It’s one thing to dutifully block out 8-9 solid hours of downtime every night. If you make it a priority, it’s usually possible to clear that time from your schedule and find a dark room to lie down in. But whether you actually sleep or not isn’t always a matter of conscious control: sometimes you just can’t seem to drop off, no matter how much you know you need the shut-eye.
While it’s easy to conclude that if you’re tired but can’t sleep, you must be the crazy one, difficulty getting to sleep or staying to sleep is actually not an uncommon problem, affecting around 15% of the population. Insomnia is clinically divided into two categories: secondary insomnia (which is caused by some other disease or condition) and primary insomnia (which isn’t). While there isn’t any safe and effective medication for either form of insomnia in the long term, eating a healthy diet is one step in the right direction, and several natural remedies are available and effective.
Sleep and Biology
To understand how insomnia works, it’s very helpful to first have a basic knowledge of how the body regulates sleeping and waking – since we obviously didn’t have alarm clocks for most of human existence, the body must have some kind of natural system for controlling when we fall asleep and how long we stay that way.
A natural hormonal cycle keeps healthy people awake and alert during the day, and sleepy at night. Cortisol, the “stress hormone” peaks in the morning to wake you up, while melatonin peaks in the evening to calm you down.
This balance of hormones is regulated by two types of neurotransmitters (chemicals that communicate with your brain), inhibitory and excitatory. The main inhibitory neurotransmitters are serotonin and GABA: these are the chemicals that signal you to be calm, relax, and go to sleep. They inhibit cortisol production and raise melatonin levels. On the other hand, excitatory neurotransmitters (such as dopamine or glutamate) signal you to wake up and be energetic. These hormones raise cortisol and lower melatonin.
As long as this system is working, you’ll feel awake in the morning and sleepy in the evening, and stay asleep through the night without any problems. However, many people’s circadian rhythms and sleeping patterns are thrown off for a variety of reasons – this is how insomnia starts.
Secondary insomnia is insomnia caused by something else – lying awake at night is just a symptom of a deeper problem, and the solution is to treat that problem, rather than focusing on the insomnia itself.
Psychological and mental disorders are very commonly associated with insomnia. Depression, anxiety, and other mood disorders are very often accompanied by sleep disturbance, which probably has something to do with the same imbalance of neurotransmitters that causes the depression. Neurodegenerative diseases like Alzheimer’s and Parkinson’s can also result in poor sleep quality.
Restless leg syndrome is one rare but extremely disruptive disorder that can cause secondary insomnia. People who suffer from restless leg syndrome are constantly disturbed by the need to move their legs and an itchy, uncomfortable feeling in the legs.
In general, insomnia is also associated with a wide variety of chronic diseases, either directly or indirectly. Heart problems are strongly associated with insomnia, especially chronic heart failure. Any condition that causes chronic pain (such as arthritis) can easily keep you up at night. GERD (Gastroesophageal Reflux Disease) falls into this category, but interestingly, even if you don't notice symptoms of reflux, treatment for abnormal stomach acid levels can help treat disrupted sleeping patterns.
Renal disorders, especially kidney failure often result in sleepless nights – and not just out of worry over the hospital bills. Kidney failure, especially in hemodialysis patients, is strongly linked to developing Restless Legs Syndrome. Sleep disorders are also a commonly reported symptom of diabetes, but this may be because diabetes is so often associated with obesity, which is a well-known factor in many sleeping problems. Since insulin sensitivity is related to normal cortisol levels, though, it’s likely that the insulin regulation problems associated with diabetes do have something to do with the sleep issues.
A problem with the thyroid gland, another important part of the endocrine system, can also underlie chronic insomnia. For one thing, thyroid dysfunction may contribute to Restless Legs Syndrome. Even without the restless legs, insomnia is a known symptom of hyperthyroidism, an autoimmune disorder of the thyroid that also causes a variety of general symptoms like fatigue, weight loss, and weakness.
Some medications can also disrupt the body’s normal circadian rhythms and provoke insomnia. Medicines that affect the brain are the most obvious culprits, but thyroid medication, antibiotics, and oral contraceptives can also sometimes be to blame.
