Obstructive Sleep Apnea (OSA) is a prevalent and serious health condition affecting millions of Americans. Characterized by repeated interruptions in breathing during sleep, OSA can lead to significant health complications if left untreated. According to the American Academy of Sleep Medicine, approximately 25 million adults in the United States suffer from OSA [1]. These interruptions, or apneas, can last from ten seconds to one minute and occur multiple times per night, severely disrupting sleep quality and overall health.

OSA is associated with a range of adverse health outcomes, including cardiovascular disease, diabetes, stroke, and increased mortality risk [2]. The condition also contributes to daytime fatigue, cognitive impairment, and reduced quality of life, highlighting the importance of effective diagnosis and treatment [3].

Treatment Modalities for Obstructive Sleep Apnea

Various treatment options are available for OSA, each with its own benefits and drawbacks. The choice of treatment often depends on the severity of the condition, patient preference, and specific anatomical considerations.

Continuous Positive Airway Pressure (CPAP) Machines

The most commonly prescribed treatment for OSA is the Continuous Positive Airway Pressure (CPAP) machine. CPAP devices deliver a steady stream of air through a mask, keeping the airway open during sleep. This prevents apneas and ensures a continuous supply of oxygen to the body.

Benefits of CPAP:

• Effectiveness: CPAP is highly effective in reducing or eliminating apneas, improving sleep quality and reducing associated health risks [4].
• Symptom Relief: Many patients experience immediate relief from symptoms such as snoring and daytime fatigue.
• Long-Term Health Benefits: Consistent use of CPAP can significantly reduce the risk of cardiovascular events and improve overall health outcomes [5].

Drawbacks of CPAP:

• Comfort and Compliance: Many patients find the CPAP mask uncomfortable, leading to issues with compliance. The noise of the machine and the feeling of claustrophobia are common complaints [6].
• Side Effects: Potential side effects include nasal congestion, dry mouth, and skin irritation from the mask.

Mandibular Advancement Devices (MAD)

Mandibular Advancement Devices (MAD) are another treatment option, particularly for patients with mild to moderate OSA. These dental appliances are designed to reposition the lower jaw (mandible) forward, enlarging the airway and preventing collapse during sleep.

Benefits of MAD:

• Non-Invasive: Unlike CPAP, MADs do not require a machine or mask, making them more comfortable and less obtrusive.
• Ease of Use: MADs are portable, quiet, and do not require electricity, making them convenient for travel.
• Compliance: Studies suggest that patients are more likely to adhere to MAD therapy compared to CPAP due to increased comfort and simplicity [7].

Drawbacks of MAD:

• Variable Effectiveness: MADs are generally less effective than CPAP, particularly in severe cases of OSA [8].
• Jaw Discomfort: Some patients experience discomfort or pain in the jaw, teeth, or gums.
• Potential for Dental Changes: Long-term use can lead to changes in bite and tooth alignment [9].

The Herbst Sleep Appliance: A Focused Review

Among the various MADs available, the Herbst Sleep Appliance stands out for its design and efficacy. The Herbst Sleep Appliance is a custom-made dental device that positions the lower jaw forward, similar to other MADs, but with some distinct features.

Design and Functionality:

• Adjustable Mechanism: The Herbst appliance includes an adjustable mechanism that allows for incremental advancement of the lower jaw, providing a customized fit and optimal airway management [10].
• Durability: Made from durable materials, the Herbst appliance is designed to withstand long-term use without significant wear and tear.

Benefits of the Herbst Sleep Appliance:

• Effective for Severe OSA: Clinical studies have shown that the Herbst appliance can be effective even in patients with severe OSA, offering an alternative to CPAP for those who cannot tolerate it [11].
• Improved Compliance: The adjustable nature of the device allows for gradual acclimatization, improving patient comfort and compliance rates [12].
• Versatility: The Herbst appliance can be used in conjunction with other treatments, such as weight loss and positional therapy, to enhance overall effectiveness.

Drawbacks of the Herbst Sleep Appliance:

• Cost: As a custom-made device, the Herbst appliance can be more expensive than other MADs.
• Adjustment Period: Patients may require an adjustment period to get used to the device, during which they may experience temporary discomfort or increased salivation.
• Regular Monitoring: Regular dental check-ups are necessary to ensure the device remains effective and to make any necessary adjustments.

