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Sleep Health

In Dr. Morgan Camp,Sleep Health on November 13, 2013 by drmorgancamp Tagged: , , , , , ,

Sleep Health

Getting enough sleep is vital to create an energy that can run through your mind, muscles, and organs from head to toe and back again. It is during your sleep that your body repairs, detoxifies, balances hormones, and resets itself for the next day so that you can live optimally. At some point in time with busy work schedules, life stresses, or illnesses, getting enough sleep for your body to remain healthy may become a challenge. With small changes in habits and help from Functional Medicine, getting control of your sleep pattern is made possible.

Symptoms and Types of Sleep Deprivation

Feeling fatigued is the obvious signal that not enough rest was had during the night. However, less obvious signs are increased weight, headaches, an inability to concentrate, mood disruptions, or an inability to develop appropriate muscle in relation to a specific exercise intensity.

There are different levels of sleep deprivation, ranging from minimal, moderate, to severe sleep deprivation known as insomnia. At Morgan Camp and Associates, we are interested in learning, down to the biochemical level, the cause of your sleep disturbances. During an interview with tailored questions along with targeted sophisticated laboratory testing through blood, urine, or salivary samples, we will know exactly where the imbalance in your body systems occurs and, more importantly, how to correct it.

Depending on your sleep habits, such as how well you fall asleep or at what time you awaken during the night, a reasonable cause of your insomnia and necessity for specialized laboratory testing can be determined. The Mayo Clinic recognizes ten causes of Insomnia: stress, anxiety, depression, medical conditions especially those affecting the gastrointestinal tract, a change in your environment or routine, medications, poor sleep habits, ‘learned ‘ insomnia due to television watching, eating too much late in the evening, and stimulants or depressants such as caffeine, nicotine, chocolate and alcohol.

Medications and Medical Causes of Insomnia

In regards to medications, many prescription drugs can interfere with sleep, including some antidepressants, heart and blood pressure medications, allergy medications, and corticosteroids. Many over-the-counter (OTC) medications, including pain medication combinations, decongestants and weight-loss products, contain caffeine. Antihistamines may initially make you groggy, but they can worsen urinary problems and increase the frequency to urinate at night. It is important to use medications appropriately and under the supervision of a practitioner who pays attention to the wide affect that most medications have on the body systems, so as to avoid causing imbalances.

Medical conditions linked with insomnia include arthritis, cancer, heart failure, lung disease, gastroesophageal reflux disease (GERD), overactive thyroid, stroke, Parkinson disease and Alzheimer’s disease. Making sure that your medical conditions are well treated may help with your insomnia?and with the use of specialized laboratory testing, the cause of your insomnia will be identified and appropriate measures taken for its resolution.

Insomnia Guidelines and Diagnostic Decision Tree

The outline below gives you a window into how we consider underlying conditions related to your insomnia as well as how we choose diagnostic tests and possible treatment plans.    Because there are so many bio-chemical, environmental, and hormonal factors involved in the etiology of sleep disorders, a myriad of problems must be ruled out depending on your symptoms, physical assessment, personal sleep history and lifestyle, and specific complaints.  Given the complicated number of factors to consider, you can see why a focused health history is so important to guiding testing recommendations and treatment plans.

Insomnia Etiology Outline

I. Symptoms worse in the 1-2 weeks prior to your Menstrual Cycle (Females only!)

– Low Progesterone

– Low Magnesium

II. Difficulty Falling Asleep:

– Low Melatonin

– Low Progesterone

– High Cortisol (Stress hormones)

III. CANT STAY ASLEEP:

– Poor Liver Detoxification

– Magnesium deficiency

– Low Blood Sugar

– High Cortisol

IV. Associated with Headaches during the day:

– Poor Liver Detoxification

– Poor Gallbladder Function

V. Light Sleep, Feeling of not being rested in the AM.

– Low Growth Hormone

Treatment Options:

I. General Guidelines for everyone:

1.Sublingual Melatonin: Start with 5 drops under your tongue at bedtime. Take every night whether you notice a benefit or not for a minimum of 3 Months. You may slowly increase the dose by 2-5 drops by night. Please note:

  • Melatonin is best taken under the tongue to avoid the liver metabolism of the hormone.
  • Signs of Too much Melatonin: Grogginess in the AM and/or Frequent Waking at night. ?If either of these occur, lower the dose by 1-2 drops until the symptoms resolve.

