Insomnia - Trouble Sleeping

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Valerian for Insomnia and Other Sleep Disorders - NIH, Office of Dietary Supplements

Melatonin FAQ - American Academy of Family Physicians

Sleep Stategies for Shift Workers - National Sleep Foundation

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Sleep Insomnia

By the National Heart Lung and Blood Institute

Use your browser's back button to navigate the insomnia menu below.

• What Is Insomina
• Causes of Insomina
• Who Is At Risk
• Signs & Insomnia Symptoms
• Diagnosis
• Insomnia Treatments
• Key Points
• Sleep Insomnia Links

What is Insomnia?

Insomnia is a condition in which you have trouble falling or staying asleep. Some people with insomnia may fall asleep easily but wake up too soon. Other people may have the opposite problem, or they have trouble with both falling asleep and staying asleep. The end result is poor-quality sleep that doesn’t leave you feeling refreshed when you wake up.
Types of Insomnia

There are two types of insomnia. The most common type is called secondary insomnia. More than 8 out of 10 people with insomnia are believed to have secondary insomnia. Secondary means that the insomnia is a symptom or a side-effect of some other problem. Some of the problems that can cause secondary insomnia include:

• Certain illnesses, such as some heart and lung diseases
• Pain, anxiety, and depression
• Medicines that delay or disrupt sleep as a side-effect
• Caffeine, tobacco, alcohol, and other substances that affect sleep
• Another sleep disorder, such as restless legs syndrome; a poor sleep environment; or a change in sleep routine

In contrast, primary insomnia is not a side-effect of medicines or another medical problem. It is its own disorder, and generally persists for least 1 month or longer.

Insomina Overview

Insomnia is a common health problem. It can cause excessive daytime sleepiness and a lack of energy. Long-term insomnia can cause you to feel depressed or irritable; have trouble paying attention, learning, and remembering; and not do your best on the job or at school. Insomnia also can limit the energy you have to spend with friends or family.

Insomnia can be mild to severe depending on how often it occurs and for how long. Chronic insomnia means having symptoms at least 3 nights per week for more than a month. Insomnia that lasts for less time is known as short-term or acute insomnia.

Outlook

Secondary insomnia often resolves or improves without treatment if you can eliminate its cause. This is especially true if the problem can be corrected soon after it starts. Better sleep habits and lifestyle changes often help relieve insomnia. You may need to see a doctor or sleep specialist to get the best relief for insomnia that is persistent or for which the cause of the sleep problem is unclear.

What Causes Insomnia?

Causes of Secondary Insomnia

Secondary insomnia is often a symptom of an emotional, neurological, or other medical disorder, or of another sleep disorder.

The emotional disorders that can cause secondary insomnia include depression, anxiety, and posttraumatic stress disorder. Alzheimer's disease and Parkinson's disease are examples of common neurological disorders that can cause secondary insomnia.

A number of other diseases and conditions can cause secondary insomnia, including:

• Conditions that cause chronic pain, such as arthritis and headache disorders
• Conditions that cause difficulty breathing, such as asthma or heart failure
• Overactive thyroid
• Gastrointestinal disorders, such as heartburn
• Stroke

Sleep disorders, such as restless legs syndrome, also can cause secondary insomnia. In addition, secondary insomnia can be a side-effect of certain medicines or commonly used substances, including:

• Caffeine or other stimulants
• Tobacco or other products with nicotine
• Alcohol or other sedatives
• Certain asthma medicines (for example, theophylline) and some allergy and cold medicines
• Beta blockers (medicines used to treat heart conditions)

Causes of Primary Insomnia

Primary insomnia is not due to another medical or emotional condition and typically occurs for periods of at least 1 month. Whether some people are born with a greater chance of having insomnia is not clear yet. A number of life changes can trigger primary insomnia, including:

• Major or long-lasting stress and emotional upset
• Travel or other factors such as work schedules that disrupt your sleep routine

Even after these causes go away, the insomnia might stay. Trouble sleeping may persist because of habits formed to deal with the lack of sleep. These habits include taking naps, worrying about sleep, or going to bed early.

Who Is At Risk For Insomnia?

