Category: Fatigue and Insomnia

Every time I see a patient at Women to Women and ask about what is going on in her life, I always hear a long list of responsibilities and priorities: women today have very full plates! Whenever I ask a patient about her sleep and whether she gets enough, it seems that almost every woman I speak with wishes that she could get more.

Some women may struggle to fall asleep or to sleep through the night because of hormonal imbalance, stress, or adrenal fatigue, while others just cannot seem to schedule in more than 6-7 hours of sleep time due to kids and jobs and all their many obligations.

We all know that sleep is important for good health and most of us probably feel like we should be getting more. But with all of life’s responsibilities and our many different priorities as women, sleep doesn’t often land at the top of our lists. But it should. Let’s look at why.

Can I get by with 6 Hours of Sleep?

Every once in awhile when life gets crazy, our sleep gets sacrificed and we have to get by on less. We may tell ourselves it’s ok because it’s just for a little while until…. But I recently came across a fascinating sleep study that shows that even just a few days of not enough sleep wreaks havoc on your mental and physical performance and your health.

In the study, researchers divided the participants into four groups: one group slept for 8 hours a night, one for 6 hours, one for 4 hours, and one poor group had to stay awake for 3 days without any sleep at all! The groups who slept for 4, 6, or 8 hours were required to maintain those same sleep hours for two weeks and along the way they were given mental and physical performance tests.

The lucky group who got to sleep a full 8 hours had consistent performance: whatever their performance level was at the beginning of the test, it remained the same throughout the entire two week period. But the groups who slept for either 4 or 6 hours experienced cognitive decreases, motor skill declines and attention lapses that grew steadily worse as the two-week trial progressed.

Everyone expected that the 4-hour a night group would be much worse off than the 6-hour a night sleepers. But one surprise was that while the 4-hour a night sleepers did do slightly worse, there was not as large a difference between the 4-hour and the 6-hour groups as you might expect.

After only one week, one quarter of the 6-hour sleepers began falling asleep randomly during the day. But even more surprising was that after two weeks, the 6-hour a night sleepers performed at the same level as if they had stayed awake for 48 hours straight!

That means that if you sleep for only 6 hours a night, after two weeks, your body will be performing as if you had pulled two all-nighters back to back! If you ever pulled an all-nighter in college at exam time, you know how you felt the next day: pretty awful and totally exhausted. Imagine doing that two nights in a row and still going to work, running your household, and taking care of your family!

But what was really fascinating to me was that the people in the study who experienced the cognitive, motor skill and attention declines were totally unaware of them. When they graded themselves, they did feel a slight decline for a couple days but then after that, they felt that their performance leveled out. In reality, they were continuing to decline each day and they were completely unaware of it!

This just goes to show that we may try to fool ourselves by saying we’re fine and just having an extra cup of coffee or an afternoon treat to keep our energy going but the reality is that our bodies are not performing optimally because they are sleep deprived. Getting less than enough sleep will reduce both your mental and physical performance after only a few days so while we can all have an off night, it’s important not to let it go on for too long.

How much sleep is enough?

While that study showed that 8 hours of sleep was adequate but 6 was not, it did not break down the sleep time in between. Not all of us can get 8 hours every night so I wanted to know what to tell my patients for whom 8 hours is simply not possible or even not preferable for them. Thankfully, a number of other studies have also looked at this question and have found that while the exact number is different for each of us, generally 7 or 7 ½ hours is the minimum amount of sleep required nightly to avoid performance disruption.

We need that time because when we sleep, we go through several different cycles, which together take about 90 minutes to complete. Two of them are particularly important for our health: deep sleep or slow-wave sleep and REM or rapid eye movement sleep. When we are in slow wave sleep, the body heals and repairs, the immune system does its work and pituitary gland releases growth hormone for muscle and tissue repair. We need this phase for physical wellness.

That’s why many elite athletes state that they sleep 11-12 hours a night; their bodies need the additional slow wave sleep time to repair and restore. In fact, one study at an elite college required basketball team members to increase their sleep from 8 hours up to 10 hours a night. They found that free throw shooting, three-point shooting and sprinting times all increased when the athletes slept longer. So if you place high physical demands on your body, whether you’re an athlete or just a busy constantly on the go mom, more sleep may be required for you to recover.

The other part of the sleep cycle that’s really important is REM sleep. During REM sleep your brain goes into dream state and clears out unnecessary information, reorganizes information, and your memory and learning are improved and distilled as you connect the day’s experiences with previous memories and experiences. Your brain requires REM sleep to perform at peak levels and memory, cognitive function and mental performance all suffer when we don’t get enough REM sleep.

In fact, research has shown that without adequate sleep, the body begins to die: mental and physical performance suffer; the immune system cannot function properly; and the likelihood of infections, weight gain, heart disease, diabetes, high blood pressure, mental health concerns and ultimately, death, increases.

The problem is that when we get older, especially at the busy perimenopausal time of our lives, we often tend to sleep less; precisely at the time we need more sleep to restore, repair and heal. One study showed that the typical 80-year-old gets 62% less slow wave sleep than a 20-year old. While more sleep facilitates healing, less sleep can accelerate aging, so extra sleep is also a great anti-aging strategy as well.

We all need to make sleep a priority and most researchers agree that we need between 7-9 hours a night. The exact number will vary by individual and you can experiment and see when you feel best. Even one week of less than enough sleep will result in significant declines so getting adequate rest regularly is a key component to feeling good, reducing your symptoms, and enabling your body’s own innate healing.

