Article from Townsend Letter:
New Whys and Ways to Sleep Better, Especially After 40
by Devaki Lindsey Berkson, DC

There are two planets. One where you get a great night’s sleep and feel phenomenal the next day. And a second where you can’t get a good night’s sleep, and your tomorrow feels like trudging through molasses.

In modern life, it’s easier to end up on planet number two. Healthy sleep is under continual attack, and threats against achieving a restorative night’s sleep keep mounting.

Today’s sleep gets mugged in many ways:

• By chronic daily stressors, like tending aging parents or having kids who announce they want to change their genders, or from single severe traumas – such as tornadoes and wildfires to anything like betrayal, getting fired, or receiving a serious diagnosis.
• By night-shift work schedules.¹
• By excessive electromagnetic field exposures² that occur regularly in towns across an America dotted with electrical and Wi-Fi towers.
• Unhealthy food habits. Magnesium lives inside red blood cells where it nudges healthy enzymes for sleep. Regularly consuming junk food³ creates nutrient deficiencies, especially magnesium deficiencies.⁴ Late night eating syndrome⁵ – lying down too much, eating too much, all too soon before bed (unfortunately normal for life in the good ole USA) – dings sleep.
• Sugary foods – like candies, colas, pastas, and pastries – disrupt the sugar hormone insulin, derailing sleep. And vice versa: chronic insomnia creates chronic blood sugar issues.⁶
• Hormonal swings can disrupt both genders.
  o Women wake from hot flashes⁷ urgently flinging off their sheets, and sleep is disrupted. Today’s toxic planet is rife with endocrine-disrupting pollutants. These hormone-altering chemicals are making some younger women develop hot flashes earlier, with sleeping issues earlier, too.
  o As middle-aged males go through “andropause,” lower levels of testosterone⁸ can worsen sleep. Again, our toxic planet and diets are promoting an epidemic of lower testosterone levels in American males,⁹ which can ruin sleep.
• Even climate change¹⁰ is being linked to worsening sleep through disasters such as hurricanes, floods, wildfires and higher temperature levels.

What Does Sleep Loss Do to Us?
Insomnia – the inability to achieve restorative sleep – gives you a worse tomorrow. You have a greater likelihood of being exhausted the next day, as well a greater risk of feeling anxious and depressed. By the way, this is also true the other way around¹¹; mood issues can worsen sleep.

“Perimenopausal insomnia”¹² is one of the most common complaints of midlife women. The perimenopause is when hormone levels yoyo as eggs age and regular ovulation becomes harder to achieve. During this time, women typically require more sleep to feel better the next day. Yet they oftendon’t get it. Bone-curdling exhaustion manifests. Life feels harder. Up to forty percent of perimenopausal women complain of serious sleep and fatigue issues. Much more so than same-aged men. Female hormones nosedive much faster in middle-age, compared to male hormones that typically decline more slowly. Though with today’s pollution, this appears to be changing.

Of note is that the age of perimenopause¹³ is lowering. This is due to hormone-altering chemicals in today’s dirty world along with today’s dirtier diets. Perimenopause historically occurred in a woman’s mid-to-late 40s. Now some women are starting their perimenopause in their late twenties and more in their thirties. As menstruation milestones wane, so does sleep.

Without adequate sleep, we’re not only tired and wired, but we also can’t think as clearly, get any job done as well, plus we are more accident-prone. Inadequate sleep promotes errors in judgment, even more neuroticism, and less mindful conscientiousness¹⁴ (no matter how much you try to sit and shut off your thoughts).

Lack of restorative sleep raises stress hormones¹⁵ (epinephrine and cortisol) that shrink the hippocampus (hippocampal atrophy). The hippocampus is the area deep inside your brain where your sense of “self” lives. I call it the seat of your 3 M’s (me-ness, memories, and motivation). Lack of sleep causes poor memory retrieval, overwhelm, and self-doubt as hippocampal function¹⁶ degrades. Maybe you’re seeing a psychotherapist when you need to address your sleep.

Excessive levels of cortisol are linked to increased belly fat that is not easy to lose.¹⁷

Excess cortisol can ding sex hormones. Higher levels of cortisol do this by “competitive inhibition.” Excessive cortisol swims inside and binds into the estrogen, testosterone, or progesterone receptors and clogs them (competes with the parent hormone). Even if your blood and saliva levels of hormones look normal on testing, these blocked sex steroid receptors can’t deliver their signals optimally.¹⁸ You feel tired, bloated, fat, and slow. No matter how many green drinks you down. No matter how much your gynecologist or endocrinologist insist that your hormone levels look normal.

Excessive cortisol can increase an adrenal and brain hormone called dehydroepiandrosterone, nicknamed DHEA. Excess DHEA can make estrogen or testosterone levels soar.¹⁹ Thus, too little sleep causes too much stress hormone, which can lower or amplify sex hormone signals, depending on lots of individual factors that make up individual physiologies, all which ups your risk of various health issues such as hormonally driven cancers.

Too high levels of stress hormones for too long depress your immune system. This puts you more at risk of diverse diseases and infections, for example, greater risks of heart disease, type-2 diabetes, and even eye diseases.

Did you know that eye doctors are now required to learn about sleep disorders, as sleep is becoming known as a major influencer on eye health?²⁰ Any person with absolutely any kind of eye disease must have their sleep tested and improved to protect their vision.

Sleep disturbances are strongly associated with “impaired” release of factors called growth or trophic factors such as brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1).²¹ Optimal functioning of growth factors protects mood, staves off depression, and maintains neuroplasticity.

