By Nurse Mark

I’ve written before (some might even say I’ve ranted) about the dangers of drugs for sleep.

If you haven’t read Kavinace Or The Lunesta Moth? You Decide! and Dying For A Good Night’s Sleep? I invite you to take a moment and do so now.

But if those articles don’t make you very afraid of the dangers of sleeping pills, maybe this most recent bit of research will.

You see, while this latest study is of special concern to those who suffer with PTSD (Post Traumatic Stress Disorder) it also applies to almost everyone who has any sort of “bad memory” that they would be just as happy to not remember.

PTSD is best known for affecting those who have been involved in horrific and traumatic situations; we think of military veterans who have seen the horrors of war or first responders who have dealt with terrible accidents and disasters or people who have survived such horrifying events as the 9/11 attacks.

But in truth, PTSD can be more subtle. It can be anything that creates a traumatic stress for the person involved. The car wreck that shook you up. The mugging that you survived. The 5th grade beating at the hands of the schoolyard bully. The nasty, bitter divorce you went through. All of these are the sort of memories that we are just as happy to forget.

So, what has all this got to do with sleeping pills?

Well, we all have occasional difficulty with sleep but people suffering PTSD are more likely to have sleep difficulties. Often, it is the memories of a traumatic event that disrupts sleep. So, it is no surprise that PTSD sufferers seek help to sleep and are often prescribed sleeping pills. Pills like Ambien, or Lunesta and other members of the “Z-drug” family, or benzodiazepines such as Valium or Librium or Ativan.

And yes, these pills do indeed help people sleep. It turns out that these pills also seem to make it easier for people to remember. Now, this might be a good thing, if it helped us to remember the things we want to remember – like the answers for the big exam, or the date of our mother-in-law’s birthday, or passwords and PIN numbers, or where we put the car keys and just where in that big parking garage did we leave the car.

But no, sleeping pills don’t help us remember these useful things. It turns out that they make it easier for us to remember traumatic and stressful things. Like the things that caused us the PTSD that is disturbing our sleep so that we want help from a sleeping pill.

Can you see the problem here?

You have unpleasant old memories that sometimes keep you awake – so you take a sleeping pill, But the sleeping pill makes it easier to revisit unpleasant old memories… and they keep you awake… Uh-Oh – I can see this is not going to end well…

A recently published study titled “Pharmacologically Increasing Sleep Spindles Enhances Recognition for Negative and High-arousal Memories.” provides plenty of caution for anyone who uses these drugs for sleep, and especially those people who may suffer from anxiety or PTSD.

In an article published by University of California Riverside on June 12, 2013, researcher Sara C. Mednick, assistant professor of psychology at UC Riverside says of of the study:

“I was surprised by the specificity of the results, that the emotional memory improvement was specifically for the negative and high-arousal memories, and the ramifications of these results for people with anxiety disorders and PTSD,” Mednick said. “These are people who already have heightened memory for negative and high-arousal memories. Sleep drugs might be improving their memories for things they don’t want to remember.”

So, what can you do if you can’t sleep – just suffer? Of course not!

Please visit Dr. Myatt’s page Insomnia where she discusses natural strategies for good sleep. We have also had excellent results with an herb called Kavinace, which potentiates GABA, one of the main inhibitory neurotransmitters. Higher GABA levels can relieve anxiety and promote restful sleep.

Let’s face it – all we really want is a good night’s sleep with pleasant dreams. So why would we take drugs that have been shown to help us dredge up unhappy memories? Banish the benzo’s and boot the Lunesta moth out of your bedroom and get a healthy, natural night’s sleep!

References:

Sleep Mechanism Identified That Plays Role in Emotional Memory: UC researchers also find that Ambien heightens recollection of and response to bad memories. http://ucrtoday.ucr.edu/15887

Erik J. Kaestner, John T. Wixted, and Sara C. Mednick, University of California: Pharmacologically Increasing Sleep Spindles Enhances Recognition for Negative and High-arousal Memories. Posted Online June 14, 2013. (doi:10.1162/jocn_a_00433) http://www.mitpressjournals.org/doi/abs/10.1162/jocn_a_00433

By Nurse Mark

Folks, is it just me, or does anyone else think the Lunesta moth in those seemingly endless television ads is just about the creepiest thing that has ever been on TV? It flits about, visiting unsuspecting victim after victim, looking for all the world like it is sucking out their souls in exchange for sleep – or is it death?