What if I Can’t Sleep?

I often have patients at Women to Women come to me saying I know I need to sleep more, but I just can’t. What should I do? Despite our best efforts and intentions, we will all experience a sleep disruption on occasion. The good news is that short-term, we can compensate for that when it occurs: our bodies will simply make up for a shortage the next night.

If you do experience a night of unrest for whatever reason, even if you only got a couple hours of sleep, don’t stress about it: sleeping for 10-12 the following night will bring you right back into sync. The key is not to let it go on for multiple nights and to get right back on track the next night.

If you have trouble sleeping, make a sleep schedule and stick to it, sleep in a dark room that is nice and cool, turn off the TV and the computer before bed and read, and avoid sugar in the evening: these tips will help you sleep through the night and allow your body to heal. Healthy nutritious food and supportive multi-vitamin supplementation can also help your body fall and stay asleep and support the many processes the body performs during sleep to stay healthy.

If you are experiencing mental symptoms such as fuzzy thinking, memory lapses, anxiety, depression, mood swings, irritability or panic attacks, you may need more REM sleep. If you are experiencing physical symptoms such as weight gain, hot flashes, or fatigue, you likely need more slow wave sleep. Either way, your symptoms are tied to your sleep cycles and more sleep will support your body in healing, just as not enough sleep can make your symptoms worse.

Making sleep a priority in your life will improve your mood and your energy, and increase your mental and physical performance, your ability to overcome challenges and your overall happiness and well-being. It will also prevent and reduce many symptoms of hormonal imbalance.

You don’t need to lie awake all night tossing and turning: You can get a good night’s sleep. We’ve helped thousands of women just like you to sleep through the night. We can help you too. Try taking an over the counter magnesium supplement a half hour before bed: calcium and magnesium should be consumed in a 1:1 ratio and many of the women I see have more calcium-heavy diets.

New research is also showing that insomnia is often connected to stress levels. If you are wired and can’t sleep or if you feel that you have a lot of stress in your life, check out our adrenal product system for sleeplessness. It’s helped wired or stressed women finally sleep peacefully.

If you have trouble sleeping but don’t feel adrenal fatigue due to stress is the cause, our Sleep Support Product can give you the added support to relax and get a good night’s sleep. It can be taken along with any of our other products as an added sleep support aid.   You can find it here.

by Marcelle Pick, OB/GYN NP

Insomnia can be one of the reasons patients see a healthcare practitioner. Night after night of unplanned wakefulness can take its toll on women – and so many women are aware of the far reaching health effects that they are often looking for ‘anything’ that will help.

Conventional healthcare practitioners are most likely to turn to sleep aids – there are many available over the counter as well as by prescription.

I’ve always found it’s better to help a woman get to the root source of her insomnia. Sleep is so important to our natural biological rhythm that it’s worth the effort to help reset its natural flow.

We all have our own unique circadian rhythm which is linked to the sunrises and sunsets of our days. Deep inside our brain clusters of nerve cells work as our internal clock, signaling the time for cell regeneration and hormone production and regulation. They also release the hormone melatonin which makes you sleepy. Light exposure – either natural or artificial inhibits melatonin production. There are times in our lives when due to life circumstances, travel or illness when our circadian rhythm will reset itself – sleep aids can help get through the moment – but its not a good solution long term.

Many women who experience sleeplessness may have physiological imbalances which are responsible for disrupting their inner clock. Diet changes and stress can easily cause daytime fatigue and nighttime insomnia. Unfortunately for many women, these become routine, rather than exceptions. If you have trouble sleeping for more than a few weeks, you are considered to have chronic insomnia.

Chronic insomnia is broken down into two distinct categories – primary insomnia and secondary insomnia. Primary insomnia is usually brought on my conditions which interfere with sleep – caffeine intake, sleep environment and low level worry.

Secondary insomnia has many more potential root causes, and many times occurs or is a result of medical or psychological concerns. Many things might contribute to secondary insomnia including: hormone balance, chronic pain, arthritis, urinary incontinence, mineral deficiencies, insulin resistance and breathing problems.

We find that for many women, hormone imbalance can be a primary culprit. Shifting hormones can cause temperature disruptions – hot flashes and night sweats which affect many women. There is a theory that shifting estrogen levels affect melatonin production – without enough melatonin are brain doesn’t receive the signal to slow and quiet down.

I recommend my patients keep a sleep log for about a week to help us figure out what might be happening during the day which is impacting sleep. Items to track are: caffeine, nicotine and alcohol consumption, foods you eat and when you eat them, exercise habits, stress levels, and the kind of medications and supplements you take – when you take them and the amounts. Your bedtime and noise and light levels when you can’t sleep.

The first step in getting back to sleep and to find out what keeps you awake. When creating a plan to get you back to sleeping well we recommend:

• Insuring that hormones are balanced! Aside from diet and lifestyle changes, you may want to consider nutritional supplements or even talking with your healthcare practitioner about hormone replacement therapy.

• Create a good nighttime routine. Set the stage for a good night’s sleep. Try to go to bed at about the same time every day, turn of all electronics about an hour before bed and make sure your environment is comfortable.

• When you are suffering from sleeplessness it’s more important than ever to support your body’s nutritional needs – during times of stress, our bodies may require more nutrients. One way to do this is take a high quality multivitamin/mineral supplement every day.