Sleep is a huge contributor to psychology. Sleep is a portal to help you sort out the things you learned and endured all day long. Studies have linked a nightly battle with insomnia to anxiety, depression, memory loss, dementia, socialization issues and even Alzheimer’s and other brain disorders, including Parkinson’s.²²

Why You Can’t Sleep

• Too much caffeine. Excess caffeine consumption has now been shown to suppress the production of melatonin in pinealocytes (cells in the pineal gland) through competitive inhibition of adenosine A2 receptors by caffeine.
  o Higher cumulative lifetime coffee consumption has been shown to reduce the size (volume) of the pineal gland! This gland makes the sleep hormone melatonin. The size of the pineal gland is referred to as the VPP (volume of pineal “parenchyma” – term for pinealocyte cells). When you regularly drink “excessive” amounts of coffee, the volume of the pineal gland shrinks. Too many cups of Joe over too many years makes your pineal gland shrink!
  o A squattier pineal gland releases less melatonin. Less sleep hormone means impaired quality of sleep, especially in later life from the long-term effects of a “life well-caffeinated.”²³ Of course, what constitutes too much caffeine and a smaller pineal gland probably depends on genetics and SNPs. It’s all individual. There are significant health benefits from coffee, so it’s a “Goldilocks” kind of thing, drinking the just right amount for your physiology.
  o Less melatonin also means more risk of cancer, as melatonin is a major anti-cancer fighting hormone.
  o How much coffee is okay? Moderation is the key. One to several cups of coffee, rather than numerous shots of espresso all day long, seems to be the healthiest for most of us.
• Too much alcohol. With advertisements on TV making alcohol look as safe as water and trendy and cool as heck, too many are drinking too much. Especially young adults. This is linked with harming sleep.²⁴
  o Each of us metabolizes alcohol differently due to various liver capabilities, body size, organ size, and genetics. Some folks can drink more and still get their Z’s, but some women will have insomnia from just one nightly glass of wine.
  o Alcohol blocks REM sleep, the most restorative type of sleep, so you wake up feeling groggy. Alcohol also reduces anti-diuretic hormone (ADH) so you may have to get up to urinate during the night, which also is sleep disruptive.
  o Women literally have smaller livers than men, so women are more vulnerable to these potential adverse effects of alcohol than males. Gender unfairness but “is-ness!”
  o Studies yoyo on how much alcohol is healthy or harmful, but most female bodies cannot handle alcohol on a daily basis, and often, those several glasses of wine at night are the enemy of your sleep.
• Too little exercise. Exercise improves your sleep; there is no doubt about it.²⁵
  Adding just 15 to twenty minutes a day of getting your circulation going, allows your body to wind down more successfully during night time hours.
• Not being outside. Even just 20 minutes a day in nature enhances well-being and sleep.²⁶ Even just looking out the window at nature, or at pictures of nature, help promote wellbeing and sleep.²⁷
• Hormone yoyo-ing. In both women and men, hormones out of balance cause sleep out of balance. From hot flashes and night sweats caused by peri- and post-menopause in ladies, to too little T (testosterone) in ratio to too much E (estrogen) in gents (especially chubby dudes), all dent sleep.
• Growth hormone insufficiency. Human growth hormone is released in the first deep-sleep episode of the night. When adequate levels are released, this phase of sleep is associated with “deep” body/mind rejuvenation. Thus, growth hormone is essential for restorative sleep and vice versa; healthy sleep promotes healthier blood levels of your growth hormone (so does digesting healthy protein and exercising). When you sleep less well and exercise too little, you produce less growth hormone. A growth-hormone-deficient body becomes less efficient at falling and staying asleep. Growth hormone naturally lowers as we age, unless we eat and digest optimally, and continue to regularly work out.
  o By the way, the 24-hr urine hormone test (by Meridian Laboratories) easily measures growth hormone (GH) levels along with other hormones and their metabolites. This is my favorite GH test.
  o The insulin-like growth factor-1 (IGF-1) test is an indirect measure of your average blood levels of growth hormone. Low blood levels of IGF-1, less than 160, are typical in severe fatigue states and elevated levels can also occur from poor sleep, worsening cancer risk or progression.
  o A Belgium double-blind, placebo-controlled study found that women who took 300 mg of oral progesterone before bed, got to sleep faster, slept better, had higher levels of growth hormone and even more stable blood levels of thyroid hormone.²⁸ Did you know that progesterone helps thyroid hormone enter the thyroid receptor to deliver its signal?
• Unresolved emotions. Emotions of sadness, fear, regret, perfectionism, and even guilt²⁹disrupt sleep. Unfinished emotional business promotes unfinished sleep. And vice versa.
  o Chronic insomnia makes you feel more insecure and anxious and these feelings then sabotage sleep. Emotions can get more chaotic in mid-life as circumstances become more demanding. Your parents get older and need help, your kids get into shockingly more trouble, close friends or family start to get ill, and you can’t believe that your own work life, relationship life, money life, etc., aren’t yet stable. Who knew that growing up doesn’t automatically make life or sleep, easier?
• Non-dippers. Healthy blood pressure is supposed to gently lower during the night (compared to pressures during the day) by approximately 10–20%. “Non-dippers” are people whose blood pressure doesn’t lower adequately during sleep. This damages restorative sleep. Make sure to turn the TV off, get the phone off the table, those ear-buds out of your ears, and have your doc check your blood pressures, sometimes with a 24-hr pressure monitor.
• Nocturnal hypertension.
  I had one patient that kept waking at 2:30 AM with rapid heartbeats. Once awake he couldn’t easily fall back asleep. In contrast, during the day his blood pressure was perfect. Heart physicals by several heart docs found nothing wrong. After three years, and after several cardiac work-ups found nothing abnormal, he continued to feel worse and worse from disturbed sleep. Finally, a functional cardiologist, I referred him to, ran a 24-hr. blood pressure test. This demonstrated that at 2:30 AM, when he’d consistently woken up with arrhythmias, his blood pressure soared to 190 over 120, even though multiple day-time pressures were continually normal and perfect. When this patient got a small dose of an anti-hypertension drug before bed; sleep immediately normalized. He slept like a baby.
  It’s critical to mention, that “nocturnal hypertension” was not the “root cause” but rather a sign of a deeper issue that had to be found and addressed. It turned out that one of his heart chambers was hardened, and also one valve had a leak, none of which was found by the many other heart docs he had seen. It was early enough to use sophisticated nutrition intervention, to ward off fatal congestive heart failure. But the point is that his insomnia and arrhythmias had been flashing red lights for deeper heart issues that were not easily identified by multiple of well-respected specialists!

