Insomnia
Insomnia is commonly defined as the habitual inability to initiate and maintain sleep, or the experience of nonrestorative sleep.[1] Insomnia is a heterogeneous problem, taking many forms, including difficulty falling asleep, frequent waking at night, early morning awakening and the inability to fall back asleep.
Insomnia is extremely common. It affects up to 30% of men and 40% of women in the U.S; more than two thirds of insomniacs are older than 50. Direct and indirect costs are estimated to be as high as $92 billion,[2] with over $2.7 billion spent on 43 million prescriptions for this condition annually.[3]
Since the middle of the last century, the average night’s sleep in the U.S. has dropped to six and a half hours from more than eight.[4]
The consequences of insomnia include daytime drowsiness, fatigue, increased risk of accidents, mood disturbances, employment and relationship problems, memory impairment and cognitive dysfunction. Half of all automobile accidents are related to sleep problems with associated tiredness.[5] Insomnia also impairs the body’s ability to heal and recover from acute and chronic illness. Lack of sleep contributes to the progression of inflammation in chronic disease. It contributes to obesity and diminishes sex appeal.
A variety of medications have been used to treat insomnia, but they uniformly fail to reproduce actual sleep, or to provide a lasting cure of insomnia. They may temporarily fix some of the symptoms of insomnia while introducing a cohort of new side effects that eventually worsen the condition.
Behavior modification is part of an approach known as “sleep hygiene”, which includes a range of non-pharmacologic interventions that are cheap, easy to implement, and contribute to lasting improvements in sleep quality and duration.[6]
Classical homeopathic prescribing is part of a safe and effective holistic approach that works well in resolving many conditions while restoring healthy sleep.
Role of Sleep
Sleep was once thought to be a relatively passive process of decreased brain activity. More recent data indicates that sleep, like consciousness, is an active process characterized by a myriad of complex electrical and neuroendocrine brain activities.
The benefits of healthy sleep are profound, as are the drawbacks of deprivation. Every system of the body is affected by sleep including physical, emotional and cognitive functioning. Sleep promotes healing and recovery from illness, improved stamina, the ability to learn and remember new skills.[7] Healthy sleep usually includes dreaming (even when it isn’t remembered), which also appears to play a powerful role in psychological and emotional health, well-being, memory and the ability to learn new tasks.[8]
Healthy sleep is still somewhat of a mystery since it is only partially understood and has never been artificially duplicated. While medications mimic the appearance of sleep, they do not reproduce the quality or restorative, integrative functions of sleep. In most cases, medications used to promote sleep, eventually backfire and erode it, making the condition dependent on escalating doses of drugs and more resistant to treatment.
Deep sleep has anti-inflammatory benefits. It helps restore hormonal balances, provides rest, and clears the mind like the “re-booting” a computer.
Sleep deprivation causes significant physical and emotional effects including changes in cardiovascular function, glucose metabolism, insulin resistance, and elevations of blood pressure, blood sugar and the hormone cortisol.[9] Long-term effects of deprivation are linked to increased risk of developing many chronic diseases including cancer, premature aging,[10] depression and gastrointestinal disorders.[11]
Sleep deprivation is an effective method of persuasion, with a history of use in times of war and in programs of indoctrination, including military and medical residency training. Deprivation affects sanity, impairs vigilance and erodes physical endurance.[12] Deprivation makes for more compliant subjects who think less, concentrate poorly, and rely on automatic behaviors. Deprivation alters brain chemistry and interferes with a sense of reality, eventually disturbing mental and emotional stability.[13]
Passage into sleep requires a gentle lapse of consciousness and awareness, coinciding with internal and external environmental supports to sustain it. In cases of chronic insomnia, the body actually looses its innate ability to relax, lapse into and sustain healthy sleep.
Sleep is an unconscious process that relies on an elegant network of biologic, chemical, hormonal and neuroendocrine pathways collectively working together as “biorhythms” or circadian rhythms. When these circadian rhythms are allowed to function unhindered, they reproduce the same biochemical patterns on a daily basis. The body relies on this system like an internal clock to efficiently manage the sleep-wake cycle. Unless it is tampered or interfered with, these internal rhythms help maintain a healthy mental, physical and emotional balance through sleep.
When the circadian pattern is regular and uninterrupted, day after day, week after week, and year after year, the physical and emotional body learns to anticipate and depend on the pattern, preparing for these cycles many hours in advance. Breaking the biorhythm in an irregular or unpredictable manner disrupts the intricate chemical network of hormones and neurotransmitters and forces the body to readapt, sometimes in midstream.
