Insomnia

Question 1

Insomnia

Answer 1

A common complaint that is divided into:
* Difficulty falling asleep (‘sleep onset insomnia’)
* Frequent or early waking (‘sleep maintenance’)

Question 2

Sleep physiology

Answer 2

• Melatonin (N-acetyl 5- methoxytryptamine) regulates sleep and the circadian rhythm. Serotonin-N- acetyltransferase
  (SAMe dependant) is released in prolonged periods of darkness, increasing the conversion of N-acetyl- serotonin (NAS) to melatonin. Levels can be tested with salivary testing
• Cortisol / adrenaline excessive sympathetic / stress response may result in high cortisol, resulting in difficulty ‘switching off’.

Question 3

Insomnia: Causes/risk factors

Answer 3

• Sleep onset: Anxiety, stimulants (e.g.,
  caffeine), climate, fears, pain, stress.
• Sleep maintenance: Hypoglycaemia, sleep apnoea, medications, high stress, alcoholism, depression, restless leg syndrome.
• Identify if the person is waking at a repetitive time and look at the
  corresponding time on the TCM clock. E.g., 1- 3am indicates liver disharmony.

Question 4

Insomnia: Natural Approach

Answer 4

• Sleep hygiene / advice
• Exercise
• Consider weight management where applicable.
• CNM Naturopathic Diet with focus on low GL foods.
• Support serotonin melatonin conversion
  and GABA (earlier), e.g., tryptophan, magnesium, B6, folate rich foods; probiotics.
  *
  Tart Montmorency cherry juice (200‒500 mls per day)
• Avoid alcohol, caffeine and tyramine containing
  foods excitatory in those who are sensitive:
  cheese, chocolate, wine and also avoid MSG!

Question 5

Insomnia: Supplements

Answer 5

Magnesium: 200‒400 mg
Lemon balm 300‒600 mg
Theanine 50‒200 mg
Zinc 10‒60 mg
Vitamin B6 10-150 mg Folate / B12 500‒1000 mcg
Vitamin C 250 ‒2000 mg Tryptophan 300- 4000 mg
5-HTP 50-300 mg

Question 6

For difficulty falling asleep

Answer 6

Passionflower, v alerian (both have GABA receptor affinity). 1‒2 tbsp dried herb infusion before bed.

Question 7

Herbs to promote deep, rejuvenating sleep:

Answer 7

Ashwagandha (a GABA agonist). 1 tsp powder in warm nut milk before bed).

Question 8

Addiction

Answer 8

Addiction to substances can both be based in behavioural and chemical addictions.
* Common substance addictions examples: alcohol, marijuana and cigarettes (tobacco).

Question 9

Addiction: Aetiology

Answer 9

• Addiction is often a way of ‘self medicating’ anxiety, as most addictive processes increase brain dopamine and / or serotonin.
• Strong association with early childhood adversity, neglect and abuse. Significant trauma in life.
• Can be associated with having no purpose in life, loss, divorce etc.

Question 10

Addiction: Nathropathic aims

Answer 10

• Address the cause.
• Assist drug(s) detoxification out of the body which lessens the severity and length of withdrawal (support phase 1 and 2 liver pathways and elimination channels).
• Support inhibitory NT levels to prevent cravings.
• Support stable energy production to prevent cravings.
• Repair some of the damage done to the body by the substance(s), bad eating habits and lifestyle.
• Support lifestyle changes and work alongside other professionals.

Question 11

Addiction: Naturopathic approach

Answer 11

• CNM Naturopathic Diet and support dopamine ― ensure sufficient dietary protein (phenylalanine, tyrosine) and co factors (e.g., folate, B6, iron etc.); minimise sugar ; avoid excess saturated fat & alcohol .
• Support stress / anxiety and sleep (GABA pathway). Adrenal support for ‘lows’ may be needed (e.g., vitamin C, liquorice etc.), but gently.
• Methylation support, tyrosine for dopamine / other NTs, but gently.
• Mucuna pruriens (up to 100 mg / day) a natural source of L dopa, sometimes referred to as ‘The Dopamine Bean’.
• Support digestion, GI microbiome (e.g., 5R protocol).
• Focus on antioxidant rich foods, including polyphenols which also support liver detoxification and the gut microbiome. Also consider probiotics that support the gut brain connection (e.g., L. plantarum L. rhamnosus , B. longum

Question 12

Addiction: Withdrawal

Answer 12

• For alcohol withdrawal: Consider alternatives, e.g., kombucha.
• For smoking cessation: Cut down other addictive substances
  (e.g., caffeine, sugar, alcohol); Skullcap (its phytochemicals bind to
  nicotine receptors); healthy low GI snacks (e.g., oat based) as the
  hand to mouth action can continue and lead to over eating; support
  dopamine balance (see earlier); increase endorphins with exercise.

Question 13

Natural approach ― alcohol

Answer 13

5- HTP
100 mg x 2 daily
* To support serotonin levels during alcohol withdrawal.

Taurine
2000 mg x 3 daily
* To support relaxation and improve liver function in chronic alcohol users

B complex
Up to 150 mg / day
* Particularly focus on replacing the lost B1 with alcohol abuse, as well as B5.

Magnesium
Up to 400 mg / day
* Relaxation, anxiety reduction , energy and optimise B1 availability to the
nervous system.

EPA and DHA
1000-3000 mg
* Support healthy fats for neuronal health.