Sleep is complicated or perhaps not so much - Sleep Matters

Sleep Matters

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Sleep is complicated or perhaps not so much

Metabobbly profile image

I am 61 and have had various issues with insomnia. In many ways now I have less of a problem than I had previously, but I have learnt a lot and I now take quite a range of supplements that enable me to handle sleep issues so at times I am no longer tired during the day.

I have joined this forum to see if there is anything else I can try. That is not so much because I am not handling things already, but I am studying how sleep works and as part of this it helps to read anecdotal reports as well as RCT research papers.

At least from my point of view I no longer normally have a problem going to sleep, but I do from time to time have a sleep maintenance problem where I wake up in the night and have difficulty getting back to sleep.

What I would say to anyone is that the first thing to do for good sleep is what is called CBT - Cognitive Behaviour Therapy (keeping the room dark, not looking at phones or computers (avoiding blue light) and having regular sleep patterns.

After that, however, I think it comes to the three sleep systems that in the end come back to the activity of the neurons.

The first of these is sleep pressure, the adenosine, (which can be affected by caffeine)

The second of these is the GABA Glutamate balance which controls how active neurons are (beyond how much people are thinking). This is affected by lots of things including Magnesium, Calcium and Vitamin D - as well as how much people are worrying about things.

The third is the melatonin system where the Pineal Gland inserts melatonin into the Cerebral Spinal Fluid that bathes the brain and has what is called a GABAergic effect.

It is I think important to separate out the melatonin processes because they are clearly circadian.

16 Replies

You sound like me, and I have had isomnia and tried everything, for 40 years. My great trigger is none that you mention, but stress, Any emotional disturbance, even though I am not thinking about it, stops me getting to sleep and when I do, staying asleep. One light at the end of the tunnel is the low frequency , Cranial Electric Stimulator. It has ear clips through which it delivers (I set for half an hour) tiny pulses, Some, like the Alpha, are expensive and that was referred to on a TV programme. My husband found the same thing by Atang, Model AT-9. Affordable. After a couple of months assessment I think this has improved the length and quality of my sleep. If you haven't done so already, try also asessment in a sleep lab.

Metabobbly profile image
Metabobbly in reply to Trill

Stress will be a thing because it makes you think about things. Magnesium products are a good way of handling this. Magnesium Threonate is quite a good one. I had a really good sleep last night with a mixture of things one of which was Mg T.

You do, however, need to make sure a number of things are in the right place. Just one thing won't be enough. So you also need to get Vitamin D levels right.

Trill profile image
Trill in reply to Metabobbly

Thanks. I already take Mg and Vit D.

I also deal with insomnia and take 5 pills of 2 different sleeping pills. I've tried lots of different meds for my insomnia and other mental illness problems through the years. They work for awhile then quit. I have racing thoughts constantly and have to take sleeping pills to shut it down or I wouldn't get any sleep. I take melatonin for my naps, when I take one, but they only help me to sleep for 2 or 3 hours. I'm on many different meds for all my health problems and I'm so tired of taking them, but I have to. I saw some kind of machine on the internet to help with depression, but my insurance won't pay for it. I haven't heard of one to help you sleep. I'll have to check it out.

Try daily meditation or at least quiet breaks during the day where you're not dwelling on anything for say, 20 minutes.

Watch out for relying on meds/supplements -- they could be hard to cope with in the long term.

~wbic, member sleep-matters forum

Metabobbly profile image
Metabobbly in reply to wbiC

Some supplements (eg Vitamin D) are good to take whenever you don't get enough from the Sun. Meds, however, may be best to avoid getting dependent on.

wbiC profile image
wbiC in reply to Metabobbly

Vit D's probably harmless (studies have shown no osteoporosis benefit except for those in institutional care). But for anyone with osteoporosis, it's probably a must anyway.

I was thinking more about any readers taking melatonin for extended periods (much better imo, to tackle any underlying daytime anxiety as the way to make it easier to stay asleep at night).