Natural Ways to Help You Sleep 
Before taking any sleep aids, even over-the-counter or natural, it’s best to work with a practitioner that understands your personal physiology and medical history. Sometimes relentless insomnia occurs due to a hidden disease. For example, excess calcium blood levels from primary hyperparathyroidism (a benign tumor on a parathyroid gland) can adversely affect the brain and manifest as insomnia. Sleep apnea, trouble breathing during sleep, can cause insomnia. Chronic hidden infections can cause insomnia.

Once disease is ruled out, natural sleep aids can be very helpful for midlife sleep issues. Some of these natural sleep aids bind to the same places in the brain as prescription sleep meds (sleep hypnotics) and may lose their effectiveness over time, just like those drugs do. Thus, it’s good to have lots of sleep-promoting tools, especially ones that work by mechanisms that do not lose their effectiveness, such as hormones, nutrients, and lifestyle improvements.

• Hormone Hacking.A healthy brain produces progesterone right inside the brain.³⁰ This is because progesterone is a brain-protective hormone in both men and women. Progesterone is also one of Nature’s chief sleep protectors.
  o Progesterone binds to the GABA³¹ receptors in the brain and calms the brain to help it turn off and promote restorative
  o Progesterone regulates a member of the neurotrophin family, brain-derived neurotrophic factor, which keeps your brain healthy. A healthier brain turns off easier at night as well as being more protected from neurodegeneration.³²
  o As we age, both genders’ brains produce less progesterone, and this contributes to poorer sleep. Progesterone therapy usually improves it. In fact, perimenopausal insomnia is often a woman’s body “screaming” for additional progesterone.³³ But sometimes males need some progesterone replacement, too.
  o Oral progesterone is a better tool to improve sleep, most of the time, than topical. This is because progesterone’s major sleep-promoting metabolite, pregnenolone, is only produced if progesterone is taken orally. When swallowed, progesterone goes from the gut into the liver (called the first hepatic pass) where liver cells morph the progesterone into sleep-promoting pregnenolone. This progesterone metabolite acts very similarly to Valium™,³⁴ but without the adverse and potentially dangerous side effects.³⁵
  o Progesterone reduces “brain on fire” or excessive inflammation in the brain. In this way, progesterone also fights depression and possibly small vessel ischemic brain disease.³⁶
  o If men are recommended progesterone, it’s usually prescribed in much lower dosages than women and can be given orally from 30 to 50 mg, or sometimes is prescribed in facial creams (Key Pharmacy in Federal Way, WA, has been making a male hormone face cream for many years).
  o Sometimes men and women need other hormones. Estrogen therapy in ladies or T replacement in gents can help achieve deeper and healthier sleep.
• Less caffeine.Too much caffeine is a commonly overlooked problem in too many insomniacs. This is because there is a lot of individuality in the “caffeine sensitivity” effect on sleep.³⁷ Some persons can drink espresso all day long and right before bed, and still sleep like a baby. Other people may be extremely sensitive to caffeine (usually due to how genetics affects the speed at which they rinse caffeine out of their bodies). These people may become insomniacs from just one caffeinated beverage a day, sometimes even in the morning. Many caffeine-sensitive folks find that not consuming caffeine after 3 PM does the trick. But sometimes any caffeine may be too much for you. We don’t appreciate that what we sip, can sap sleep.
  o Make sure you aren’t suffering sleep issues because you are hitting Starbucks too often for your physiology. Also, as crazy as it seems, caffeine can promote sleep apnea, even in kids.³⁸ There is a lot of caffeine in many sodas.
  o There are gender differences, too. Women are typically more sensitive to caffeine than gents. Women metabolize caffeine much more slowly than men.³⁹ This is why many men can down a cup of coffee right before bed, while if a woman did this, she would spend the night staring at the ceiling.
• Melatonin is secreted by the brain’s pineal gland in response to cycles of light and darkness. Melatonin regulates your ability to stay “in sync” with light and dark, in sync with Mother Earth. Melatonin is thus often helpful for traveling across time zones, to keep you in sync with new light and dark cycles. When you are more in sync with light and dark, you are tired at night and sleep deeply, and are more awake and energized during the day. When melatonin production or metabolism is dysregulated, this gets reversed; you can’t sleep at night and are tired throughout the day. You’re out of sync with Nature’s light and dark cycles
  o Natural melatonin secretion is dysregulated by light at night, depression, shift work, seasonal affective disorder, and as you read above, excessive caffeine intake over a long period of time.
  o Melatonin is a major antioxidant and protector of estrogen, keeping it from acting less as a cancer-causing molecule in both men and women. Melatonin, in combination with omega-3 fatty acids, especially does its estrogen and cancer fighting actions while you sleep, if your levels of melatonin are high and healthy enough (PS Meridian 24-hr hormone test assesses melatonin levels. Excessively high melatonin levels can suggest health issues such as cancers. This test has helped me ID cancers on several patients.)
  o The usual dose is 0.5–3.0 mg, taken one-half hour before bedtime. (I have found it works best as a non-time-released tablet chewed and held under the tongue for 30 seconds)
  o For some recent cancer patients, the dosage can go up to 20 mg, but this must be done in conjunction with an in-the-know doctor.
  o Melatonin can safely be used with aromatase inhibitors⁴⁰ and estrogen blockers, as it has been shown to reduce some of their adverse side effects.
  o Melatonin itself acts as a natural aromatase inhibitor and also limits cancer growth by additional helpful mechanisms other than aromatase blocking. Melatonin is one of the cancer patient’s best friends.
