Skim reading Heather Sandison's new "Reversing Alzheimer's" at our local B&N the other day (although super sad: my fave B&N on Warren & West, was shuttered last January), I latched on to her sleep tips pages. I suppose someone else has given this topic an equally thorough treatment somewhere and I have missed it, but boy was this impressive.
It actually harkened back to my first years of Chinese medicine aka acupuncture school in Los Angeles. Those acquainted with the "pattern differentiation" approach to Chinese medicine likely already know this, but it was a first for me.
In Chinese medicine, particularly Chinese herbal medicine, we were taught to focus on the different characteristics of what might constitute a given person before us 's insomnia. Struggle with winding down or turning off thoughts? Gui Pi Tang's your go-to. Seem to repeatedly awake at 2 a.m.-3 a.m waking? Give Xiao Yao San a go. Insomnia from just plain late night eating? Bao He Wan (or my fave, Curing Pills)'s got you covered. Extreme restlessness & frequent waking? Check out Gentiana. And these are just the first four.
See table with 10 insomnia types and corresponding traditional Chinese medicine formulas at this link.
Fast forward to the 21st century.
While Gui Pi Tang has helped more than one client to kick intractable benzodiazepine (& even "Z-drug" hypnotics) habits-- TAKEN DURING THE DAY, NOT THE NIGHT!! isn't that cool/nuts?-- and continues to this day to be one of my fave Chinese herbal formulas, there's also something to be said for actually trying to figure out what the heck is going on.
So here's a functional medicine slash "root cause" 21st century update to all that:
Struggle with winding down at night?
You likely need amino acids.
Taurine & glycine being the top two (and glycine alone might be enough), with theanine bringing up the rear.
If you don't mind powders, Designs For Health actually has a Taurine-Glycine (only) product. Check it out at our Fullscript link (image below) or from our Designs For Health store at this link.
Discounts (20-25%) at our Fullscript dispensary are automatic; Designs For Health HQ frowns upon publishing such things (it's a dog eat dog world out there), so shoot us a message (via our Reach Out page), and we'll send you the code if you prefer to do the DFH direct thing.
HS also adds that melatonin can help here (i.e., falling asleep/winding down) but also notes that many (most?) melatonin formulations these days contain "way too much" melatonin.
The human body is said to produce around 0.3 mg of melatonin (yeh, zero point three-- not even three!) each night, so I suppose honoring her naturopathic medicine roots, H looks to mimic that: certainly no more than 1 mg-- or at least start there. And don't go any higher than 2 or 3 mg. To do this, you'll likely have to go to a kid's version.
I realize that there are now time-released melatonin products (I even have a bottle from Pure in my drawer), but cannot comment on them at this time.
Dr.Mark Holthouse (of the IFM hormone faculty) shares that many of his clients find the "branched chain" amino acids (leucine, isoleucine, valine) quite helpful for sleep-- especially the cortisol crowd. HS doesn't mention these, but it's also something good to know.
The most recent research on this appears to support the idea that, as is said to be the case with phosphatidylserine (which I really want to work but remain unimpressed-- at all kind of crazy doses: 100 mg to 2,000 mg!!), the BCAAs somehow blunt the effect of cortisol (or at least cortisol's catecholamine offspring). Looking for published papers (master's thesis, publication: maybe it's just the valine, and the leucine-isoleucine not necessary??) on this... But if this is you, maybe try it!
Staying asleep is said to be the domain of serotonin
5-HTP, the most proximal serotonin precursor, is your friend here, 100-200 mg being the sweet spot for most.
Alot of 5-HTP products have other things in them, most commonly B6, sometime B3. With the DFH product, as just one example, that creates a problem if you want, for example, 200 mg and not 100mg-- because then you are double dosing the B6 as well.
Integrative Therapeutics' is just pure 5-HTP, so at present I kind of prefer that. I'm sure there are other companies-- and will double back.
But staying asleep is also the domain of stable blood glucose (& oxygen for that matter) levels overnight.
(Nighttime breathing issues (for me, a symptom of other (correctable) things & not really C-PAP worthy) are not covered here.)
So that means Bye-Bye to evening imbibing (only if you want to sleep (& detox), as well as doing one's best to honor the 12/3 intermittent fasting rule: NO EATING WITHIN 3 HOURS OF BEDTIME (or at least nothing that quickly converts to glucose).