~wbic, member sleep-matters forum

Metabobbly profile image
Metabobbly in reply to wbiC

I agree that people should be careful with melatonin as it has a range of effects (the vast majority of which are good, however). However, it is clear that people do need to maintain an adequate level of vitamin D. Furthermore there is a gene that is upregulated when people have a higher level of vitamin D and that helps with other things because it emphasises a new metabolic pathway. However, because the metabolism of vitamin D is a multi stage process it is something that requires individual thought for each person taking it.

Adding to this last night, for example, I slept well from just before 10pm to just after 4.15am. My fitbit measured that as 5 1/2 hours sleep and I know I will be able to work all day without being tired. I am 61 and I have had insomnia problems for decades, but I don't take medication, instead I use CBT and supplements (admittedly quite a complex regime of supplements). Although exogenous melatonin has its role I did not have to take it to maintain my sleep last night. I do think the route to improving sleep without meds is the best option. When I have tried things like diphenhydramine they have been really counter productive.

My test of adequate sleep is not being tired all day until about 9pm.

wbiC profile image
wbiC in reply to Metabobbly

10pm-415pm = 6 1/4 hrs, within the healthy norm of 6-7 hours ('8' is now recognized as too much for many people).

Five hours or less is thought to lead to eventual mental disorders/dementia over the long term (for most people, I imagine there are exceptions).

I'd go by the clock and not 'fitbit'. Do you receive renumeration for your activities being downloaded (and 'monetized') by fitbit's maker?

~wbic, member sleep-matters forum

Metabobbly profile image
Metabobbly in reply to wbiC

I record both the timing and how long fitbit thinks I am awake. I do know that I spend some time awake between my original sleep time and when I finally wake up. I also concentrate on what I think is good for my own health and don't really worry about whether fitbit obtain useful aggregate information or not.

Sleep is insanely complicated and no amount of reading research will tell you how all aspects of it work because researchers don't know how it all works exactly. Adenosine is one of dozens of compounds that triggers sleep pressure. Gaba and glutamate are the tip of another iceberg that no one is sure how big it is. You need to at least expand beyond the pineal gland to the full HPA axis and ways it can malfunction. Even then you still will only have a fraction of what can play a role in insomnia. neuroscientificallychalleng...

We have an ever growing list of things that create sleep pressure or stimulate alertness. We also have an ever growing list of changes that occur to every possible type of substance in the body from day to night and alteration to the function of majority of organs during sleep. One of the last papers I read was a researcher who basically said every researcher they knew investigating sleep disorders had stopped researching problems with sleep and started researching what sleep looks like when it works correctly because no one even knows what should be happening. Every complex living organism is required to sleep in some way and we have no idea why.

If you want info on all possible things to look at that could potentially impact insomnia I'd have to write you a multiple chapter book. A good place to start looking for the cause of your insomnia is in your various health issues even if they are minor and seem unrelated. That can provide clues for a more specific approach. Otherwise just on the surface you've got 3 major areas of potential sleep disturbances consisting of neurotransmitter balance, hormone balance, and immune system shifts that occur both to trigger sleepiness and alertness. The alerting part is important during the day or you don't respond to the sleep pressure when it happens in the evening. If you are always suffering high sleep pressure and are functioning through being constantly tired for weeks, months or even years then how does your body recognize when it does need to go to sleep? Everyone concentrates on the sedating parts and nighttime activities but you need day to have night or it all blends into one and sleep becomes random. Those with chronic fatigue syndrome understand this the best.

Melatonin is an often over hyped and misunderstood signalling substance that does more to trigger the release of other substances that cause sleep pressure and decrease alerting substances rather than directly making you sleepy. Melatonin actually interferes with deep sleep and rem if it remains high into the night and can be very bad to increase depending on the individual and what problems they are having. Humans can also have normal nightly sleep without melatonin production if they have no other problems contributing to poor sleep. Not that melatonin isn't quite helpful at maintaining circadian rhythm, important for things beyond sleep, and it contributes to not only your day/night rhythm but seasonal awareness as well. It can certainly be very good to try if you are having issues maintaining a consistent sleep schedule but it will not suddenly create sleep pressure by itself and supplements rather than attempts at natural increases may reduce sleep quality for many people.