• Magnesium-rich foods and supple-mentation. Magnesium is Nature’s Valium. It relaxes the body and mind. Magnesium deficiency is linked to causing insomnia.⁴¹ It’s easy to become deficient in magnesium. Magnesium is deficient in the Standard American Diet (often referred to as SAD). This diet is typically low in green vegetables. Magnesium “lives” inside the center of the chlorophyll molecule that gives veggies their green color. In essence, magnesium is “captured sunlight.” Sufficient magnesium inside your red blood cells, where magnesium does most of its magic, makes you feel relaxed and calm, like lying outside under the sun.
  o However, healthy magnesium levels are not easy to maintain inside red blood cells, no matter how normal blood (serum) levels appear.
  o Why? Magnesium is constantly “rinsed out” of the body during times of chronic or severe stress. And today, who’s not stressed?
  o To make magnesium matters even more confusing, many magnesium supplements don’t contain the “elemental” levels that the label says will be in there, which are necessary for keeping your red blood levels healthy.
  o Thus, there are a lot of magnesium insufficiencies and misunderstandings.
  o Magnesium supplementation before bed may help you sleep more soundly. Sometimes taking taurine⁴² helps keep magnesium more anchored inside the red blood cell and less at risk of being rinsed out. You could refer to taurine as a “magnesium-sparing nutrient” (coined by Berkson).
• Gamma-Aminobutyric acid, or γ-aminobutyric acid, or GABA, is the chief “inhibitory” neurotransmitter that “quiets” down the central nervous system. Some people do well taking 500 mg of GABA one half hour before bed. Some require more. But it’s not easy for GABA to pass the blood brain barrier, whereas the progesterone metabolite does and also signals GABA receptors.
• CBD oil.Cannabidiol (CBD) is a major “non-intoxicating” component of cannabis and possesses anti-epileptic, anxiolytic, anti-hyperalgesic and sleep-promoting properties. CBD signals GABAA receptors. It works in both capsule or drop form, but the dose varies greatly depending on the individual and the cause of insomnia. The CBD signals the cannabinoid system, which relaxes the central nervous system and by the way, overlaps with oxytocin signals.⁴³
• Magnolia bark.This herb is especially helpful for sleep, if the cause of insomnia is due to elevated nighttime levels of the stress hormone cortisol. This herb lowers both stress hormones (cortisol and adrenaline) and keeps these lower all night to allow you to sleep.
  o Magnolia bark reduces the time it takes you to fall asleep and increases the amount of time you spend in both REM sleep and non-REM sleep.
  o Magnolia acts like an “herbal magnesium.” It reduces anxiety. For some people, magnolia bark can be as effective as diazepam (valium) without the risks of dependency or adverse side effects. The typical dosage is 250-500 mg taken with dinner and also before bed.⁴⁴Severe insomniacs may need much more at the beginning but can taper down after sleep improves for at least two weeks.
• Moon Drops.This is a pleasant vanilla-flavored homeopathic that works for a lot of my patients when slowly dissolved in the mouth half an hour before bed. It comes in such a cool-designed small box, tastes delicious, and works so well that it’s a real go-to natural sleep aid, if your progesterone replacement is not doing the trick or you want to try to fix your issues sans hormones.
• L-Theanine.This amino acid increases the levels of the three neurotransmitter musketeers – GABA, serotonin, and dopamine – calming neurotransmitters that “live” inside the brain and regulate emotions, mood, concentration, alertness, energy, and sleep.
  o L-theanine promotes healthier daytime emotions and nighttime sleep, helps with menopause- and andropause-related mood swings, difficulty concentrating, and it even helps some people regulate portion control.
  o If you’re a caffeine junkie, L-theanine may even help counteract the anti-sleep effects of caffeine.⁴⁵
• 5–HTP.5-HTP (5–hydroxytryptophan) increases serotonin, which is then converted to melatonin. 5-HTP is, thus, a melatonin-booster. Start at 100 mg, three times per day. Gradually increase to 200 mg, three times per day. Some cases of IBS (irritable bowel syndrome) are worsened by excessive levels of serotonin so don’t take this without working with a smart doc, especially if you have gut issues.
• Herbal helpers.
  o  (Valeriana officinalis) in capsule form – the liquid has a bitter taste though some of my patients think the liquid works better/faster –  at 150–300 mg standardized to 0.8% valerenic acid. Take one hour before pulling the covers up. Dormeasan ® drops are an organic valerian and hop tincture mixture that doesn’t have a severe bitter taste. The dosage is 30 drops half an hour before bed. Putting the drops in a half cup of your favorite nighttime tea is a effective sleep-promoting routine.
  o Traditional Chinese medicines. One is called Suan Zao Ren.⁴⁶ The formal name is Semen Ziziphi spinosae. It is the dried ripe seed of the sour jujube or spiny date. It has been used for hundreds of years in China to treat insomnia as well as reducing severe sleep disruptive dreams.⁴⁷ This herb is especially helpful for patients trying to take low dose naltrexone (a super immune booster) but who begin having overwhelming dreams or insomnia as an adverse side-effect. Dosage varies depending on the product.
  o Another standard Chinese formula is called Gui Pi Tang.⁴⁸ Again, dosage varies depending on the product.
  o Pueraria mirifica. An herb⁴⁹ from Thailand used for hundreds of years to promote sleep by helping your body’s natural estrogen reduce hot flashes or nasty sensations of dysphoria. Boron is a mineral that also helps bodies utilize estrogen in both ladies and gents.⁵⁰ Estrogen is produced in six places inside a healthy brain and promotes sleep in both genders, although males, of course, have less estrogen than females. Sometimes I recommend the herb and boron together.
  o Pregnancy insomnia: Lettuce Seed (Lactuca sativa L. seeds) has been shown, in a human pregnancy study, to promote better sleep in insomniacs and found safe to take during pregnancy.⁵¹ The dose is one 1000 mg capsule of lettuce seed a half-hour before bed.