If you wake up with a startle at 1 a.m. or, more often, 3 a.m. (often but not always after having alcohol in the late evening-- or "too much" sugar before bed), it's very likely that you had a blood sugar crash. I never really believed this and still don't quite understand how or why this happens, but apparently your body freaks out as your blood glucose levels come whooshing down from (what's that famous Coney Island (or Cedar Point) roller coaster? the Cyclone? the Blue Streak??) and actually releases CORTISOL (yes, cortisol! at 3 a.m.!!) to liberate glycogen stores from the liver and convert them into quickly usable fuel to stabilize everything. So just when you were entering a lovely Delta Sleep phase, you get a blast of ... "fight or flight" neurotransmitters?? Lovely.)
Do a search for "hepatic glycogenolysis" and/or "gluconeogenesis."
Magnolia tree bark aka Magnolia officinalis (Hou Po in Chinese herbal medicine) is the best thing I know of here. Alot of practitioners like Relora (magnolia with cork/phellodendron tree bark (Huang Bai in Chinese herbal medicine), but I find that nothing really beats the TCM formula with magnolia bark in combo with perilla leaf, ginger, pinellia, hoelen (aka poria): Ban Xia Hou Po Tang. Just 1 capsule of granules (or 2-3 tiny tablets) seem/s to be enough here. It's kind of amazing.
Chronic daytime (adrenal) stress can also feed into this, but the most common culprit is the blood glucose/insulin roller coaster. And the only way to address this really is to teach the body to burn both carbs & fats for fuel. (The Bredesen/ReCODE folks call this "metabolic flexibility," and it's particularly important as we get older: think 60s, 70s, 80s and beyond.) Some people find that a Tbsp or so of full fat yogurt or something similarly fat rich (quarter of an avocado-- while they're still available!) tides them over 'til dawn. Again, think it through & experiment.
Racing thoughts or "monkey mind?"
Work on your GABA-glutamate system (but also rule out blood sugar spikes & dips)
Here your friends are (L-)theanine, GABA itself, vitamin B6, magnesium. HS includes zinc.
Theanine: 100-400 mg; most folks start with 200 mg, but keep in mind body size & other factors
GABA: typical dose is 300 mg at bedtime
HS kind of LOVES Xymogen's RelaxMax. If you're okay with powders, you can find it in our Xymogen online store (email signup at this link, code ROOT RES) or at our Fullscript store by clicking on the image below. There is also an unflavored option.
Just one note of caution, if you aren't already aware: reactions to B6 vary TREMENDOUSLY, even making some folks feel speedy or jittery if they go just 10 mg, so kind of have to Know Oneself and experiment here.
HS likes the kind of trendy P5P version of B6, but folks on the IFM faculty (or somewhere else?) note that if you have gut issues, the P5P version might not be best for you. (The phosphate molecule needs to be "liberated" at the intestinal wall in order for the B6 to get into your bloodstream, and if you have gut issues this "dephosphorylation" process might be impaired, or so the thinking goes.) In this case, the good ole pyridoxine might be your B6. HS starts most folks at 25 mg.
Insomnia types, suggested supplements, summary table
Issue | Focus on | Using | Typical dosing |
Trouble winding down | Amino acids | Taurine, glycine, theanine Melatonin | 3 g, 2 g, 100-400 mg 0.3 mg |
Staying asleep | Serotonin | 5-HTP | 100-200 mg at bedtime |
Cortisol (if it doesn't fall naturally in early evening) | Phosphatidylserine | Vast range: 100 mg - 2 g (after dinner) | |
BCAA (or just valine) | 300-600 mg (of each) | ||
Waking with racing thoughts | GABA | Theanine | 200 mg |
GABA itself | 300 mg | ||
B6 (P5P) + zinc | 50 mg/25 mg | ||
Magnesium threonate | 1 g after dinner | ||
Improve overall sleep quality | Blood sugar stability, hormones | Inositol (myo-, chiro-) | 1-2 g |
Progesterone (oral) | 100-200 mg before bed | ||
Dhea (sublingual/ nanoemulsion might be more effective) | 5-10 mg, women; 10-25 mg, men |
Magnesium
The magical sleep mix for my Chinese medicine fertility & OB/GYN prof was B6 with magnesium at bedtime. I tried it then, and I was pretty impressed.
Back then mag threonate didn't really exist (or at least wasn't so trendy-- or I just didn't know about it), and even today I'm not yet convinced it's appreciably superior to glycinate or malate-- or even, sigh, citrate (or aspartate). So again, experiment. With the exception of threonate, most Mg dose recs say 300 mg 2x for men and 200 mg 2x daily for women. But these are rough outlines and probably are also dependent on stress levels & what one's eating.
Since the amino acid glycine is also very calming for many, Mag Glycinate (200-300 mg at bedtime?) seems like a nighttime winner to me-- maybe in combo with other forms of magnesium during the day?