Conclusion

Obstructive Sleep Apnea is a significant health issue in the United States, impacting millions of individuals and contributing to a host of adverse health outcomes. Effective management of OSA is crucial for improving quality of life and reducing the risk of serious health complications.

Continuous Positive Airway Pressure (CPAP) machines and Mandibular Advancement Devices (MAD) are the primary treatments for OSA, each with unique benefits and drawbacks. CPAP machines are highly effective but may have issues with patient compliance due to discomfort. MADs, including the Herbst Sleep Appliance, offer a comfortable and portable alternative, though they may be less effective in severe cases.

The Herbst Sleep Appliance, with its adjustable mechanism and custom fit, represents a significant advancement in MAD therapy, providing a viable option for many patients. As research continues to evolve, the combination of patient preference, severity of OSA, and specific anatomical considerations will guide the choice of the most appropriate and effective treatment.

References:

1. American Academy of Sleep Medicine. (n.d.). Obstructive Sleep Apnea. Retrieved from AASM
2. Peppard, P. E., Young, T., Palta, M., & Skatrud, J. (2000). Prospective study of the association between sleep-disordered breathing and hypertension. New England Journal of Medicine, 342(19), 1378-1384.
3. Punjabi, N. M. (2008). The epidemiology of adult obstructive sleep apnea. Proceedings of the American Thoracic Society, 5(2), 136-143.
4. Sullivan, C. E., Issa, F. G., Berthon-Jones, M., & Eves, L. (1981). Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. The Lancet, 317(8225), 862-865.
5. Weaver, T. E., & Grunstein, R. R. (2008). Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proceedings of the American Thoracic Society, 5(2), 173-178.
6. Aloia, M. S., Smith, K., & Arnedt, J. T. (2007). Examining the impact of untreated sleep apnea in CPAP nonadherers: a randomized controlled trial. Behavioral Sleep Medicine, 5(1), 1-14.
7. Hoffstein, V., & Deegan, P. (2003). Comparison of the efficacy of continuous positive airway pressure and oral mandibular advancement device in patients with severe obstructive sleep apnea. American Journal of Respiratory and Critical Care Medicine, 168(2), 239-247.
8. Ferguson, K. A., Cartwright, R., Rogers, R., & Schmidt-Nowara, W. (2006). Oral appliances for snoring and obstructive sleep apnea: a review. Sleep, 29(2), 244-262.
9. Riley, R., & Powell, N. (1990). Treatment of obstructive sleep apnea with a mandibular repositioning device. The Journal of Oral and Maxillofacial Surgery, 48(8), 792-797.
10. Mehta, A., Qian, J., Petocz, P., Darendeliler, M. A., & Cistulli, P. A. (2001). A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. American Journal of Respiratory and Critical Care Medicine, 163(6), 1457-1461.
11. Marklund, M., Verbraecken, J., & Randerath, W. (2012). Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy. European Respiratory Journal, 39(5), 1241-1247.

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Low moods or depression could be caused by inadequate sleep. Whether it’s that exam you’ve been dreading, the horrible date you can’t seem to get out of your mind or the insurmountable workload ahead of you, lack of consistent quality sleep will take its toll on your physical and emotional health. And it doesn’t take all that much sleep loss to get the dark clouds to show either.¹

It Doesn’t Take Much
Studies support the fact that even one or two nights of sleep disruption can cause significant changes to brain chemistry, which negatively affects our moods. If you’re someone who truly believes you only need four to six hours of sleep per night to get by because you happen to be one of those “go-getters,” think again, because all you may be getting is a case of the blues. In fact, one study from the University of Pennsylvania found that when subjects were allowed only 4.5 hours of sleep per night for a one-week period, they all described feelings of mental exhaustion, anger, sadness and excess stress during the day. All it took was a few days of a normal sleep cycle to get these subjects to smile again.²

Unfortunately, less and less of us are getting enough quality sleep. It’s been estimated that we sleep 25 percent less than our ancestors did even though our body has remained relatively unchanged. While the average amount of shuteye of our great grandparents in 1900 was nine hours, most people currently check in at a paltry seven.