Avoid Sleep Hypnotics Like the Plague
Regular use of sleeping pills, prescription sleep hypnotics, are linked to making you die prematurely from diverse causes.⁵² Even taking less than 18 sleep hypnotics in one single year has been linked to dying prematurely from all-cause mortality.⁵³ By the way, the authors of this study pointed out that this was the 19th scientific investigation linking sleep hypnotics to premature death. This means that the link between taking sleeping pills and decreasing your time on earth is well established! The sleeping pill fix is not worth it. If you take them, use them for the shortest time possible while you fix the root issues causing your insomnia.

Also, these meds are habit forming. Plus, they lose their effectiveness over time as the brain builds up tolerance.

Sometimes doctors say that since sleeping pills are dangerous why not take allergy antihistaminedrugs as they cause less dangerous drowsiness. Not true. Antihistamine meds block acetylcholine, which lubes neurotransmitters and is crucial for memory. The use of antihistamines, either pharmaceutical or over-the-counter, is now reproducibly linked to increased risk of cognitive decline and dementias⁵⁴ as well as premature death and increased risk of cancer.⁵⁵

For every three years on regular use of antihistamines, the increased risk of dementias increases significantly. Stay away!

Sleep medications can cause other issues. More car accidents. Poorer job performance. Addiction. When you try to stop taking these meds, you get “rebound-worsened insomnia,”⁵⁶ which makes them very difficult to stop. And…you risk late night atypical behaviors or food binges that you can’t even remember when you wake up the next morning.

You Gotta Laugh
I love the scene in Grace and Frankie where Jane Fonda (Grace) gathers up her courage and energy to break up with her beau when he comes down at night to raid the fridge. But the next morning he acts like it never happened.

Lily Tomlin (Frankie) queries to Jane, “Did you break up in English? Was he even in the room?”

But the truth comes out – it was an Ambien break-up!

Now Jane Fonda has to break up with him again when the Ambien is out of his bloodstream, and he is vertical and conscious.

I have had some patients admit to me that when on Ambien, they wake up in the morning to 10 empty tuna cans strewn throughout the kitchen and a mouth that tastes of fish!

Too Much Sleep Isn’t Better
Both excessive longer and shorter sleep hours are associated with increased mortality.⁵⁷ Sleeping more than you need, it turns out, can be just as detrimental as sleeping too little. Just like Goldilocks, you need to find the optimal “just right” amount of sleep that works best for you.

Sleep-Boosting Lifestyle

• Eat less junk foods, especially high glycemic ones that spike your blood insulin. Excessive blood sugar and insulin levels ding sleep.
• Drink less alcohol and limit caffeine intake.
• Limit IT exposure before bed and during sleep. Many people are sleeping with their phones under their covers or on their nightstands. This can disrupt sleep⁵⁸ as the blue lightthat comes off screens mimics the light of full daylight. This can disrupt sleep as well as promote insulin resistance and keep you fat!
• Get regular exercise. Especially outside. Or work out at a gym, but stand outside in front of the gym for a bit of time to get sunlight, even on cloudy days. Or just look outside the window and let the vision of nature inside your body/mind and spirit.
• Try to find your most sleep-promoting mattress. Science now shows that many memory foam mattresses and pillows outgas dangerous solvents. For years. When will the bad news stop?
• Sleep in as a dark room as possible. Excess artificial light emitted from lights on in the bathroom or from street lights, televisions, monitors, smartphones and other devices can suppress melatonin production and sleep quality. Some very sensitive and ill people even need to “turn off” their electronics several hours before bed to start winding their brain and nervous systems down adequately to achieve restorative sleep.
  Keep in mind, though; this may not be truth for all. There was a book by an anthropologist (it’s out of print now and I can’t find the name) who traveled the world assessing cultural differences in sleep. Some indigenous tribes did well sleeping with full light, chickens in the room, and 15 people on top of each other. Perhaps they did not have the constant barrage of electromagnetic fields that US towns and citizens now have.
• Clean up. Creating orderly spaces in your bedroom and home reduces cortisol levels, which then soothes spirits and sleep.
• Resolve your emotions as best as you can. Unhealthy emotions make for unhealthy sleep, and vice versa. Emotional house-cleaning soothes spirits and sleep.
• Don’t eat before bed, for most of us. It takes approximately three hours for your stomach to empty after a meal. Thus, it’s an ideal practice to stop eating at least three hours before bed. Part of insomnia is the American habit of snacking while lying down in front of the TV late at night. But we are all different. Some people sleep better with a light snack before bed, one that is high in protein but low in refined carbs.
• Deal with grinding your teeth. Sleep is harmed by bruxism (teeth grinding). The combination of insomnia and tooth grinding is considered a primary sleep-related movement disorder.⁵⁹ Bruxism can be helped by mouth guards, and sometimes by identifying and avoiding intolerant foods. Adverse food reactions can cause any ongoing issue. Food is powerful!
• Getting up to pee. Drinking excess fluid before bed may cause you to wake up in the middle of the night to urinate and this then disrupts your sleep cycle. If you don’t drink too much before bed, yet you wake up to pee, this suggests cortisol dysregulation. Appropriate lower nighttime levels of cortisol are supposed to keep you sound asleep, even if your bladder starts to fill up. Some people with severe adrenal fatigue and cortisol dysregulation have to wake up many times during the night to urinate and suffer with severe sleep issues. Fluid intake, adrenal health, and cortisol issues all overlap in affecting urination and ability to achieve deep restorative sleep.
• Regular wind-down routines help signal your mind and body that it’s time for sleep. Even changing your sheets more often can contribute to a healthier sleep and be part of this ritual. If I were super wealthy, I’d have someone change my sheets nightly!
• Mindfulness. I often suggest mindfulness exercises to my patients. I am seeing more and more patients, especially women, who are so chaotic during the day that they have abandoned congruency with their bodies and can’t turn off their minds during sleep. If they do achieve hours of sleep, those hours still seem less restorative. Most of my patients are already rushing to fit in yoga, meditation, or workouts (so oxymoronic), so I recommend unique focused exercises that I learned while living with Swami Satchitananda at Yogaville East in the 1970s. Acupuncture is also a physical way to achieve more physiologic and emotional balance that contributes to better sleep.⁶⁰
• A message from your deeper self… is your sleep issue trying to tell you something? Persistent sleep problems may be flashing red lights on your physiological dashboard saying that something is off in your life that needs attention and healing. If true for you, try to gently fix these issues. Put some intention and/or prayer onto these issues to inform your higher self that they need recovery. Sometimes repeating healing affirmations or requesting guidance (by repeating a simple inquiry over and over again) – before falling asleep – helps your unconscious take over and heal ongoing woes while you count sheep. You may be surprised to wake up to obvious restorative answers!