• You also may want to consider one of nature’s own sleep aids – calming teas or even a supplement with herbs that assist with sleep. I always recommend working with a healthcare practitioner to help choose the right supplement for you.

• If you try some of these steps and don’t see relief, you may want to consider looking into behavior modification techniques for insomnia. There are wonderful choices available – guided imagery, cognitive behavioral therapy, mediation – the list goes on.

I hope I’ve reassured you that insomnia is a highly treatable condition that doesn’t necessarily need pharmaceutical intervention.

When you listen to the messages that your body is sending, you can often provide just the support you need!

by Marcelle Pick, OB/GYN NP

Our bodies have some interesting sensations from time to time, and sometimes we don’t know why. Restless legs syndrome (RLS) is one of those perplexing conditions that leave patients, and their doctors, with some unanswered questions. When patients come to me describing their legs as having the “creepy crawlies,” and a persistent tingling that makes them want to move around, I know this struggle has a tremendous impact on their lives. They have difficulty sitting still, relaxing, and even sleeping.

Conventional medicine has not had much success helping people with RLS and the associated periodic limb movements in sleep (PLMS). There are new prescription medications available, but they come with many unwanted side effects. We don’t really know why this is reported twice as often in women than men, or what the pathophysiology is, but we do know we can help using a natural approach. Let’s take a look at RLS and some natural ways to address this mysterious condition.

What exactly is restless legs syndrome?

The symptoms of RLS can be overwhelming. It is described as an electric-current sensation flowing through the legs, and even sometimes the arms, tugging from the inside, necessitating movement for immediate relief. It is especially prevalent at night, causing sleep loss for the sufferer as well as her partner. Patients experience unusual sensations that perpetuate tossing and turning, a need to move around, get out of bed, and rub their legs. The symptoms often increase while at rest. Diagnostic criteria for RLS is as follows:

• A pins and needles sensation urging you to move your legs
• Symptoms are worse at night
• Symptoms come on or increase with rest
• Movement provides immediate relief

But RLS has another symptom for many patients – sleep disturbance. Because of this, RLS is actually classified as a sleep disorder, requiring patients to seek treatment. There is a noticeable pattern of movement in a majority of cases – repetitive leg movement every 30 seconds or so, lasting one to three seconds, referred to as periodic limb movements in sleep. The movements may be severe enough to wake someone up. Others may be unaware of this activity, but wake up tired and wonder why. PLMS is usually diagnosed through a sleep study which will confirm this activity.

There are two main types of restless legs syndrome: primary RLS and secondary RLS. Studies suggest that anywhere from one in four to one in 20 people suffer from RLS symptoms. Both forms are linked to low levels of dopamine, a hormonal neurotransmitter. Dopamine is an important messenger in the brain helping to regulate much of our body’s functions, including thinking, behavior, mood, and especially in the case of RLS – sleep and movement. Low levels of dopamine can trigger the urge to move our limbs, as found in RLS. But an extreme inadequacy of this hormone can cause tremors and the severe movements associated with Parkinson’s disease.

We know that primary RLS has a genetic component stemming from a malfunction in the way dopamine is metabolized in both the brain and the body. Secondary RLS may be caused by faulty iron metabolism, since iron is part of the chain in dopamine production.

Who is at risk for RLS?

• Individuals with a family history of primary RLS
• Individuals with iron deficiency anemia
• Individuals with end-stage kidney disease or hemodialysis
• Pregnant women
• Frequent blood donors
• Those who have undergone gastric surgery.
• Children with AD/HD

RLS and sleep

My patients with restless legs syndrome complain most about their lack of sleep. One in four people diagnosed with RLS experience sleep disturbance, and 80 percent experience PLMS. They are in seemingly constant movement – kicking, jerking, and shaking their legs and arms throughout the night. This causes difficulty falling asleep, night-waking, and loss of important restorative sleep, oftentimes for partners too.

The science behind increased symptoms at night is due to the timing and patterns of the natural release of dopamine. This neurotransmitter mirrors our circadian rhythms, releasing high levels in the morning and low levels in the evening, causing disruption in sleep. The problem is that over time, insomnia or lack of sleep can impact our health in many ways. Our moods and daily functioning becomes unstable after prolonged bouts of insomnia. But if this pattern continues for years, our cognitive function, stress response, mood regulation, and our immunity can be severely affected.

A 2003 survey conducted at a sleep disorder clinic revealed some unsettling results. More than 50 percent of patients with RLS, PLMS, and other chronic sleep disorders, reported suffering from depression. What’s worse, is that antidepressants, including the family of medications known as selective serotonin re-uptake inhibitors (SSRI’s), can aggravate PLMS, making it a vicious cycle. Although we do not fully understand all of the factors around restless legs syndrome, we do know that our natural sleep-wake patterns are modulated by neurotransmitters which play a role in this and other associated conditions, proving that how well we sleep can make a profound difference on our entire life.

RLS and genetic coding

While there are genetic links to primary RLS, geneticists still have not honed in on the specific genes causing this condition. Research suggests that RLS is present in about half of first-degree relatives with RLS. There was a recent study proclaiming more definitive proof of a genetic variant, but the link geneticists found was only present in those diagnosed with PLMS, not those solely with RLS. Remember not all people who suffer from RLS have PLMS. Periodic limb movement in sleep is identified 80 percent of the time. Interestingly, these recent genetic studies were documented by paid consultants to the manufacturers of RLS drugs.