The amount of severely sleep-deprived people seems to be exploding. Almost a third of all North Americans now sleep less than six hours per night. Pretty crazy stuff when you consider that the former President of the United States, Bill Clinton, once admitted to only getting four to five hours of sleep each night.³ Alarmingly, the vast majority of our new sleep habits cropped up over the last 10 years or so. Our modern life is filled with text messages, energy shots, and brightly lit computer screens that keep us up well after our bodies are clamoring for a soft bed and comfy pillow.

Following are some important facts about the relationship of sleep deprivation and depression that you must be well aware of:

1. Adequate sleep enhances a person’s well-being.
2. Anxiety from lack of sleep further causes agitation that could lead to chronic insomnia.
3. Difficulty sleeping is the first sign of depression.
4. Sleep restores chemical balances in the brain and body.

How Sleep-Debt Hurts
Scientists have always thought that the brain organizes and restores everything while we sleep (especially memories). This is why lack of sleep seems to disorganize our body functions and everything else in between.

Although sleep-researchers have proposed various theories about why lack of sleep makes us so moody, it wasn’t until quite recently that scientists pinpointed the exact reason. It turns out that our emotional well-being is to a large part regulated by healthy sleep patterns. For instance, research presented by the National Institute of Mental Health in Bethesda, Maryland, showed that people who experience a lack of quality sleep on a regular basis (called accumulating sleep debt) experience interference with the functional regulation of the amygdala—an area of the brain responsible for the processing of our memories and emotional reactions. This interference causes an overreaction of the amygdala, pushing it towards negative emotional stimuli.⁴

From Bad to Worse
The National Institutes of Health recently found that a battery of “cutting edge” sleeping pills only boost sleep time anywhere from 11 to 19 minutes.⁵ When it comes to side effects, prescription sleep aids make you act like you’ve just come from another planet. Many regular users report driving without remembering, sex that they can’t recall, and conversations that never registered in their minds. In other words, amnesia. A paid mouthpiece for drug companies, Gary S. Richardson, MD told the New York Times in chilling fashion, “If you forget how long you lay in bed tossing and turning, in some ways that’s just as good as sleeping.” Sorry Dr. Richardson, but wiping our memories a la Sunshine of the Spotless Mind is not my idea of refreshing sleep.

When evaluating natural sleep aids, you should look for a mechanism of action that is effective, yet safe. Any natural formula for sleep enhancement should work by:

1. Boosting melatonin or tryptophan levels in the brain.
2. Blocking the tryptophan-destroying enzyme IDO (indoleamine 2, 3-dioxygenase).
3. Lowering high levels of circulating stress hormones.

Don’t let unhealthy sleeping habits get the best of you and turn you into someone you’re not. Get to the bottom of your sleeping problems to keep your moods in check and instead of using side-effect riddled and habit-forming drugs, try introducing research-proven side-effect free nutrients like; melatonin, Ziziphus jujube, theanine, and 5-HTP, before bed in order to experience the ultimate sleep.

References:

1. Regestein Q, “Sleep debt and depression in female college students.” Psychiatry Res. 2010 Mar 30;176(1):34–9. doi:10.1016/j.psychres.2008.11.006. Epub 2010 Jan 15.
2. Dinges, D. et al., Cumulative Sleepiness, Mood Disturbance and Psychomotor Vigilance Decrements During a Week of Sleep Restricted to 4–5 Hours Per Night. Sleep. 1997 Apr; 20 (4): 267–77.
3. Sylvestre-Williams, R. “Three Reasons You Need More Sleep.” Forbes on-line). 2012, July 31.
4. Motomura Y, Mishima K. [Sleep and emotion: the role of sleep in emotion regulation]. Brain Nerve. 2014 Jan;66(1):15–23.
5. Saul S. Sleep Drugs Found Only Mildly Effective, but Wildly Popular. NYTimes.com. October 23rd 2007.

The post Sleep Is The Ultimate Anti-Depressant appeared first on Total Health Magazine.

Life is complex and its highest goal seems to be achieving and sustaining dynamic balance in all its systems—physical, mental, emotional and social. Sleep is an essential part of that balance. Nearly all animals and even some plants sleep on a regular basis. In sleep, creatures rest, repair and rejuvenate themselves. Our body is governed by dozens of internal clocks that coordinate hormone production, hunger, moods, body temperature and energy level. Many of these are related to our patterns of sleeping and waking.