Sleep Performance Anxiety… Go to Bed Without It
We tell patients you “must” have eight hours of sleep or your toes will fall off. But some tribes around the world sleep for four hours, wake up and dine and party, and then go back to sleep for four hours, and are healthy and happy. My mother lived to 96 years of age and was never ill till her early 90s. She had infinite energy and only slept four hours a night. So did Einstein.

Even though practitioners make recommendations, everything ultimately has to be individualizedto you… even sleep.

Maybe you do better on less sleep than the average bear. I used to sleep four or five hours a night, like my mother, and did great. But once I had a kidney removed, those short beneficial sleep nights were a thing of the past. I then had to sleep more and sleep better to have happier tomorrows. Need for optimal hours of sleep morphs with your personal life circumstances. Tune in and try to sense how many hours of sleep work best for you. You may need more hours of sleep when healing from illness or moving through tragedy than when all of your hours are humming healthfully.

The healthiest body is one you listen to.

If All Else Fails…Gabapentin 
I had a number of patients that tried everything but still couldn’t sleep, and thus were miserable. I did my geeky thing and sleuthed the peer review literature. Science-based articles showed that the old-time safe medication, gabapentin,⁶¹ lubes the sleep pathways to “retrain” the brain for healthier sleep. This is an off-label use of this medication that is typically used to treat nerve root pain. But it’s an amazing helper for some people with severe non-responsive insomnia.

Gabapentin, 100 to 300 mg, taken one-half hour before bed for a few months helps brain cells retrain themselves for a good night’s sleep. I’ve been recommending this for about a decade. It is not 100 percent foolproof. One patient told me it made her more jittery and less able to sleep. But most start sleeping that very night.

Presently, many medical sleep centers are recommending gabapentin because it’s so effective for so many insomniacs.

Remember, integrative medicine is a combination of both sides of the healing coin. It’s okay to use drugs for a while when they work, and you can eventually get off them once your brain has re-learned to sleep deep. After using gabapentin for four to nine months, you’ll start responding to simple melatonin and magnesium one-half hour prior to bedtime, when before these didn’t work. You need to slowly taper off this medication. Adding more magnesium helps you do so in a shorter period of time.⁶²

Don’t use this medication if you have kidney disease without working with a physician in-the-know.

May the therapeutic sleep force be with you!

• If you want me to help you with your sleep issues, contact me via my consult section at drlindseyberkson.com.
• Check out my podcast on sleep at Dr. Berkson’s Best Health Radio.

Author Bio:
Devaki Lindsey Berkson, DC, has been in practice in functional medicine, with an emphasis on nutrition, hormones, intimacy, and digestion, for decades. Dr. Berkson is professor for higher board certification programs for medical professionals to become functional practitioners, such as A4M and PCCA. Dr. Berkson was a scholar at a hormone think-tank at Tulane, published original research with the University of Texas Medical School at Houston, and is a research fellow with Health Sciences Collegium. Dr. Berkson has been asked to be on a panel for the symposium “Functional Medicine is Coming” to the entire hospital staff at Houston Memorial Hospital this summer in 2019. Dr. Berkson wrote the first gut, mind, nutrition book published by Wiley (Healthy Digestion the Natural Way) and one of the first books on hormone-altering-chemicals (Hormone Deception. Dr. Berkson’s newest book, Sexy Brain, presents the newest health issue (environmental castration) and how to protect our intimacy and brain. Dr. Berkson consults around the world with patients and their docs. She has a very popular podcast, Dr. Berkson’s Best Health Radio, along with Berkson Blog at DrLindseyBerkson.com.