The body adjusts readily enough in youth, but as it ages, it is less able to change as quickly. Sometimes even simple changes in routine can lead to large disruptions of sleep and wakefulness. This is one reason why advancing age is associated with a greater number of sleep disturbances.
When insomnia first strikes, its roots are frequently traceable to one or more well-defined disturbances of medical, chemical, dietary, environmental, emotional or behavioral causes described below. These causes frequently combine in a complex web of interaction that can be remedied by utilizing simple sleep hygiene techniques coupled with carefully selected classical homeopathic medicines.
Sleep Hygiene
Sleep hygiene is the practice of certain activities that sustain the internal and external environments in a manner conducive to sleep. Sleep hygiene requires attention to the details across a range of environmental, chemical, emotional and behavioral and dietary factors. Careful evaluation of these details should be followed by diligence in mitigating and correcting the obstacles to natural sleep.
Sleep hygiene works best when specific patterns are followed repeatedly and consistently without significant variation or interruption on a daily and weekly basis. This means that sleep and waking cycles should be observed and adhered to with as much regularity and as little variation as possible. Weekend changes in pattern, and shift work that demands alterations in sleep cycles should be avoided. For best results, the same schedule, without significant variation, should be adhered to 24/7 and 7/52.
Causes and Treatments
a. Medical
Thorough medical screening of insomnia is essential since nearly 50% of cases are related to preexisting medical conditions.[14] Any underlying illness or condition can be associated with insomnia. Some of the more common conditions include headaches, asthma, fibromyalgia, GERD, menopause, and pain syndromes.
Sleep Hygiene: A complete review of systems coupled with a thorough medical history is essential in every case of insomnia. Holistic management of these conditions focusing on resolution should be the object of any modifications in treatment. Holistic management not only helps to resolve the underlying situation, but it may also limit exposure to potentially toxic treatments and side effects.
Classical homeopathic and holistic medical management can improve health and reduce dependency on medications thereby significantly reducing the risk of sleep complications from many illnesses.
b. Psychiatric and Emotional Disorders
Approximately 40% of people with chronic insomnia suffer from coexisting psychiatric or emotional problems. Almost any psychiatric condition can contribute to insomnia. Examples include depression, bipolar disorder, anxiety disorder, panic disorder, Obsessive Compulsive Disorder (OCD), and paranoia. In addition to psychiatric conditions, any significant change in emotional status can contribute to acute insomnia. Grief, worry, fear, joy, exaltation and boredom are all associated with altered states of brain chemistry and the potential for downstream disruptions in sleep. Emotion has an extremely powerful effect on brain chemistry and sleep.
Sleep hygiene: A thorough mental/emotional inventory, including a review of significant changes in personal relationships, must always be included in the interview. Investigation should also address any emotional state that may have been present at the time when the sleep disturbance initially developed, particularly if this condition began during childhood. The role of emotional factors and stresses must be considered, including any learned fear of sleep or dread of insomnia, which can in itself, contribute to the problem.
Attention must be paid to any history of abuse, neglect or trauma, which are all commonly associated with insomnia. These may require psychological counseling and psychotherapeutic intervention before improvement in sleep may be expected.
Since any strong emotion can impair the ability to sleep, it is important to become conscious of these factors so that appropriate steps can be taken to resolve them. A variety of methods exist to help with these emotional states. The solution may be as simple as a conscious decision to set aside these issues so that they may be picked up in the morning.
Techniques like meditation, visualization and relaxation are extremely helpful tools that should be instituted early in treatment. Many other interventions including depth psychotherapy, Cognitive Behavioral Therapy (CBT), autogenic training, biofeedback, hypnosis, paced respirations, and progressive muscle relaxation can be helpful in calming these emotional factors and increasing the likelihood of sleep.[15] Techniques of “paradoxical intention”, whereby the insomniac is advised to gently try to remain awake for as long as possible can also be effective.[16]
Classical homeopathic treatment can be helpful in many cases of psychiatric and emotionally driven insomnia.
The use of pharmaceutical medications to quell these symptoms should be reserved as a means of last resort, since these agents will frequently complicate any chemical imbalances, introduce unpleasant and crippling side effects and eventually worsen sleep in the long run.
