BOTANICAL /NUTRITIONAL PROTOCOLS FOR INSOMNIA AND OTHER SLEEP DISORDERS. David Winston, RH (AHG)

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1 BOTANICAL /NUTRITIONAL PROTOCOLS FOR INSOMNIA AND OTHER SLEEP DISORDERS David Winston, RH (AHG)

2 Lack of sleep and poor quality sleep have been linked to: Increased risk of heart disease Hypertension Obesity Insulin resistance Work related injury Lack of focus and concentration Immune and HPA axis depletion

3 Sleep Patterns For some, sleeping is easy Sleep affected only under intense stress Chronic sleep problems: long sleep latency, interrupted sleep, poor quality sleep or early waking

4 Dyssomnias

5 Insomnia

6 Causes of chronic insomnia: Anxiety disorders Depression Dementia Chronic pain Pregnancy Menopause Aging Medications Recreational drugs

7 Other contributors: Circadian rhythm disorders Restless leg syndrome Sleep apnea/hypopnea Periodic limb movement disorder (PLMD) Poor sleep hygiene/irregular sleep habits

Orthodox treatment for insomnia Older therapies focused on the use of benzodiazepine tranquilizers (Ativan, Halcion, Restoril ) but they have very significant adverse effects.

8 Orthodox treatment for insomnia Older therapies focused on the use of benzodiazepine tranquilizers (Ativan, Halcion, Restoril ) but they have very significant adverse effects. For insomnia caused by depression, antidepressants such as trazodone, amitryptyline, or doxepin are used. In the 1990 s benzodiazepine receptor antagonists were introduced. These medications include zolpidem (Ambien ) and zalepion (Sonata ). These medicines are less likely to cause dependence and grogginess upon waking but many people do become dependent and they lose efficacy with long-term use.

Lunesta (eszopiclone) is non-narcotic and, according to studies, reduces sleep latency, helps maintain sleep, and unlike many sleep aids, does not

9 Rozerem (ramelteon) selectively binds to the suprachiasmatic nucleus (SCN) and is believed to help reset the body s internal clock. Manufacturer s claim it can be used long-term without dependency but common side effects include somnolence, fatigue and dizziness. Lunesta (eszopiclone) is non-narcotic and, according to studies, reduces sleep latency, helps maintain sleep, and unlike many sleep aids, does not lose efficacy over long periods of time. It cannot be taken by pregnant women and common adverse effects include dizziness, loss of coordination and withdrawal symptoms when discontinued.

retention, and confusion Behavioral therapies for insomnia

10 Over-the-counter medications Primarily antihistamines Can cause daytime grogginess, dry mouth and eyes, urinary retention, and confusion Behavioral therapies for insomnia Biofeedback Hypnosis Meditation Relaxation training Cognitive-behavioral therapy

Orexins Significant effects on wakefulness and sleep

narcolepsy Blocking of orexin OX(1) and OX(2) receptors

especially adaptogens (possibly nootropics and nervines as

11 Orexins Significant effects on wakefulness and sleep promotion A total lack of orexinergic function can cause narcolepsy Blocking of orexin OX(1) and OX(2) receptors induce somnolence in rats, dogs and humans Some herbs, especially adaptogens (possibly nootropics and nervines as well) help to re-regulate the hypothalamus, which may explain their benefits for insomnia.

12 Long Sleep Latency - Difficulty falling asleep often caused by: Stress Persistent thoughts Noise Excessive light Muscle tension Over-excitement Stimulants Late eating Exposure to computers and television screens

Enhancing sleep Develop regular sleep habits Do not eat

watching scary or anxiety provoking movies Do not

relaxing bath Read a book Drink a cup of hot Chamomile

13 Enhancing sleep Develop regular sleep habits Do not eat within 3 hours of bedtime Avoid use of stimulants Avoid watching scary or anxiety provoking movies Do not exercise before bedtime Try to avoid arguments Take a relaxing bath Read a book Drink a cup of hot Chamomile or Sleepy Time tea Making love to your partner or cuddling R. Legg

14 Enhancing sleep A few minutes of deep breathing exercises Earplugs Eye covers or reduced light exposure

15 Herbs for Long Sleep Latency

16 Passion Flower herb Passiflora incarnata

17 Chamomile flower Matricaria recutita

18 Scullcap herb Scutellaria lateriflora Martin Wall

19 California Poppy fresh root & herb Eschscholtzia californica

20 Melatonin helped children with idiopathic chronic sleep onset insomnia

21 Irregular sleep pattern-induced insomnia: Swing-shift workers, pilots, physicians, nurses, military personnel, can have extremely erratic schedules that negatively affect circadian rhythms

23 Melatonin

24 Calming or neutral adaptogens Schisandra Jiaogulan

25 Deficiency (yin) insomnia: Is a deficiency condition, the patient is exhausted, asthenic, often pale with HPA axis hypo-functioning Nervines and nourishing, stimulating adaptogens are the primary herbs for deficient insomnia

26 Nervines

27 Fresh Milky Oat seed Avena sativa

28 Chamomile flower Matricaria recutita

29 Lemon Balm herb Melissa officinalis

30 Hawthorn fruit & flower Crataegus oxycanthoides, C. monogyna Martin Wall

31 Lavender flower Lavandula angustifolia

32 Linden flower - Tilia platyphyllos

33 Stimulating/Nourishing Adaptogens

34 Asian Ginseng root Panax ginseng Martin Wall

35 American Ginseng root Panax quinquefolius

36 Holy Basil Ocimum sanctum

37 Excess (yang) insomnia: Excess condition, type A behavior, hypertension, anxiety, irritability, restlessness, or agitation Icanhascheezburger.com

