An Urban Dilemma
As a holistic doctor in New York City, my patients often complain to me about the things that are keeping them up at night: garbage trucks rattling by, drunken bar-goers screaming at 4 a.m., business dinners running into the wee hours with excessive food and alcohol, high-stress jobs that don't end at the office, honking cars, loud neighbors, construction... The list is endless. The city, itself, is in a constant state of energy overload. And what self-respecting New Yorker doesn't have a cell phone clamped to their ear most of the time? A small 2008 study linked cell phone use to fractured sleep patterns, as well as ADHD-like symptoms, depression and poor memory in children and teens. Needless to say, the good people of New York are in a state of nervous system overload. And if my practice is any indication, they're not sleeping well.
The Country That Never Sleeps
Insomnia is a modern plague. Sleep problems affect an estimated 70 million Americans, and 50 percent of these cases involve chronic sleep disorders. The consequences are manifest and range from on-the-job injuries and fatalities to chronic health issues such as obesity, diabetes, depression and cardiovascular problems. The cost of insomnia to the nation's economy in lost productivity is $63.2 billion. In 2010, more than 66 million prescriptions for sedatives and hypnotics were dispensed, according to IMS Health. Do the drugs work? Not really, if the rising number of people who can't sleep is any indication. The side effects of such drugs can be nasty: People can engage in nocturnal activity that they don't remember and wake up feeling groggy, among other things. Benzodiazepines like Ativan and Xanax are strongly addictive. Rebound insomnia, where sleep is virtually impossible when the person stops the medication, is a common occurrence among the patients I see. And there's worse news: A recent study suggests that taking sleep medications is associated with a fivefold risk of dying an early death.
Reestablishing sleep patterns without the use of pharmaceuticals is not only possible but also preferable when you think about the drawbacks of sustained sleeping pill use. It requires a delicate and highly personalized approach including nutrition, botanicals and lifestyle changes. Herewith are my top five strategies for the harried urbanite, though these will work for anyone who wants to catch some quality shut-eye.
The Five Sleep Rules
1. Keep your cortisol under control: When you are stressed or anxious, your adrenal glands produce cortisol. Can't sleep because the same thoughts spin around endlessly in your head? Odds are that you have high cortisol, which has been supported by studies. The best remedy for this is taking adaptogenic herbs like Siberian ginseng, ashwagandha and rhodiola, which all help to nourish the adrenal glands and help the body to cope with stress more effectively. Nervous tension also robs your body of magnesium, which it needs to relax its muscles. Consider a magnesium supplement or upping your intake of high-magnesium foods like green leafies, pumpkin seeds and almonds. Lastly, give your anxiety an outlet. Find a hobby, connect with nature (even Central Park), and do something you love every single day.
2. Nourish yourself properly: That means eliminating caffeine and sugar (sorry, Starbucks fans). Unfortunately, these two mainstays of the sleep-deprived (also nicotine) raise cortisol, increasing your body's susceptibility to insomnia later in the day. Watch out for caffeine in tea, chocolate, and soda. If you are prone to anxiety, don't have more than one caffeine-containing drink per day, and have it before noon. Green tea can also be high in caffeine so use it sparingly. Sugar is a mood-destabilizer and can deeply affect sleep. If you eat a lot of sugar or foods that get digested into sugar (such as breads, breakfast cereals, pasta, and rice), your blood sugar level will rise after eating them. Regular consumption causes your blood sugar level to vacillate all day. This triggers anxiety, depression and mood swings, potentially resulting in insomnia. Try to base your diet on vegetables and protein (fish, poultry, eggs, meat), fruit, nuts, seeds and good fats such as olive oil, flaxseed oil and organic coconut oil.
3. Develop a sleep routine: The body and mind (and especially the adrenal glands) respond well to habit. I have my insomniac patients get in bed before 11 p.m. at the latest, even on weekends. Also important: a blacked-out bedroom (challenging but important for urban dwellers) that is cool and comfortable. Have a partner who snores, active and noisy pets, or loud neighbors? Sleep in another room or get earplugs. An hour before bed, drink a cup of strong chamomile tea. Baths are excellent, especially when adding two cups of Epsom salts and three drops each of jasmine, lavender, and chamomile essential oils.
4. Exercise vigorously: For people who just aren't sleeping, I recommend exercising to the point of exhaustion. The human body is designed to move, not to sit hunched over a computer screen all day. Gentle exercise like walking and stretching will help quell anxiety; however, exercise that makes you sweat releases endorphins that act as powerful tranquilizers and are the ticket for a better night's sleep. A study that came out last year evaluated more than 2,600 men and women ages 18-85, and concluded that 150 minutes of moderate-to-vigorous exercise a week improved sleep quality by 65 percent.
5. Calm the mind: It is common for people who can't sleep to worry about not sleeping. The more worry, the less sleep. To these patients, I cite the example of Buddhist monks who get very little sleep, yet are perfectly rested. How is this possible? Meditation. In fact, a small, 30-person study indicated that in subjects who meditate, the need for sleep declines. Repetitive prayer also works to subdue looping thoughts that avert sleep, as does deep, focused breathing.
Making all of these changes at once might seem daunting, so try adding one at a time for about a month. For the typical New Yorker, insomnia didn't happen in a day, so reestablishing sleep habits will take a bit of time. A bit of patience -- not the forté of most New Yorkers -- is key. I'd love to hear about your experiences with insomnia or what's worked for you to sleep better: Tweet me at DrMauraND, leave a comment here or find me on Facebook.
 "Alternative Medicine Review"; Green Tea Monograph; 2000
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