Sometimes shifting one’s perspective to accept the inevitability of insomnia can help neutralize the stress created by this condition. Once this situation is de-stressed, the time can be constructively utilized for inward reflection or meditation. In this way, insomnia can be perceived as a window of opportunity to explore and quietly contemplate one’s life (an opportunity that is frequently missing in the busy, hectic world). The gift of insomnia means that nighttime can become a time of deep reflection, introspection, poetic inspiration, solitude and silence, missing during the busy day. Taking advantage of insomnia in this manner, can diffuse the angst and stress, while providing personal insight, emotional freedom and greater self-understanding. Insomnia might be considered an opportunity to creatively explore within.
c. Chemical
Chemical causes of insomnia are extremely common. The most widespread causes are pharmaceutical medications, including prescription nonprescription (over the counter) drugs, herbs and nutritional supplements.
More pharmaceuticals, herbs and supplements are consumed today than ever before in human history. Two thirds of U.S. adults over 60 are taking more than 5 prescriptions drugs a day, while more than one fifth of children under 12 years old are using at least one prescription medication.[17] The ingredients in these formulations interact within the body in unpredictable and sometimes unexpected ways.[18] The average prescription medication causes over 70 side effects, including insomnia.
Many medications act alone to disrupt sleep, while others act in unison, combining in vivo, to create new biochemical moieties with poorly understood and unrecognized effects.[19] Some medications disrupt sleep when they are administered, while others affect it when they are withdrawn. A huge number of medications disrupt sleep either directly or indirectly. These medications include, but are not limited to
- ADHD Medications
- Alcohol
- Allergy Medications
- Antidepressants
- Antihypertensive Medications
- Antiparkinsonian Medications
- Asthma Medications
- Caffeine containing Medications
- Chemotherapeutic Agents
- GERD Medications
- Hormones
- Diuretics
- Laxatives
- Tobacco and Nicotine
- Seizure Medications
- Recreational Drugs
Many herbal compounds and supplements contribute to or cause insomnia. Some of these include:
- Ginseng
- Barberry
- Uva ursi
- Ephedra or Ma huang
- Goldenseal
- Green and Black teas
- Coffee
- Melatonin
- Adrenal “support” formulas
- Essential Oils
The use of medication to suppress symptoms of illness should be avoided whenever possible, since this method of treatment frequently results in sleep disrupting side effects. These complications are not only extremely common, but highly predictable, and increase in frequency and likelihood as the number of medications, supplements and herbs increases. Volumes of medical data have documented these phenomena, but the texts and online data are still incomplete.
Sleep Hygiene: A complete medication, herb and supplement inventory should be obtained. Ingredients on all products should be reviewed and nonessential items eliminated. All medications, herbs and supplements known to affect sleep should be discontinued while symptoms are closely monitored. Ideally, the ingestion of any compound capable of affecting sleep (positively or negatively), should be eliminated (under medical supervision) until the actual effects are determined.
Chemicals can disrupt sleep regardless of the time of day when they are administered. These agents can and do continue to affect the body many hours, and sometimes days after their administration. Metabolism and excretion of these compounds varies widely, depending on the combination of agents being utilized, environmental and genetic factors. Even so-called “sub-therapeutic” levels of many compounds still have the potential to produce profound effects.[20]
Not only can the metabolism of these agents vary widely from person to person, but individuals can react idiosyncratically and unpredictably to different combinations of drugs and herbal supplements.[21]
It is important to remember that most pharmaceuticals (and herbs) on the market are backed by limited and incomplete safety data. Most medications receive only the bare minimum requirement of study (if any) before approval by the Food and Drug Administration (FDA) and most serious side effects and “black box warnings” are discovered after the drugs were approved and marketed.[22] The FDA admits that improper procedures and political lobbying has frequently contributed to the approval of medications that should never have been accepted.[23],[24]
Since the majority of people taking pharmaceuticals engage in polypharmacy, the potential for chemical interactions is extremely important and remains virtually ignored.[25] As a result, these agents, singly and in combination, are responsible for many complications and deaths.[26]
The use of medications, herbs and supplements to promote sleep frequently backfires and leads to greater disruptions.[27] Some of the common sleep medications include:
Benzodiazepines- these attach to specific gamma-aminobutyric acid (GABA) receptors, and induce non-REM sleep. They block the transition to deeper levels of stage 4 REM sleep. Even when these agents are helpful in inducing sleep, they prevent the progression to the deepest levels of regenerative sleep. They pose very serious risks of physical and psychological addiction and dependence.