RLS drugs and their side effects

Sleep disorders are tricky, especially when trying to balance medications whose side effects include somnolence, or drowsiness. To impact an already disrupted natural sleep pattern with a medication affecting sleep seems confusing. The two drugs approved in the United States for treatment of RLS are Mirapex and Requip. These medications (originally developed for treatment of Parkinson’s disease,) work by trying to help the body make dopamine more available to receptors. They are effective in some symptom relief, which in turn may help with sleep. But they also have serious side effects.

The most commonly observed adverse effects of Mirapex (pramipexole dihydrochloride tablets) are nausea and somnolence/sleepiness. The most commonly observed adverse effects of Requip (ropinirole hydrochloride) are nausea, somnolence, vomiting, dizziness, and fatigue.

Here is a scary thought — people taking either Mirapex or Requip have reported falling asleep during normal everyday activities — including driving. Although some clinical experts believe this only occurs when patients have preexisting problems with somnolence, some patients have reported that falling asleep sometimes happens sometimes without any warning signs! In addition, the side effect of sleepiness can occur up to a full year after beginning treatment.

Although these medications are helpful to some people, I strongly recommend understanding all of the implications of using them. They are not only linked to fatigue, but other disturbing side effects including pathological gambling, compulsive eating, and hyper-sexuality. RLS will certainly affect quality of life, but so do these other severe side effects.

RLS and lifestyle

Because we are uncertain about the definitive causes of restless legs syndrome, it leads us to ask about lifestyle and environmental factors. Can those play a role in the development of restless legs syndrome? In my practice I have seen several issues that may contribute to or exacerbate RLS, including smoking, excessive caffeine use, and excessive alcohol use. Also, commonly prescribed antidepressants in both the SSRI and tricyclic families note RLS as a side effect. In fact, any medication that counteracts our ability to produce dopamine can have an impact. But the good news is, that we can positively influence our dopamine production through both finding the root cause of the condition, and helping fix it with more focused nutrition. Research is now revealing the significant role of nutrition, and other more natural approaches to RLS.

Key ingredients to help produce dopamine

Both iron and folate play key roles in the production of dopamine. I have noticed that many of my patients suffering from RLS also seem to be deficient in both iron and folate. In fact, iron deficiency is a known condition associated with RLS. Supplementing with iron and folate can improve the symptoms of RLS, but it is important to work with your practitioner if you don’t notice an improved difference in your symptoms after a trial of iron and/or folate, to determine how well you are able to metabolizing these nutrients. Magnesium levels also have an impact on RLS. For the absolute best results you may want to consider working with a practitioner familiar with nutrigenomics – the study of the molecular relationship between nutrition and gene response. But here are the basics.

Iron

Iron supplements are encouraged when lab tests reveal lower than normal levels. Most women over the age of 35 do not need supplemental iron, and it is important to maintain appropriate levels – not too much, and not too little. If your serum is low, you can increase you iron through diet or an oral iron supplement in conjunction with vitamin C which helps absorption. However, iron supplements can have their own side effects including digestive upset and constipation. It is also important to take calcium supplements separately from iron, as studies indicate calcium can inhibit iron absorption.

Iron-rich foods:

• Hormone-free, grass-fed beef, pork, lamb; liver and other organ meats
• Free-range chicken, duck, turkey, (especially dark meat and liver)
• Seafood, including clams, mussels, sardines, anchovies, and especially oysters
• Broccoli and leafy greens, such as kale, turnip greens, and collards
• Legumes like lima beans, pinto beans, green and black-eyed peas
• Walnuts, cashews, and peanuts
• Yeast-leavened whole-wheat bread

Folate

Folate is an important nutrient to help prevent digestive disorders and nutritional deficiencies. Pregnant women require eight to 10 times more folate, which could help explain the increased RLS occurrence in pregnant women. Folate deficiency can lead to conditions associated with RLS, including lower limb numbing and tingling, fatigue, and depression. Adding 1 to 30 mg of folate to your diet may help relieve some of the symptoms of RLS. In certain cases, patients may feel added folate is not helping, and assume it is because they don’t need it. But that may not be the case. Some people have difficulty metabolizing folate, due to a common genetic variant present in anywhere from one to 40 percent of people, depending on ethnicity and other factors.

Foods rich in folate:

• brewer’s yeast
• black-eyed peas
• soy flour & soy beans
• kidney beans
• lima beans
• garbanzo beans
• lentils
• beef and lamb liver
• bran
• walnuts
• fresh spinach
• fresh kale
• asparagus

Magnesium

Magnesium is important for proper conduction of nerve impulses and muscle contraction. Researchers have discovered a relationship between magnesium levels and RLS. Studies indicate that magnesium may be too quickly transported from the blood to the cerebrospinal fluid. It may also be interacting with the iron transport system and dopamine receptors affecting RLS symptoms. I have had success with patients who have added magnesium through food, as well as supplements. I recommend 400-600 mg per day, taken before bed. You can also take a multivitamin that includes magnesium.