Insomnia is a common disorder. One in 3 adults occasionally has insomnia. One in 10 adults has chronic insomnia. Insomnia affects women more often than men, and it can occur at any age. However, older adults are more likely to have insomnia than younger people. People especially prone to insomnia include those who are:

• Under a lot of stress
• Depressed or who have other emotional distress
• Working at night or having frequent major shifts in their work hours
• Traveling long distances with time changes (jet lag)

What Are the Signs and Symptoms of Insomnia?

The main symptom of insomnia is trouble falling and/or staying asleep, which leads to lack of sleep. The lack of sleep can cause others symptoms, such as:

• Waking up feeling tired or not well rested
• Feeling tired or very sleepy during the day
• Having trouble focusing on tasks
• Feeling anxious, depressed, or irritable

• Have any new or ongoing health problems
• Have painful injuries or health conditions (such as arthritis)
• Take any medicines (over-the-counter or prescription)

• How often you have trouble sleeping and how long the problem has persisted
• When you go to bed and get up on workdays and days off
• How long it takes you to fall asleep, how often you wake up at night, and how long it takes to fall back asleep
• If you snore loudly and frequently, or wake up gasping or feeling out of breath
• How refreshed you feel when you wake up, and how tired you feel during the day
• How often you doze off or have trouble staying awake during routine tasks, especially driving

• Whether you worry about falling asleep, staying asleep, or getting enough sleep
• What you eat or drink, and whether you take medicines before going to bed
• What routine you follow before going to bed
• What the noise level, lighting, and temperature are like where you sleep
• What distractions, such as a TV or computer, might be in your bedroom

Getting a Physical Exam

How Is Insomnia Treated?

Avoid substances such as:

• Caffeine, tobacco, and other stimulants taken too close to bedtime (effects of caffeine can take as long as 8 hours to wear off).
• Certain over-the-counter and prescription medicines that can disrupt sleep (for example, some cold and allergy medicines).
• Alcohol. An alcoholic drink before bedtime may make it easier for you to fall asleep. But alcohol triggers sleep that tends to be lighter than normal and makes it more likely that you will wake up during the night.

Good bedtime habits include:

• Following a routine that helps you wind down and relax before bed, such as reading a book, listening to soothing music, or taking a hot bath.
• Not exercising, eating heavy meals, or drinking a lot shortly before bedtime.
• Making your bedroom sleep-friendly. Avoid bright lighting and minimize possible sleep distractions, such as a TV, computer, or pet.
• Going to sleep around the same time each night and waking up around the same time each morning, even on weekends. If possible, avoid night shifts or alternating schedules at work and other causes of irregular sleep schedules.

Cognitive-Behavioral Therapy

• Relaxation training and biofeedback at bedtime to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood.
• Replacing worries about not being able to fall asleep with more positive thinking that links being in bed with being asleep. This method also teaches you what to do if you’re unable to fall asleep within a reasonable period.
• Talking with a therapist individually or in group sessions to help you consider your thoughts and feelings about sleep. This method may encourage you to describe thoughts racing through your mind in terms of how they look, feel, and sound. The goal is for your mind to settle down and stop racing.
• Limiting the time you spend in bed while awake. This method involves setting a sleep schedule and, at first, limiting total time in bed to the typical short length of time you’re usually asleep. At first, this schedule may make you even more tired because some of the allotted time in bed will be taken up by difficulty sleeping. The resulting fatigue (tiredness) is intended to help you get to sleep more quickly. Gradually, the length of time spent in bed is increased until you get a full night of sleep.

For success with this type of therapy, you may need to see a therapist who is skilled in this approach weekly over 2 to 3 months. Cognitive-behavioral therapy is as effective as prescription medicine for many types of chronic insomnia. It also may provide better long-term relief than medicine alone.

Medicines

Insomnia - Key Points

Links to Other Information About Insomnia NHLBI Resources

NIH State-of-the-Science Conference Statement: Manifestations and Management of Chronic Insomnia in Adults (NIH Consensus Development Program)

Current Research (ClinicalTrials.gov)

Sleep and Vitality 101

By Jacob A. Teitelbaum, M.D.

More and more Americans are feeling overworked, overtired, and overcome by life’s demands. We just do not have the energy we need to meet our responsibilities to the people we care about. More importantly, we don’t even have the energy to have fun! It seems that a constant feeling of fatigue has become part of the American way of life.

