get your zzz's, naturally

Everyone knows a good night’s sleep is a requirement for optimal well-being. A poor night’s sleep has an immediate impact on how one feels the next day, and multiple night’s of poor sleep can lead to major health problems from heart disease to cancer.

Rather than focus on long-term concerns, let’s simply focus on how we feel. A poor night’s sleep makes for a miserable next day, and the issue compounds when it becomes the norm. This is true of our children as well, a recent study showed that a child that get one less hour of sleep per night functions at a grade level two years behind. Meaning that a 6^th grader sleeping one hour less than they should has the cognitive function of a 4^th grader.1 Likely a similar effect in poor sleeping moms and dads as well.

There is no doubt that a good, consistent routine has an impact on quality sleep. Try to be consistent each evening and get started early enough to allow yourself the time to wind down. Be sure that your sleeping space is as dark as possible to allow a full pulse of melatonin, the sleep hormone stimulating a deep and restful sleep. Use a mask if you need one.

Lifestyle factors weigh heavy in quality sleep as well. People that spend the day eating processed grain products and refined sugars have spiking blood sugars, shown to increase the risk of restless leg syndrome and other sleep disturbances. Regular exercise also promotes good, quality sleep at night. Sleep apnea is a major contributor to sleep problems and should be managed with lifestyle change first. Not sure if sleep apnea is a culprit? Ask your doctor to order a free, in-home overnight oximetry test.

For most, reaching for a pharmaceutical to sleep becomes the last straw. Taking something allows them to achieve a decent night of sleep, and doctors, realizing the benefits of good sleep are quick to write the prescription. But is this the best laid plan? Recent evidence would suggest that in fact, sleeping pills may be too good to be true. People prescribed 18 or fewer doses of sleep aids per year were 3.6 times more likely to die than those who took none (18-132 doses = 4.3 times and more, and 132 doses were 5.3 times more likely to die). In addition, the high dose group was 35% more likely to have developed major cancer.2

Gotta sleep and can’t? Start by setting a course of lifestyle change, but sometimes more help is needed. I look at insomnia as two separate sleep problems: falling asleep or staying asleep. There are certainly cases of a combination, but often people suffer from one more than the other. Determining which affects you more will help in choosing the best starting point.

 Problems Falling Asleep:

- Breathe: Learning a series of breathing exercises can have great benefit in starting the sleep process. Read my blog post on breathing for more.

- Chamomile tea: Drink 1-2 cups while preparing for sleep. Caution in those with hay fever.

- Avoid caffeine after noon

- Herbal products that contain Valerian, Hops and/or Passionflower have been used for centuries without the concerns of modern sleep aids and can work well for assisting with sleep onset.

 Problems Staying Asleep:

-Melatonin: This sleep hormone is best in helping achieve a deep and restul night’s sleep. I prefer a controlled-release version to cover the whole night. Start at 1-2.5 mg and safely increase up to 10mg if needed. Ideally this is a temporary need for 4- 6 weeks.

 Mind Racing: Racing mind can be the culprit in either type of insomnia.

- Cognitive-Behavioral Therapy: An amazing form of therapy that has strong evidence for insomnia as well as depression, post-traumatic distress and behavior change.

- Overworking adrenals: Measuring bedtime salivary cortisol can help determine if its your adrenals, by stimulating inappropriate night time cortisol release, and driving restless sleep. If this is the case, some great assistance can come from:

            - Ashwaganda: A great herb for promoting calming and relaxation.

            - Phosphatidylserine and L-Theanine: Nutrients involved in the calming of an over-stressed system.

On the path toward optimal health, good quality sleep is essential. Start first with making the lifestyle changes you have been considering anyway: whole foods nutrition, regular exercise and practicing relaxation. After that, identigy the roots of your sleep issue and consider natural agents to help support good sleep. Consider them temporary support while you continue to work on your overall health.

Have you successfully improved your poor sleep? Please share your story below...

References:
1. Avi Sadeh, Reut Gruber and Amiram Raviv. The Effects of Sleep Restriction and Extension on School-Age Children: What a Difference an Hour Makes. Child Development Vol. 74, No. 2 (Mar. - Apr., 2003), pp. 444-455
2. Kripke DF, Langer RD, Kline LE. Hypnotics' association with mortality or cancer: a matched cohort study. BMJ Open Volume 2 Issue 1, 2012

The Problem with Bioidentical Hormone Replacement

No, it's not cancer risk. We can monitor that risk pretty closely with salivary hormone levels so that the balance between estrogen/testosterone and progesterone (breast cell proliferation) and estradiol and progesterone (uterine) is optimal.

The risk is your doctor not realizing the therapeutic window that needs to be achieved and that blood monitoring is not all that helpful. Too little hormones is a problem, but so is too much. Often, excessive levels of hormones lead to the same symptoms as too little (save for hot flashes): water retention, weight gain, cognitive change, insomnia, irritability.

When we start hormones with the anticipation of it being the only measure that needs to be taken to achieve health, we get into trouble. You cannot ignore the impact that diet, stress and lack of exercise have on health and excpect the hormones to "cure-all". Doing this leads often to starting out with a hormone dose that's too high or continuing to push the dose because we don't feel better all the while ignoring the food sensitivity or heavy amounts of unmanaged stress.

Checking for excess levels in blood doesn't cut it. I once heard the director of a lab quote that hormone levels have to reach 10 times the overdose amount in order to show up in blood as too high. 10 times you ask? That's exactly what we see in saliva. Most women we see in the office on BHRT regimens that are not feeling well have an estradiol level >100 (nl 4-10) and progesterone >2000 (nl 100-300). The lab can't even quantify the number it's so high!

I recently saw a client that had these excessive levels, couldn't understand why she was gaining weight and fatigued and her thyroid was normal. We focused on her hormone replacement regimen and checked salivary levels. They were all undetectably high. After several months of gradually lowering, she came into the office to report that the most recent drop in progesterone dosage (which finally got her saliva level below 1000 for the first time in years) she immediately stopped craving carbs and has started losing weight.

I love BHRT. I have found it to be the missing piece in a lot of women's journey toward health. But it cannot be the only piece, and it cannot be blindly given with no monitoring for balance. Start low and go slow, but also focus on the trifecta of optimal health: stress management, whole foods nutrition and digestive balance. Then make dosage changes based on how you are feeling and the tissue levels of hormone (saliva, not blood).