Gaba is a better one to concentrate on for a quicker solution but not as easy to supplement since plain GABA will not cross the blood brain barrier. You have to use modified forms or gabapentinoids such as valerian root. GABA has it's negatives as well but far less of them and has a direct effect on the nervous system and brain activity.

When we are talking neurotransmitters the 2 most major ones for practically everything are serotonin and dopamine. Everyone hears plenty about serotonin. Dopamine is commonly mistakenly thought of as nothing but a stimulate and avoided or ignored. Half it's receptors are actually downregulating (reduce nervous system and brain activity). This is actually greater than the number of serotonin receptors, which are mostly alerting with only 1 pair being calming. ADHD is a good example if you are at all familiar with the rapid thoughts, impulsive actions, and often mood imbalances that are a result of low dopamine in certain parts of the brain. Circadian rhythm disorders are common with ADHD. Occasionally depression or even anxiety is treated by dopaminergic meds and supplements such as welbutrin or macuna puriens rather than serotonin based treatments.

Dopamine and serotonin have to stay balanced. More serotonin=less dopamine and the reverse. Proper amounts of both keep activity across the brain balanced, your mood stable, allow your brain to interpret nervous system signals correctly, and both greatly impact timing and quality of sleep. Too high of dopamine is much the same effect as too much caffeine but too low of dopamine will interfere with your ability to follow your schedule and bedtime routine as well as reduce rem sleep quantity during the night.

Doing things to increase dopamine and improve the function of dopamine pathways is what decreased my sleep latency and increased my average rem per night from 10mins to 1-2hrs. This made a massively greater difference than simply trying to sleep longer. Another person with a different problem will find any increase in dopamine increases insomnia, possibly reduces deep sleep too much, or potentially triggers anxiety. That's why you need to look at any clues into your specifics to have an idea what to pursue.

Those are only a few of the many neurological pathways to look at and I wouldn't even start with neurotransmitters if I had no idea what was contributing to my insomnia. Hormones are much simpler and very likely to interfere with sleep even with very minor differences that aren't recognized as a health problem. They are also far easier to correct. Especially if you are limited to otc options. Provided they are mild and not so far off as to be a serious medical issue.

Cortisol is of course the obvious hormone that everyone concentrates on but it can spike for the simplest reasons even when you are not under stress. Cortisol and orexin/hypocretin (it got named twice) are basically some of the opposites to things like melatonin. They trigger all sorts of other hormones, neurotransmitters, immune components, etc.... that alert the body so you can fulfill your needs to stay healthy or stay awake when there is danger. Merely being hungry can trigger that response and prevent proper sleep. While the only medication or supplement that can impact orexin is prescription belsomra there are numerous supplements out there to lower cortisol by itself such as phosphatidylserine or combination supplements for supporting function of the HPA axis. You want cortisol and orexin to rise in the morning or you will lose both daytime alertness and some of the sleep pressure created when they drop at night. Lack of any orexin results in narcolepsy.

Thyroid hormones also help regulate proper sleep. Even if you are not recognized as having hypo or hyper thyroidism having levels that are not ideal for your body or lack of any change from day to night can still have a more minor impact on either nighttime sleep or daytime energy. Thyroid supporting supplements can help with minor imbalances that aren't severe enough for medical treatment. People with only slightly less than ideal thyroid levels may simply need to be more exact about the temperature of their house both day and night than the average person in order to help maintain circadian rhythm and get quality sleep at night. Warmer daytime and cooler nighttime can be as important as light for some.