Research has shown that the same processes that cause lack of energy can rob us of sleep, saddle us with excess weight, disrupt our hormonal balance, and create significant amounts of stress in our daily lives.1 Chronic stress can dramatically contribute to fatigue, sleep disorders, irritability, and anxiety.2 This research simply confirms what most of us already know–uncomfortable stress can really wear us out mentally and physically! It can take away the satisfaction of a job well done. It can take away our ability to believe in ourselves. And, sadly and maybe most importantly, continual stress can take the fun and joy out of life.2

In this article, I discuss the 3-step process I call “Vitality 101.” People do not have to accept pain, insomnia, or fatigue. It’s time for everyone to feel great and have a life they love!

Step 1 - Nutrition

Good overall nutrition is important for everyone! As a foundation product to support energy levels, a powdered drink mix is a pleasant, easy way to ensure that you are taking all of the needed vitamins, minerals, and amino acids that you need to have great energy all through your day.

In addition to the powdered energy drink mix, it is important that you also take a high potency vitamin B-complex supplement. This should include niacinamide, thiamin, riboflavin, vitamin B6, vitamin B12, pantothenic acid, and choline, which are especially important to restore the energy production needs of your body. It is also critical to get enough water, as most Americans are chronically dehydrated.

Step 2 – Rest Your Body

Having trouble sleeping is one of the most troubling symptoms of stress. While the stress is wearing us down and making us tired, it’s also keeping us tense and unable to relax. The result? That easy drift into sleep becomes harder and harder. And if we are lucky enough to actually get some shut-eye, stress will often wake us up, sometimes several times a night.3

This occurs because excess stress suppresses the sleep center in the brain.4,5 It is important to break the “stress/insomnia cycle” early, before it results in pain and hormonal and immune dysfunction!

Because good quality sleep is how the body repairs and re-energizes itself, it may be helpful to use herbal products to promote good quality sleep. There are many natural supplements that are marketed as sleep formulas. To get the best results, it is very important that the right ingredients are in the sleep formula you buy. Look for a supplement that has a blend of herbs that promote deep sleep, such as valarian, L-theanine, hops, passionflower, Jamaica dogwood and wild lettuce. This combination of herbs is important as each herb addresses a different aspect of sleeplessness and muscle tension caused by stress. Taking only one or two of these herbs alone is much less likely to be effective.

Step 3 – Manage Excess Stress Levels

In this fast paced world, it is important to learn to manage the stressors in our lives. Glandular extracts, such as raw adrenal extract, can offer natural support to help our bodies deal with the effects of stress and, in turn, can boost your energy levels.

Exercise is another stress buster. Using your body physically is important for good health. Find something that is fun for you, however, or you are unlikely to stick with it!

It will be great to get a good night’s sleep. Are there also any other natural alternatives that could help promote relaxation and increase my energy levels during the day?

Yes, there are. Rhodiola rosea is an all natural herb that has long been used to help relieve stress and increase energy. Rhodiola has also been used to lift our moods, improve sexual satisfaction, and even help in certain nervous system disorders.23 First used in Siberia and Russia, Rhodiola is now being extensively studied and has been found to increase resistance to toxins (both physical and chemical), balance the work of the body, help memory storage and mental functioning, and improve resistance to physical and emotional stress.23,24

In clinical trials, the most effective Rhodiola rosea extract was found to contain 3% rosavins and 1% salidroside. While there are many Rhodiola supplements in health food stores, only those containing these specific amounts can provide the best results.23,24

Rhodiola rosea is an all-natural herb that has long been used to help relieve stress and increase energy. In Clinical trials, the most effective Rhodiola rosea extract was found to contain 3% rosavins and 1% salidroside.

Does stress zap my energy in any other ways besides making me lay awake at night and causing me to be a zombie the next morning?

Most people are familiar with the body's dramatic response to an emergency. The heart pounds, the muscles constrict, and the lungs expand—and while this is happening, we are capable of greater than normal strength and speed. This response is the body's way of rescuing itself when faced with an emergency. We don't have to think about it to make it happen. It's automatic.

The same can be said of a chronic stress response. Whether we're late for a business meeting because we're stuck in traffic, or worrying about how we are going to pay for our children’s college tuition, our response to stress happens automatically. The difference between the two is that the body's response in an emergency starts and resolves itself quickly. The response to being stuck in traffic may not.