Zolpidem (Ambien)- this is a short-acting hypnotic that potentiates GABA, an inhibitory neurotransmitter, by binding to GABA receptors at the same location as benzodiazepines.[28] Zolpidem helps initiate sleep, but does not maintain it. It can be particularly difficult to discontinue this medicine since it typically requires increasing dosages to combat worsening insomnia and leads to rebound insomnia when discontinued. Frequent side effects include: memory loss, amnesia, asthenia, ataxia, confusion, euphoria, headache, insomnia, vertigo, dyspepsia, hiccup, nausea, arthralgia, myalgia, upper respiratory infection, double vision, and urinary tract infections. [29]
Eszopiclone (Lunesta) tends to worsen sleep problems once it is discontinued. Frequent side effects include: chest pain, migraine, and peripheral edema and depression.[30] The only clinical trials of eszopiclone published, so far, were funded by the drug’s manufacturer.
Ramelteon (Rozerem) binds to melatonin receptors, and as a result, it interferes with other hormonal systems. Ramelteon increases prolactin levels and has been associated with an increased incidence of cancer in laboratory animals.[31] Side effects include: nausea, diarrhea, myalgia, and arthralgia, exacerbated insomnia, headache, fatigue, depression, hallucinations, and upper respiratory tract infections.[32]
Antihistamines like diphenhydramine (Benadryl) are typically associated with prolonged morning drowsiness and often require the use of stimulants like caffeine to counteract it. Users run the risk of ping-pong cycles, utilizing daytime stimulants to stay wake and nighttime sedatives to fall back to sleep. This behavior has been associated with increased risk of adverse cardiovascular events.[33]
Many sleep agents contribute to psychological as well as physical dependence. Discontinuation can be extremely difficult, since withdrawal symptoms typically lead to rebound insomnia, that is worse than the original condition.
Drugs and herbs used to promote sleep should never be considered “first-line” approaches for acute insomnia unless circumstances warrant no other options. These chemicals should be reserved for use only when hygienic and behavioral methods have failed.
The overflow of many pharmaceutical products into the environment and the water supply poses another concern.[34] Many medications pass through the body intact before they are secreted in feces or urine.[35] As more of the population uses medications, these chemical residues have built up in the water table. Exposure to these drugs is more common today than ever before via contaminated food and water. As a result of this contamination, a cornucopia of pharmaceutical and chemical wastes are consumed regularly, unknowingly, unwittingly and in increasing amounts by more of the population than ever before.
The effects of this long-term pollution have not been extensively studied, and are only vaguely understood. Unnecessary use of pharmaceuticals to promote sleep, or to treat other conditions, must be curtailed both individually and globally since this reckless practice endangers everyone.
d. Diet
Dietary habits, patterns and irregularities can contribute significantly to sleep pattern disruptions. The largest “smoking gun” in the kitchen is caffeine and related compounds like theobromine (found in chocolate). These ingredients directly interfere with sleep as a result of their stimulatory effects on the central nervous system (CNS). Another frequently abused dietary ingredient, ethyl alcohol, initially depresses the CNS and promotes drowsiness, but it leads to significant disruptions of sleep patterns and poor sleep quality.
Meal size and timing can significantly affect sleep. Large meals consumed shortly before bed distend the abdomen put pressure on the diaphragm, restrict breathing and lead to discomfort. Going to bed hungry with an empty stomach can cause hunger, trigger low blood sugar, and stomach discomfort. Both over and under-eating can prevent sleep.
Sleep hygiene: Diet and eating habits should be carefully evaluated in relation to sleep problems. Offending foods must be completely removed from the diet regardless of the time of day when they are consumed. As noted above, even extremely small residues of some chemicals will demonstrate significant biochemical and bioenergetic effects on sleep many hours, even days later.
Both over- and under-eating should be discouraged. Consuming a small snack shortly before bedtime promotes the coordinated release of neurotransmitters and endorphins creating a primal sense of “well being” facilitating sleep induction. The digestive process also contributes through a phenomenon known as an “alkaline tide”, which is marked by a slight rise in blood pH after eating. This chemical change appears to trigger drowsiness, ease the transition into sleep and promote longer sleep duration.
Some foods naturally high in the amino acid tryptophan (turkey, nut butters, figs, rice, tuna and bananas) are more likely to induce sleep when consumed shortly before bedtime. Other foods high in the amino acid tyramine (spinach, potatoes, tomatoes and soft cheeses) delay or retard the evolution of sleep. Foods high in magnesium and B-complexes may also augment sleep.
Napping shortly after the noontime meal (a traditional practice) not only helps enhance brain function, energy, mood and productivity. It also helps regulate the sleep-wake cycles leading to improved nighttime sleep patterns. This nap must be brief (see below).
