Why patients suffer from insomnia?
Sometimes a patient lack a progress despite a proven protocol? Perhaps they do not get a quantity and quality of their sleep. Up to one third of the population struggles with insomnia.5 Research indicates that poor sleep is inflammatory,6 disrupts the blood brain barrier7, and causes irritability, fatigue, poor memory and difficulty concentrating.8Furthermore, insomnia is associated with many health problems including cardiovascular,9 psychiatric,10 neurological,11 digestive, metabolic and rheumatological12 dysfunction. Insomnia is a complex condition, arising from multiple environmental, medical, behavioural and cognitive disorders.13
GABA is a Key Piece of the Sleep Puzzle
Despite the complexity surrounding insomnia, there are some key clues that can help us help patients catch those elusive ‘zzz’s. We know that glutamatergic neurotransmission excites the neurons, promotes alertness, and when elevated (e.g. by stress), reduces the quality and duration of sleep.14 Nature’s answer to glutamate is gamma amino butyric acid (GABA), as it antagonises glutamate signalling and is crucially involved in the regulation of sleep and wakefulness.15 Research shows that patients living with insomnia have reduced levels of GABA, and that GABA receptor activation improves sleep in these individuals.16 This explains why benzodiazepines, which act on GABA pathways, are effective at improving sleep in insomniacs. The addictive nature and undesirable side effects of benzodiazepines, however, lead us to look for GABAergic alternatives that may improve sleep without the negative effects.
Magic GABA will put you to sleep
Herbs like zizyphus, passion flower and California poppy, which act on the GABA pathway to improve sleep quality in your patients. In vitro, zizyphus was found to support GABA neurotransmission by causing an increased expression of GABA-A receptors, and by stimulating the synthesis of glutamic acid decarboxylase (GAD), which converts glutamate into GABA.17 In animal models, zizyphus was shown to increase sleep time and improve circadian cycle.18 Passion flower has been found to bind to and stimulate GABA and benzodiazepine receptors and enhance GABA uptake, producing an anxiolytic effect.19,20 California poppy also has an affinity for GABA receptors, resulting in sedating effects.21
Dial Glutamate Down for a Good Night’s Sleep
Dampening down the stimulating effects of the excitatory neurotransmitter, glutamate, may help your patients get the quality sleep they are craving. Zizyphus has been found in animal studies to effectively inhibit glutamate signalling.22 Several herbs and lavender essential oil, which has been found to be a competitive antagonist of glutamate binding in neuronal membranes.23 Oral administration of 80 mg per day of lavender essential oil improved sleep quality and quantity in adults suffering from anxiety disorder in a randomised, double-blind comparison study.24
Anxiety may cause Insomnia
Anxiety and depression are closely associated with insomnia.25 Interestingly, the neuroplastic, maladaptive changes that occur with these conditions are also seen in insomnia,26suggesting they share similar pathophysiological processes. Passion flower has been shown to reduce symptoms of anxiety in as little as ten minutes,27 and has demonstrated similar efficacy to benzodiazepine medication (Figure One).28
Figure One: Hamilton anxiety score for passion flower vs. benzodiazepine in generalised anxiety disorder.29
Lavender essential oil has also been found to reduce anxiety,30 and to do so more effectively than SSRI medication (Figure Two).31 Addressing potential drivers of insomnia, such as anxiety, may be another mechanism by which you can improve sleep in your insomniac patients.
Figure Two: Hamilton anxiety scale total score change over 10 weeks.32
No Pain May Lead to Sleep Gains
Pain certainly is never welcome, but this is particularly true when it exacerbates insomnia. Persistent pain is characterised by long-term increases in synaptic glutamate signalling in nociceptive pathways,33 as well as a lack of inhibition from GABA.34 Therapeutic interventions that stimulate GABA and inhibit glutamate signalling may be useful in the management of insomnia accompanied by chronic pain. This formula targets pain as a driver of sleep disturbances with the aid of Jamaica dogwood, traditionally used as an analgesic, spasmolytic and mild sedative. California poppy may be particularly useful for pain-associated insomnia as it was found to reduce pain with comparable efficacy as a common, pain-relieving pharmaceutical medication.35
Don’t Lose Sleep Over Insomnia
Sleep is a common concern that may be contributing to a number of your patients’ health problems. Thankfully, nature has provided some potent answers to the sleep puzzle. Don’t lose sleep over insomnia as Nature has provided us with a diversity of herbs to provide powerful sleep support, aiding sleep onset and reducing night-time waking.
Source: Metagenics 2016
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22. Zhang M, Ning G, Shou C, et al. Inhibitory effect of jujuboside A on glutamate-mediated excitatory signal pathway in hippocampus. Planta Med. 2003;69(8):692-5.
23. World Health Organisation. “Aetheroleum Lavandulae”. WHO Monographs on Selected Medicinal Herbs. 2007;3:219-28.
24. Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010 Feb;17(2):94-9.
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35. Rolland A, et al. Neurophysiological effects of an extract of Eschscholzia californica Cham. (Papaveraceae). Phytotherapy Research 2001;15:377-381.