Magnesium-rich foods:

• almonds
• black-eyed peas
• black beans
• Brazil nuts
• buckwheat
• fish roe
• ground flaxseed
• lima beans
• molasses
• old-fashioned oats
• pine nuts
• pumpkin seeds
• roasted cashews
• sesame tahini
• soybeans
• sunflower seeds
• walnuts
• whole wheat

RLS and emotions

Emotional well being is an integral part of a healthy physical body. In conditions like restless legs syndrome, I ask my patients to look beyond the symptoms and consider what may be causing these issues in the context of their emotions. Are their legs trying to tell them something? Where are they experiencing emotional restlessness in their lives? It is important to take a step back and take an honest look at the bigger picture of inner well-being. It’s amazing what we can discover when we think about changes we need to make in our daily lives that may be contributing to physical symptoms from stress, or other emotional variables.

When we work with our body naturally, we can utilize safe and effective techniques such as nutritional supplementation to help correct some of the imbalances. Conditions like restless legs syndrome can significantly interrupt daily life, but we can work to figure out what our body needs, and provide that in a course of treatment. When we use our body’s own wisdom to heal, we can rest more than our legs, we can rest our minds, and our spirits. And that is definitely worth the effort.

by Marcelle Pick, OB/GYN NP

Stress affects women in so many ways – one of the greatest reasons women come to see me is because they aren’t sleeping – most of the time it’s related to stress. Fuzzy thinking, fatigue, insomnia can have profound effects on the way women navigate through their day – and we all know that today more than ever before women have more responsibility and less down time!

Many women struggle with feelings of inadequacy – they don’t understand why they aren’t able to juggle everything in their lives effortlessly. When we really think about it, we can see that a cycle of stress/less sleep/more stress/ is playing out! No wonder we feel like we can’t keep up!

It’s a very personal journey to learn how to break this cycle. Every woman experiences stress differently, and every woman will have her own set of solutions to help cope with the stressors in her life. Women to Women always recommends looking at diet, lifestyle and nutritional supplements to help restore balance to a body which is being taxed in so many different ways.

In my experience, the anti-depressants and sleeping pills aren’t really the answers for women. Getting to the root cause of your stressors will help break the cycle being established – it takes more time than taking a pill – but the end result is worth it!

by Marcelle Pick, OB/GYN NP

Topics covered in this article:

• Herbal sleep remedies
• Sleep aids from natural biochemical
• Nutritional tips to improve sleep

It’s no secret that many women today will say they need more sleep. Even when we do finally get to go to bed, the quality of our sleep is not what it should be. All day we race from one task to the next, and when we lie down to rest, our minds continue to spin. We can be so bogged with thoughts of what we’ve done and what’s left to do to that sleep escapes us.

We all know that good, sound sleep is vital to our well-being. If you have trouble sleeping, there could be many causes, but many times I see a big connection between insomnia and stress. Our sleep cycles (circadian rhythms) are directly connected to our stress hormones. Many of the common sleep aids, such as Tylenol PM, Lunesta or Ambien don’t really address the source of sleeplessness, and they often have a “hang-over” effect which leaves users feeling groggy and foggy in the morning.

Thankfully, to inspire hope, nature has given us plenty of ways to promote restful sleep. You can get your sleep cycle back in balance by addressing the cause of the problem. And in the meantime, there are some safe and natural ways to help you get some much-needed rest in the meantime. Let’s look at this a little closer.

Herbal sleep aids

For hundreds of years, women have been using these herbs to promote relaxation and rest. I’ve promoted herbs at in my practice for decades and my patients have seen wonderful results.

• Passionflower (passiflora incarnate): Scientists believe this soothes the nervous system through increasing the availability of GABA, a relaxing chemical. It’s calming effects may also be determined by the same receptors in the brain which are sensitive to prescription-strength sedatives, but without the troubling side effects. Passionflower can be found in powders, tinctures, teas and infusions.

• Chamomile – Roman or English: (matricaria recutita, chamaemelum nobile): This herb’s relaxing and calming effects are most commonly attributed to the flavonoid apigenin. As with passionflower, apigenin appears to increase the availability of GABA in the brain. It is used commonly to treat sleeplessness, anxiety and nervousness.

• Kava kava (piper methysticum): The phytochemicals found in the root of the kava plant are thought to work through increased binding to GABA, dopamine and opiate receptors in the brain, and therefore help to relieve anxiety, insomnia and restlessness. The food and drug administration had concerns about kava and liver damage in 2002, but these concerns may have been related to overuse of the product or inferior product quality.

• Valerian (valeriana officinalis): This herb was used in ancient Greece and in Rome as a mild sedative and relaxant. In recent studies it has been proven effective as a sleep aid and anti-anxiety agent in both animal studies and in clinical trials. It works to relieve the brain’s nervous tension by binding to GABA receptors.

Good sleep habits

• Nutrition/Hydration: Consider what and when you’re eating and drinking. Some things to think about are: sugar, caffeine, alcohol. Keep track and see if you discover a pattern between your intake of these stimulants and your sleep.

• Establish a routine: Set a consistent bedtime if you can. Try to unplug and wind down one hour before bed. If you exercise, consider exercising in the morning.

• Assess your environment: Try to make sure your room is dark, fairly quiet and your bed is comfortable for you. Don’t let light, clocks, phones or other electronics disturb your rest.

• Think about your stress level: Cortisol is the stress hormone which is linked to your circadian rhythms. Supporting good adrenal health and cortisol balance can do a lot to help reset your sleep-wake pattern.

If you want to learn more, see our articles on adrenal imbalance and sleep.