Not only does this glowing, silent, somehow vaguely malevolent moth spook me, the drug that it represents spooks me too. No, let me rephrase that: Lunesta, AKA eszopiclone, is a drug that scares the bejeebers out of me as does it’s stereoisomer zopiclone (Imovane) and it’s cousins zaleplon (Sonata) and zolpidem (Ambien and AmbienCR).

These drugs, known collectively as the “Z-drugs” have been around since the late 1980’s and early 1990’s, and they have been shrouded in controversy since their approval by the FDA.

Many have been critical of the “research” that has been conducted and used to obtain FDA approval. This research is almost always sponsored and conducted by the drug companies themselves, and as one analyst / researcher found:

“Of 56 randomized controlled trials of drug treatments of insomnia which reported the funding source, all but 5 were apparently funded by the industry.”

and

“the odds ratio for finding results favorable to industry in industry-sponsored trials was 3.6 times as high as in non–industry-sponsored studies”

Others have been critical of the effectiveness of the drugs:

“Sometimes, efficacy data get lost. Lunesta (eszopiclone) was approved in 2004 for chronic insomnia. Sepracor, its manufacturer, began an intense direct-to-consumer advertising campaign — spending more than $750,000 a day in 2007 — featuring a luna moth that transforms frustrated insomniacs into peaceful sleepers. Lunesta sales reached almost $800 million last year [2008]. Clinicians who are interested in the drug’s efficacy cannot find efficacy information in the label: it states only that Lunesta is superior to placebo (…).3 The FDA’s medical review provides efficacy data, albeit not until page 306 of the 403-page document. In the longest, largest phase 3 trial, patients in the Lunesta group reported falling asleep an average of 15 minutes faster and sleeping an average of 37 minutes longer than those in the placebo group.”

Wow! A whole 37 more minutes of sleep… at what risk?

Still others are critical of a drug that was initially promoted to be less addictive than the benzodiazepines like Valium that it was intended to replace, but that has turned out to be just as or even more dangerously addictive both psychologically and physically than the older drugs and just as prone to misuse and abuse. It seems that unskilled attempts to stop the use of these drugs can lead to severe rebound insomnia, delerium, seizures, and other problems – especially in older people.

Then there are the now-infamous cases of sleep-driving and other behaviors engaged in by people under the influence of these drugs. For some strange reason the Kennedy family seems to be prone to problems with this drug… Both Kerry and Patrick Kennedy have wrecked their cars while taking this stuff, and others have been known to engage in bizarre eating, sexual, and other behaviors while under the influence, with no memory of their acts afterwards.

That spooks me… But here’s the “topper”:

According to a 2012 study in the British Medical Journal, if you take as little as one or two sleeping pills a month you are statistically three and a half times more likely to die than someone who takes none.

Further, Among patients prescribed hypnotics, cancer incidence was increased for several specific types of cancer, with an overall cancer increase of 35% among those prescribed high doses.

That doesn’t just “spook” me – that scares the bejeebers out of me!

“But dammit!” you say, “I need something to help me sleep – I’m under a lot of stress, and I need my sleep! What good is all this if you can’t help me get some sleep?”

Hmmm… Well, that’s probably what Michael Jackson said to his doctor, and look where that got him…

But I’m not heartless – I understand the need for a good night’s sleep, and I have suffered as everyone has from restless nights of poor sleep. There are alternatives. Safe alternatives. Effective alternatives. More natural alternatives.

Everyone has of course heard of Melatonin as a sleep aid. Melatonin is a hormone decreases with age. Melatonin is a potent antioxidant that helps regulate Circadian rhythms. It should be used in almost all cases of insomnia. Melatonin is also an an “anti stress” hormone. 1-3 mg can be 45 minutes before bed. It can be increased in 3 mg increments as needed for sleep. Melatonin is only effective for sleep onset insomnia when a person has low melatonin levels. This occurs more commonly in older people.

Another natural substance that we have found to be very effective is called Kavinace. Kavinace potentiates GABA, one of the main inhibitory neurotransmitters. Higher GABA levels can relieve anxiety and promote restful sleep. This supplement works incredibly well as a sleep aid and anti-anxiety formula for people who are low in GABA and we have many patients and customers who swear by it.

Both Dr. Myatt and I use kavinace and melatonin every night and we find them very effective. Yes, we do sometimes awaken through the night, as does almost every normal person, but we find that these two supplements are important to ensuring that we get a full, refreshing nigh’s sleep.