Americans and many other fast paced modern societies appear to be experiencing an upsurge in Gastroesophageal Reflux Disease (GERD). The act of reclining or sleeping after a light meal does not cause GERD, and the recommendation to avoid sleep after eating does not prevent GERD. If GERD is present then it must be specifically addressed with proper techniques to resolve it. Once this is accomplished, through non-pharmacologic means, napping and pre-sleep snacks can both be achieved without harm. Those at risk for GERD should avoid overeating, and follow essential non-pharmacologic steps to strengthen the Lower Esophageal Sphincter (LES), to actively resolve this condition.[36]
e. Environment
The sleep environment plays an extremely important role in the ability to achieve and sustain normal, restorative sleep patterns. Many factors in the environment contribute to or detract from sleep quality including: ambient light, noise, temperature, humidity, air quality, odors, perfumes, bed and mattress quality, electromagnetic fields (EMF), WiFi and electrical pollution. These factors can play a role, singly or in combination, preventing or interfering with healthy sleep patterns.
Sleep hygiene: The sleep environment must be thoroughly reviewed and details regarding the placement of windows, electrical devices and other fixtures must be closely examined. Particular attention should be paid to the impact of shared beds and bedrooms when spouses, partners or roommates have conflicting environmental sleeping preferences.
In most circumstances the sleep environment should be at least slightly cooler than the rest of the home. An open window should provide fresh air while adequate blankets should be available to provide comfort and warmth. Room air should move and be exchanged, replenishing during sleep either naturally through an outside facing window, or through means of fans and ventilation systems. The need for supportive pillows for the head and legs should be considered in each case. Window dressings should exclude most outdoor light without interrupting airflow.
Too much or too little noise can be a factor. Particular attention should be paid to early childhood experience and personal preferences. Knowing how an individual slept (or didn’t sleep) as a child may also shed light on the current sleep problem.
If the early childhood environment was conducive to sleep, what factors are different now? Was the early childhood environment noisy, quiet, hot, cold, stuffy, etc.? Bedroom windows that faced away from noisy streets in childhood may indicate a need for a similar environment as an adult. Earplugs should be considered only if the environment is unavoidably noisy, but should be considered a temporary solution; a new environment may need to be found.
Recent investigations suggest that electromagnetic fields (EMF), including home wi-fi, cell phones, wireless phones, smart meters and electrical appliances in close proximity to the bedroom, and particularly the head of the bed, can disturb sleep. These appliances may need to be moved or disconnected (if they draw current) during sleep hours.
All home wireless devices, WiFi, wireless phones and cell phones should be turned off, or re-positioned in a distant location from the bedroom (and the head of the bed) at night. Wireless phone base stations emit EMFs on a continuous basis, and these fields travel directly through most walls, floors and ceilings. Cell phones emit radiation in a pulsed format when they are turned on, even when they are not in use. EMF exposure from these devices drops precipitously with distance, which is why they should be kept as far away from the body as possible. All wired electrical devices (drawing a current), including alarm clocks and electric blankets, emit EMFs and should not be in close proximity to the body (particularly the head) during the hours of sleep. Turning these devices off at night, moving them away from the head, or replacing them with non-electric analog devices should be considered.
Exposure to at least 30 minutes of intense sunlight (without sunglasses or sun block) during the midday is one of the most important methods of reestablishing the biological circadian rhythms of the sleep-wake cycle.[37] Direct sunlight at mid-day has many benefits including the efficient production of vitamin D and the suppression of melatonin. Regular daily exposure to sunlight (not through glass) improves sleep ability at night. Similarly, the use of intensely bright lights at night should be avoided, since this may cause greater circadian dyssynchrony.
f. Behavior
Activities that over stimulate, either cognitive or physical functioning, late in the day can disrupt sleep cycles. Vigorous physical exercise, stimulating conversations, intellectual or unfulfilled sexual arousal, television, homework and other cognitive endeavors that lead to heightened consciousness can all contribute to insomnia.
Sleep hygiene: Establishing a regular evening routine that culminates in the act of going to bed, is extremely important in training (and retraining) the brain to fall asleep. This routine should involve a series of activities that do not lead to excessive stimulation. Every attempt should be made to adhere to a regularly scheduled pattern that keeps exercise early in the day, while reserving evening hours for more a relaxed “winding down” of activities.
Behavioral habits should be part of a regular and predictable pattern that is repeated on a daily basis at consistently set times. There should be minimal or no difference in this pattern between weekends and weekdays.