Our body’s own sleep-support

Our own bodies have their own prescription for helping us sleep. When my patients come to me with sleep troubles, depending on their unique situation, I may use supplements to help them gently return to their normal sleep-wake pattern. These combine natural herbs, minerals and molecules to help you sleep naturally, without waking up groggy or feeling hung-over. Talk to your practitioner to see if you would benefit from supplements.

Note: If you are currently taking antidepressants or any medications for sleep or mood disorders, be sure to talk to your healthcare provider before stopping your medication or trying any of the supplements mentioned in this article.

• Phosphatidylserine (PS) is a molecule which is a basic component of our brain and of our nerve cell membranes. It may help cell-to-cell messaging and communication, and also help interaction between the hypothalamus, pituitary and adrenal glands. This allows for a more effective response to stress and so helps sleep.

• Melatonin is a hormone that is naturally produced by the gland in your brain known as the pineal gland (whenever it senses the sun going down, or you dim the lights). As melatonin increases, our body becomes less alert and more ready for sleep. Melatonin begins to decrease after puberty, more so even after the age of 40. Supplemental melatonin is very safe and beneficial for people with insomnia. You may want to think about discussing this option with your healthcare provider.

• 5-hydroxytryptophan (5-HTP) is an amino acid which is produced naturally in our bodies during the production of melatonin and serotonin. The supplemental form is extracted from the seeds of a plant named griffonia. 5-HTP supplements can be very helpful for the release of melatonin without accessing the brain’s light-regulation system, by increasing serotonin. This makes it beneficial as a sleep aid.

Minerals and vitamins to calm and support restful sleep

What about B Vitamins? As a general rule, it’s best to take B vitamins in the morning, or in the first part of your day. They help to decrease anxiety, and because of this, they are often included in natural sleep aids. However, taking B vitamins later in the day can sometimes make people feel more alert. Some women report an energy boost from the B-vitamin so in that case, it’s best to take them in the morning and after the noon meal or an afternoon snack. This may help to avoid the mid-afternoon slump which many of us feel, especially those who have an adrenal imbalance.

Some women are surprised to hear certain natural vitamins and minerals can be beneficial for sleep. Research has shown improvements in anxiety and stress with supplementation with vitamins and minerals. Low magnesium in particular has been found in studies to be associated with anxiety and poor sleep. The ratio of calcium to magnesium has also been correlated with perceived levels of anxiety and stress.

Combining factors

Feeling good involves looking at multiple factors. Sleep is indeed important to health, but it doesn’t tell the whole story. Our sleep patterns are determined by our environment, our diet our stress levels just to name a few. My wish for you is that you will find an approach which works for you to, not only to sleep well, but one that addresses your entire health picture.

Women to Women offers quality nutrient support, herbal stress support and our one-on-one phone support is always there for you. You don’t need to rely on the sleeping pills offered in the drug store. You can make choices that are uniquely right for you and that are natural.

by Marcelle Pick, OB/GYN NP

Our ancestors had it pretty easy when it came to sleep – when the sun went down you went to bed and to sleep – and when the sun arose so did you! Simpler times……

Women today talk of waking well before the sun, staying up well into the night or waking just a few short hours into sleep and tossing and turning through the night. What’s happened?

We can put into one simple word: Stress. Not just your ordinary everyday stress – like waking up late and rushing through your morning routine – but multiple, sometimes chronic stress which dysregulates your normal body rhythms and causes multiple imbalances which disrupt your sleep.

Your adrenal glands, which release your stress hormones (adrenaline and cortisol), are being called into action more and more during our busy days. Your body doesn’t differentiate the stress caused by seeing police lights in your rear view mirror to the stress placed on your body by missing a meal. In either scenario, cortisol is released to help you. When you are under constant stress, whether real or perceived, there may be a continual flow of cortisol and when your cortisol level is high at night, your body is getting the message to stay alert and awake.

When sleeping, our parasympathetic nervous system should be moderating our blood pressure, breathing and heart rate into a relaxed state. If we can’t relax, sleep will be difficult to achieve.

So many patients I see are so desperate for sleep that they have tried over-the-counter products which sometimes produce unwanted side effects. When I talk with these women, they want help in achieving a restful, restorative sleep.

So many are surprised when we talk about keeping stress at bay during the day to help with sleep. Finding ways to keep your stressors in balance will pay off with a good night’s sleep. Sometimes making a list with a potential plan helps, other times talking with a friend helps, exercise helps for some, prayer helps for others. What’s important is that you find something that will work for you!

I also talk with my patients about the stress that a body out of balance can cause with respect to sleep. For instance, when your hormones are out of balance, you may experience night sweats. Talk about disrupting sleep! If you are not eating well and your blood sugar is moving through peaks and valleys – especially at night, you may wake up hungry – getting out of bed, turning on the lights, eating, and then trying to get back to sleep can be a real challenge! So many factors help to keep your body in balance. Good sleep is a culmination of all of these!

I also ask women to eat mindfully when it comes to sugar, alcohol and caffeine. A food journal also helps.

Creating a sleep routine can be very helpful. Setting your bedtime to allow 7 hours of sleep establishes a routine that your stressed out body will appreciate.