And no spooky little glowing moths flitting around in our bedroom…

References and further reading:

Daniel F. Kripke, M.D., Who Should Sponsor Sleep Disorders Pharmaceutical Trials? J Clin Sleep Med. 2007 December 15; 3(7): 671–673.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2556906/

Lisa M. Schwartz, M.D., and Steven Woloshin, M.D., Lost in Transmission — FDA Drug Information That Never Reaches Clinicians. N Engl J Med 2009; 361:1717-1720, October 29, 2009
http://www.nejm.org/doi/full/10.1056/NEJMp0907708

Hypnotic dependence: zolpidem and zopiclone too”. Prescrire Int 10 (51): 15. February 2001.

Wong CP, Chiu PK, Chu LW (September 2005). “Zopiclone withdrawal: an unusual cause of delirium in the elderly”. Age Ageing 34 (5): 526–7.

Jones IR, Sullivan G (January 1998). “Physical dependence on zopiclone: case reports”. BMJ 316 (7125): 117. PMC 2665371.

Aranko, K; Henriksson, M; Hublin, C; Seppäläinen, Am (Jul 1991). “Misuse of zopiclone and convulsions during withdrawal.”. Pharmacopsychiatry 24 (4): 138–40.

Kerry Kennedy DUI Arrest Likely Caused by Sleep Driving — Just Like Cousin Patrick’s Capitol Hill Crash (Updated) , Forbes 7/14/12.
http://www.forbes.com/sites/kaifalkenberg/2012/07/14/kerry-kennedy-was-likely-sleep-driving-just-like-her-cousin-patrick/

FDA Says Pills Can Cause ‘Sleep-Driving’ The Associated Press, Wednesday, March 14, 2007
http://www.washingtonpost.com/wp-dyn/content/article/2007/03/14/AR2007031401027.html

“Hypnotics’ association with mortality or cancer: a matched cohort study,” British Medical Journal.
http://bmjopen.bmj.com/content/2/1/e000850.full

By Nurse Mark

Are you Dying For A Good Night’s Sleep?

If you take even a few sleeping pills a year the answer may be “Yes!”

To sleep, Perchance to dream… Has been the sometimes elusive goal of mankind for millennia. Most people will have trouble sleeping at some time or another – usually it’s temporary, and often related to a particular stress or upset. That is normal, and it won’t be a problem for long. Good sleep will return.

For some others, sleep becomes an almost impossible goal – many become so desperate as to be willing to try almost anything to achieve a few hours of blessed unconsciousness. Michael Jackson comes to mind… he is resting now.

Millions of Americans fall somewhere in between the two extremes – and for them a quick trip to the doctor and then to the drugstore to fill a prescription for sleeping pills is something that starts innocently enough but grows into a ritual that is ever-more difficult to escape. Yet escape they must.

That’s because now in addition to the long-known problem of habituation, recent research has given us clear evidence that even infrequent use of sleeping pills results in a significantly increased risk of death and frequent or regular use of these drugs results in a massive increase in death risk, including risk of death from cancer!

“Habituation” is a medical term which simply means that not only does the person find it increasingly difficult and even impossible to sleep without drugs, the drugs themselves must be taken in larger and larger doses to achieve the same effect.

Habituation is an important effect to consider, because the study, reported in the prestigious British Medical Journal made the following points:

• Patients receiving prescriptions for zolpidem, temazepam and other hypnotics [aka “sleeping pills”] suffered over four times the mortality as the matched hypnotic-free control patients.
• Even patients prescribed fewer than 18 hypnotic doses per year experienced increased mortality, with greater mortality associated with greater dosage prescribed.
• Among patients prescribed hypnotics, cancer incidence was increased for several specific types of cancer, with an overall cancer increase of 35% among those prescribed high doses.

For those interested in further reading (this is a very dense article) the study, titled “Hypnotics’ association with mortality or cancer: a matched cohort study,” can be found here: http://bmjopen.bmj.com/content/2/1/e000850.full

Fair warning – if you use sleeping pills, even occasionally, you are going to feel very alarmed and worried after you read that report.

Here’s a quick breakdown of the numbers:

People who used sleeping pills more than 132 times each year were FIVE TIMES more likely to die during the study period. To make that number of uses easier to understand, that 132 times a year works out to 11 times a month, or less than 3 times a week.

People using between 18 and 132 doses each year were four times more likely to die. These are the people who only use a sleeping pill less than twice a month to 11 times a month – which is not very often!

But here’s the most scary finding: Those people who only took 18 or less doses per year were still more than 3.5 times more likely to die than people who took no sleeping pills at all.

Let’s say that again: according to the study, if you take as little as one or two sleeping pills a month you are statistically three and a half times more likely to die than someone who takes none.

So what can you do if you are having trouble sleeping?