The body makes the “stress hormone”, cortisol, to handle the normal stresses of day-to-day living. But in an emergency situation, the adrenal glands, located above the kidneys, secrete increased amounts of this hormone until the emergency passes. Then the body returns to its normal function. Unfortunately, however, chronic stress is more complex. When our body is subjected to increased amounts of the hormone, cortisol, for an extended time, this can damage our health and deplete our energy. Studies have shown that increased cortisol production caused by long-term, chronic stress depletes our energy levels by creating havoc with our hormone balances and exhausting our adrenal glands.25-28

How can I control the stress in my life and re-energize?

Many people who are under constant stress may have adrenal burnout. Adrenal burnout occurs when the adrenal glands are constantly producing cortisol in response to chronic stress. Over time, this exhausts the adrenal reserve, meaning the adrenal gland can no longer increase cortisol production in response to stress.29

The good news is that changes in our hormone levels can return to normal when stress is decreased. The key is learning how to deal with daily stress to allow the body to return to its normal state. I discuss additional techniques for coping with stress in my recent book Three Steps to Happiness! Healing Through Joy (see my website, www.jacobteitelbaum.com, for more information). In addition to stress control, it is important to supplement your adrenals with a glandular therapy regimen to ensure healthy cortisol levels and adrenal function.29,31 Glandular therapy, which uses the concentrated forms of bovine (cow) or porcine (pig) glands, can improve the health of our glands. Pioneers in the field of endocrinology (the study of hormones) hypothesized that glandular extracts worked by providing nutrients the body lacked and thus repaired the malfunctioning gland.30

Adrenal Extract

If you are one of the unlucky folks with stressed out adrenal glands, you should see great results from taking raw adrenal supplements. Be sure to buy adrenal extract supplement that contains both whole adrenal and cortex adrenal. The best adrenal supplement should also contain vitamin C, vitamin B6, and pantothenic acid. That’s because the adrenal glands use these vitamins to manufacture cortisone and other compounds. It just makes sense to purchase an adrenal supplement with these adrenal-supportive nutrients.31-39

Liver Extract

Did your grandmother ever tell you to eat your liver so that you didn’t get “tired blood”? Well, it turns out that she was right. Liver extract is another glandular extract that can help improve energy levels.

Liver extract is an excellent source of highly bioavailable nutrients including iron, B vitamins (especially B12), and other minerals. The stamina and energy-enhancing benefits of liver are widely touted. Liver extract has been shown to support healthy function of the liver and increase the energy levels inside our body. 40-42

Because heat will destroy the key components in the liver, a high quality liver extract supplement should be cold-processed and encapsulated to enhance speed and absorption of nutrients from liver. A high quality aqueous liver extract supplement should also contain vitamin B12 to support healthy blood iron and oxygen levels to energize.

I know exercise can help alleviate stress, but I am too tired to exercise and I am getting fat!

One of the most frustrating aspects of stress is the connection to weight gain. Fatigue leads to weight gain, which leads to more fatigue, which can cause more stress, which only causes more fatigue. One of the culprits responsible for this vicious cycle is the lack of sleep. This causes growth hormone deficiency which is one of the causes of the weight gain.43,44

Bitter orange is a nutritional supplement that can give you a boost of energy to break this cycle. It comes from the unripened dried fruit of a citrus fruit called Citrus aurantium.45,46 Bitter orange extract contains a natural alkaloid, synephrine, that is related to the ephedrine alkaloids.46-49 Similar, but not identical in structure to ephedrine, synephrine can suppress your appetite, boost your energy, and increase metabolism without serious negative side effects.

Synephrine attaches (in a process known as “selective binding”) only to the specific receptors in the body’s cell which increase the rate of fat release from body stores and increases metabolism (thermogenesis). Other substances that may help with weight loss are non-specific binders, meaning they bind to many cell receptors in the body. This can lead to side effects such as elevated heart rate, elevated blood pressure, anxiousness, insomnia, and dry mouth.47,49,50 Because bitter orange binds only to specific receptors, it does not cause these adverse effects.