Practice good sleep hygiene. This includes:

• Limit light in your bedroom. Dark shades or curtains on the windows, block lights from digital devices.
• Keep the temperature of your bedroom comfortable for sleep. Being too hot or too cold will awaken you.
• Turn off electronics – email, text, social media at least one hour before you go to bed. Allow your brain time to ‘power down’.
• Choose your reading carefully – any reading is not relaxing or causes your mind to whir is not going to help your sleep.
• Keep your bed for sleeping or sex. Send the right message to your body that being in bed is a time for sleep.
• Sleep only in your bed.
• Wear comfortable sleepwear. Clothes that are too tight or too loose will twist and bind and inevitably wake you.
• Consider a dietary supplement to help you fall asleep or stay asleep.
• Evaluate when you exercise. If you’re routine has been to exercise at night, you may want to consider moving that time to morning or midday.

Sleep is so important to help your body regenerate, rebuild and restore. A good night’s sleep is worth every effort you put into it!

 

by Marcelle Pick, OB/GYN NP

I’m sure that you’ve heard a lot about Lyme disease and how it can affect our bodies. Let’s explore more about this disease and what it might mean for you. Low-grade Lyme disease is very persistent and can exist in your body for years without being diagnosed. It usually is associated with the symptoms of feeling extremely tired and chronic fatigue. This is an important topic because the occurrence of Lyme disease has spread rapidly (it’s been identified in nearly all the U.S. states). And to compound the matter, it is frequently undiagnosed even after specific tests have been given to detect the disease. The actual diagnosis of Lyme disease if very difficult and is still even not well accepted in the medical community.

There are a variety of tests that have been developed to detect Lyme disease in humans, but vague or false results are commonly seen with the usual Lyme titers and also with the Western blot test. An increased sensitive test, called polymerase chain reaction (PCR) testing, is available in a few areas. The PCR test will identify the deoxyribonucleic acid (DNA) that is present in the Lyme bacteria. Polymerase chain reaction (PCR) is growing in its use and availability. However, PCR remains a research technique, in part because laboratories performing PCR tests must be meticulous in technique to minimize the likelihood of false-positive results

However; this only indicates if you have the Lyme bacteria in the present. If the test is negative it is certain that you do not have Lyme now. In addition, the test has not yet been standardized for regular diagnosis.

In addition, there is another confusing feature about Lyme disease. It is that although most cases respond quite well to antibiotic treatment, some symptoms might continue or recur in a few of the treated patients; and this would require additional antibiotic treatment. In some cases, a patient might develop ongoing chronic symptoms and might have permanent damage to the joints and nervous system. Some scientists speculate that treatment with specific antibiotics might even improve the survival of the Lyme bacterium, under certain conditions in some patients. This is why, if you suspect that you might have been infected with Lyme disease, it’s very important that you to contact a health-care professional who is familiar with the symptoms, the testing, and the treatment of this disease.

The good news is that you can make a full recovery from these infections (diseases such as Lyme disease and the Epstein–Barr virus) that deplete your energy. It might take a long time, even if you think you feel much better following your initial diagnosis and treatment course. We’ll talk more in other articles about immunologically–mediated symptom “constellation” conditions, such as these, that have symptoms of fatigue as a major side-effect. For now, suffice it to say that while we do not have all the answers (these conditions are complex), research continues and there is hope. Hang in there and continue to create your healthy lifestyle and take care of the most important person—you!

For more information, please see our more comprehensive articles on fatigue.

by Marcelle Pick, OB/GYN NP

Something new to try – yoga techniques for insomnia

Getting a good night’s sleep is underrated in our fast-paced culture and it can be hard to get into the habit of a good sleep routine. Research has shown that yoga can help insomnia. A small Harvard study showed that by practicing just 30-45 minutes of yoga, people fell asleep 30% faster and reduced their nighttime waking by 35%.

Kundalini is an ancient form of yoga based on the concept that there is “coiled energy” in the spine which connects to the “subtle body’s” energy centers and channels. The scientific community is studying Kundalini techniques, such as alternate nostril breathing, that are currently being practiced to help people manage anxiety, insomnia and other sleep disorders.

Alternate nostril breathing. When we’re under stress or feeling anxious, we tend to breathe mostly out of our right nostril, which is connected to our left brain. This activates our sympathetic nervous system, the channel responsible for the classic stress response – dilated pupils, increased core temperature, sweating, and increased heart rate and blood pressure. Check throughout the day to see what’s true for you — are you left or right-nostril dominant, or is your breathing alternating and balanced?

If you’re having trouble relaxing and falling asleep, or if you wake up during the night, try gently holding your right nostril closed with your finger, and breathe deeply and slowly through your left nostril for at least 3 minutes. Then release your finger and breathe normally.

This type of breathing is simple, but it may take some practice before you’re able to do it for several minutes at a time. If you have nasal congestion, try again later. This technique can be very effective and calming.

Meditation

One of the most wonderful ways to quiet your mind is through meditation. Meditation offers many health benefits, improving blood pressure, circulation, and heart health. It also supports mood, self-confidence, and relaxation.

Try this method to help clear away worries before bed. Focus on your breathing, without trying to change it. Quietly notice your inhalation and exhalation, returning your thoughts to your breathing whenever you realize you have become distracted. For more information on the wonderful benefits of breathing, read our article, “Deep Breathing – The Truly Essential Exercise.”

Good sleep is important to our overall health and wellbeing. During sleep, our cells take the time to heal and detoxify, refueling and recharging for the day ahead. By starting slow and making small changes, you can discover what techniques help you get the best night’s sleep.

by Marcelle Pick, OB/GYN NP

As primary caregivers, working mothers and instinctive people-pleasers, women are extremely prone to fatigue. Every day I see patients who commute to work 40+ hours a week, then zoom home to the demands of children, aging parents, and running a household, remaining on the go throughout the day and getting little rest at night.

