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Insomnia  Information

Edward Lichten, M.D.,PC
180 East Brown Street
Birmingham, MI 48009 
248.593.9999

MEDICAL BREAKTHROUGH: Calciferol (Vitamin D3) cures Insomnia!

BACKGROUND INFORMATION:           Most people encounter sleep difficulties from time to time, often related to stress or pain. Many of these bouts get better without treatment. Unfortunately, in a significant proportion of the population, sleep problems turn into insomnia, which is defined as the chronic inability to fall asleep or to enjoy uninterrupted sleep. Some research suggests that attitudes about sleep, and the sleep patterns and behaviors prompted by these attitudes, make certain individuals vulnerable to chronic insomnia. The good news is that there is a simple answer: vitamin D3, Calciferol, deficiency.

Just how big a problem is insomnia? The National Sleep Foundation surveyed more than a thousand adults in 2002. Thirty-five percent said that, every night or almost every night of the previous year, they had at least one out of these four symptoms: difficulty falling asleep, waking a lot during the night, waking up too early and not being able to get back to sleep, or waking up feeling un-refreshed. About 15 percent of the survey group reported taking either a prescription sleep medication or an over-the-counter sleep aid at least a few times a month. A study of the Canadian population found that 24 percent of people ages 15 and older reported insomnia, defined in this study as a "yes" response to the question "Do you regularly have trouble going to sleep or staying asleep?" Some of the factors associated with insomnia in this study included being female, being widowed or single, having a low education level, low income, unemployment, smoking, life stress, physical health problems, and pain or activity limitation. Although age did not seem to be a factor in this survey, other studies have shown that insomnia increases with age. For example, 4 percent of a sample of older European adolescents met criteria for insomnia disorder as defined by the Diagnostic and Statistical Manual, 4th edition (DSM-IV) of the American Psychiatric Association. Compare this to a group of 330 elderly patients in a family practice, in which 57 percent met criteria for DSM-IIIR insomnia disorder. Whatís worse, insomnia is not a benign problem. Difficulty falling asleep or staying asleep is associated with an increased risk of dying in the elderly. Many elderly insomniacs take naps during the day; in addition to making insomnia worse, naps are related to higher mortality in this age group.  INSOMNIA INCREASES RISK OF DYING IN THE NEXT FIVE YEARS by 400%!

Although many people believe that psychiatric disorders such as depression and anxiety cause insomnia, the reverse may actually be true. The National Institutes of Mental Health Epidemiologic Catchments Area study found the risk of developing a new depression was 39.8 times higher for insomniacs than for those without sleep problems. Other research, however, suggests that too little sleep--in particular too little rapid eye movement (REM) sleep--can bring on a fibromyalgia muscle pain state. This seems to be related to the drop of growth hormone, measured as insulin-like growth factor-1 (IGF-1) seen in these fibromylagia-like disorders.

Doctors are ignorant of the simple facts of the biology of sleep.  We are all animals that depend on a wake-sleep cycle. This is called the circadian rhythm.  This rhythm is set up by our exposure to sunlight.  There is more insomnia when there is a lack of sunlight or darkness such as near the North pole. We know that sunlight triggers the skin to form calciferol, commonly known as Vitamin D3.  The same hormone, yes, Vitamin D is a hormone, is added to milk to insure that children get some hormone to help form long bones and teeth. But Vitamin D3 does so much more. It has not been recognized yet that Calciferol controls the release of melatonin and regulates the pituitary release of growth hormone.  You can imagine what the lack of regular sleep-wakefulness does to any mammalian being. It is extremely disruptive. Remember the movie INSOMNIA with Al Pacino and Robin Williams?  It took less than one week for Pacino to be suicidal. Fortunately there is a simple cure.

The simple diagnostic test is the Vitamin D 0,25 OH test. Normal values are a range of 50 to 75.  I regularly see insomniacs with values of less than 20 even less than 10.  And because dark skinned individuals, African-Americans, Hispanics, middle easterners, and those from the Indian continent need more sunlight, their levels are typically lower.

And the simple treatment is take Vitamin D. The best form is liquid and placed on the tongue at nighttime.  I regularly use 2000IU drop, two drops.  There is no toxicity reported to those taking less than 20,000 IU per day.  But the appropriate follow-up laboratory test every three months will show when a normal range is reached.

Before discussing the additional amino acids and minerals to assist good restful sleep, we must dismiss the 'experts' who wish to blame the individual, not their lack of scientific understanding.

Some doctors state "it is all in the individual's attitude!  How wrong can they be! They state "why would someone spend more time in bed than they actually need? Attitudes towards sleep seem to be very important. Charles M. Morin and colleagues at Virginia Commonwealth University found that insomniacs held stronger beliefs than good sleepers about the detrimental consequences of insomnia to physical and mental health, they made stronger attributions of mood disturbances and lack of energy to poor sleep, and they perceived their sleep as less controllable and predictable. Individuals with sleep-onset insomnia (that is, difficulty falling asleep as opposed to difficulty staying asleep) were more likely than those without insomnia to focus on worries, problems, and noises in the environment prior to sleep, and to think about not sleeping or about something that had happened during the day. For instance, if you believe that you cannot function adequately without having had a good nightís sleep, then even one night of poor sleep may trigger behaviors such as staying in bed later or taking a long nap. These behaviors are likely to make the insomnia chronic

So how much sleep do you actually need? And how can you tell if you are getting the right amount of sleep? Although eight hours per night is a figure repeated so often that itís become an article of faith, the reality is that sleep need is highly individual. Large-scale epidemiological studies have shown that sleeping seven hours per night is associated with lowest mortality risk compared to longer or shorter sleep. In addition, it is likely that as we age, sleep need decreases.