Just like our body’s overuse of the stress response, our genetic blueprint for sleep has not evolved quickly enough to keep pace with our emerging 24-hour-a-day lives. Thomas Edison’s proudest invention, electric lighting, ruined people’s sleep habits. Before that invention, most Americans slept an average of 10 hours a night. In the 1950s and 1960s, the average dropped to eight, and it now hovers around seven and continues to fall. Today, more than one in three people boast of sleeping six hours or less. The trend is similar throughout the world.

Even minimal sleep loss can have profound effects on all aspects of our lives. We are less alert and attentive, more irritable and moody, and our relationships suffer. As our concentration and judgment diminish and our ability to perform even simple tasks declines, our true productivity shrinks. At the same time accident rates increase, as do health problems, particularly those in our gastrointestinal, cardiovascular and immune systems.

When we lose sleep, or our sleep is of poor quality, we also put ourselves and those around us at high risk for accidents. Drowsy drivers cause at least 100,000 highway accidents and 1,500 deaths in the U.S. each year. Perhaps nothing brings the point home more clearly than the finding that there is a seven percent increase in accidental deaths in the four days after we lose one hour of sleep following the spring shift to daylight saving time, compared to the week before and the week after. The pattern is reversed in the fall, when we gain an hour’s sleep for one night.

A “Doing” Society
As a culture we don’t respect or value being, dreaming or sleeping. As a result we don’t spend enough time on it—time is money, after all. In the past 25 years we have added 158 hours to our annual work and commuting time or a full month of working hours. According to William C. Dement, MD, PhD, director of the Sleep Disorders Clinic and Laboratory at the Stanford University School of Medicine, working mothers with young children have added 241 hours to their work and commuting schedules since 1969. Dement passionately believes “. . . Americans need to wake up to the crucial importance of sleep in their lives.”

Studies by Dr. Michael Irwin and colleagues at the University of California San Diego and San Diego Veterans Affairs Medical Center suggest that even a modest loss of sleep reduces the body’s immune response. Twenty-three healthy men, aged 22–64, spent four nights in a sleep lab. They were allowed to sleep normally the first two nights but the third night they were kept awake from 3:00 to 7:00 A.M. The following morning, for 18 of the men, the activity of the immune cells that fight off viral infections fell significantly. When the men were allowed to sleep through the next night uninterrupted, the level of immune cells returned to normal. This indicates that sleep deprivation—even one-half night of lost sleep—decreases the body’s ability to ward off infection.

The National Sleep Foundation points to our escalating pace of life, work pressures and aging as the primary reasons why many medical specialists now believe sleep disorders to be the number one health problem in America.

Stages of Sleep
To accomplish its critical role of rejuvenation, sleep is a dynamic process with a complex “architecture” all its own. Sleep labs monitor sleep patterns through the use of electrodes attached to specific locations on a subject’s face and scalp. Physiological changes are recorded on graph paper in a series of lines that resemble the jagged outlines of a mountain range.

After about half an hour, one moves into physically restorative sleep, as cells start to repair and rejuvenate. This sleep may be decreased or absent in the elderly, who awaken more frequently during the night. After an hour or so, one shifts into a highly active stage characterized by accelerated dreaming and rapid eye movements, hence the name REM sleep. Though we may dream in all stages of sleep, dreams occur most frequently in REM sleep and are usually more vivid and emotional than during other stages.

It is primarily during REM that our bodies and minds are refreshed and rejuvenated. Newborns spend almost 50 percent of their sleep time in REM; by three months, REM is only 30 percent. At six months, it is down to 20 percent. In rapidly growing young adults, it rises again to 25 percent. For most adults, REM sleep occurs every 90 minutes throughout the night. The first REM period is brief, lasting around five minutes. As each REM period ends, you ascend back into non- REM sleep and then cycle between them for the rest of the night. As the night progresses, REM periods become longer, up to 30–45 minutes, and REM becomes a dominant part of the sleep cycle.

Without enough REM sleep it becomes harder to focus on day-to-day activities. Also, it is believed that during the dreaming of the REM phase, the subconscious mind analyzes the day’s events and processes feelings, also essential for mental health.