Author Footnotes:

1. Belcher R, Gumenyuk V, Roth T. Insomnia in shift work disorder relates to occupational and neurophysiological impairment. J Clin Sleep Med. 2015 Apr 15;11(4):457-65
2. Liu H, et al. Occupational electromagnetic field exposures associated with sleep quality: a cross-sectional study. PLoS One. 2014 Oct 23;9(10):e110825.
3. Tan X, et al. Effects of exercise and diet interventions on obesity-related sleep disorders in men: study protocol for a randomized controlled trial. 2013 Jul 26;14:235
4. Nielsen FH, Johnson LK, Zeng H. Magnesium supplementation improves indicators of low magnesium status and inflammatory stress in adults older than 51 years with poor quality sleep. Magnes Res. 2010 Dec;23(4):158-68.
5. Kandeger A, et al. The relationship between night eating symptoms and disordered eating attitudes via insomnia and chronotype differences. Psychiatry Res. 2018 Aug 2;268:354-357.
6. Yamamoto N, et al. Insomnia increases insulin resistance and insulin secretion in elderly people. J Am Geriatr Soc. 2010 Apr;58(4):801-4
7. Baker FC, et al. Insomnia in women approaching menopause: Beyond perception. 2015 Oct;60:96-104.
8. Sofimajidpour H, Teimoori T, Gharibi F. The Effect of Testosterone on Men With Andropause. Iran Red Crescent Med J. 2015 Dec 26;17(12):e19406.
9. Travison TG, et al. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab. 2007 Jan;92(1):196-202.
10. Rifkin DI, Long MW, Perry MJ. Climate change and sleep: A systematic review of the literature and conceptual framework. Sleep Med Rev. 2018 Aug 4. pii: S1087-0792(18)30076-5.
11. Mason EC, Harvey AG. Insomnia before and after treatment for anxiety and depression. J Affect Disord. 2014 Oct;168:415-21.
12. Guo T, et al. Acupuncture for perimenopausal insomnia: A systematic review and meta-analysis protocol. Medicine (Baltimore). 2018 Jun; 97(24): e11083.
13. Berkson LJ. Hormone Deception, 3rd ED. Awakened Medicine Press. 2016.
14. Sassoon SA, et al. Association between personality traits and DSM-IV diagnosis of insomnia in peri- and postmenopausal women. 2014 Jun;21(6):602-11.
15. Suh M. Salivary Cortisol Profile Under Different Stressful Situations in Female College Students: Moderating Role of Anxiety and Sleep. J Neurosci Nurs. 2018 Aug 28.
16. Wingenfeld K, Wolf OT. Stress, memory, and the hippocampus. Front Neurol Neurosci. 2014;34:109-20.
17. Jackson SE, Steptoe A. Obesity, perceived weight discrimination, and hair cortisol: a population-based study. 2018 Aug 11;98:67-73.
18. Flegr J, et al. The relation of cortisol and sex hormone levels to results of psychological, performance, IQ and memory tests in military men and women. Neuro Endocrinol Lett. 2012;33(2):224-35.
19. Topor LS, et al. Cortisol Stimulates Secretion of Dehydroepiandrosterone in Human Adrenocortical Cells Through Inhibition of 3βHSD2. Journal of Clinical Endocrinology & Metabolism. 1 January 2011; 96 (1): E31–E39.
20. Sun MH, et al. Nonarteritic anterior ischaemic optic neuropathy and its association with obstructive sleep apnoea: a health insurance database study. Acta Ophthalmol. 2018 Aug 31.
21. Rusch HL, et al. Improved Sleep Quality is Associated with Reductions in Depression and PTSD Arousal Symptoms and Increases in IGF-1 Concentrations. J Clin Sleep Med. 2015 Jun 15; 11(6): 615–623.
22. Cipriani G, et al. Sleep disturbances and dementia. 2015 Mar;15(1):65-74.
23. Park J, et al. Lifetime Coffee Consumption, Pineal Gland Volume, and Sleep Quality in Late Life. 2018 Jul 14.
24. Lam T, et al. Insomnia and Regulation of Sleep-Wake Cycle With Drugs Among Adolescent Risky Drinkers. J Clin Sleep Med. 2018 Aug 30. pii: jc-18-00061.
25. Passos GS, et al. Exercise improves immune function, antidepressive response, and sleep quality in patients with chronic primary insomnia. Biomed Res Int. 2014;2014:498961.
26. Pasanen TP, Tyrväinen L, Korpela KM. The relationship between perceived health and physical activity indoors, outdoors in built environments, and outdoors in nature. Appl Psychol Health Well Being. 2014 Nov;6(3):324-46.
27. Ulrich RS, et al. Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology. 1991;11(3):201-230.
28. Caufriez A, et al. Progesterone prevents sleep disturbances and modulates GH, TSH, and melatonin secretion in postmenopausal women. J Clin Endocrinol Metab. 2011 Apr;96(4):E614-23
29. Schmidt RE, et al. Too Imperfect to Fall Asleep: Perfectionism, Pre-sleep Counterfactual Processing, and Insomnia. Front Psychol. 2018 Aug 7;9:1288.
30. Singh M, Su C. Progesterone, brain-derived neurotrophic factor and neuroprotection. 2013 Jun 3;239:84-91.
31. Arbo BD, et al. Effect of low doses of progesterone in the expression of the GABA(A) receptor α4 subunit and procaspase-3 in the hypothalamus of female rats. 2014 Aug;46(3):561-7.
32. Singh M, Su C. Progesterone, brain-derived neurotrophic factor and neuroprotection. 2013 Jun 3;239:84-91.