On the other hand, if you feel tired but canít fall asleep during the day, then your tiredness is more likely fatigue instead of sleepiness. This is due to adrenal exhaustion, lack of DHEA and lack of cortisol. Although many people, including researchers, use the terms fatigue, tiredness, and sleepiness interchangeably, they are different conditions. Most people can distinguish sleepiness or drowsiness such as that felt after being up out of bed all night waiting in the emergency room with a sick child, from the fatigue or weariness experienced after running a marathon. Such "acute" fatigue is different yet again from the "chronic" fatigue experienced by cancer patients, sufferers of chronic fatigue syndrome or fibromyalgia. Chronic fatigue is experienced even without exertion and does not improve with rest or sleep. One hypothesis suggests that chronic fatigue, like depression, may be caused by too much REM sleep. Experiencing this non-drowsy kind of tiredness together with insomnia strongly suggests a person is getting more sleep than he or she needs.

For worriers, the good news is that all this cognitive-behavioral therapy is bull-sh-t. By measuring Calciferol levels and replacing Vitamin D3 high dose oral drops, sleep patterns will revert within a few days.  We add 100- 200mg of 5-HTP (hydroxy-tryptophan) to increase serotonin naturally. Another logical addition is 1000mg of elementary magnesium or milk of magnesia. Magnesium helps relaxation of the restless leg muscles and works to calm down overactive brain (cortex) cells.

For depression, take this same 5-HTP can be taken at 100mg dosages throughout the day to assist in the treatment of depression. Depression seems to respond directly to stabilization of the pineal gland (circadian rhythm), adrenal and gonadal support, vitamin and mineral therapy. See right column for 'pearls' to assist you in treatment. For true chronic insomniacs that fail to respond, we add over-the-counter gabapentin 500mg 1-2 nightly for 5 out of 7 nights. Rarely does anyone not sleep normally!  This is fortunate for our patients, but unfortunate for the pharmaceutical business that charges $4 per sleeper med.

For more information, seek out the articles on depression, cortisol and DHEA. Together, these non-pharmacological and natural treatments for chronic insomnia are more effective and longer lasting than any 'sleep' medications. If all else fails, I add Ataraxģ (for hives). In dosages of 25-50mg, the relaxation effect works well short-term!

Finally, the longer you are awake, the more exercise you get during the day, the more slow-wave (delta) sleep you will have when you do sleep. Slow-wave sleep is associated with feeling you have slept well, and with feeling refreshed. To sleep well, then, get up early, but avoid going to bed early. I canít express this any better than the following proverb, which predates Benjamin Franklin by more that 200 years: "At grammar-school I learned a verse, that is this, Sanat, sanctificat, et ditat surgere mane." That is to say, "Early rising maketh a man whole in body, holier in soul, and richer in goodliness." (Anthony Fitzherbert (1470-1538): The Book of Husbandry, 1523).

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LICHTEN's PEARLS

Insomnia
1. Measure Calciferol (Vitamin D3) 0,25 OH to determine lack of appropriate sunlight-pineal function.
2.   Measure IGF-1 to determine if the sleep-wake cycles are disrupting tissue repair. Low levels of IGF-1, less than 160, are typical in fibromalygia and fatigue states.


Fatigue
1. Measure TSH, T3free, T4free, TBG, Thyroid peroxidase antibodies, Thyroid antibodies, Reverse T3, on all with fatigue, cold hands/feet, weight gain and FIBROMYALGIA.

2..  Measure cortisol and DHEA levels in saliva at 7AM, 11 AM, 4 PM and 10PM for those having problems stabilizing thyroid replacement.

3. Measure serum cortisol, pregnenolone, progesterone, and DHEA-S in the AM for those with memory problems.

4. Screen for zinc, magnesium, and selenium deficiency in hair analysis. Iodine deficiency is noted in all.

5. Replace thyroid slowly and immediately. Add cortisol  in low doses if indicated by saliva test or clinical parameters.

Sex Hormones
1. Menopause is typical in women with insomnia. Measure the FSH and LH to show hyper-secretion by the pituitary. LH triggers the hot flush and normal FSH and LH are less tha 10mIU/ml.  With addition of appropriate estradiol, the FSH and LH will drop and the insomnia and hot flushes will disappear.

2.  For men, elevated FSH and LH and low testosterone/SHBG are seen in andropause. Sleep disturbances identical to the woman's hot flush with LH spikes can be seen. Again, by replacement of the appropriate  dosage of testosterone, the symptoms of insomnia and sleep waking at 3-4 AM will often abruptly disappear.