bed. The same goes for certain herbal remedies like rhodiola. Talk to your naturopathic doctor to get a good schedule for your natural remedies and supplements.

You’re Spending Too Much Time On Your Bed

The bed is not the place to watch TV, scroll on your phone, send emails or do work. When we do this, the brain starts to associate the bed with wakefulness rather than sleep. When it comes to sleep we need to convince our busy minds that when we are in bed, it’s time to shut down and sleep. If you need background noise to fall asleep, consider music or white noise. Tossing and turning in bed when you can’t sleep also disturbs this sleep-bed association. That’s why it’s recommended to get out of bed when you can’t sleep and do something relaxing (screen free) until the desire to sleep returns. When that happens, you try going to bed again.

Of course, these are only a few things that could be contributing to your inability to sleep. Working with an experienced health care provider can help you get to the bottom of your unique sleep issues. If you need help managing your sleep and you want to learn more about how a naturopathic doctor can help you, get in touch.

Melatonin for Sleep: What You Should Know

It’s not fun to struggle with sleep. Not being able to get a good night’s sleep can have a serious impact on your quality of life. Melatonin is a popular sleep aid that many turn to as a solution to their sleep woes. Melatonin is a hormone that is produced in your pineal gland (part of your brain). The production of melatonin is controlled by the level of light and darkness in the environment. Typically, melatonin release starts shortly after the sun sets. It tends to peak in the very early hours of the morning (e.g. 2-4 am) and then starts to decline. Light (especially blue light) blocks the production of melatonin. In addition to regulating sleep, melatonin plays a role in many other functions in the body. It’s a potent antioxidant and it regulates functions like immunity, energy, metabolism, mood and the activity of hormones. Below are some important facts about melatonin.

Effectiveness

Most of the evidence around melatonin shows that it can be helpful for those who have a biological clock that is thrown off. This includes people dealing with jet lag and night shift workers. There is also some evidence that it can help people who have insomnia for no particular reason (primary insomnia) by slightly decreasing the time it takes to fall asleep, improving sleep quality and increasing morning wakefulness. The effectiveness of melatonin can increase over time and then may eventually hit a plateau after several weeks.

Melatonin and Age

As we age, we start producing melatonin later and later after sunset. The peak levels of melatonin in the body also decreases with age. For this reason, scientists believe that melatonin may work better in people over 50 years of age compared to younger people.

Prolonged Release Forms

Melatonin can often be found in two different forms: regular and prolonged release. When you take regular melatonin orally, it tends to peak pretty soon after you take it (e.g. an hour). The levels spike higher than what your body would naturally have produced and then they quickly start to decrease. Experts have found melatonin levels can drop back to baseline anywhere between 2-8 hours of taking it. With prolonged released forms, the melatonin levels in your body rise more slowly, don’t go as high and drop back down more slowly. Some patients experience better results with prolonged release forms although more studies are needed to verify this difference in effectiveness.

Dosing

Typically, 1-5 mg doses are used (more is not better when it comes to melatonin supplements for sleep). People often take melatonin at the wrong time. In most research studies, melatonin is taken 30-60 minutes before bed.  

Side Effects and Safety

Many people tolerate melatonin well without any side effects, but side effects are still possible for some people. Melatonin can cause vivid dreams and nightmares in some individuals. It can also cause grogginess the next day as well as headaches. I tend to avoid melatonin in patients with depression as it has been associated with transient depression and worsening current depression. Melatonin also interacts with a number of different medications, supplements and health conditions so it’s important to speak to your naturopathic doctor and medical doctor prior to taking melatonin. The safety of taking melatonin continuously long term has not been well studied. This is why I always discuss with my patients about how long and how often we will incorporate melatonin into their plan.

Managing Your Sleep Beyond Supplements

Treating sleep difficulties involves more than just a sleep supplement. A well-rounded approach is required. Underlying conditions like anxiety, depression, thyroid disorders and sleep apnea need to be ruled out or treated. We also need to focus on other factors that can enhance sleep like specific behaviour changes and certain nutrition and lifestyle recommendations. I often find it helpful to incorporate other treatments like acupuncture for my patients with insomnia.

