Strategies for Supporting Sleep
Sleep is something our body should do naturally, but one third of adults in the USA don't get enough of it. Find out how supplements support sleep and better sleep hygiene habits improve overall health.
Lack of sleep has officially reached widespread proportions with the Centers for Disease Control and Prevention reporting that one in three adults in the United States don’t get enough sleep.  What makes this issue even more critical is that sleep is so important to overall health.
While one is sleeping, there are two different cycles and stages: REM and Non-REM (NREM). NREM sleep makes up a majority of the portion of times sleeping and is mainly parasympathetic activity resulting in lowered heart rate, blood pressure, temperature, etc. REM sleep is often thought of as the “dream period”; however, a study released in 2017 showed that dreams can occur in NREM sleep as well. An author of a study that came out of University of Rochester in 2013 likened sleeping to a dishwasher cycle for the brain where it cleans itself of toxic metabolic byproducts . That alone should be a reason for everyone to obtain the best sleep possible!
Sleep deprivation can also affect a person on a genetic level. Insufficient sleep alters gene expression and influences inflammatory balance, brain function, and neural plasticity. It also changes gene transcription responsible for regulating the circadian rhythm thus compounding the effects of sleep deprivation.,
Sleep is something our body should do naturally, yet 50-70 million Americans suffer from some form of trouble sleeping, resulting in the pharmaceutical industry for sleep aids being a multi-billion dollar industry., These medications are not without serious side effects.
For many people who have trouble sleeping, just the idea of lying down at night introduces feelings of worry and dread. Patients need to learn and understand how the lifestyle choices they make can interfere with sleep, or support better sleep. When patients decide to prioritize sleep, they are often surprised at how other aspects of their life drastically improve—physically, mentally, and emotionally.
Discussing Sleep Hygiene
At this point in time, it’s safe to say that a majority of patients are looking at some sort of screen the majority of the day. They are also likely working long hours and neglecting sleep in order to take care of other life responsibilities.
It is so incredibly important to discuss sleep hygiene patterns with patients. Most people will agree these are things they should do, but a practitioner should encourage these changes as if they were a prescription. These lifestyle habits can positively affect the sleep-wake cycle and return patients to a normalized sleep pattern, resulting in adequate amounts of sleep. Practicing good “sleep hygiene” includes following the same calming routines before bed, going to bed at the same time each night and waking up at the same time each morning, allowing for at least 8 hours of sleep.
Go to bed and wake up at the same time each day.
Have a relaxing nighttime routine (that does not involve screens).
Do not eat or drink within 2 hours of going to bed.
Stop screens (phones, laptops, television) for 1-2 hours before bed.
Avoid alcohol or stimulants in the evening.
Get regular exercise and have daily exposure to natural light first thing in the morning.
These practices help re-train the body to a healthy sleep cycle and it takes persistence.
Nutrients and Herbs to Support Sleep
While learning to implement these sleep hygiene habits, nutrients and herbs can offer support. Below are a few of the most common and popular ingredients in sleep products. They are often combined to work synergistically.
Melatonin is a hormone of the serotonin cascade and naturally increases during nighttime/darkness when it is secreted by the pineal gland in the brain. Its main job is to support the natural sleep-wake cycle. Melatonin is non-addictive, has a short half-life, and helps people fall asleep. It is beneficial because it does not have a negative feedback to the natural production of endogenous melatonin. According to the National Center for Complementary and Integrative Health, melatonin supplements may help people who struggle with sleep including those with jet lag or sleep issues associated with shift work. Melatonin has become a “go-to” for sleep support for many integrative healthcare providers.
Tryptophan (and 5-HTP) – Tryptophan helps support sleepiness. Tryptophan can help modify serotonin levels, and serotonin is a precursor to melatonin. Similarly, 5-HTP is used because it is the derivative of tryptophan and the direct precursor to serotonin and subsequently melatonin. 5-HTP is generally dosed at 50-100 mg, while tryptophan is usually dosed at 500-1000 mg or more.
L-theanine is an amino acid found in green tea leaves. It helps support relaxation and is ideal for people who are looking for quality sleep. This natural substance has the unique ability to support the increase of alpha brain waves that promote a relaxed feeling and decrease beta brain waves which stimulate an excited state. The authors of a 2015 review paper published in the Journal of the American College of Nutrition state, “Unlike conventional sleep inducers, L-theanine is not a sedative but promotes good quality sleep through anxiolysis.”
Valerian root (Valeriana officinalis) has been used for centuries as probably the best known herb for sleep. Valerian binds to GABA A receptors in the brain, and the volatile oils can also inhibit degradation of GABA, increasing levels of GABA (gamma-aminobutyric acid) in the brain. GABA is an important neurochemical for sleep that our brains make naturally. It acts as an “inhibitory neurotransmitter” and quiets the activity of the neurons in the central nervous system to increase feelings of relaxation and calm. Healthy levels of GABA promote and protect sound and restful sleep, and help ensure we spend the right amount of time in slow-wave (NREM) and REM sleep, the two deepest and most restorative sleep stages. In this way, valerian can help support quality of sleep.