Insomnia
Insomnia affects 20 to 43 percent of American adults at some point in their lives. Insomnia most commonly consists of difficulty falling asleep. In fact, 50 percent of senior citizens have difficulty falling asleep on any given night. The National Sleep Foundation (NSF) identifies three categories of insomnia: transient, short-term and chronic. Chronic insomnia afflicts 15 percent of adults, 50 percent of the elderly. It lasts more than a month and sometimes for decades. It can be related to underlying medical, behavioral or psychiatric problems such as depression, possibly involving a serotonin imbalance in the brain.

Simple changes in daily routine may be surprisingly effective in improving sleep quality:

• Avoid caffeinated beverages (even if taken early in the day, they can disrupt sleep)
• Avoid alcohol and nicotine for at least two hours before bedtime
• Exercise regularly, but not too close to bedtime
• Get up at the same time every day regardless of when you went to sleep.

Insomnia rarely exists in a vacuum and is often viewed as a symptom of an underlying problem, much like a fever suggests infection. Sufferers generally have other psychiatric disorders that are leading them to feel distress, such as anxiety and depression. Or they may have more serious underlying physical disturbances including hyperthyroidism, endocrine imbalance, diabetes, hypoglycemia, fibromyalgia, arthritis, cardiac and respiratory problems, sleep apnea, restless leg syndrome or drug and alcohol abuse.

It is important, therefore, to undertake a full investigation of what could be contributing to insomnia before suggesting or undertaking a specific treatment. Unfortunately, only about half the people suffering from sleep disturbances seek the advice of a healthcare professional and many of these individuals are prescribed sleeping pills, while the underlying disorder causing the insomnia goes untreated.

Although the ability to sleep well may diminish with age, the need for sleep does not. In addition to specific sleep disorders, older people are more likely to suffer medical problems that can interrupt, delay and/or shorten sleep, as may some of the drugs used to treat these conditions.

Pharmaceutical Medications
According to the National Sleep Foundation, in the treatment of transient and short-term insomnia “sleeping pills have a role” but “once the source of the stress or disruption is dealt with or improved sleep hygiene shows positive effects, medications are discontinued, usually within two weeks.” In chronic insomnia, “sleeping pills have a limited role and are not intended for long-term use.” Most medical authorities recommend that benzodiazepine use be limited to four weeks.

Despite the fact that drug therapy is recommended only as temporary sleep support, approximately seven percent of the population take medication regularly, 13 percent use prescription sedatives and 87 percent use over-the-counter (OTC) products. The OTC products include depressants and antihistamines that slow brain activity and cause drowsiness. These drugs break down slowly in the body and produce next-day drowsiness. While they may help with occasional or mild insomnia, they don’t work with continued use, for which they were never intended. They should be used only under doctor’s supervision by those with glaucoma, peptic ulcer, seizure disorder or prostate enlargement.

Benzodiazepines
It is estimated that American doctors write 60 million prescriptions a year for sedative-hypnotic drugs like Valium— up from 47 million in 2006, according to IMS Health, a health care services company. Besides anxiety, insomnia is the most common reason that people take benzodiazepines. There is almost unanimous agreement that these drugs effectively induce sleep, reduce the time it takes to fall asleep and increase total sleep time for the first several nights. Side effects, however, include morning sleepiness, rebound insomnia and disruption in thinking. With significant amounts still in their systems, users are “hung over” the next day and their level of alertness is impaired.

Since insomnia increases with age, many elderly patients are given benzodiazepines, often with disastrous results. Those over 65 comprise about 15 percent of the population, yet they consume up to 45 percent of sleep medications and 40 percent of the nation’s benzodiazepines. The negative effects are worse for them and there is far too little awareness of this phenomenon. A particularly tragic effect of the benzodiazepines is an increase in accidents due to a loss of muscle coordination, which appears to strike the aged more than younger patients.

Benzodiazepines: Tolerance and Addiction
At any age benzodiazepines quickly produce a tolerance, so that one has to increase dosage to achieve results. Worst of all, 15 to 30 percent of long-term users become addicted. Most research has shown that their beneficial effects for sleep last only a few weeks, yet many patients feel unable to sleep without them after months or even years of use.

Research indicates that benzodiazepines interfere with REM sleep. Neurotransmitters such as norepinephrine and serotonin are considered crucial for new learning and retention.

