Dietary Factors Affecting Sleep

Reactive Hypoglycemia & Food Allergy: Reactive hypoglycemia 1,2  and food

allergy 3,4,5  have each been reported to cause insomnia. In my experience, many patients

report that they sleep better after undergoing a nutritional program designed to improve

blood glucose regulation or after identifying and avoiding allergenic foods.

Reactive hypoglycemia should be suspected particularly in patients who develop various

symptoms in the late morning or late afternoon (before mealtime), who experience an

improvement in symptoms after eating, and who crave sweets.

Food allergy should be suspected in patients who have other conditions that are frequently

caused by food allergy, such as migraines, perennial rhinitis, or eczema.

Caffeine: It is well known that some people experience insomnia when they consume

caffeine, 6,7  particularly when they have it in the evening. Patients who suffer from anxiety

appear to be more susceptible to the insomnia-inducing effect of caffeine than people

without anxiety. 8  Individuals with caffeine-induced insomnia metabolize caffeine more slowly

than individuals who are not adversely affected by caffeine.

In one study, the mean plasma half-life of caffeine was significantly longer (7.4 hours vs.

4.2 hours; p < 0.05), and the mean plasma caffeine concentration 8 hours after ingestion of

2 cups of coffee was significantly higher, in people who experienced caffeine-induced

insomnia than in those who did not. 9  Among 10 self-rated poor sleepers, the longest

caffeine half-life was 11.4 hours, compared with a maximum half-life of 4.8 hours among 10

normal sleepers. 10

Thus, in some individuals a significant amount of caffeine will be present in the blood at

bedtime, even if caffeine is consumed only in the morning. A trial of complete caffeine

avoidance would therefore be worthwhile for patients who suffer from insomnia. The newer

issues that concern me is the caffeinated drinks our children and adolescents have become

accustomed to drinking.

Helpful Nutritional Supplements for Sleep

L-Tryptophan: Tryptophan is a precursor to serotonin, which plays a role in normal sleep

function. A number of clinical trials have found that supplementation with 1-2 g of L-

tryptophan 20-30 minutes before bedtime improved insomnia. 11,12,13,14  L-Tryptophan appears

to be most effective for patients with mild insomnia, healthy individuals who have longer-

than-average sleep onset latency (the amount of time required to fall asleep), and people

who have clear awakenings 3-6 times during the night (see below). L-Tryptophan has also

been reported to be effective for insomnia in chronic alcoholics. 15

Some studies have found that L-tryptophan is not beneficial for insomnia. Factors that may

explain these negative results include short duration of treatment and the type of insomnia

being treated. One study in which L-tryptophan was not effective lasted only 2 days, 16  but it

may take up to 2 weeks before a beneficial effect is seen. 17

In a study of patients with severe insomnia, those who reported clear awakenings 3-6 times

per night showed a good response to L-tryptophan, whereas there was no improvement in

patients who experienced clear awakenings 1-2 times during the night, or in those who

reported dozing on and off throughout the night, twilight sleep, and a blurring between

sleep and wakefulness. 18

For best results, L-tryptophan should be administered on an empty stomach along with a

small amount of carbohydrate. Taking L-tryptophan with a protein-containing meal would

decrease its efficacy, because other amino acids present would compete with L-tryptophan

for uptake into the brain. Co-administration of L-tryptophan and antidepressants that

increase serotonergic activity (such as selective serotonin-reuptake inhibitors, amitriptyline,

or monoamine oxidase inhibitors) may increase both the efficacy and the toxicity of the

drugs.

If a patient is taking one of these medications, L-tryptophan should either be avoided

completely (particularly in the case of monoamine oxidase inhibitors) or used with caution

and in low doses.

Niacinamide: Administration of 3 g/day of niacinamide to 2 women with moderate-to-

severe insomnia and to 6 individuals with normal sleep patterns resulted in a significant

increase in rapid-eye-movement (REM) sleep in all cases. In addition, the women with

insomnia experienced a marked improvement in sleep efficiency after 2-3 weeks of

treatment. 19  While the mechanism of action of niacinamide is not certain, it may work by

increasing serotonin concentrations in the brain.

I have seen a few patients in whom supplementation with 1-2 g/day of niacinamide was

beneficial for insomnia. A 68-year-old man came to my office with a life-long history of

insomnia. He had seen numerous conventional and holistic practitioners, but had not found

an effective treatment that did not cause side effects. Since the only nutritional treatment

he had not tried was niacinamide, he was advised to take 1,000 mg during the day and

again at bedtime. He experienced considerable improvement, and at his last follow-up visit

3 years later, was still sleeping well on the same regimen.