Bedtime should be a time of relaxation. Thinking and worrying should not be performed in bed. The performance of routine activities of daily living (ADL) in the bedroom and particularly on the bed can lead to the unintended association of these activities with the bed, and should be avoided. Only relaxing activities that provide pleasure, like reading, listening to soft music and sex, may be performed in the bedroom. Activities like paying bills, studying, working on the computer, doing homework, worrying or trying to work out the problems of the day or other cognitive tasks should not be performed on the bed or in the bedroom. The bed and the bedroom should be reserved for the exclusive activity of sleep
Good sleep hygiene may include the technique of writing down bothersome thoughts, worries and anxieties and leaving them on paper to be “set aside”, and consciously “picked up” again the next morning. Once concerns and “to do’s” are written down, the note pad should be set aside, sometimes even placed outside the bedroom door, in a symbolic gesture of exclusion. This action is helpful in establishing a more relaxed and “clean” state of mind and environment.
If worries or anxieties cannot be vanquished in this manner, then the practice of meditation or guided imagery should be added.[38] Techniques that help calm the mind are taught in many civilizations and societies throughout the world, but are almost entirely forsaken in the U.S. This neglect has unfortunate consequences, since these skills not only provide lifelong benefit with regard to sleep and emotional stability, but they also improve mental focus, concentration and cognitive function.
Nocturnal waking should not be accompanied by the use of bright lights since these can re-set the internal clock. When using the bathroom and after returning to bed it is helpful to preempt the thinking process by beginning a meditation upon waking. This should be accomplished consciously by refocusing on the dream state, or by practicing a focused meditation or visualization. This technique can help prevent the activation of higher cortical brain functions, which inhibit sleep and initiate hormonal pathways toward alertness.
If sleep does not come within 20 – 30 minutes after going to bed, it is best to get up out of bed and focus on some other activity for a short period of time. Staying in bed “trying” to fall asleep is usually counterproductive and leads to greater loss of sleep and more frustration. If the mind is preoccupied, then either resolve the issue or make adequate notes so that this concern can be taken up the following day. Consider having a light snack before returning to bed.
Shift work that continually alters sleep-wake cycles can seriously impair the ability to attain full and restful sleep leading to a condition known as Shift Work Disorder (SWD). Shift work patterns are usually more easily tolerated at a young age, but as the brain and body age there is less ability to continually re-adapt to the changing patterns in sleep wake cycles that this type of shift work demands.
Naps
Naps, commonly discouraged with insomnia, can be extremely beneficial if they are regularly scheduled events, restricted to a single, brief “power nap” during the midday. The nap period should not exceed 20 minutes, even if actual sleep is not achieved during this time. Naps should be a scheduled part of the daily routine, best taken after lunch or sometime in the early afternoon. Nap breaks can be extremely refreshing, improving alertness, enhancing job performance, and increasing energy without resetting the circadian rhythm or disrupting the nighttime sleep pattern.[39] The napping process also provides the nervous system with “practice” in the art of relaxing, when there is less at stake. This exercise helps in calming the mind whether or not sleep is actually achieved. Naps can help the body relearn the “art” of sleeping, but they should not exceed 20 minutes.
Classical Homeopathic Medicine
Once the forgoing hygienic factors are addressed, classical homeopathic medicine (CHM) can be extremely helpful in permanently resolving insomnia. Since CHM does not directly involve the use of drugs, chemicals or herbs, it usually doesn’t interfere with or worsen sleep disturbances or lead to rebound or withdrawal symptoms when it is stopped. CHM does not cause physical dependence or addiction, nor does it cause side effects as long as classical methods of prescription are adhered to.[40]
CHM works via non-chemical, non-physical means assisting the body in achieving and re-establishing healthful sleep patterns. The mechanism of this action is unknown.
CHM has a track record of improving overall health and reducing the dependence upon conventional medications by helping the body balance and resolve underlying conditions. Numerous studies attest to the fact that homeopathy helps the body recover more quickly from illness, thereby significantly reducing the risk of exposure to potentially harmful medications and their side effects.[41] This choice of holistic treatment makes more sense as a first line option before pharmacologic interventions are attempted for insomnia.
Many homeopathic medicines have demonstrated activity helping to correct sleep abnormalities, but finding the correct medicine for an individual case requires the proper application of homeopathic principles in that selection process. A routine analysis of several current homeopathic repertories reveals over 460 different homeopathic medicines and more than 570 different rubrics referenced for this problem. [42]
Random and superficial selection of homeopathic remedies, not following CHM prescription guidelines, is more likely to result in failed prescriptions. When each individual case is treated on the basis of its unique identifying characteristics then there is an excellent chance of success. Following a detailed, in-depth analysis is more likely to reveal these determining factors and to assure that a proper and accurate selection of medicine will take place.