During REM sleep, the brain’s neurotransmitter supply is replenished. By inhibiting neurotransmitter restoration, a lack of quality sleep interferes with the ability to learn and remember.

Adequate REM is vital for memory storage, retention, organization, reorganization and new learning. A good analogy is that REM sleep is like running a cleanup program on your computer. During the day we generate a lot of open and disconnected circuits and probably end up with plenty of fragmented and corrupted files. Unless we run our nightly cleanup, the next day our human computer is likely to run slower and less efficiently, to say nothing of the occasional system errors and total crashes we’re likely to face.

A recent study at Rush-Presbyterian-St. Luke’s Medical Center in Chicago, Illinois, revealed that increased REM sleep time contributes significantly toward reducing negative mood overnight. Just think of all the prescriptions written for neurotransmitter- enhancing antidepressants when the underlying problem is actually sleep deprivation. As we have seen, some of the very drugs given to treat these symptoms prolong and exacerbate them.

All of this illustrates why the effects of REM deficiency, sleep deprivation and fatigue often develop a self-perpetuating cycle:

• Decreased sleep reduces REM
• Reduced REM prevents rejuvenation
• Unrejuvenated, we are more susceptible to stress
• Feeling stressed decreases sleep.

Statistics On The Elderly And Benzodiazepines

• In a study of 16,000 people over age 65, the risk of traffic accidents was significantly greater for those taking benzodiazepines.
• In the United States, falls are a leading cause of accidental death in people over age 65.
• Falls contribute to 40 percent of nursing home admissions.
• Five percent of falls result in hip fractures and other injuries that require hospitalization or immobilization for an extended period.
• The elderly have both a higher risk of falling and a higher rate of hip fractures when taking benzodiazepines.
• In one study involving 6,000 patients, those taking flurezepam, diazepam or chlordiazepoxide had a risk of hip fracture 1.8 times greater than those not taking the drug.
• In a study of 100 hospital patients age 70 and over who had fallen, and 100 controls (also over age 70) who had not fallen, there was a higher rate of falls associated with benzodiazepine use.

L-theanine
Having created a social epidemic of sleep deprivation, we need now to turn away from drugs that basically knock us unconscious then rob us of our precious restorative REM sleep. In addition to its ability to promote calm and well-being, the amino acid found in green tea, L-theanine, may provide an effective natural treatment for insomnia. In an appropriately increased dosage, it seems to work with the body to bring on deep restful sleep without interfering with sleep’s natural cycles. Researchers in Japan gave volunteers 200 mg of L-theanine daily and recorded their sleep patterns on devices worn around their wrists. The L-theanine didn’t cause the subjects to sleep longer, but it did cause them to sleep better. It was documented that sleep quality, recovery from exhaustion, and refreshed feelings were all enhanced by L-theanine. Those taking L-theanine felt like they slept longer than they actually did.

Melatonin
The hormone melatonin is instrumental in establishing our daily rhythms. As we age our melatonin levels decrease, with the steepest decline occurring after 50. Melatonin supplements may play a role in restoring internal sleeping and waking rhythms as it works on an underlying physiological cause of sleep disorder. In an Israeli study at the Technion Medical School in Haifa, men and women between the ages of 68 to 80 had their time to fall asleep cut by more than half (from 40 minutes to 15 minutes) with the use of melatonin. They also reported their sleep was more refreshing.Walter Pierpaoli, MD, PhD and William Regelson, MD, in their book The Melatonin Miracle recommend 1 to 5 mg at bedtime. They suggest you begin with 1 mg the first night and if it works, continue with that dose. If it doesn’t work, increase by 1 mg each night, but only up to a 5 mg maximum. If you wake groggy, they suggest you cut back. Your internal clock should be reset after about two weeks, at which point they recommend you discontinue melatonin.

In my practice I suggest melatonin in the same manner for short-term, low-dose use. While its popularity has increased due to its possible anti-aging effects, it is still a hormone that needs to be appropriately prescribed and monitored.

