Integrative-Health Approaches for Better Sleep

Sleep plays a vital role in long-term health and wellness and is as essential as food and water for survival.[i]?A few nights without restful sleep or occasionally experiencing sleep disturbance is normal and will not have long-term effects. However, regular sleep disturbance is common and does impact long-term health on many levels.

Long-term sleep deprivation is linked to an increased risk of physical conditions including high blood pressure, diabetes, heart disease, stroke, and kidney disease.[ii]?Additionally, long-term sleep disturbance can impact psychological and cognitive health, causing an increased risk of depression, anxiety, cognitive decline, and dementia.[iii],?[iv]??

What are sleep disorders?

It is normal to have nights where you do not sleep well or get an adequate amount of sleep. However, sleep disorders are those that regularly affect or impair your ability to fall asleep or stay asleep, resulting in daytime drowsiness and other symptoms.?

The most common sleep disorders include:

• Insomnia – A sleep disorder where you experience trouble falling asleep and staying asleep, causing daytime fatigue.?
• ?Sleep apnea – A sleep disorder that involves a person’s breathing being interrupted during sleep throughout the night. The types of sleep apnea are:?
• ?Restless legs syndrome – A sleep disorder that causes the legs to move in a manner that is intense and often irresistible, resulting in difficulties falling and staying asleep.?
• Narcolepsy – A neurological sleep disorder that affects the regulation of sleep and results in sudden attacks of sleep and excessive daytime drowsiness. People who are diagnosed with narcolepsy have a hard time maintaining regular daytime routines when sleep may come on suddenly without warning. Learn more?here.

What are the conventional ways of treating sleep disturbance?

Conventional approaches to address sleep disturbance include altering daily habits, improving sleep hygiene, pharmaceutical interventions, and behavioral approaches, such as Cognitive Behavioral Therapy for Insomnia (CBT-I).?

Daily Habits & Sleep Hygiene

Some habits that can have a significant impact on sleep include:[v]?

• Consuming large amounts of caffeine or other stimulants (such as cigarettes and energy drinks) throughout the day or too close to bedtime.?
• Drinking alcohol.?
• Taking naps longer than 30 minutes during the day.
• Shift work.
• The use of technology (such as smartphones and the computer) and watching TV close to bedtime.?
• Excessive light and noise.
• Inconsistent schedule/no bedtime routine.?
• Having inconsistent sleep hygiene. Defined as the practices and habits that promote and are conducive to sleeping well on a regular basis. Some activities that help promote sleep hygiene include[vi]:?
• Establishing a sleep routine: getting up and going to bed at the same time every day.?
• Finding ways to help you relax before you go to sleep that do not involve the use of screens.?
• Removing technology such as smartphones and TVs from your bedroom.?
• Exercising regularly (it is recommended to avoid exercise three hours before your regularly scheduled bedtime).
• Avoiding large meals, alcohol, or caffeine close to bedtime.

Pharmaceutical Interventions

Prescription medication is available to help you fall asleep and stay asleep. Although these medications are initially effective and some are approved for long-term use, doctors often do not recommend relying on medications for chronic sleep disorders because they can negatively impact your natural sleep cycle.[vii]

?The most used, over-the-counter medications to address sleep disturbance are diphenhydramine and doxylamine succinate, which are both antihistamines. Although it is oK to occasionally take these medications, long-term use may be linked to dementia and Alzheimer’s disease.[viii]???

Cognitive Behavioral Therapy for Insomnia (CBT-I)

If you are experiencing insomnia or sleep disturbance, CBT-I is considered a first-line treatment to address your sleep-related issues. CBT-I is designed to help you understand how your thoughts and behaviors may be affecting your sleep, and, on average, takes four to eight sessions.[ixi]?Components of CBT-I sessions may include:?

• Cognitive reappraisal?– Addressing and changing negative and unproductive thoughts around sleep.?
• Behavioral strategies?– Developing good behaviors, habits, and routines to help support sleep hygiene. This may include relaxation strategies and counter-arousal methods.?
• Psychoeducation?– Providing you with research and education around the connection between thoughts and behaviors and their impact on sleep.?

Exercise

There is substantial evidence supporting the use of exercise to help address disrupted sleep patterns and sleep disorders. Although exercising too close to bedtime can disrupt sleep, maintaining regular daytime moderate aerobic exercise increases the quality and amount of slow-wave sleep, which is the deepest phase of sleep.[x]?Slow-wave sleep helps the body recover and rejuvenate and assists with memory consolidation. Research has found that only 30 minutes a day is needed to help address sleep disturbances, and some may experience the benefits to sleep immediately.[xi]

Integrative-health approaches to helping with sleep disturbance and sleep disorders

?Some estimates have found that over 50% of adults use integrative-medicine approaches to address sleep disturbances.[xii]The National Center for Complementary and Integrative Health has stated that, although more research is needed to understand potential side effects and efficacy, there is evidence supporting the use of integrative-health modalities such as nutritional supplements and mind-body practices to address sleep disturbance– and disorder–related symptoms.[xiii]

Acupuncture

Acupuncture?is a practice in which a trained specialist called an acupuncturist stimulates specific points on the skin called acupoints, usually with a needle. Stimulating acupoints increases the release of chemicals like endorphins (naturally produced pain reducers) in the body and brain.