Reproductive hormones are hugely important for mood and sleep and once again must go up and down based on sleep cycles. Estrogen and testosterone are stimulating/alerting and go up in the morning while progesterone is calming and goes up at night. If that doesn't happen or levels of the more alerting hormones start too high and drop too rapidly at night then numerous bad things occur that can result in less or poor quality sleep. Lack of rise in the morning can cause difficulty waking up even after a good night of sleep. With age these hormones tend to reduce and can contribute to worsening sleep quality over time as well as some of the negative health effects seen with old age. Some integrative health or naturopathic doctors recommend progesterone supplementation for everyone as they get older and especially women after menopause.

The immune system's role in sleep is a complexity I haven't sorted out enough yet and don't get into unless it really looks like it applies to a specific person. Basically this is the last thing you want your sleep problems to include because it is the least understood and most difficult to try to fix including finding any doctor with the knowledge to help. The overall run down feeling when you have a common, minor illness often has nothing to do with your body being under strain while fighting off a pathogen. It's a trick your body uses to make you rest so you don't do something that does cause strain and impair the body's ability to get rid of the illness quickly. Immune responses can make you feel like sleeping when you don't need to sleep or keep you awake when you do need to sleep. How exactly this works in the case of chronic inflammatory disorders and some theories linking fibro and cfs to immune disorders is still theory. The complications that can result from covid-19 is potentially teaching us a lot more about these immune system problems and how they affect energy, mood, and sleep.

Finally we've got the really vague stuff that doesn't initially look like it has anything to do with sleep and includes overall nutrition problems. An example is poor protein methylation due to low absorption of vitamins, bad diet, or genetics like some MTHFR gene variants, which can lead to a build up of waste byproducts or failure to make necessary compounds including going back to the glutamate you mentioned. A broken kreb cycle will break sleep along with cognitive function resulting in brain fog, fatigue, difficulty with problem solving, and lack of concentration. But that's one rabbit hole that if you go down it you may remain lost forever and never reach the end. There is always another aspect to how the body converts nutrients back and forth into the things it needs and ways that it can go wrong. Finding the exact broken spot and fixing it can take years even with a knowledgeable doctor and most aren't all that knowledgeable about such things.

There are endless places you could look that might contribute to your sleep problems after you get past what in the US is called "sleep hygiene" (maintaining a schedule, comfortable bedroom, relaxing evening activities, day/night light exposure, etc...). You really need some hints where to even start and sometimes even when you think you have the cause it's not as simple as it first appears.

I'm surprised I didn't hit some post length limit sending that :P

Whereas I would agree with a lot of what you say, there is clearly evidence that Melatonin is GABAergic in the sense that it reinforces the effect of GABA.

This research result:

Admittedly on a different mammal indicates that.

I don't think Melatonin is primary a signalling hormone, but instead there is a delay in the negative feedback because it is injected primarily into the CSF from the pineal gland rather than primarily into blood serum. The CSF turns over about every 5 hours so that will create a delay even if melatonin concentration is 5-20 times that in blood serum.

When people take it before bed it increases serum levels and reduces endogenous production through a negative feedback mechanism either in the SCN or the Pineal or both. I have seen the SCN referred to in this way.

In the end, however, I think it comes back to a mixture of adensosine based sleep pressure and how active neurons are (which is affected by a vast number of things many of which you list).

That is why CBT is so important as a first step as that is relatively easy to maintain.

Your points about GABA are also good, but additionally I have seen it reported that even if you get GABA into the CSF the effect of that wears off as the balance is pushed back by homeostasis.

Hello, I can relate. I can’t sleep much either. I worked as practicing student many years ago with that kinda therapy and is what’s currently helping my father whose lack of sleep is worrisome. For me what it’s been working is walking. Yeap, good old walking. It’s helping my anxious little heart.

Metabobbly profile image
Metabobbly in reply to tinaazure

Do you take any dietary supplements such as Magnesium, Zinc or Vitamin D3?

tinaazure profile image
tinaazure in reply to Metabobbly

I only probiotics and capra colostrum (for tat bug Bactria nervous system connection). Which it’s my believes cure my IBS

Metabobbly profile image
Metabobbly in reply to tinaazure

It is difficult to say with certainty, but if you are d3, mg or zn deficient that will hit sleep.

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