Serotonin and 5-hydroxy-tryptophan (5 HTP)
Sleep disorders are sometimes linked with lowered brain levels of the neurotransmitter serotonin. Normally before sleep serotonin levels build up and at a certain point the sleep response begins. Melatonin, a metabolite of serotonin, is also involved. Where inadequate levels of serotonin are the problem, antidepressant drugs known as SSRIs, which selectively inhibit serotonin re-uptake, can promote sleep. However, these pharmaceuticals have serious side effects and should be avoided when safer natural treatment is effective. Many of my patients notice that their sleep improves markedly after a few weeks of taking the amino acid, 5-HTP, from 50–200 mg at bedtime. Alternatively you can take L-tryptophan though it requires 10 times the dose. Its sale was severely restricted after a contaminated batch in 1989 caused serious negative reactions, though it is once more on the market. A metabolite of tryptophan, 5-HTP, is readily available as a supplement. Used in depression and anxiety, it likely has a serotonin- and a melatonin-enhancing effect, helping to regulate sleep naturally.

Other Sleep-Promoting Herbs
Other sleep-promoting herbs include California poppy, skullcap, hops, passion flower and reishi mushroom. There are excellent combination formulas that contain combinations of these nutrients.

Sleep Promoting Behavior Changes Our ability to sleep is greatly influenced by simple behavioral habits, patterns and cues. This is good news. Paying attention and taking responsibility for developing healthy “sleep hygiene” has been shown to result in permanent improvement in people’s ability to fall and stay asleep and feel more satisfied with their sleep. There are instructive books on the subject and although they don’t yet provide enough information about herbal treatments, the National Sleep Foundation provides valuable resources.

Keeping a sleep log for a few weeks may be helpful in identifying behaviors that are contributing to your sleep problem. Record when you wake up, go to sleep, drink caffeinated beverages, exercise, eat and any other suspected sleep-stealers.

Adapted from 8 Weeks to Vibrant Health, by Hyla Cass, MD and Kathleen Barnes, available at www.cassmd.com.

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THE ROLES OF TRYPTOPHAN
Although tryptophan is one of the least abundant essential amino acids, it is one of the most critical. It serves as a precursor for the production of the neurotransmitter serotonin and the neurohormone melatonin. The positive effects of this process are proven to promote good mood, relaxation, deep sleep, healthy sleep-wake patterns, emotional stability, dreaming, and creative imagination. Tryptophan can also be diverted to produce niacin (vitamin B3), with all it’s vital functions, which we discuss later.

SEROTONIN
Serotonin is considered the “mood neurotransmitter” a chemical messenger in the brain that keeps us emotionally and socially stable. Women often have more problems than men in maintaining their moods since their cycling hormones affect serotonin levels. This would explain the emotional shifts in premenstrual syndrome and, during menopause, when many women experience increased moodiness, irritability, and sensitivity to pain.

Women who are low in serotonin are likelier to express their anger inwardly, with depression and even suicidal behavior. In contrast, research shows men who are low in serotonin are often violent and may even engage in dangerous criminal behavior. Alcohol and drug abusers also are often low in serotonin. The good news is we can successfully correct these imbalances by supplying supplements that raise serotonin.

MELATONIN
Melatonin is a molecule made from serotonin. It has a significant influence on our hormonal, immune, and nervous systems. Melatonin helps to set and control the internal clock that governs the natural “circadian” rhythm (day and night cycles) of the body, through its sensitivity to light, keeping us “in sync” with the rhythms of nature. Each night the pineal gland produces melatonin, which helps us fall asleep. Then, with morning light, melatonin levels dip, and we awaken refreshed.

Melatonin also has anti-inflammatory effects that can be useful in treating osteoarthritis. Since it both helps improve sleep patterns and relieve pain, melatonin is an ideal supplement for chronic fatigue syndrome and fibromyalgia.

NIACIN
Niacin or vitamin B3 is an essential nutrient in protein, and fat metabolism. It is also needed in the production of serotonin from tryptophan. In the 1950s, Drs. Abram Hoffer and Humphrey Osmond discovered that large doses of niacin were able to reverse acute schizophrenic episodes, and treat seriously ill patients. In fact, it is likely these patients were suffering from pellagra, or niacin deficiency disease, and were showing one if not all of its typical 3 D’s: dementia, dermatitis (eczema) and diarrhea. The mental illness, though, was often the first sign. They treated patients with as much as 3 gm twice daily with excellent results. See Dr. Hoffer’s Adventures in Psychiatry: The Scientific Memoirs of Dr. Abram Hoffer.