Failure to implement CHM prescribing methods (even if so called “homeopathic” medicines are used) is more likely to result in treatment failure since adherence to the “Law of Similars” is the determining factor of whether a homeopathic medicine is likely to work. In other words, if homeopathy is not applied “homeopathically”, namely on the basis of homeopathic laws and principles it will be no more likely to succeed than placebo. Homeopathy, like any other system of medicine, must be utilized according to the dynamics upon which it is based, or it may not produce the desired results.
Homeopathy is a complete system of medicine. It is not an integrative adjunct medical modality that can simply be substituted into treatment plans in place of conventional medications. CHM is not an allopathic medical system and it cannot be applied allopathically with any realistic expectation of success.
Most CHM physicians have extensive experience working with individuals suffering from sleep disorders. These professionals have a thorough knowledge homeopathic literature, which is derived from world-wide evidence-based experience spanning over two hundred years.
Certain homeopathic medicines are particularly well suited to the treatment of sleep disorders. These medicines, cited below, should not be construed as anything more than examples out of a large group of medicines. These may be useful in a pinch, but should not be substituted for a thorough, in-depth CHM analysis.
Argenticum nitricum- Individuals needing this medicine frequently suffer from anxious insomnia. They are extremely distraught and kept awake by numerous fears and worries.
Arsenicum album- Individuals benefiting from this medicine also tend to be anxious, but they also demonstrate a physical restlessness. They frequently don’t sleep because they can’t get physically comfortable and must continually change places and positions at night.
Coffea cruda- Individuals benefiting from this medicine often experience a heightened sense of awareness and mental activity at night. Their minds are active, racing through many thoughts even though their bodies may be exhausted.
Nux vomica- Individuals who benefit from this medicine are typically accustomed to relying on a pattern of various medicines to sleep and others to wake up in the morning. There is frequently a history heavy coffee and alcohol use.
A thorough CHM analysis is part of comprehensive care. Each homeopathic medicine is capable of affecting many different organ systems, ailments and conditions. The common denominator in this method of prescribing is the individualized application of data gleaned from the scientific laws of observation in each case.
Conclusion
Insomnia is an extremely common and complex problem that can result from a number of different causes. Insomnia is a symptom of disturbance, not a disease in itself. Addressing this condition requires a thorough analysis of each case to identify factors that may cause or contribute to the problem. Medications used to treat insomnia are associated with frequent complications and side effects, and they only rarely solve the problem. These drugs only address the symptoms insomnia and fail to resolve any of the underlying issues. They deliver a modicum of temporary relief, sometimes exacerbating the condition.
Treatment of insomnia begins with a thorough evaluation and investigation into the circumstances surrounding the health, environment, emotional state, behavior and diet. Once any contributing factors from these areas are identified and addressed, Classical Homeopathic Medical treatment commences. CHM is based on the individual characteristics of each case. It offers a unique and effective method of treatment without any of the usual side effects or significant risks associated with conventional medications. Resolution of both acute and chronic insomnia can be achieved using a holistic analysis. This may result in increased overall health and well being beyond the “quick fix” temporary resolution of symptoms so common in the allopathic medical system.
Ronald D. Whitmont is Clinical Assistant Professor of Family and Community Medicine at New York Medical College. He has a full time practice of Classical Homeopathy in Rhinebeck and New York City, New York. He is 1st Vice President of the American Institute of Homeopathy and former president of the Homeopathic Medical Society of the State of New York.
His website is: www.homeopathicmd.com
His email is: homeopathicmd@earthlink.net
[1] Harsora P. Nonpharmacologic Management of Chronic Insomnia. Am Fam Physician. 2009;79(2):125-130,131-132.
[2] Irwin MR. et al. Comparative meta-analysis of Behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol. 2006;25(1):3-14.
[3] Chesson AL Jr, Milligan SA. Current Trends in the Management of Insomnia. Emerg Med. 2002; April: 11- 20.
[4] Brody JE. Personal Health. NYTimes Science Times. May 31, 2011:D7.
[5] Gulland J. To Sleep, Perchance to heal: Managing Sleep Disorders Without Medications. Holistic Primary Care 2008 Fall:21-22.
[6] Morin CM, et al. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA. 1999. 28(11):991-999.
[7] Stickgold R. J Cognit Neurosci, March 2000.