33. Ziomkiewicz A, et al. Higher luteal progesterone is associated with low levels of premenstrual aggressive behavior and fatigue. Biol Psychol. 2012 Dec;91(3):376-82
34. Lancel M, et al. Pregnenolone enhances EEG delta activity during non-rapid eye movement sleep in the rat, in contrast to midazolam. Brain Res. 1994 May 16;646(1):85-94.
35. Terán-Pérez G, et al. Steroid hormones and sleep regulation. Mini Rev Med Chem. 2012 Oct;12(11):1040-8.
36. Baulieu EE. Steroids and Brain, a Rising Bio-Medical Domain: a Perspective. Front Endocrinol (Lausanne). 2018; 9: 316.
37. McHill AW, Smith BJ, Wright KP Jr. Effects of caffeine on skin and core temperatures, alertness, and recovery sleep during circadian misalignment. J Biol Rhythms. 2014 Apr;29(2):131-43.
38. Marcus CL, et al. Long-term effects of caffeine therapy for apnea of prematurity on sleep at school age. Am J Respir Crit Care Med. 2014 Oct 1;190(7):791-9.
39. Bracco D, et al. Effects of caffeine on energy metabolism, heart rate, and methylxanthine metabolism in lean and obese women. Am J Physiol. 1995 Oct;269(4 Pt 1):E671-8.
40. Aydin M, et al. Letrozole induces hepatotoxicity without causing oxidative stress: the protective effect of melatonin. Gynecol Endocrinol. 2011 Apr;27(4):209-15.
41. Nielsen FH, Johnson LK, Zeng H. Magnesium supplementation improves indicators of low magnesium status and inflammatory stress in adults older than 51 years with poor quality sleep. Magnes Res. 2010 Dec;23(4):158-68.
42. Lou J, et al. Taurine-magnesium coordination compound, a potential anti-arrhythmic complex, improves aconitine-induced arrhythmias through regulation of multiple ion channels. Toxicol Appl Pharmacol. 2018 Oct 1;356:182-190.
43. Bakras T, et al. The direct actions of cannabidiol and 2-arachidonoyl glycerol at GABAA receptors. Pharmacol Res. 2017 May;119:358-370
44. Mucci M, et al. Soy isoflavones, lactobacilli, Magnolia bark extract, vitamin D3 and calcium. Controlled clinical study in menopause. Minerva Ginecol. 2006 Aug;58(4):323-34.
45. .Jang HS, et al. L-theanine partially counteracts caffeine-induced sleep disturbances in rats. Pharmacol Biochem Behav. 2012 Apr;101(2):217-21.
46. Liu L, et al. Herbal Medicine for Anxiety, Depression and Insomnia. Curr Neuropharmacol. 2015 Jul; 13(4): 481–493.
47. Xie ZW. Chinese Herbal Medicine Compilation, 2nd ed. Beijing: The People’s Medical Publishing House; 1996.
48. Liu L, et al. Herbal Medicine for Anxiety, Depression and Insomnia. Curr Neuropharmacol. 2015 Jul; 13(4): 481–493.
49. Yusakul G, et al. Enzyme linked immunosorbent assay for total potent estrogenic miroestrol and deoxymiroestrol of Pueraria candollei, Thai herb for menopause remedy. J Nat Med. 2018 Jun;72(3):641-650.
50. Bello M, et al. Several effects of boron are induced by uncoupling steroid hormones from their transporters in blood. Med Hypotheses. 2018 Sep;118:78-83.
51. Pour ZS, et al. Double-blind randomized placebo-controlled trial on efficacy and safety of Lactuca sativa L. seeds on pregnancy-related insomnia. J Ethnopharmacol. 2018 Aug 30;227:176-180.
52. Chen HC, Su TP, Chou P. A nine-year follow-up study of sleep patterns and mortality in community-dwelling older adults in Taiwan. 2013 Aug 1;36(8):1187-98.
53. Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open. 2012 Feb 27;2(1):e000850.
54. James W. Hypnotics and the Risks of Dementia. J Clin Sleep Med. 2017 Jun 15;13(6):837.
55. Murray MT. Sleeping Pills Associated with More Than 320,000 Premature Deaths Annually in the United States. Natural Medicine Journal. April 2012;4 (4).
56. Hirase M, Ishida T, Kamei C. Rebound insomnia induced by abrupt withdrawal of hypnotics in sleep-disturbed rats. Eur J Pharmacol. 2008 Nov 12;597(1-3):46-50.
57. Hublin C. Sleep and Mortality: A Population-Based 22-Year Follow-Up Study. 2007 Oct 1; 30(10): 1245–1253.
58. Raap T, Pinxten R, Eens M. Artificial light at night disrupts sleep in female great tits (Parus major) during the nestling period, and is followed by a sleep rebound. Environ Pollut. 2016 Aug;215:125-134.
59. Klasser GD, Rei N, Lavigne GJ. Sleep bruxism etiology: the evolution of a changing paradigm. J Can Dent Assoc. 2015;81:f2.
60. Guo T, et al. Acupuncture for perimenopausal insomnia: A systematic review and meta-analysis protocol. Medicine (Baltimore). 2018 Jun;97(24):e11083.
61. Lo HS, et al. Treatment effects of gabapentin for primary insomnia. Clin Neuropharmacol. 2010 Mar-Apr;33(2):84-90.
62. Dean, C. Interview: “The Miracle Of Minerals In A Depleted World.” 2015. June 6, 2015. Global Health Summit 2015.

Consult your doctor before using any of the treatments mentioned in this article.

Reprinted with permission from the February/March 2019 Townsend Letter and Devaki Lindsey Berkson, DC

Learn how you can benefit from more Townsend Letter articles.