Hops (Humulus lupulus), well known for beer making, is also known to promote relaxation and sleepiness. Like valerian root, hops works to enhance GABA levels in the brain. And like valerian root, hops has long been a favorite of herbalists to support sound sleep and is the herb of choice to support falling asleep faster. Because of its extreme bitterness, hops capsules are often better accepted than liquid extract.
Skullcap (Scutellaria lateriflora) is a member of the mint family and supports a calming and relaxing effect on the body. It can be used throughout the day in lower doses to support nervous system balance, or in higher doses in the evening to support normal healthy sleep. It’s a special favorite of herbalists to recommend for those who easily experience overwhelm, and for those who are “wired but tired”.
Lemon balm (Melissa officinalis) is a lemon-scented herb from the mint family used by herbalists for its calming effects and to support relaxation and healthy sleep. It’s commonly used as a tea because of it’s enjoyable aroma and flavor. A 2015 randomized placebo-controlled trial published in the Journal of Ethnopharmacology demonstrated that lemon balm can help support heart function.
Magnolia (Magnolia officinalis) bark comes from the Asian medicine traditions and contains the compounds honokiol and magnolol which both affect the GABA A receptor and support healthy sleep. Honokiol may shorten sleep latency to NREM sleep. Magnolol may also have similar effects and has been shown to increase the number of REM and NREM sleep cycles. Magnolia bark and it's various constituents have been shown to help modulate cortisol production and therefore is used in nighttime formulas to support healthy HPA axis function and sleep.
Passionflower (Passiflora incarnata) is a wonderful gentle herb for sleep issues, though best used as a synergist. It is another herb that binds to GABA A receptors and may be helpful for people feeling overwhelmed with daily responsibilities that are affecting their ability to sleep. This herb can also be used throughout the day as desired, to help support calmness and relaxation.
Oftentimes, these ingredients are combined in formulas to work synergistically to support sound sleep. All of these substances are considered safe and effective. And, everyone is unique in the dosing and combinations that work best for them.
According to Lisa Murray RDN, Medical Educator at Emerson Ecologics: “One mistake people often make is taking these supplements only close to bedtime. If patients complain that the supplements don’t work, they may not be allowing enough time for them to work, or the dose may be too low. For example, I often recommend taking L-theanine before dinner, as studies show the effect on cortisol is 3-4 hours after ingestion. Calming herbs taken early in the evening “set the stage” for sleep by slowing down brain activity and supporting the “rest and digest” parasympathetic response. This is the concept of having a cup of calming lemon-balm and chamomile tea after dinner to support digestion and relaxation. I do recommend patients experiment with different dosing schedules and see how they respond to taking sleep supporting supplements right before or after dinner, and again before bed, in order to understand how these natural substances promote relaxation for them.”
“It’s also important to counsel patients to watch for the physical signals that it’s time for bed, like yawning, or nodding off while watching TV. We all get stuck in our usual routines, but when we ignore our body’s sleep signals, we send the message back to ‘stay up.’ It surprises a lot of patients who are used to staying up late, that they are able to fall asleep easier, sleep better and longer if they pay attention and follow their sleep signals. Sometimes that means going to bed two or more hours earlier than they normally do! Supplements can be really helpful and effective, if we don’t ignore and override their effects.”
Supporting Optimal Cortisol Levels During Sleep
It is widely known that even when a person is sleeping, the human body is incredibly active. There are innate systems in place to help create and maintain homeostasis. There is a clear rhythmic connection between the HPA axis, the hormone cortisol, and sleep. Often, after long periods of stress, this rhythm becomes disrupted, or worse, reversed. This has a serious impact on sleep.
After we have been asleep for a few hours, cortisol levels begin to rise, peaking in the morning when we are ready to start the day. If cortisol levels remain high throughout the day and at bedtime, sleep is negatively affected. Utilizing calming herbal adaptogens (such as ashwagandha, holy basil, magnolia and reishi) and nutrients such as phosphatidylserine in the evening can be beneficial for supporting and stabilizing normal HPA-axis function and subsequently sleep.
Ashwagandha extract is an adaptogenic herb shown to help reduce cortisol levels in stressed individuals. According to the results of a 2012 study in the Indian Journal of Psychological Medicine, in addition to a reduction in cortisol, the participants taking the ashwagandha also had significantly lower stress assessment scores than the control group.
The amino acid L-theanine is also a good choice to help patients balance their HPA axis. In a 2016 study featured in the journal Nutrients, L-theanine helped significantly decrease salivary cortisol response to a stressor three hours post-dose. It’s interesting to note that the decrease in salivary cortisol in this study did not show up one hour after ingestion but was present three hours after. This supports timing of dosing at least 3 to 4 hours before bedtime. In another double-blind, placebo-controlled, crossover study, subjective stress response was significantly reduced one hour after the L-theanine was given. In addition, resting alpha activity was increased in the L-theanine group, indicating that it can promote an alert state of relaxation rather than grogginess. In this 2016 study, a drink powder containing 200 mg per dose of L-theanine was used.
Overall, in addition to considering diet quality, caffeine intake, activity level, medications and mental health, practitioners should also focus on ways to improve patient’s sleep. Sleep, often overlooked, is one of the most important pillars of health and well-being.