I am a 37 year old woman who hasn’t slept without using sleeping pills for almost 5 years. Even with the pills I’m lucky to get 5-6 hours. I’m tired all day but feel anxious and edgy. I want to get off my sleeping pills and get a good night’s rest…please help!! – Tired but Wired
Dear “Tired but Wired”,
I’m so glad you’re ready to get off those drugs and get some real sleep. Hypnotic drugs like Ambien, Restoril and Xanax are widely used to treat insomnia. A 2012 study published in the British Medical Journal looked at medical records of over 10,000 patients and found an increased risk of mortality and cancer in users of these medications. What’s most concerning is the more of these drugs a patient took the more likely the patient was to die! If death isn’t enough to deter you from these drugs the side effects probably will. Depression, lethargy, amnesia and overall drugged feeling are no way to live your life.
Let’s look at what needs to happen to get you off the sleeping pills and on to a good night’s sleep. First, what is your sleeping environment? A dark, peaceful room is essential. That means get the TV out of your bedroom, quiet the dogs, kids, husband and neighbors. Second, we need to eliminate anything in your life not conducive to sleep. Caffeine, alcohol, chocolate, late eating, and late exercise can be too stimulating for some people. Next, a regular sleep schedule is imperative. Going to sleep and waking up at the same time every day, even on weekends, is a must to establish a healthy circadian rhythm. I suggest 10pm-6am +/- 1 hr as a good sleeping time. Most people need 8-9 hrs of sleep per night. Taking time to wind down in the evening is also important. You can’t expect to fall asleep right after running 5 miles, eating dinner, cleaning and arguing with your teenager.
Stress can also negatively impact sleep. Stress causes the release of adrenaline and cortisol from your adrenal glands. Cortisol is important because it sets your sleep/wake cycle. Cortisol should be highest in the morning and lowest in the evening. It wakes you up when it’s high and causes sleepiness when it’s low. Stressful times can cause consistently high cortisol levels throughout the day, evening and night which will prevent sleep. A simple blood test can diagnose an abnormal cortisol level. In my practice I measure both AM and PM cortisol levels to make sure we see a normal drop from AM to PM. Sometimes I see an inverse cortisol curve in insomniacs where it’s lowest in the morning and highest in the evening, causing sleepless nights and lethargic mornings. But, it’s persistently high cortisol combined with many sleepless nights that cause the all too common “tired but wired” feeling.
There are many effective natural sleep aids. A double-blind placebo controlled study published in 2011 in the Journal of the American Geriatrics Society confirmed the efficacy of Melatonin 5mg when administered with Zinc 11.25mg and Magnesium 225mg. In my practice I use a combination supplement of melatonin, magnesium, B6 (this vitamin helps the body make more melatonin) and relaxing herbs such as passion flower, valerian root extract, lemon balm and chamomile. This supplement is taken right before bed. I also concentrate on balancing cortisol levels. To decrease evening cortisol levels I use Ashwaganda root 250mg, phosphatidylserine 50mg and Magnolia bark extract 225mg taken at about 8pm. Then I’ll give a small dose of bio-identical cortisol in the morning to patients that have low AM cortisol. This resets the normal cortisol curve and energizes patients who wake tired. I do recommend AM exercise to increase cortisol, if that’s not a viable option for you then late afternoon exercise is ok.
This approach works amazingly well as long as all stimulants are removed from the diet (yes even your morning coffee) and sleeping medications are discontinued. I find it only takes 1-3 weeks for people to see huge sleep improvements. Caffeine withdrawal headaches and side effects from stopping hypnotic drugs commonly occur but usually pass quickly. I tell my patients a little initial discomfort is worth the restful sleep you will soon be getting…so relax, have a cup of chamomile tea, and sweet dreams!
Yours in health,
Dr. Alexis McNeil, NMD
Inspired by her mother’s battle with breast cancer, Dr. McNeil changed career paths from artist/designer to physician. It was Naturopathic Medicine that extended her mother’s life and enlightened Dr. McNeil to her passion for healing.
Upon earning her medical degree from Southwest College of Naturopathic Medicine, Dr. McNeil completed a 2 year residency in Acute Family Medicine and Women’s Health at Centro De Salud Familiar in downtown Phoenix, AZ. As a physician she has remained true to her artistic talents by incorporating cosmetic injections into her practice, truly treating women inside and out. Together with her husband Dr. Jason McNeil, they formed North Valley Medical Center; a full service primary care clinic dedicated to compassionate patient centered care. Out of the office you will find Dr. Alexis with her family and friends, doing yoga, enjoying good healthy organic food and wine, or hiking with her dogs.
Feel free to email questions/comments to dralexis@nvmedicalcenter.com