Clinical Pearls from a Visionary Pharmacist on Sleep. By: Harlan Lahti, BSc Pharm, DNM

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1 Clinical Pearls from a Visionary Pharmacist on Sleep By: Harlan Lahti, BSc Pharm, DNM

2 Personal Journey into Sleep Therapy As a pharmacist, my goal is to help people get off drugs Biggest issues in Canada & USA: - Sleep & Sleep aids - 75% of people have sleep problems

3 Sleep: Misconceptions and Myths Snoring is harmless? You can thrive on less than 7 hours sleep? Teenagers sleeping in class is just a bad habit? Daytime sleepiness always means not enough sleep at night? Sleeping Through the Night is a Relatively New Invention Benjamin Reiss, New York Magazine, March 8, 2017

4 The Pineal Gland The Pineal gland: Size of a grain of rice (5-8 mm), grows until 2 years old Abundant melatonin levels in children are believed to inhibit sexual development Primary function is to product melatonin Easily becomes calcified Connected to the eyes and sensitive to light stimulation

5 Basic Requirements of a Good Sleep What interferes with a good night sleep? Try these recommendations for a good night sleep: Regular sleep schedule Dark, cool room Limited caffeine & alcohol Avoid electronic use before bed, esp screen time Reduce exposure to light before bed, esp blue LED light Reduce excessive LUX over 180 Stress & Anxiety cover clock

6 The Core for Good Sleep Results Why is your patient not sleeping?

7 Sleep Debt

8 Ideal Sleep Ranges Group Age Ideal Hours of Sleep Newborn 0-3 months hours Infants 4-11 months hours Toddlers 1-2 years hours Preschoolers 3-5 years hours School age children 6-13 years 9-11 hours Teenagers years 8-10 hours Younger adult years 7-9 hours Adult years 7-9 hours Older adults 65 + years 7-8 hours A strong relationship exists with diabetes, hypertension, depression and amount and quality of sleep The older you get, the less sleep you need The brain rests during sleep average adult get 6.6 hours

9 How Much Sleep Do We Actually Need? Forget about 8 hours, you need super-sleep Scientists are waking up to the realization that everything we thought we knew about a good night s rest may be wrong Oliver Moody, The Times (London), Aug 5, 2017 You many not actually need 8 hours of sleep in one chunk!

10 Signs of Insomnia Four Traits of Insomnia 1. Difficulty falling asleep 2. Frequent waking 3. Waking early and not getting back to sleep 4. Waking unrefreshed

11 The Sleepless Patient The Basic Sleep Questionnaire will: Help figure out WHY a patient is not sleep Help tailor a sleep program This may take some hand holding to change patterns and daily habits

The Basic Sleep Questionnaire Do you have trouble falling or staying asleep, how often do you wake? Do you take ANY drugs - OTC, alcohol, tobacco, weed, caffeine When do you go to bed?

12 The Basic Sleep Questionnaire Do you have trouble falling or staying asleep, how often do you wake? Do you take ANY drugs - OTC, alcohol, tobacco, weed, caffeine When do you go to bed? When did you eat before bed? Last exercise? Do you watch TV, use computers, cell phones have WiFi or any electronic in your bedroom? Do you live near a cell phone tower (check website)? Is your bedroom COMPLETELY dark? Black out curtains? No digital clock near the bed? Is your bathroom brightly lit? Too much LUX? Dimmer switches? Do you experience stress and anxiety? Hormonal imbalance or postmenopause (bio-identical hormones)? Do you experience pain, muscle stiffness? Do you snore? What position do you sleep in? Back, side, front? Have a partner in bed? Do they keep you awake? What natural sleep aids have you taken that DON T work? Have you taken melatonin? What was your reaction to it?

13 Sleeplessness Sleeplessness WHEN and WHY does it occur? Some cases of chronic insomnia get some benefit from sleep drugs - recommend for only 2-3 months - after stress, death in family, diagnosed with chronic illness Benzodiazepine drugs show insufficient evidence for helping sleep (Xanax, Ativan, Valium) - Sedatives with extreme withdrawal effects - A melatonin withdrawal program can help with withdrawal side effects (ex. tremors, seizures)

Melatonin to the Rescue Fall asleep faster ~ Stay asleep longer ~ Wake refreshed Master hormone that regulates sleep Pineal and gut produces melatonin Gut problems = melatonin issues & potential

14 Melatonin to the Rescue Fall asleep faster ~ Stay asleep longer ~ Wake refreshed Master hormone that regulates sleep Pineal and gut produces melatonin Gut problems = melatonin issues & potential ineffectiveness Natural supplement for Melatonin Deficiency Non-addictive, cannot overdose, safe (except during pregnancy and kids under 12 yrs regulation of hormones) - Safely study 75 mg nightly with 1400 women for over 4 years in the Netherlands no serious side effects reported

Melatonin + B6 Decreased melatonin production and sleep issues can develop with aging and lifestyle factors (artificial light, exposure to electrosmog including laptops/tv/computers).

15 Melatonin + B6 Decreased melatonin production and sleep issues can develop with aging and lifestyle factors (artificial light, exposure to electrosmog including laptops/tv/computers). Support for: Difficulty falling asleep (insomnia) Waking in the night Jet lag and shift work Seasonal affective disorder Strong antioxidant & anti-inflammatory for brain, neurological, heart & cancer protection Medicinal Ingredients: Melatonin mg Vitamin B mg

16 Individualized Dosage for Melatonin Melatonin Individualized Dosage: 1. If too stimulated indication that the gut needs to be treated. Pathogenic bacteria love melatonin and create byproducts that are too stimulating. Treat the gut first and candida overload for several months, then go back and use melatonin 2. Wake like a Zombie Melatonin hangover too much, too soon. Back off dosage and slowly increase as patient can handle it. Clinical pearl look directly into the morning sun and will snap out of it 3. Nightmares melatonin increases dreamstate and may reflect the stresses of the day. Have patient push through if possible and deal with stress/anxiety 4. Headaches too much, too fast. Liver is not able to break down fast enough. Reduce dosage and recommend liver detoxification.. 5. The sublingual lozenge will bypass the liver. If issue with taking any dose, then add 4-5 g of L-Glycine powder to promote tolerating melatonin better. L-Glycine prepares the body for sleep by lowering core body temperature.

Stress and Anxiety Solution Stress and Anxiety recommendations: Avena Sativa

before bed & 1 tab under tongue if wake in the night An-X-Vita (anxiety)

address underlying anxiety issues Geopathic Stress recommendations: Geovita 12

17 Stress and Anxiety Solution Stress and Anxiety recommendations: Avena Sativa (calm CNS) 30 drops in water before bed Melatonin + B6 1 tab under tongue 30 min before bed & 1 tab under tongue if wake in the night An-X-Vita (anxiety) anxiety, 5-10 drops before bed - cover alarm clock in room - Rubimed therapy can address underlying anxiety issues Geopathic Stress recommendations: Geovita 12 drops twice daily - move location of bed, use dowser or Reba testing to determine best location

18 Data and Science VS reality Melatonin and Weed Voodoo Data on Natural Health Products Prepare a Melatonin detox program before the problem hits

19 Thank you for your interest Canada biomedicine.com USA terra-medica.com

Insomnia. F r e q u e n t l y A s k e d Q u e s t i o n s

Insomnia. F r e q u e n t l y A s k e d Q u e s t i o n s Insomnia Q: What is insomnia? A: Insomnia is a common sleep disorder. If you have insomnia, you may: Lie awake for a long time and have trouble falling asleep Wake up a lot and have trouble returning to