2.Magnesium: The best forms for sleep are Magnesium Glycinate or NeuroMag (Magnesium Threonine).

II. Condition Specific Treatments:

1.Suspect High Cortisol (High Stress Hormones)

1.Consider Salivary Adrenal Hormone Test Kit

2.If High Consider:

2.Indigestion/Heartburn (In Dr. Camp’s experience this is one of the most common over-looked causes of Insomnia in all of his patients)

1.Consider Stool Parasitology to check for

  • H pylori
  • Candida
  • Consider ALCAT test for Food Sensitivities

3. Poor Liver Function

1.Avoid Alcohol, especially high sugar content wine!

2.Consider Organic Acid Testing at Metametrix

3.Consider supplements:

Female Hormone Changes Associated with Insomnia:

1.Low Progesterone: Suspect Low Progesterone if any of the following conditions exist:

  • You experience increased anxiety, insomnia, bloating, or water retention the last 1-2 weeks of your menstrual cycle or
  • You are over the age of 40 and have insomnia that has worsened as you have gotten older

If you are peri-menopausal:  contact Dr. Camp’s office for a lab slip to check your progesterone. If you are pre- menopausal, you should have your level checked ideally on Day 19-21 of your cycle.  Call us at (415) 383-9903

2.Low Estrogens: Suspect Low Estrogens if any of the following conditions exist:

  • Hot Flashes, Night Sweats, Fatigue, Eye Dryness, Vaginal Dryness, Depression
  • You are over the age of 40 and have insomnia that has worsened as you have gotten older

3. Low Growth Hormone: Suspect Low Growth Hormone if any of the following conditions exist:

  • Greater than Age 40
  • Sagging Skin, Loss of Muscle Tone
  • Light Sleep w/ excessive need for sleep
  • Chronic Anxiety for no reason

Male Hormone Changes Associated with Insomnia:

1. Low Progesterone: Suspect low Progesterone if you are male and any of the following exist:

  • You are over 40 and experience nervousness, anxiety, feel irritable or aggressive and generally “tensed.”
  • You have developed male-patterned baldness, abdominal bloating and weight game, are overweight.
  • Superficial, light and/or nervous sleep

2. Low Testosterone: Suspect low testosterone levels if you are male and over 40 (however it can happen in men as young as 30) and the following exist:

  • Behavior changes such as irritability, nervousness, indecisiveness, reduced self-confidence and initiative, and lack of mental firmness.  New onset of depression, anxiety and memory loss.  Classically, a reduced sex drive.
  • Physical changes such as reduced body hair, smaller muscles and reduced exercise endurance, premature aging, flat hair, male pattern balding, dry eyes, pale face, and overweight or increased abdominal obesity.
  • Disturbed sleep

3. Low Growth Hormone: Suspect low growth hormone if any of the following exist:

  • Greater than Age 40
  • Sagging Skin, Loss of Muscle Tone
  • Light Sleep w/ excessive need for sleep
  • Chronic Anxiety for no reason
  • Not feeling rested after getting enough sleep.

*For all male and female hormone deficiency concerns as a cause of sleep disturbances, please set up an appointment and/or get the appropriate labs from us for replacement therapy to improve your sleep.  We are experts in this line of medicine.

Sleep Hygiene and EMF’s

There is now an entire body of evidence suggesting that habits prior to sleep (such as TV watching in bed) and exposure to EMF’s (such as having a cell phone next to your head while you sleep) can have serious effects on your sleep.  The following is a link to an article reviewing appropriate sleep hygiene habits that will improve your sleep:

http://articles.mercola.com/sites/articles/archive/2010/10/02/secrets-to-a-good-night-sleep.aspx

In general, the following habits will improve your chances of a good night’s sleep:

  • Do not watch TV or work on the computer an hour before going to bed
  • TV’s and video games should be placed outside the bedroom.
  • Avoid stimulating foods and drinks before bedtime such as alcohol, chocolate, and caffeine.
  • Do not engage in vigorous exercise or activity in the late evening.
  • Create a soothing sleep routine to promote sleep.  Examples include:  take a lavender aromatherapy bath by candle light before bed or try reading for the hour prior to bed instead of watching TV or working on the computer, and always avoid stressful conversations and situations several hours prior to bedtime if possible.