Guided Meditation

Guided meditation?is a mind-body practice that uses the imagination and sensory memory to induce a state of relaxation and physiological, emotional, and attitudinal responses. A common example used to illustrate the power of guided imagery is imagining eating a lemon. By describing eating a lemon using the five senses, a person will begin to salivate as though they had just taken a bite from the fruit itself; the body responds to the imaginative description in a realistic manner. In a similar manner, imagining being in a relaxed space through all of the senses can create a physiological experience of being relaxed—turning on a relaxation response.?

Mindfulness Meditation

Meditation?is a practice that involves consciously exerting control over breathing and attending nonjudgmentally to the present moment. It produces multiple physiological and chemical effects such as decreased heart rate, blood pressure, and cortisol (stress hormone) levels.

Yoga

Yoga?is an ancient practice rooted in Indian philosophy. The type of yoga that is most commonly practiced in the United States involves a combination of breathing techniques (pranayama), physical postures (asanas), and meditation (dhyana). There are variations on how yoga is practiced based on the lineage and the approach taken by your practitioner, so the physical demands of the practice will vary. The poses can be altered to accommodate a seated or wheelchair practice.

Tai Chi

Tai chi?is a moving meditation practice that combines the use of slow and deliberate movements with meditation and breathing practice and can help build balance, coordination, strength, and functional capacity. Tai chi is widely considered a safe way of addressing physical and mental symptoms and can be modified for people who have challenges, pain, and weakness.?

Supplements

Herbs and supplements involve taking a plant extract in liquid, powder, or pill form, usually orally, to either maintain or improve an individual’s health. There is some evidence to support the use of supplements to improve sleep.?

?After ruling out sleep apnea or other medical conditions, helping patients improve their sleep through the judicious use of supplements and good sleep hygiene is an important way to practice integrative health. Slow-release melatonin has been shown to improve the quality of life for both children with autism and their parents, for example.[xiv]?It can also be prescribed to help with jet lag for frequent or long-distance travelers. Other supplements with some evidence for assisting with sleep include lavender, valerian,[xiv]?chamomile tea or extract,[xvi],?[xvii]?and passionflower extract,[xvii],?[xix]?melatonin,[xx]magnesium,[xxi],?[xxii]?L-theanine,[xxiii]?and 5-HTP.[xxiv]?After checking for medication interactions, many patients can successfully substitute combinations of these ingredients for drugs prescribed for insomnia—with fewer side effects.

Bottom Line

Both conventional and complementary therapies are available to help treat sleep disturbance and sleep disorders. Although pharmaceutical interventions work and are available for occasional use, long-term use is discouraged and has been associated with adverse effects on health such as dementia and Alzheimer’s disease.?

?Integrative-medicine approaches can improve your sleep hygiene by helping you find alternative ways to relax as well as engage in other forms of physical activity (such as yoga and tai chi). Depending on your particular sleep-related issues, supplements such as melatonin, valerian, L-theanine or others may also help address sleep disturbance. Devices in the area of TMS (transcranial magnetic stimulation) and electromagnetic devices such as Alpha-stim, Fisher devises, and others are also an option?

?Before making adjustments to your routine and integrating any new approaches, it is recommended you speak with a physician about how to best incorporate these practices in a way that promotes healthy sleep.

[i]?National Institutes of Neurological Disorders. (2021, August 24).?Brain Basics: Understanding Sleep. Retrieved fromhttps://www.ninds.nih.gov/Disorders/patient-caregiver-education/understanding-sleep.?

[ii]?National Heart, Lung, and Blood Association. (2021, August 22).?Sleep Deprivation and Deficiency. Retrieved fromhttps://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency.?

[iii]?Sabia, S., Fayosse, A., Dumurgier, J., van Hees, V. T., Paquet, C., Sommerlad, A., Kivim?ki, M., Dugravot, A., & Singh-Manoux, A. (2021). Association of sleep duration in middle and old age with incidence of dementia.?Nature Communications, 12(1), 2289.?https://doi-org.liboff.ohsu.edu/10.1038/s41467-021-22354-2

[iv]?Savard J, Ivers H, Villa J, Caplette-Gingras A, Morin CM. Natural course of insomnia comorbid with cancer: an 18-month longitudinal study. J Clin Oncol. 2011 Sep 10;29(26):3580-6. doi: 10.1200/JCO.2010.33.2247. Epub 2011 Aug 8. PubMed PMID: 21825267.?https://www.ncbi.nlm.nih.gov/pubmed/21825267

[v]?Medic, G., Wille, M., & Hemels, M. E. (2017). Short- and long-term health consequences of sleep disruption.?Nature And Science Of Sleep, 9, 151–161.?https://doi-org.liboff.ohsu.edu/10.2147/NSS.S134864

[vi]?National Institute on Aging. (2021, August 30). Getting a Good Night’s Sleep. Retrieved from?https://www.nia.nih.gov/health/infographics/getting-good-nights-sleep.