First, it is well worth working with a doctor who understands sleep difficulties and is willing to look beyond the simple and easy “out” of just prescribing a sleeping pill. There are as many reasons for sleep problems as there are people who aren’t sleeping!

Is the problem “primary insomnia” – the “I can’t slow my thoughts down and get to sleep” kind of insomnia? (This is the “Michael Jackson” kind of insomnia)

Is the problem “secondary insomnia” – the “I come awake in the small hours of the night and can’t get back to sleep” kind of insomnia? (This is more common in older people and people with unstable blood sugar or hormone imbalances)

Or, is it some combination of the two?

Is sleep being interrupted by something like snoring, sleep apnea, muscle cramps or urinary frequency?

Are there external factors like noise, light, a restless bed-partner, pets, too hot, too cold, or uncomfortable bedding?

Are there internal factors like unstable blood sugar, mood or emotional disorders, or neurotransmitter or hormone imbalances?

All these things must be considered and either ruled out, eliminated, or treated if healthy sleep is to be restored. The help of a good holistic physician can literally be a lifesaver!

Dr. Myatt has a webpage where she discusses insomnia and some common recommendations here: Insomnia

For those who just want to jump ahead to the “short course” here are some of our most effective supplements to promote healthy sleep.

Maxi Multi: 3 caps, 3 times per day with meals. Optimal (not minimal) doses of  B complex vitamins and magnesium (both found  in Maxi Multi) are particularly important for insomnia.

Melatonin: this hormone decreases with age. Melatonin is a potent antioxidant that helps regulate Circadian Rhythms. It should be used in almost all cases of insomnia. Melatonin is also an an “anti stress” hormone.

Some people complain that they tried melatonin and it didn’t work for them. We usually find that they tried it in a form that they swallowed, as a tablet. Melatonin is not well-absorbed this way, and we recommend that it be take sublingually – that is, dissolved under the tongue. This allows the hormone to enter the bloodstream more directly and without being altered by stomach acids. Rarely, others complain that melatonin helped them sleep, but left them feeling groggy the next day. If this occurs, try taking a smaller dose – a half or even a quarter-tablet to start with.

L-5-HTP (5-Hydroxy-Tryptophan) 100 mg: 1 cap, 3 times per day, twice with meals and once before bed. Dosage may be increased to 2 caps, 3 times per day after 2 weeks if response is inadequate. L-5-HTP is a neurotransmitter precursor; most neurotransmitters decrease with age.

Magnesium (amino acid chelate): 2 tabs, 45 minutes before bedtime. (In addition to what is contained in Maxi-Multi) Magnesium is a “calming” mineral.

Lavender Essential Oil: Used as aromatherapy, lavender has a balancing, relaxing and uplifting effect. Apply several drops to a cotton ball or diffuser to help drift peacefully off to sleep.

Here is a trick that was taught to me as a young Nurse by an old, very experienced European Nurse: It is common practice in some European hospitals to put a few drops of lavender oil on pillows to help relax patients and promote sleep. I know why lavender was held in such high value by our ancestors – it works!

Kavinace – This is our “secret weapon” for treating insomnia. Kavinace potentiates GABA, one of the main inhibitory neurotransmitters. Higher GABA levels can relieve anxiety and promote restful sleep. Kavinace works amazingly well as a sleep aid and anti-anxiety formula for people who are low in GABA. Usually 1-2 capsules taken at bedtime (or better, a half-hour before bed) will promote a fine, restful sleep. Three capsules can be used, but may result in a “hangover” sleepiness or “just feeling too well-rested” the next day for some people. Yes, it really is that effective!

Finally, there is a new product that we are trying with a few select patients: Lavela WS 1265 Lavender Oil Capsules.

We have seen very convincing evidence in peer-reviewed medical journal articles regarding it’s effectiveness in reducing anxiety and promoting sleep, and there are very positive reports from those patients who have tried it. It is safe, well-tolerated, non habit-forming and non-sedating. It’s once-a-day dosing is convenient and effective.

We are not actively stocking this product yet as we are still assessing it – but we have a limited number of sample packets available that provide 10 days of treatment – that is probably double what is necessary to achieve a good effect, from what we are seeing so far.

We will not send these samples out to anyone who is not using the more proven sleep aids of both sublingualMelatonin and Kavinace – but if you are serious about getting a good night’s sleep and want to try a 10 day sample course of Lavela WS 1265 Lavender Oil Capsules then please request it when you order your Melatonin and Kavinace – we will of course ask you to please record and report back to us your experience with this new product.

‘Till tomorrow, Pleasant Dreams…