Secondary insomnia accounts for many people’s inability to get a good night of sleep, but it doesn’t cover every case: it’s perfectly possible to have none of the problems above but still be unable to get to sleep. This is called primary insomnia. Frequently, people with primary insomnia can pinpoint exactly what’s bothering them: one particularly stressful event or situation in their lives like the death of a loved one, stress over unemployment, or another specific reason that’s “keeping them up at night.” Sometimes, this worry can become a self-perpetuating cycle when worrying over your insomnia prevents you from falling asleep. Anyone can fall prey to this, of course, but an overview of available studies suggests that insomnia is generally associated with older age, female gender, and a personal history of mental and psychiatric disorders (such as depression).
Primary insomnia caused by situational stress or anxiety can often lead to hormonal changes that prevent you from sleeping properly in the long term. Chronic stress triggers the adrenal glands to constantly produce high levels of cortisol (remember that cortisol is a major stimulant), so if you’re constantly stressed, you’re very likely to have problems falling asleep.
In extreme cases, chronic stress can lead to an even worse problem called adrenal fatigue. The adrenal glands are the part of your endocrine system responsible for regulating cortisol: if they’re overworked for too long, they can stop functioning normally, causing you to suffer from too little cortisol (constant fatigue and an inability to wake up).
As well as problems that react on the hormones directly, some people also have trouble getting to sleep because of issues with their neurotransmitters (the amino acids that regulate the production of cortisol and melatonin). A deficiency of either serotonin or GABA can cause abnormal cortisol levels. Serotonin is converted to melatonin, so if you aren’t producing enough serotonin, you’ll stay constantly on high alert. GABA doesn’t produce any relaxation hormones, but it does inhibit stress hormones, so a GABA deficiency can also throw off the cortisol/melatonin balance.
Thus, even if you don’t have any other disease causing insomnia, stressful life events or circumstances can kick off a chain of reactions that deregulate the hormonal cycle governing wakefulness and sleepiness. Unfortunately, many of these reactions form a positive feedback loop, so stress can build on itself and cause serious hormonal problems further down the line.
Conventional Medications for Insomnia
As with every other health problem in the modern world, a variety of commercial medications exist to treat insomnia. These range from over-the-counter sleep aids like Benadryl and Unisom to prescription medicines, especially a class of drugs called benzodiazepines. Benzodiazepines are hypnotic drugs – they work by increasing GABA activity, thus lowering cortisol levels.
Benzodiazepines, however, are not ideal for long-term use. Patients often develop a tolerance to these drugs, requiring more and more of them for the drug to keep working. Chronic use of hypnotic drugs can also cause unpleasant side effects like daytime sleepiness, or unusual sleep behaviors (sleepwalking, sleep eating, or doing other things in your sleep). The withdrawal effects can be very unpleasant and even dangerous, and the drugs have the potential to cause rebound insomnia, a condition where your sleep actually gets worse after taking sleeping pills, because your body is now dependent on them.
Some doctors and researchers are instead turning to non-benzodiazepine drugs in an attempt to avoid these side effects, but even non-benzodiazepines aren’t safe or advisable for long-term use, especially in vulnerable populations like children or the elderly. Some antidepressants, antihistamines, and other kinds of drugs are also occasionally prescribed for insomniacs, but all of these drugs also come with their own set of adverse side effects.
It’s not an answer anyone wants to hear, but the truth is that there really is no safe and effective long-term pharmacological therapy for insomnia. This doesn’t mean that there’s nothing you can do – on the contrary, the next section details several non-medicinal techniques that are a much better bet than chronic prescription pills.
Dietary Therapies for Insomnia
Diet isn’t as obviously connected to insomnia as it is to other problems like IBS or diabetes, but as long as your body is involved, your dietary habits will have at least some effect. On a macronutrient level, a very low carb diet is often associated with poor sleep, and adding in a moderate amount of safe starches, especially in the evening, can help normalize your sleeping patterns. Carbohydrates have been shown to shorten sleep onset by increasing the levels of serotonin and tryptophan in the brain. It’s not necessary to add a lot of carbohydrates – the diet can still be low-carb overall, with a small amount of starch in the evening a few days a week. In fact, it’s not even beneficial to eat more carbohydrates, since neurotransmitters are similar to insulin in that they can provoke a kind of resistance. If your body is used to serotonin spikes, you’ll start needing more and more serotonin just to feel sleepy; it’s best to keep a moderate level all the time, avoiding extremes and the need for a bigger and bigger dose.
