Alternative ways to get your Z'S.
Complementary and alternative medicine (CAM) therapies encompass a variety of disciplines, including nutrition, exercise, and mental and respiratory health. So, it stands to reason that people experiencing sleep difficulties have delved into the realm of alternative medicine to help get a better night's rest.CAM therapies are health treatments not classified as standard western medical practice and not evaluated by the Food and Drug Administration. Essentially, they are alternative remedies that are used along with more conventional medical treatment. Examples of CAM therapies include acupuncture, yoga, hypnosis, biofeedback, herbal remedies and aromatherapy, to name a few.
In late 2007, researchers at the Mayo Clinic found that a high number of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) said they had used or were interested in using CAM therapies. Of the 406 OSAHS patients surveyed, 20 percent were using CAM therapy specifically for improving sleep at the time of the survey; 52 percent reported using CAM; and 58 percent expressed an interest in using CAM to improve sleep in the future.
Symptoms of OSAHS such as fatigue and disruptive sleep are nonspecific, and many cases remained undiagnosed. So, individuals with undiagnosed OSAHS may seek relief through CAM without realizing medical treatment exists. Others may be deterred by formal sleep evaluations, which they consider inconvenient.
Diagnosed OSAHS patients may not be satisfied with conventional therapy. Compliance with medical modalities for sleep problems is challenging, and adverse effects such as daytime sleepiness can result. In addition, medical intervention may impact neurobehavioral performance, quality of life and cardiovascular morbidity, which prompts patients to turn to other options.
The Mayo Clinic study should remind sleep practitioners to inquire about the use of CAM when taking a history of people with OSAHS. But alternative medicine has been used for other sleep problems, too, including insomnia and circadian rhythm disorders. What follows is a basic primer of what patients might tell you they are taking to "remedy" their sleep problems--should you ask.
Tryptophan
Tryptophan is one of the essential amino acids and the precursor for serotonin. Brain serotonin function is believed to promote sleep regulation and cognitive processes. Sleep abnormalities and associated behavioral decline often are attributed to deficient brain serotonin activity.
Brain uptake of tryptophan is dependent on nutrients that influence the availability of tryptophan through a change in the ratio of plasma tryptophan to the sum of the other amino acids. According to one study, evening dietary increases in tryptophan that is available for uptake into the brain can enhance alertness early in the morning after an overnight sleep. 2 This is most likely due to improved sleep.
Studies also have shown that consuming alpha-lactalbumin rich in tryptophan can help improve sleep and morning alertness, as well as cognitive performance under stress. Alpha-lactalbumin is the primary protein in human milk, and the second most prominent whey protein in bovine milk.
When taken in pill form, tryptophan has been shown to cause nausea, dizziness, drowsiness, headache, dry mouth or tremor in patients using it.
Melatonin
Melatonin is a hormone that is synthesized by the pineal gland in humans. Although the effects of melatonin are poorly understood, it plays a critical role in the regulation of the sleep-wake cycle and other circadian rhythms. In essence, melatonin may help the body when it's time to sleep and wake up.
Melatonin supplements (in pill form) can be taken to boost levels in the body. Both natural and synthetic melatonin are available. Natural melatonin is made from the pineal gland of animals. This form could be contaminated with a virus and is therefore not recommended. The synthetic form of melatonin does not carry this risk. A pharmacist can help patients determine which kind of melatonin is in their supplement.
Melatonin has been studied in the treatment of insomnia, as well as in the prevention of jet lag. Beyond that, however, there is little scientific evidence that melatonin has a role in promoting health or treating disease.
People who take melatonin supplements have reported sleepiness, headache, upset stomach, depression or feeling hung over. Although these adverse effects are minimal, long-term studies examining efficacy and toxicity of melatonin supplements are needed. For example, the medical community does not know if melatonin causes problems when taken with other medicines, or how melatonin may affect diseases and other medical conditions.
Herbal supplements
The effects of some herbal supplements have been studied for use in sleep disorder patients. Mostly, herbals have been researched for patients suffering from insomnia. One of the most common herbals taken for sleep problems is valerian (Valeriana officinalis). Some studies suggest that valerian helps with the sleep onset and sleep maintenance. In one study, valerian extract was found to be as effective as the antianxiety drug Serax in patients with insomnia. However, more research is needed before a final conclusion can be made about the safety and effectiveness of valerian for insomnia.
Headache, blurred vision, nausea, change in heartbeat, and morning grogginess have been associated with taking valerian.
Chamomile is another commonly used herb for the treatment of insomnia. Often found in certain teas, chamomile can produce a calming effect on the body prior to bedtime. The FDA considers chamomile to be safe, and the herb has no known adverse effects.
Other herbs promoted as effective sleep remedies include passionflower, hops, ginseng, lemon balm and skullcap. The German government has approved certain herbs (valerian, hops and lemon balm) for the relief of sleep problems. However, clinical studies to evaluate the effectiveness and safety of herbs are scarce. More information is required before these herbs can be recommended as a first line of treatment against insomnia.
Counseling patients
It's always important to tell sleep disorder patients that although these CAM therapies may help offset some of their symptoms, they will not cure their disease. Here are some guidelines for counseling patients who want to integrate CAM therapy with conventional medicine:
* Always keep an accurate record of what alternative treatments patients are using in their medical chart.
* Tell patients that if they experience side effects such as nausea, vomiting, rapid heartbeat, anxiety, diarrhea or skin rashes, to stop the treatment and contact a physician immediately.
* Avoid CAM therapies made with more than one herb.
* Beware of commercial claims of what alternative therapies can do. Look for scientific-based sources of information.
* Select brands carefully. Only purchase brands that list the herb's common and scientific name, the name and address of the manufacturer, a batch and lot number, expiration date, dosage guidelines and potential side effects.
And remember, although randomized, placebo-controlled studies are available for most of the aforementioned CAM therapies, rigorous scientific data supporting their beneficial effects haven't been found for the majority.
Stephanie Richardson is a freelance medical writer in Philadelphia.
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| Author: | Richardson, Stephanie |
|---|---|
| Publication: | FOCUS: Journal for Respiratory Care & Sleep Medicine |
| Date: | Jan 1, 2009 |
| Words: | 1119 |
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