[8] Blakeslee S. For Better Learning, Researchers Endorse ‘Sleep on it” Adage. NYTimes, March 7, 2000:F2.
[9] Van Cauter E. The Lancet, 1999;354:1435-1439.
[10] www.thelancet.com/newlancet/sub/issues/vol354no9188/body.early1435.html
[11] Drake CL. Sleep 2004;27:1453-62.
[12] Ellenbrogen JM. Neurology 2005;64:E25-27.
[13] Gumenyuk V, et al. Sleep 2010; 33:703-713.
[14] Silber MH. Clinical practice. Chronic insomnia. N Engl J Med. 2005;353(8):803-810.
[15] Edinger JD, et al. Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. JAMA. 2001;285(14):1856-1864.
[16] Chesson AL Jr, et al. Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep medicine report. Standards of Practice Committee of the American Academy of Sleep medicine. Sleep 1999;22:1128-1133.
[17] Prescription Drug Use Soared in Past Decade. Vital Statistics. NYTimes. October 19, 2010: D7.
[18] Anastasio GD, et al. Drug Interactions:Keeping it Straight. Am Fam Phys. Sept 1, 1997, 56(3):883-894.
[19] Trovato A, et al. Drug-Nutrient Interactions. Am Fam Practitioner. November 1991(44)5:1651-58.
[20] A fact known to be true, due to experience with infinitesimal doses, in the science known as homeopathy.
[21] This is another fact brought to light by many years of homeopathic experience.
[22] Lasser KE, et al. JAMA 2002, 287(17):2215-20.
[23] Harris G, Halbfinger DM. F.D.A. Reveals it Fell to a Push By Lawmakers. NYTimes, September 25, 2009:A1,A19.
[24] Stout D. Ex-F.D.A. Chief Pleads Guilty in Stock Case. NYTimes, October 17, 2006: A21.
[25] Jaret P. Dangerous Drug Interactions. Hippocrates. June 1999:23-29.
[26] Peck P. Deaths From Adverse Drug Reactions Reach 100,000 a Year. Metaanalysis Causes Concern. Int Med News, May 15, 1998:32.
[27] Kolata G. When Drugs Cause Problems They Are Supposed to Prevent. News Analysis. NYTimes. October 19, 2010: 18.
[28] http://en.wikipedia.org/wiki/Zolpidem – cite_ref-pmid17049955_1-0Lemmer B (2007). “The sleep-wake cycle and sleeping pills”. Physiol. Behav. 90 (2-3): 285–93. doi:10.1016/j.physbeh.2006.09.006. PMID 17049955.
[29] http://www.drugs.com/sfx/ambien-side-effects.html#S5.4 accessed May 20, 2011.
[30] Kripke DF (August 21, 2007). “Greater incidence of depression with hypnotic use than with placebo”. BMC Psychiatry 7: 42. doi:10.1186/1471-244X-7-42. PMC 1994947. PMID 17711589. http://www.biomedcentral.com/1471-244X/7/42.
[31] Zammit G, Erman M, Wang-Weigand S, Sainati S, Zhang J, Roth T (August 2007). “Evaluation of the efficacy and safety of ramelteon in subjects with chronic insomnia”. J Clin Sleep Med 3 (5): 495–504. PMC 1978328. PMID 17803013. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1978328.
[32] Gulland J. To Sleep, Perchance To Heal: Managing Sleep Disorders Without Medications. Holistic Primary Care. Fall 2008: 21-22.
[33] Thorpy M. Sleep Hygiene. 2003. http//www.sleepfoundation.org/article/ask-the-expert/sleep-hygiene.
[34] Raloff J. Drugged Waters. Science News March 21, 1998, 153:187-189.
[35] Nachatelo M. How drugs are polluting our water. Natural Health Magazine. September 2001:51-53.
[36] For more information see previous newsletter on this topic. “GERD”, December 2010.
[37] Khalsa SB, et al. J Physiol 2003;549(pt 3):945-952.
[38] See Healthjourneys.com for a wide selection of guided imagery CD’s and downloadable audio files.
[39] Ficca G, et al. Sleep Med Rev 2010;14:249-258.
[40] For a Definition of Classical Homeopathy, see position paper, The American Institute of Homeopathy at www.homeopathyusa.org
[41] Riley D. Fischer M. Singh B. Haidvogl M. Heger M. Homeopathy and conventional medicine: an outcomes study comparing effectiveness in a primary care setting. J Altern Complement Med 2001;7(2):149-59.
[42] MacRepertory, Kent Homeopathic Associates, San Rafael, CA.