While niacinamide is generally well tolerated, administration of large doses has occasionally

resulted in clinically significant elevations of aminotransferases (liver enzymes) and, rarely,

chemical hepatitis (chapter 15). Patients taking large amounts of niacinamide (1,500 mg

per day or more) should therefore have periodic tests to monitor liver function. Be very

careful in the use of therapeutic doses of niacinamide in patients who have, or are at risk of

developing, liver disease (such as chronic alcoholics).

L-Tryptophan & Niacinamide: Supplementation with niacinamide appears to increase the

serotonergic effect of L-tryptophan by inhibiting the enzyme, tryptophan pyrrolase, which

breaks down tryptophan in the liver (chapter 287). In my experience, the combination of L-

tryptophan and niacinamide (500-1,000 mg of each, taken before bedtime) seems to be

more effective for some than either of these nutrients alone.

Magnesium: Insomnia is one of the symptoms of magnesium deficiency. 20  The typical

Western diet contains less than the Recommended Dietary Allowance for magnesium. In

addition, various types of physical and mental stress can lead to magnesium depletion and

an increased magnesium requirement. 21  For these reasons, many otherwise healthy people

have suboptimal magnesium status.

In my experience, some patients experience improved sleep after beginning magnesium

supplementation, usually 100-500 mg/day. This mineral has been reported to improve

sleep efficiency in patients with insomnia associated with restless legs syndrome or periodic

limb movements in sleep. 22

Vitamin B12: In case reports, 5 patients with chronic (> 18 months) disorders of their

sleep-wake cycle improved after supplementation with 1,500-3,000 µg/day of vitamin B12.

In these patients, the vitamin that was administered was methylcobalamin. My favorite

source is to use methylcobalamin B12 shots or readisorb spray or a sublingual tab, all

available at our natural pharmacy.

In my experience, my patients report the most improvements in sleep while receiving

intramuscular vitamin B12 injections or meyer infusions for various conditions (usually

1,000 µg every 1-4 weeks).

Other Useful Treatments

Melatonin: Melatonin is a hormone secreted by the pineal gland that plays a role in

regulating the sleep-wake cycle. Serum melatonin levels in normal humans are low during

the day and increase significantly at night. Serum melatonin levels decrease with advancing

age, and this decrease may contribute to the increased frequency of insomnia in elderly

people. In elderly people with insomnia, peak melatonin levels were significantly lower

and/or the onset of the peak level was delayed, when compared with age-matched subjects

with normal sleep patterns,

Most, 26,27,28  but not all, 29  clinical trials have found that nighttime administration of melatonin

is an effective treatment for age-related insomnia, delayed sleep phase syndrome, and

pediatric sleep disorders, and for insomnia in patients with major depression 30  or chronic

schizophrenia. 31  Melatonin was also used successfully to help patients withdraw from

benzodiazepine therapy, without compromising sleep quality. 32

While most studies used pharmacological doses of melatonin (2-5 mg at night), there is

evidence that a physiologic dose (0.3 mg at night) is also effective for treating insomnia in

elderly people. Pharmacological doses may induce hypothermia and may cause plasma

melatonin levels to remain elevated into the daytime hours. 33

The mechanism of action of melatonin in treating insomnia is not fully understood, although

in some cases it appears to work by restoring circadian rhythms to normal.

Melatonin is usually well tolerated, but it may cause morning sleepiness, a reduction in

sperm count, or other side effects. In addition, the long-term safety of using melatonin to

treat insomnia is not known. Therefore, use the lowest effective dose, and try periodically to

discontinue treatment. One study found that elderly people with delayed sleep phase

syndrome (i.e., they could not fall asleep until 5 a.m.) who responded to 1-2 mg of

melatonin at night, could successfully discontinue the treatment after 8 weeks without

experiencing a return of their abnormal sleep patterns.

Valerian (Valeriana officinalis): The root of Valeriana officinalis (valerian) contains 2

substances that have sedative effects. In double-blind trials, administration of various

valerian preparations decreased sleep onset latency and improved sleep

quality. 36,37,38  Valerian is typically taken 30-60 minutes before bedtime. The dosage varies

according to the preparation used. Valerian is generally well tolerated, but there have been

occasional reports of increased sleepiness the next morning.

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