It’s important to look for a bitter orange supplement that also contains natural sources of caffeine, such as green tea and cola nut. Scientists have found that the energy boosting properties of bitter orange extract work better when combined with caffeine. Clinical studies have found that caffeine actually prevents the body from becoming resistant to the effects of synephrine. Caffeine combined with synephrine also helps stimulate other cellular receptors that are important to weight loss.48

What other supplements can help boost my energy?

Panax ginseng has been a part of Chinese medicine for over 2,000 years. It is traditionally used to support health and the immune system.51 There is a great deal of research on this herb showing it can help our cardiovascular system, our central nervous system, our overall hormone function, and help boost our fat metabolism.52,53 Panax ginseng extract has even been found to help athletic endurance.54

But make sure that the ginseng extract you buy is bound to phosphatidylcholine. Research has shown that when ginseng (as well as other herbs) are combined with phosphatidylcholine, they work faster and are absorbed better.55

Eleutherococcus extract is another herbal supplement that helps boost energy. This funny sounding extract, formerly known as Siberian ginseng, has been used to restore vigor, improve general health, restore memory, promote healthy appetite, and increase stamina. Eleutherococcus extract diminishes fatigue and boosts energy by increasing the weight of the adrenal glands and regulating levels of cortisol.56,57

Lifestyle Treatments

Altered digestion, food intolerances, decreased energy, fatigue, cognitive problems, and sleeplessness create the need for changes in daily living routines. These can include alterations in diet; exercise modifications; alterations in activities of daily living according to one's energy level; and sleep/rest management. All may require the assistance of a professional clinician, such as a chiropractor, nutrition specialist, physical and/or occupational therapist, mental health professional, or sleep therapist.16

Conclusion

Super busy lives demand super strength nutrition. Start with a powdered nutritional supplement and make sure you are getting at least 8 hours of sleep a night. Rhodiola rosea, glandular extracts, and ginseng can offer natural nutritional support in your busy life to boost your energy levels. These nutritional supplements can be used daily and you will feel energized to get through each day's challenges and opportunities!

Resources

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2. Stress and Fatigue. Discovery Health Website. Available at: http://health.discovery.com/diseasesand cond/encyclopedia/3090.html. Accessed on January 29, 2003.

3. Sleep and Depression. National Sleep Foundation Website. Available at: http://www.sleepfoundation.org
/ask/sleepanddepression.html. Accessed on July 30, 2002.

4. Miller DB, O'Callaghan JP. Neuroendocrine aspects of the response to stress. Metabolism 2002 June;51 (6 Suppl 1):5-10.

5. Rodenbeck A, Hajak G. Neuroendocrine dysregulation in primary insomnia. Rev Neurol (Paris) 2001 Nov;157(11 Pt 2):S57-61.

6. Lactucarium. In: Fleming T., ed. PDR® for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998: 453-4.

7. Hops. In: Blumenthal M., ed. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 1998: 147.

8. Hops. In: Fleming T., ed. PDR® for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998: 400-1.

9. Jamaica Dogwood. In: Fleming T., ed. PDR® for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998: 428-9.

10. Yofogoshi H, Kobayashi M, Mochizuki M, Terahima T. Effect on theanine, r-glutamylethylamide, on brain monoamines and striatal dopamine release in conscious rats. Neurochemical Research. 1998;23: 667-73.

11. Juneja L, Chu D, Okubo T, Nagato Y, Yokogoshi H. L-theanine: a unique amino acid of green tea and its relaxation effect in humans. Trends in Food Science & Technology. 1999; 10: 199-204.

12. Atelle AS, Xie JT, Yuan CS. Treatment of insomnia: an alternative approach. Altern Med Rev. 2000;5:249-259.

13. Leathwood PD, Chauffard F, Heck E, Munoz-Box R. Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man. Pharmacol Biochem Behav. 1982;17:65-71.

14. Leathwood PD, Chauffard F. Aqueous extract of valerian reduces latency to fall asleep in man. Planta Med. 1985;51:144-148.

15. Lindahl O, Lindwall L. Double blind study of a valerian preparation. Pharmacol Biochem Behav. 1989;32:1065-1066.

16. Balderer G, Borbely AA. Effect of valerian on human sleep. Psycho-Pharmacol. 1985;87:406-409.

17. Schulz H, Stolz C, Muller J. The effect of valerian extract on sleep polygraphy in poor sleepers: a pilot study. Pharmacopsychiatry. 1994;27:147-151.