Zinc needs vary tremendously. And I don't immediately associate zinc with sleep issues, but HS says that both B6 and zinc help with the conversion of glutamate to GABA, and she's the rock star! (James Greenblatt also headlines zinc in his ZEBRA mnemonic for nutritional tapering off of sleeping pills, antidepressants and anti-anxiety meds, so there must be something to it.)
If your body is needing to control chronic (or even acute) viral infections-- even unknown/undiscovered infections ones, you will likely require more zinc than average. Stress levels, yet again, will influence need.
A (high-ish) reasonable dose for men seems to be around 50-60 mg daily (the official/conservative rec is more like 25-30 mg).
Zinc from food is WAY MORE EFFECTIVE, in my experience, than zinc from a supplement. In a word: oysters, oysters, oysters, if you eat shellfish & find/afford clean ones. In terms of zinc, nothing else can really touch oysters. Crabmeat & lobster meat are runners-up. You can eat ALOT of green pumpkin seeds. (But since most come from China, be mindful of potential heavy metal contamination.) Maybe beef/lamb/chicken livers? Pâté? Braunschweiger? Scrapple?
But remember that, just as sodium & potassium must be in balance, just as magnesium & calcium must be in balance, just as estradiol & progesterone must be in balance, just as estradiol & testosterone must be in balance, zinc & COPPER must be in balance. So many people look for a zinc supplement with a tiny bit of copper in it-- just to be prudent. (DB actually uses Source Naturals' OptiZinc!) And/or they monitor blood levels.
Overall restless sleep & early waking
HS doesn't really include this in her Sleep Supplements section, but for my money this is kind of the realm of 2 things: physical activity (including daily release of musculoskeletal tension, whatever that looks like for you) and ... hormones (more Dhea adequacy than anything else)
Again, experiment.
Quicksilver Scientific recently made many sex hormones commercially available (for topical application only): estrogen, estriol, progesterone. No T yet though.
Willy-nilly HRT makes me a little nervous though. I think it's best to do this with someone who knows what s/he is doing. Dr. Ann Hathaway, in Marin County, CA is my lode stone, but she gets a cool $600 an hour-- and I think is only taking dementia folks these days. Marcelle Pick (NP) in Maine, and Wendy Warner (MD), in Bucks County, PA, have also impressed me.
And because just about all the adrenal & sex hormones can "turn into" one another, I find that even just a little (or ESPECIALLY just a little) Dhea support can work wonders. Especially if you're under chronic stress or over, say 50.
Here we (by which I mean the IFM hormone faculty mostly) are generally talking about no more than 10 mg daily for women and no more than 25 mg daily for men. Rough guidelines.
I know that some of the practitioners are using 50 mg (of both Dhea and pregnenolone), but they are also regularly measuring blood (or saliva) levels. These folks have very, very low baselines levels, and supplementation is gauged so as to get them back up to within a reasonable range for their age. (Please don't go all Suzanne Somers; that didn't end well.) And it can be taken sporadically-- probably even more effective taken sporadically.
And just to circle back a bit... don't not try Chinese herbal medicine if you are at all intrigued! (Unless you're taking alot of prescription medicine, in which case maybe wait until you have figured out how to get off of most or all of it.)
Gui Pi Tang and formulas like Xiao Yao San, Long Dan Xie Gan Tang, Wen Dan Tang, Ban Xia Hou Po Tang, An Mian Tang can be absolutely life transforming (in a subtle & long-term way).
(Because, as we are learning more each day, much of what's going on in the brain is actually "coming from" the gut (& products of gut bacteria, viruses, fungi, archea) & because the effect of many (most?) of these Chinese herbal formulas is actually mediated through their effect on gut bacteria & gut mucus, Chinese herbal medicine may actually have been way, way ahead of its time: treating the gut to treat, well, just about everything in the body!)
And what works for one person may not work for another. A classmate of mine swore by Chai Hu Long Gu Mu Li San ("more relaxing than 2 glasses of Cabernet," she'd boast) but did absolutely nothing for me. Maybe this is where biochemical individuality comes into play.
Mayway is a great and storied company, in Oakland, CA, I believe. But bang for buck (and honestly, just overall quality/dependability) I like Anaheim-based Active Herb. Here is a link to the Sleep Support page of their public website.
I was first introduced to Active Herb at our Samra school clinic, now, alas, shuttered, on Olympic & Burlington. We bought them for like $7 and sold them for $15. Even today the price has not changed much.
But check out the Insomnia-Anxiety page of the Mayway website first (link here); it's very attractively put together. And the Active Herb website, less elegant but also quite useful, lets you kind of nose around by symptoms.
It's a bit Alice in Wonderland: Mad Hatter, Red Queen and all the gang.
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