Good sleep affects every aspect of your health. Getting your sleep corrected can be a gateway to vastly improving the quality of your life.

Does Your Bedtime Really Matter?

There are a lot of theories in the wellness industry about the optimal bedtime for adults. Some say that going to bed at 10 pm is optimal for cell repair and renewal. Some say that any sleep after midnight is only worth half the value of sleep before midnight.

I used to insist on going to bed at 10 pm every night but as life got busier, 11-11:30 pm became the new norm. But does that 1-1.5 hour delay really make a difference if I sleep in to make up for it? What does science have to say about this? Does bedtime matter, or should we only be concerned about the number of hours of sleep that we’re getting?

Our sleep happens in cycles. On paper, we should have around 4-5 cycles of sleep throughout the night that last 90 minutes each. Within a cycle, we shift between deeper and lighter sleep (non-REM and REM sleep) and then repeat the process in the next cycle, and the next, and so on until it’s time to wake up.

Many scientists agree that the earlier you go to bed, the more time is spent in the deeper phases of sleep during each sleep cycle. As your bed time gets later, you’re more likely to spend a larger chunk of your sleep cycles in a lighter sleep.

Sleeping late can affect memory, thinking, energy levels and other important health factors. Some doctors argue that going to bed no later than midnight is important to get that deeper quality of sleep we need in order to thrive during the day.

Another reason to avoid a late bedtime is the “second wind”. Do you ever notice that at a certain time in the night you go from feeling sleepy and ready for bed to feeling awake again? This is the second wind phenomenon and many people notice it around 10:30-11 pm, although the timing can be different for everyone. Our body’s internal clock seems to have a built-in wakefulness period in the night that causes this second wind. Going to bed around the second wind time can make it harder to fall asleep. Even ancient systems of medicine from different cultures recognize this phenomenon and recommend going to bed before it happens.

So we’ve established that going to bed earlier likely makes for a better quality of sleep. But can an earlier sleep actually help with cell renewal? The sleep hormone, melatonin, rises when the sun sets and it becomes dark outside. Melatonin is an antioxidant and has been shown to play an important role in DNA repair and other very important repair processes. The later into the night that you stay awake (especially if lights and screens are on), the more your melatonin levels are suppressed. This can potentially impact all of the repair processes melatonin is involved in.

Overall, it seems like science doesn’t point to an exact perfect bedtime. But most sources seem to agree that a late bedtime that’s closer to midnight or later is not ideal, even if you sleep in. If you’re feeling groggy in the morning, you might want to consider experimenting with an earlier bedtime to find what works for you. As for me, I’ve recently reinstated my 10 pm rule and I’m absolutely loving it.

Sleeping the right way for your body is a critical step in transforming your physical and mental health. Diet, stress management, digestion, exercise and lifestyle are other key pillars of health. I work on these areas with all of my patients. If you don’t feel your best right now, it’s worth getting expert help to get these core health factors in order so you can give your all to everyone and everything that’s important to you.

Reducing Inflammation Can Reduce Anxiety and Depression

How are your 2019 goals going? Do you feel like you’re making progress with your New Year’s resolutions? Or is your mental health weighing you down? It can be disappointing to make all these goals for your new year and then realize that you don’t feel like taking steps towards them because you’re too anxious, depressed, unmotivated or irritable. “New Year, New You” might already be fading away to “New Year, Same Old”. Sometimes before you start tackling your goals, you need to get your head in the right space first. If you’re struggling with anxiety or depression, that means doing everything you can to improve your chances of healing.    

There is exciting research in the field of mental health regarding the role that inflammation plays in anxiety and depression. Laboratory studies have found that inflammation impacts regions of the brain associated with fear and anxiety. Scientists have also found that factors that increase inflammation like poor diet, poor lifestyle, illness and stress can interfere with the production of serotonin and dopamine. These are brain chemicals that are important for mood and happiness.