38 Nervines Lavender Hawthorn Passion Flower St. John s wort Linden flower Lemon Balm Fresh Oat

39 Sedatives Valerian Hops Zizyphus seed California Poppy Gambir

40 Anxiolytic agents Bacopa Kava Chinese Polygala St. John s wort Blue Vervain Motherwort

41 Calming Adaptogens Jiaogulan Reishi Ashwagandha Schisandra

42 Menopausal insomnia Motherwort Passion Flower

43 Hormone Balancing Herbs Black Cohosh Chaste Tree Shatavari Licorice Night Blooming Cereus

44 Pain-induced insomnia: Herbal, over-the-counter or prescription analgesics Meditation, deep breathing exercises, and laughter all increase endogenous endorphins and can also be adjuncts to treatment.

45 Analgesics Jamaica Dogwood Black Cohosh Corydalis Indian Pipe

46 Antiinflammatories St. John s wort Meadowsweet Willow Bupleurum Turmeric Boswellia Ginger

47 Age related insomnia: Causes: Age-induced sleep disturbances, medications, poor nutrition Treatments: Lavender essential oil Nervines and adaptogens Exercise

48 TCM Insomnia Patterns

Liver yin deficiency: Lack of stored blood in the liver

Symptoms include anger, palpitations, dizziness, dry

Suan Zao Ren Tang (sour Jujube decoction) contains

49 Liver yin deficiency: Lack of stored blood in the liver can cause deficient heart blood and shen. Symptoms include anger, palpitations, dizziness, dry eyes and mouth, irritability, and insomnia. Suan Zao Ren Tang (sour Jujube decoction) contains Jujube seed, Poria, Anemarrhena root, Ligusticum root, and Licorice. Jujube Licorice Ligusticum

Astragalus Spleen and heart deficiency: Prevents the spleen from making blood and

Symptoms include excessive dreaming, easy waking, tiredness, long sleep latency,

Gui Pi Tang (restore the spleen decoction) Red Ginseng, Astragalus, Atractylodes,

50 Astragalus Spleen and heart deficiency: Prevents the spleen from making blood and the deficient heart cannot control the blood or store shen. Symptoms include excessive dreaming, easy waking, tiredness, long sleep latency, impaired memory and a pale complexion. Gui Pi Tang (restore the spleen decoction) Red Ginseng, Astragalus, Atractylodes, Poria, Jujube seed, Longan fruit, Saussurea root, honey-fried Licorice, Dang Gui and honey-fried Chinese Polygala root. Longan fruit Atractylodes

51 Kidney and heart deficiency: Prevent the Chinese kidney from nourishing the heart due to lack of jing Symptoms include poor memory, dark circles under the eyes, a red quivering tongue, a thready, quick pulse, palpitations, fatigue, and insomnia. Tian Wang Ba Xin Dan (Emperor of Heavens special pill to tonify the heart) Unprocessed Rehmannia, Ginseng, Tian Men Dong, Mai Men Dong, Figwort root, Salvia miltiorrhiza, Fu Ling, Chinese Polygala, Dang Gui, Schisandra, Biota seed, Jujube seed, Platycodon, and Cinnabar. Bai Zi Ren/Biota seed (Platycladus orientalis)

52 Sleep apnea/hypopnea: Serious health risks Treatments: Losing excess weight CPAP machines Dental devices

53 Daytime hypersomnia: Excessive daytime sleepiness Occasional or chronic? Vitamin D

54 Restless Leg Syndrome (RLS): Legs feel uncomfortable with an internal itching or other uncomfortable sensations and an involuntary need to move the legs. Iron deficiency, and occasionally calcium or magnesium deficiency. Familial (genetic) neurological disorders Degeneration of the vertebral discs Pregnancy Renal failure Some medications

55 Horse Chestnut Ashwagandha Scullcap Blue Vervain

56 Herbs that increase peripheral circulation may also reduce symptoms. Butcher s Broom Prickly Ash Blueberry Ginkgo Lycium

57 Parasomnias

58 Night terrors, excessive dreaming, sleepwalking, sleep eating, and problems associated with mental illness. In TCM these conditions would be associated with extreme disturbed shen.

59 Night terrors: Bach Flower Remedy, Rock Rose or Rescue Remedy Nervine/sedative herbs may be of benefit

dreaming they learn that unlike the "real world", in which they

60 Teach children to work with their dreams. By teaching children the powerful techniques of conscious dreaming they learn that unlike the "real world", in which they are small and powerless, in the dream world, they are strong and can be in control of their life.

61 Overactive dreaming I use nervine/sedative herbs such as Passion flower, Ye Jiao Teng stem (Polygonum multiflorum), Suan Zao Ren/Jujube seed (Zizyphus jujuba), Chinese Polygala root, Mimosa bark, and Biota seed. Passion Flower Ye Jiao Teng Zizyphus seed Chinese Polygala Biota seed Mimosa

BOTANICAL /NUTRITIONAL PROTOCOLS FOR INSOMNIA AND OTHER SLEEP DISORDERS. David Winston, RH (AHG)

BOTANICAL /NUTRITIONAL PROTOCOLS FOR INSOMNIA AND OTHER SLEEP DISORDERS David Winston, RH (AHG) Lack of sleep and poor quality sleep have been linked to: Increased risk of heart disease Hypertension Obesity