Avoiding Electro-Magnetic-Frequency’s in the bedroom is another important strategy to consider.  The evidence suggests that exposure to high levels of EMF’s may cause headaches, fatigue, nervousness, and a host of health problems including insomnia.  Here is a second link if you would like to read more about this:

http://articles.mercola.com/sites/articles/archive/2008/02/21/are-you-sleeping-in-a-dangerous-electrically-polluted-bedroom.aspx

The following strategies will help reduce bedroom EMF’s:

  • Unplug all electrical devices in your bedroom while sleeping.
  • Put your cell phone on “airplane mode,” leave it in a different room or turn it off altogether.
  • Avoid digital clocks on the bedside table.
  • Mattresses with metal coiling may conduct electricity from other sources exposing you to high levels of EMF’s.

The evidence suggesting the health and sleep risks of EMF’s is gaining.  Do not ignore electrical devices in your bedroom as a source of insomnia, and instead find ways to reduce them or remove them.

Brain Neurotransmitters

Science is uncovering new information about the importance of brain neurotransmitters.  It is a constantly developing field of medicine.  Neurotransmitters are specialized cells in the body and brain that carry specialized electrical information between neurons or nerves.  These specialized messages initiate the cells to do specific activities or they may signal specific neural pathways.

There are both excitatory neurotransmitters that cause energy and motivation and rev up your brain and system, and there are inhibitory neurotransmitters that cause sleep, calm, and relaxation.

Elevated levels of excitatory neurotransmitters at the wrong time can lead to sleep disturbances.  So, for example, elevated levels of adrenalin when you are stressed out will excite the brain and nerves making sleep difficult.  Other excitatory neurotransmitters include histamine, norepinephrine, and glutamate.  Ideally, these neurotransmitters are at high levels during the day and at low levels during the night.

Conversely, low levels of the inhibitory, calming neurotransmitters during the evening will lead to sleep disturbances as well.   Calming, inhibitory neurotransmitters include serotonin, GABA, Taurine, and glycine to name a few.  These neurotransmitters ideally will be at lower levels during the day supporting wakefulness, and they will be at higher levels during the evening and night helping to induce sleep.

The delicate balance between excitatory and inhibitory neurotransmitters are also elemental to the production of melatonin—a key hormone for sound sleep.  Around bedtime, the drop in excitatory neurotransmitter levels and a rise in inhibitory levels signal the production of melatonin.  During the night, low levels of excitatory transmitters and melatonin are what the body needs for deep, restful sleep.

Exercise

Regular exercise is an important factor contributing to restful sleep.  30 minutes of cardiovascular exercise 3-4 times a week as a minimum requirement will help cause relaxation and sleep.

Timing of when you exercise appears to be important.  The worst time to exercise would be right before bed or anytime after 7 p.m.  In this case, it would be too stimulating.  Avoid!

The best time to exercise to promote sleep appears to be late afternoon or very early evening anytime prior to 6 or 7 p.m.  This is because the exercise will raise your body temperature.  Body temperature changes are intricately related to the brain neurotransmitter production and balance described above.  As your body temperature cools down over several hours after exercising, calming neurotransmitters begin to get produced in relation to the body temperature change.

Exercising in the morning is another good time to exercise, but will not have the same sleep inducing properties as the late afternoon.  Exercise in the morning will promote a reduction in stress and a sense of well being which overall will benefit your sleep.

 

Concluding Remarks

Lack of optimal sleep is a common complaint at our practice, and with good reason!  Sleep deprivation is a known factor in most chronic health problems including cardiac disease, diabetes, obesity, fatigue, and immune problems including cancer.

With an accurate history and appropriate labs, practitioners of functional medicine such as Morgan Camp MD and Associates can discover the cause of your insomnia on a hormonal and biochemical level.  Lifestyle changes may be necessary as well.  If you would like a more thorough investigation of the cause of your insomnia, please make an appointment for a thorough assessment!

Optimal sleep is key to feeling vibrant and healthy!

Written by Marya Grosse, FNP

Nurse Practitioner at Morgan Camp, MD & Associates