It’s no wonder women are tired. And I’m not talking about ordinary fatigue here — the kind that goes away after a good night’s sleep. For so many women, fatigue becomes a chronic condition that silently undermines their lives and eventually their health.

When women do seek treatment for fatigue, their healthcare providers will often assure them their symptoms are perfectly normal. In part that’s because medical practitioners are as inured to fatigue as their patients — they’re tired too! But it’s also because they don’t take it seriously: fatigue isn’t a disease, after all.

The problem with this indifference is that chronic fatigue is a serious problem. Women are left with no options to reverse its downward spiral, which leads to premature aging, compromised immune function and, ultimately, heightened risk of disease.

But you don’t have to be trapped in the downward spiral! Fatigue — be it mild, moderate or severe — can for almost all women be reversed completely. And it’s a joy for me too to see women get their energy back — to see their whole love of life restored. So let’s talk about how you can do that for yourself.

The downward spiral into chronic fatigue

Once you’ve ruled out any serious medical condition, chronic fatigue begins as a deceptively simple problem: the demands on your body are greater than the support it is getting. The pattern starts as mild fatigue, which goes away after a good night’s sleep and a little exercise. But chronic fatigue is not temporary – symptoms persist and usually worsen with time, and a good night’s sleep leaves you feeling as tired as before.

Sometimes the downward spiral is triggered by a particularly stressful event, a bout with the flu, or a prolonged stretch of insomnia. In other cases the initial causes are more mysterious, and potentially more troubling. Symptoms of chronic fatigue tend to slowly worsen over time. Women, who are excellent multi-taskers, often ignore their fatigue until it leads to other symptoms, like depression, binge-eating and weight gain. Alternatively, some women tune out their bodies’ signals until they become too loud to ignore — a case of the blahs turns into feeling bone-tired each and every day.

Symptoms of fatigue

Symptoms of fatigue tend to build, slowly worsening, until you feel like a hamster stuck on an exercise wheel. And fatigue can show itself in many ways. For many women these symptoms ebb and flow with their monthly cycle. But in real fatigue they last for weeks or more. Eventually the symptoms are nearly constant. They include:

• Feelings of exhaustion (mental and physical)
• Being tired in the morning, even after a full night’s sleep
• Feeling rundown or overwhelmed
• Inability to bounce back or recover from illness or stress
• Headaches
• Joint pain
• Uncharacteristic muscle soreness after physical exertion
• Depressed mood, loss of energy, or “blah-ness”
• Poor short-term memory, confusion, irritability
• Lightheadedness or a “spacey” feeling
• Strong food cravings (particularly for sweets or other carbs)
• Dependence on caffeine, sugar or alcohol, especially in the afternoon and early evening
• “Second winds” after 6:00 pm

by Marcelle Pick, OB/GYN NP

If you’re suffering from constant fatigue, it’s a sign that your body’s normal systems are being disrupted. There’s no reason to try to push through or ignore it. If you’ve tried to get more sleep, reduce stress and change your lifestyle— but you’re still relentlessly tired — your fatigue deserves to be taken seriously. Fatigue tends to snowball, gradually worsening, until you feel like a hamster stuck on an exercise wheel — exhausted and losing steam but not getting anywhere.

The effects of constant fatigue — it’s more than being tired

Unfortunately, women often ignore their increasing fatigue until it leads to other symptoms. By that time, the side effects of fatigue may become nearly constant. They include:

• Feeling exhausted (mentally and physically)
• Being tired even after sleep
• Inability to bounce back from illness
• Headaches
• Joint pain
• Depression
• Poor short-term memory, confusion, irritability
• Food cravings (particularly for sweets/carbs)
• Getting a “second wind” after 6:00 PM that interferes with your ability to sleep later on

The key is not to dismiss your mild symptoms of fatigue when you first notice them. Instead, take the first step and figure out the cause of your fatigue.

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What are common underlying causes of fatigue?

I always pay close attention when any woman tells me she’s exhausted — even if it’s her only symptom. Fatigue is debilitating and discouraging because it can interfere with every aspect of your life — even the fun things.

For women, fatigue is often related to an underlying issue in the endocrine system. What’s more, one endocrine imbalance may be affected by another — such as over stressed adrenal glands intensifying symptoms of hormonal imbalance.

There may be other possible causes contributing to fatigue as well, including: chronic inflammation, food allergies and chemical sensitivities, Lyme disease or the other factors. And fatigue can also result from the combination of several of these factors. Working with a functional medicine practitioner can help you get to the root of your fatigue.

What is Chronic Fatigue Syndrome?

Chronic Fatigue Syndrome (CFS) is distinct from the types of fatigue we discuss here. CFS refers to severe, continued tiredness that is not relieved by rest and does not appear to be directly caused by other medical conditions. For more information, read our article, “Chronic Fatigue – Get Your Energy Back!” and our many other articles in our Insomnia and Fatigue section.

When fatigue takes over: one woman’s experience

Daniela, 33, somehow manages to keep up with her hectic life. She’s always busy in her job as an office manager, coordinating the activities of her two young sons, and training for a 5K race. But lately, she can’t seem to fall asleep at night and wakes up to scribble “to do” lists. And during the day, she’s having trouble focusing.