Of course, inflammation is not the only factor involved in anxiety and depression but numerous studies have found that anxiety and depression patients seem to have higher levels of inflammation markers in their blood and cerebrospinal fluid. It also seems like anxiety and depression can further increase inflammation in the body (sounds like a vicious cycle, right?). It has even been found that some patients with mental health conditions have a genetic predisposition to higher levels of inflammation. Some doctors are using the term “brainflammation” to describe this connection between mental health and inflammation.  

Naturally, scientists want to see if reducing inflammation can reduce symptoms of anxiety and depression. Herbs that reduce inflammation such as turmeric have been able to reduce symptoms of both anxiety and depression in several studies. There are many other natural ways your naturopathic doctor can use herbal medicine and nutritional supplements to reduce inflammation.

But beyond taking a pill, how else can you reduce inflammation? Eat well. Sleep well. Exercise. Relax. Lose Weight. These are core pillars of health and key ways to reduce inflammation.

Confused about all the information out there on how to eat well? Talk to a naturopathic doctor. Our whole job is to sift through the truth and the trendy myths to give you the diet information that will actually help you without overwhelming you. Not sleeping well despite drowning in melatonin supplements and sleepy tea? Talk to a naturopathic doctor. We’ll set you up on a science-based plan that solves your unique sleep problems. If you need support with losing weight, managing stress and exercising, naturopathic doctors can help you or connect you to resources and other people that can help you.

January can be such an exciting month full of promise for the year to come. It doesn’t have to be a month of disappointment and failed New Year’s resolutions. If you take the right steps and get the right support, this can be a year of real progress in your physical and mental health. If you want “New year, New you” to be true for you in 2019, prioritize yourself and prioritize your mental health.

Treating Depression Holistically

In 2012, 2.8 million Canadians reported having symptoms of mental health conditions like depression. With the coldest and darkest time of the year looming ahead of us, many are being impacted by seasonal affective disorder. However, millions of people experience mood disorders completely unrelated to the season. For some, these dips in mood may not be severe enough to be considered clinical depression but they are still negatively impacting happiness and wellbeing. For others, their symptoms are consistent with clinical depression.

Though there are many causes of depression, scientists argue that our lifestyle may be contributing to the rise in depression in the modern world. We move less, eat more, connect less with loved ones, sleep poorly and often feel pressed for time. Depression, in turn can make you less interested in connecting with family and friends or doing the things you used to love. It’s frightening to lose that feeling of looking forward to something that once brought you joy or interest. When you’re depressed, it’s easy to feel like you may never get to experience that joy or excitement again – or that you never really did experience it in the past.  

Medication and/or psychotherapy are important first line treatments to consider in cases of depression. But we should not stop there. Many researchers recommend including “lifestyle medicine” as part of a well-rounded, holistic treatment plan for depression. According to a paper published by BMC Psychiatry (PMID: 24721040), “lifestyle medicine” includes the following:

-          Improving diet

-          Physical exercise

-          Recreation and leisure

-          Relaxation and mindfulness/ meditation

-          Improving sleep

-          Improving environment (i.e. less exposure to pollution, chemicals, noise and more exposure to nature)

-          Social time

-          Reducing alcohol and smoking

Some of these concepts are still budding areas of research but the risk of trying them is low and your life will likely benefit in more ways than one for trying them. It has been argued that these interventions can improve depression by improving the health of your brain and hormones and by reducing inflammation (yes there is a connection between inflammation and depression).

As a naturopathic doctor, I recommend many of these treatments along with herbal medicine and acupuncture to my patients struggling with their mood. If a patient really needs medication, I never expect them to choose between medication or a naturopathic approach. With the right guidance, natural approaches can mesh perfectly well with medication. I also never expect a patient to change their lifestyle overnight. When mood and motivation are low it can be hard to make even the simplest changes to daily routines. Small, realistic steps are important to prevent discouragement.

With depression, the goal is not simply to numb the feelings of sadness but to move towards wellbeing and happiness. I want my patients to feel excited again about their lives, their family, their friends, their work and their ambitions. I believe a well-rounded, holistic approach to depression is key to getting closer to those goals.