A 51-year-old exhausted woman came to the clinic. She had a history of sleep disorders, but lately her sleep onset insomnia was so profound that some nights she was only getting about two hours’ sleep. As a result, her life was becoming unbearable and she was constantly fatigued.
She was in perimenopause as her menstrual cycles had started to change, being more infrequent and less bleeding. Apart from that she had no other menopausal symptoms. However, there is a known connection with menopause and insomnia as the levels of melatonin (the sleep hormone) can drop by up to 50 per cent during this time.
Apart from the insomnia, she had had a lot of stress in the past couple of years with an acrimonious divorce, now completed, and she was getting occasional palpitations and leg cramps. She also occasionally had symptoms of reflux, with known food triggers of wheat and dairy so generally avoided these, and her bowel was sluggish at times. She also had the occasional bout of mild thrush or cystitis.
She was taking magnesium, probiotics, a protein powder, a zinc and vitamin C complex and 5mg of melatonin at night.
As she was working from home setting up a new business — she had lost the old one during the divorce — she was on the computer for many hours during the day and was rarely going outside in the sun. She had also stopped exercising for the last few months as she was so busy — and now too tired.
Treatment
We discussed evolving a practice to remove the days’ worries: taking time in the evening to work through the day, making lists for the next day, and clearing the mind of all the things she had to think about – the Bach Flower remedy white chestnut can help with this.
Reducing light exposure at night and blocking out the blue band on phones and computers can help. Even better is not using computers after dark: they can significantly lower your melatonin levels. For a good night’s sleep, a dark, quiet room with no electronic devices nearby is the optimal environment; you can switch your mobile phone to airplane mode if essential.
Humans evolved over millennia, with light in the red/yellow band, such as from firelight or candlelight, being critical for the correct secretion of melatonin, the “sleep hormone”. Using yellow or red globes or shades over lights and avoiding fluorescent light at night is important.
To balance the circadian rhythm cycle and ensure appropriate melatonin secretion it is necessary to get out in the sunlight during the day. If working on computers it is good practice to spend 10 minutes every hour in the sun without sunglasses. Research has shown that more exposure to sunlight during the day leads to less fragmented and deeper sleep at night.
While she was supplementing with melatonin, the dose was not enough to work for her since the effective dose can vary enormously among individuals, so I suggested she initially double it then gradually increase it further if needed. Melatonin is a prescription-only medication in Australia.
Avoiding heavy meals late at night will improve sleep. Ideally eat before 6pm and allow at least three hours after eating before going to bed.
She needed to begin a regular exercise program, preferably outside during the day — even 10 minutes in the sunlight hourly would help.
I suggested having a nap during the day, as this reduces the urgency for a good night’s sleep, and 30 to 60 minutes will improve a person’s mental acuity. She didn’t like the idea of napping during the day, but I suggested it might help until her sleep patterns had become better regulated.
While she was taking magnesium, the dose was insufficient to be fully effective, so doubling the dose was an option. Taking it at night would be more effective than the morning.
Lavender helps reduce anxiety and encourages sleep. She added lavender oil to her pillow or burned it in an infuser to relax both the body and mind.
Caffeine levels needed to be monitored, a common culprit in insomnia. Alcohol needed to be avoided. Many think it helps them sleep better, but it actually promotes poor sleep quality. She had reduced her caffeine to one cup of coffee per day but was inclined to have a few glasses of wine with her meal at night. This had increased with her stress, I suggested she avoid it until her sleep patterns had re-established themselves.
She wanted to try a herbal mixture, so I made up a sleep mix of valerian, hops, passionflower, withania, magnolia and lemon balm with the dose being 10ml taken half an hour before bed. I also recommended a general herb mix with black cohosh, Siberian ginseng, motherwort, gotu kola, nettle, olive leaf and pau d’arco bark.
Overall she was happy with this program and managed to do most of it. The herbs for sleep were very effective initially, but the effect wore off a little over time; however, with all the other things she was doing, her sleep patterns became much more regular, and apart from the occasional bad night, she was getting about seven or eight hours’ sleep regularly. Her quality of life improved significantly over the next several months.