18. Robbers JE, Tyler VE. Tyler's Herbs of Choice. New York, NY: The Haworth Herbal Press; 1999:154.

19. Valerian. In: Blumenthal M, Goldberg A, Brinckmann J., ed. Herbal Medicine. Expanded Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 2000:397.

20. Valerian radix. In: WHO Monographs on Selected Medicinal Plants, Vol. 1. Geneva: World Health Organization; 1999:267-276.

21. Passion Flower. In: Fleming T., ed. PDR® for Herbal Medicines. Montvale, NJ: Medical Economics Company; 1998: 573-5.

22. Passion Flower. In: Blumenthal M., ed. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 1998: 179-80.

23. Kelly G. Rhodiola rosea: A possible plant adaptogen. Altern Med Rev. 2001;6:293-302.

24. Brown R, Gerbarg P, Ramazanov Z. Rhodiola rosea: A phytomedicinal overview. Herbalgram. 2002;56: 40-52.

25. Porth C. Vascular smooth muscle. In: Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998:315-316.

26. Sapolsky R. Stress, Glucocorticoids, and Damage to the Nervous System: The Current State of Confusion. Stress. 1996 ;1:1-19.

27. McIntosh L, Sapolsky R. Glucocortoids may enhance oxygen mediated neurotoxicity. Neurotoxicity. 1996; 17:873-82.

28. Lombroso P, Sapolsky R. Development of the cerebral cortex: Stress and brain development. J Am Acad Child Adolesc Psychiatry. 1998;37:1337-9.

29. Teitelbaum J. From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001:1.

30. Glandular Therapy. In: Lininger S, ed. The Natural Pharmacy. Rocklin, Calif: Prima Publishing; 1998: 550-2.

31. Redmann A, Mobious K, Hiller HH, Oelkers W, Bahr V. Ascorbate depletion prevents aldosterone stimulation by sodium deficiency in the guinea pig. Eur J Endocrinol. 1995;133:499-503.

32. Kolb E. Some recent discoveries of metabolism and function of ascorbic acid.Z Gestamte Inn Med. 1990;45:205-210.

33. Ghosh MK, Chattopadhyay DJ, Chatterjee IB. Vitamin C prevents oxidative damage. Free Radic Res. 1996;25:173-179.

34. Kodama M, Kodama T, Morakami M, Kodama M. Vitamin C infusion treatment enhances cortisol production of the adrenal via pituitary ACTH route. In Vivo. 1994;8:1079-1085.

35. Fatima H, Lhuisser M, Guilland JC. Chronic exercise affects vitamin B6 metabolism but not requirement of growing rats. J Nutr. 1997;127:1219- 1228.

36. Benderitter M, Hadj-Saad F, Lhuisser M, Maupoil V, Guilland JC, Rochette L. Effects of exhaustive exercise and vitamin B6 deficiency on free radical oxidative process in male trained rats. Free Radic Biol Med. 1996;21:541-549.

37. Tarasov IuA, Sheibak VM, Moiseenok AG. Adrenal cortex functional activity in pantothenate deficiency and the administration of the vitamin or its derivatives. Vopr Pitan. 1985;4:51-54.

38. Pietrzik K, Hesse C, Hotzel D. Influencing of aceltlyation and corticosterone biosynthesis through long-term pantothenic acid delivery in rats. Int J Vitam Res. 1975;45:251-261.

39. Teitelbaum J. From Fatigued to Fantastic. New York: Penguin Putnam Inc.; 2001: 34-7.

40. Combe GF. The Vitamins: Fundamental Aspects in Nutrition and Health. San Diego, Calif: Academic Press, Inc; 1992: 379, 383.

41. Yokochi S, Ishiwata Y, Saito H, et al. Stimulation of antiviral activities of interferon by liver extract preparation. Arzneimittelforschung. 1997;47:968-974.

42. Preziosi P, Nistico G, Marano V. Double-blind study of a total liver extract in patients with hepatic dysfunction. Int J Clin Pharmacol Biophram. 1975;11:210-215.

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44. Kato Y, Murakami Y, Sohmiya M, Nishiki M. Regulation of human growth hormone secretion and its disorders. Intern Med 2002 Jan;41(1):7-13.