Certain micronutrients are also important for getting quality sleep. Magnesium is probably the best known – many people find that taking supplemental magnesium or eating food rich in magnesium (like nuts) just before bed helps them settle down and get to sleep more quickly. Zinc may also show some benefits.
Vitamin D can also be wonderful for helping restore a natural circadian rhythm: since our bodies mainly absorb Vitamin D through the sun, taking it in supplemental form provides some of the benefits of a dose of sunlight. Sunlight is one of the main signals your body uses to regulate your circadian cycle, so in the winter months or if you can’t get up with the sun, try a dose of Vitamin D to naturally signal your body that it’s time to wake up.
A Paleo diet also has an effect on the chronic diseases associated with secondary insomnia. Diabetes, for example, is often associated with sleep disturbances, and a Paleo diet low in processed starches and sugars is one of the most effective ways to manage diabetes. Thyroid problems also respond well to Paleo, as do chronic infections in general, especially autoimmune problems.
Restless Legs Syndrome is associated with iron deficiency (making Paleo a great option for sufferers, since it’s so high in red meat), but supplementing iron can be dangerous, so make sure you get a blood test to see whether or not you actually are iron deficient. It’s also strongly connected to Celiac Disease, so a Paleo diet that excludes gluten might be one way to help manage it.
Thus, a solid Paleo diet can not only help to manage the symptoms of primary insomnia, but also help prevent or treat the conditions associated with causing secondary insomnia. Diet alone might not be enough to give you complete relief, but it’s a solid first step and a great foundation to build on as you look at other treatments.
Supplements and Natural Remedies
As well as eating a healthy diet high in micronutrients and low in food toxins, some people find that certain supplements can be very helpful for getting a good night of rest. For example, supplemental melatonin or GABA can be helpful. It’s best to be very careful with these supplements, though, since taking too much can cause daytime drowsiness, a constant feeling of fatigue, and the need to sleep far more than normal.
Lifestyle Changes and Psychological Treatments
As well as what you eat, your lifestyle can also have a huge effect on the quality of your sleep. Getting into a bedtime routine can help train your body’s hormonal rhythms to expect sleep at the same time every day, so you’ll start settling down more easily. It’s also important to practice good sleep hygiene: make sure you’re sleeping in a dark room at a comfortable temperature, and try to avoid any kind of screens (computer, smartphone, or TV) for at least an hour before you hit the sack. The blue light emitted by these electronic devices is a strong stimulant, because it’s similar to the light the sun gives off during the day; the warmer light from lamps and lightbulbs is much better for relaxing in the evening.
Since stress is such a major factor in primary insomnia, stress management can have a huge effect on the quality of your sleep. This is much easier said than done, of course, especially in the modern world. But even something as simple as 10 minutes of meditation before bed can deliver noticeable results – and it’s much more pleasant to spend 10 minutes meditating than to spend 2 hours lying awake.
In terms of professional help, cognitive behavioral therapy is considered the safest and most effective long-term treatment for primary insomnia. In this kind of treatment, a psychologist helps you re-adjust your attitudes and behaviors surrounding sleep, and manage any stressors that might prevent you from getting quality rest. Cognitive behavioral therapy (CBT) is safe for anyone to try, and unlike medications, carries no risks of side effects or withdrawal.
Insomnia is a tricky problem to tackle because it’s largely regulated by neurological mechanisms that researchers don’t fully understand, and it can be caused by such a wide variety of primary and secondary conditions. Since it helps you keep your blood sugar even, reduce physiological stress, and manage chronic diseases, a Paleo diet is one great tool for managing primary or secondary insomnia. If a dietary approach alone isn’t enough, the first step is to understand why you can’t sleep; after that, taking the appropriate measures to treat the root cause or restore your normal hormonal balance can bring much more effective long-term relief than popping sleeping pills night after night.