Dr. Hoffer also discovered that niacin had a cholesterol-lowering effect. This nutritional approach is to this day among the most effective treatments for an unhealthy cholesterol profile.

Elevated cholesterol has been identified as a contributing factor to cardiovascular heart disease, the leading cause of death in America. Niacin is unique in that it plays the dual role of reducing LDL the “bad” cholesterol, and increasing HDL the ”good” cholesterol, improving heart health and longevity. The dose is 500 mg—1 gm twice daily. A harmless side effect is flushing that stops after 30 minutes or so. Another more serious (but uncommon) side effect is liver toxicity especially with the sustained release form of niacin. Many common drugs have liver toxicity as well, so simply exercise caution here. You can substitute non-flush niacin (inositol hexanicotinate), or niacinamide forms of niacin, but they are slightly less effective.

TRYPTOPHAN THE NATURAL PATH
Tryptophan is essential for the production of key neurotransmitters. Many depressed patients have low levels of tryptophan. Researchers have found that when they take depressed patients who have improved and then deprive them of tryptophan, their depression returns. This was demonstrated in a double-blind study at Oxford University’s Department of Psychiatry. Young women with a history of depression were divided into two groups and given a diet either excluding or including tryptophan. Neither the subjects nor the researchers knew who received which diet. At the end of the experiment, 10 out of 15 women on the tryptophan-free diet were significantly depressed, while none on the tryptophan diet were. When the participants in the deprived group were then given a diet containing tryptophan, their depression lifted. I have certainly seen this same response in my own practice, as well.

An adequate supply of tryptophan, combined with B vitamins, is also critical to the chemistry of social interaction. We have seen how tryptophan deficiency leads to depression, impulsivity, and aggressiveness, while tryptophan supplementation is an effective antidepressant. In addition, a recent study showed that healthy volunteers given one gram of tryptophan three times daily for 12 days showed an increase in their self-confidence and sociability and a decrease in quarrelsomeness. Meanwhile, the placebo group showed no such effect. However, once they were given tryptophan, they showed the same positive change.

Tryptophan has also been shown to be effective in treating manic depression and depression associated with menopause. Tryptophan is also a useful and safe pain reliever, in such cases as dental pain, headaches (migraines in particular), and cancer pain. It appears to work by increasing the pain threshold. Other potential uses for tryptophan include in Parkinson’s disease, epilepsy, and schizophrenia, (as discovered by Dr Abram Hoffer).

TRYPTOPHAN VS. SSRIs
A substance natural to the body, tryptophan is considerably safer than the antidepressant prescription drugs referred to as selective serotonin re-uptake inhibitors (SSRIs). The predominant brand names are Zoloft, Paxil, Prozac, Celexa, and Lexapro. With total sales exceeding $20 billion annually, the SSRIs are used to treat depression, anxiety, and some personality disorders. While useful for certain patient populations, as with all drugs, they have significant side effects, leading to many individuals abandoning their prescriptions. Certain drugs in the SSRI category are required by the Food and Drug Administration (FDA) to display a “black box” warning, regarding possible suicidal behavior stemming from their use.

While both SSRIs and tryptophan enhance serotonin activity in the brain, their actions differ. By inhibiting the breakdown of the serotonin, the drugs are misdirecting the brain into thinking there is more serotonin, while giving the amino acid is actually restoring needed levels. For more details, see my book, Natural Highs. Why use a drug with its serious side effects when a natural (and much cheaper) product is available, one that solves the problem at its root cause? I certainly follow this principle in my psychiatric practice.

SLEEP STUDY
A recently completed clinical pilot study using Tryptopure™, a very pure brand of tryptophan from Japan, revealed the following benefits. Participants reported significant decreases in the time needed to fall asleep and showed substantial increases in actual sleep time during the night. Participants also reported a significant lowering of the number of times they woke up during the night. Most importantly, the participants of the tryptophan study showed a marked improvement in the ability to function during the day.

Recommended Dosage: For depression or insomnia take 1,000–3,000 mg daily of L-tryptophan, in divided doses, or all at once at bedtime, depending on your response. It is best absorbed away from protein, and with a carbohydrate snack, such as a piece of fruit or fruit juice, plus B vitamins, which are required to convert it to serotonin. A multivitamin should be able to supply the required amount, and can be taken with meals some time that day.

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