45. Bitter Orange. In: Blumenthal M., ed. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 1998: 313-14.

46. Bruneton J. In. Pharmacognosy, Phytochemistry, Medicinal Plants. Hatton CK, trans-ed Paris, France: Lavoisier Publishing; 1995: 447–8.

47. Penzak S, Jann M, Cold J, Hon Y, Desai H, Gurley B. Seville orange juice: synephrine content and cardiovascular effects in normotensive adults. J Clin Pharmacol. 2001; 41:1059-63.

48. Colker C, Kalman D, Torina G, Perlis T, Street C. Effects of Citrus aurantium extract, caffeine, St. John’s wort on Body weight, lipid levels, and mood states in overweight healthy adults. Current Therapeutic Research. 1999; 60: 145-53.

49. Pathak B, Gourgeon R. Thermic effect of Citrus aurantium in obese subjects. 1998. McGill Nutrition and Food Science Center, Royal Victoria Hospital.

50. Hedrei P, Gourgeon R. Thermogenic effect of beta-sympathicomimetric compounds extracted from Citrus aurantium. 1997. McGill Nutrition and Food Science Center, Royal Victoria Hospital.

51. Colker C, Kalman D, Torina G, Perlis T, Street C. Effects of Citrus aurantium extract, caffeine, St. John’s wort on Body weight, lipid levels, and mood states in overweight healthy adults. Current Therapeutic Research. 1999; 60: 145-53.

52. Ginseng root. In: Blumenthal M., ed. Herbal Medicine: Expanded Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 2000:170-175.

53. Gillis CN. Panax ginseng pharmacology: a nitric oxide link? Biochem Pharmacol. 1997;54:1-8.

54. Singh A, Saxena E, Bhutani KK. Adrenocortocosterone alteration in male, albino mice treated with Trichopus zeylanicus, Withania somnifera and Panax ginseng preparations. Phytother Res. 2000;14:122-125.

55. Morazzoni P, Montalbetti A, Malandrino S, Pifferi G. Comparative pharmacokinetics of silipide and silymarine in rats. Eur J Drug Metab Pharmacokinet. 1993;18:289-297.

56. Blumenthal M, Goldberg A, Brinckmann J., ed. Herbal Medicine. Expanded Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 2000:106-109.

57. Wagner H, Norr H, Winterhoff H. Plant Adaptogens. Phytomedicine. 1994;1:68.

Herbal Ingredient Effect on Sleep Insomina

Hops - Acts as mild sedative and has a sleep inducing effect. 7,8

Jamaica Dogwood - Has been found to be mildly sedative and is often used for anxiousness.9

L-Theanine - Causes significant increases of neurotransmitter concentrations in the brain, which promotes muscle relaxation and improves sleep.10,11

Passionflower - This herb has been clinically studied for its ability to improve sleep quality.12-20

Valerian - This herb eases nervousness and insomnia.21,22

Insomnia - Sleep Resources

Women and Sleep National Sleep Foundation

Sleep Disorders National Library of Medicine

Children's and Sleep National Sleep Foundation

ClinicalTrials.gov Sleep Initiation and Maintenance Disorders - National Institutes of Health

Sleep Disorders National Jewish Medical and Research Center

Sleep Disorders Patient Education Institute - Interactive Tutorial

Sleep Disorders Food and Drug Administration

Circadian Rhythm Disorders Cleveland Clinic Foundation

Insomnia Mayo Foundation for Medical Education and Research

National Center on Sleep Disorders Research National Center on Sleep Disorders Research

Brain Basics: Understanding Sleep National Institute of Neurological Disorders and Stroke

Insomnia: How to Get a Good Night's Sleep American Academy of Family Physicians

Good Night's Sleep National Institute on Aging

Sleep and Seniors: Insomnia Isn't Inevitable as You Age Mayo Foundation for Medical Education and Research

Sleep and Aging National Institute on Aging

Depression, Behavior Problems More Common in Kids with Sleep Disorder Nemours Foundation

Nutraceutical Research

A growing body of evidence shows how nutraceuticals may offer many advantages for the future of medicine.

• Carotenoids
• Colostrum
• Cranberry
• Elderberry Extract
• Fucoidans, Alginates, Laminarines
• Glyconutrients
• Lo Han Kuo
• Lotus Seed
• Polyphenols