[vii]?Gray, S. L., Anderson, M. L., Dublin, S., Hanlon, J. T., Hubbard, R., Walker, R., Yu, O., Crane, P. K., & Larson, E. B. (2015). Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study.?JAMA Internal Medicine, 175(3), 401–407.?https://doi-org.liboff.ohsu.edu/10.1001/jamainternmed.2014.7663

[viii]?Gray, S. L., Anderson, M. L., Dublin, S., Hanlon, J. T., Hubbard, R., Walker, R., Yu, O., Crane, P. K., & Larson, E. B. (2015). Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study.JAMA Internal Medicine, 175(3), 401–407.?https://doi-org.liboff.ohsu.edu/10.1001/jamainternmed.2014.7663

[ix]?Edinger, J. D., & Sampson, W. S. (2003). A primary care “friendly” cognitive behavioral insomnia therapy. Sleep, 26(2), 177–182.?https://doi-org.liboff.ohsu.edu/10.1093/sleep/26.2.177

[x]?Park, I., Díaz, J., Matsumoto, S., Iwayama, K., Nabekura, Y., Ogata, H., Kayaba, M., Aoyagi, A., Yajima, K., Satoh, M., Tokuyama, K., & Vogt, K. E. (2021). Exercise improves the quality of slow-wave sleep by increasing slow-wave stability.?Scientific reports, 11(1), 4410.?https://doi-org.liboff.ohsu.edu/10.1038/s41598-021-83817-6

[xi]?Hopkins Medicine Health, (2021, August 25).?Exercising for Better Sleep. Retrieved from?https://www.hopkinsmedicine.org/health/wellness-and-prevention/exercising-for-better-sleep.

[xii]?Huang, C. Y., Chang, E. T., & Lai, H. L. (2018). Use of integrative medicine approaches for treating adults with sleep disturbances.?Applied Nursing Research: ANR, 43, 49–55.?https://doi-org.liboff.ohsu.edu/10.1016/j.apnr.2018.06.016

[xiii]?The National Center for Complementary and Integrative Health. (2021, August 26).?Sleep Disorders: In Depth. Retrieved from?https://www.nccih.nih.gov/health/sleep-disorders-in-depth.

[xiv]?Davenport L. Melatonin benefits kids with autism, ups parents’ quality of life. Medscape Medical News, April 2019. Available at https://www.medscape.com/viewarticle/911804. Accessed August 22, 2019.

?[xv]?Bent S, Padula A, Moore D, Patterson M, Mehling W. Valerian for sleep: A systematic review and meta-analysis. Am J Med. 2006 Dec;119(12):1005-12.

?[xvi]?Chang SM, Chen CH. Effects of an intervention with drinking chamomile tea on sleep quality and depression in sleep disturbed postnatal women: a randomized controlled trial. J Adv Nurs. 2016 Feb;72(2):306-15. doi: 10.1111/jan.12836.

?[xvii]?Adib-Hajbaghery M, Mousavi SN. The effects of chamomile extract on sleep quality among elderly people: A clinical trial. Complement Ther Med 2017;35:109-114. doi:10.1016/j.ctm.2017.09.010.

?[xviii]?Guerrero FA, Medina GM. Effect of a medicinal plant (Passiflora incarnata L) on sleep. Sleep Sci. 2017 Jul-Sep;10(3):96-100. doi: 10.5935/1984-0063.20170018.

?[xix]?Lee J, Jung HY, Lee SI, Choi JH, Kim SG. Effects of Passiflora incarnata Linnaeus on polysomnographic sleep parameters in subjects with insomnia disorder: a double-blind randomized placebo-controlled study. Int Clin Psychopharmacol. 2020 Jan;35(1):29-35. doi: 10.1097/YIC.0000000000000291.

?[xx]?Xie Z, Chen F, Li WA, Geng X, Li C, et al. A review of sleep disorders and melatonin. Neurol Res 2017;39(6):559-565. doi: 10.1080/01616412.2017.1315864.

[xxi]?Ikonte CJ, Mun JG, Reider CA, Grant RW, Mitmesser SH. Micronutrient inadequacy in short sleep: Analysis of the NHANES 2005-2016. Nutrients 2019;11(10). doi: 10.3390/nu11102335.

[xxii]?Djokic G, Vojvodi? P, Korcok D, Agic A, Rankovic A, et al. The effects of magnesium – melatonin – Vit B complex supplementation in treatment of insomnia. Open Access Maced J Med Sci 2019;7(18):3101-3105. doi: 10.3889/oamjms.2019.771.

[xxiii]?Kim S, Jo K, Hong KB, Han SH, Suh HJ. GABA and l-theanine mixture decreases sleep latency and improves NREM sleep. Pharm Biol. 2019;57(1):65-73. doi: 10.1080/13880209.2018.1557698.

[xxiv]?Hong KB, Park Y, Suh HJ. Sleep-promoting effects of the GABA/5-HTP mixture in vertebrate models. Behav Brain Res. 2016;310:36-41. doi: 10.1016/j.bbr.2016.04.049.