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Please discuss everything with your doctor first.

Sleep Aids

Yes, it's true that some people have a mutation in a gene called DEC2 that allows them to sleep very little, around six hours, and be healthy with no fatigue. [5]  There are even reports of "hypersomniacs" that do well on less than an hour a night.  But chances are, if you're reading this, you're not one of them and you're tired and you need some way to get some more sleep.  In fact, maybe you read about how some extra sleep will boost your testosterone, increase your libido and improve your erectile performance.  Regardless of your reason, I've got a number of suggestions, mostly from the research, that show you how you can more easily fall asleep and also improve the quality of your sleep while you're at it.

If you are a quasi-insomniac for some reason, try to get to the root of the issue which is probably stress, anxiety and/or caffeine. In the meantime, you can rotate through the these short term to get you back on track:

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  1. Exercise.  A 2009 study showed that, on average, every hour that a child was sedentary added 3 additional minutes required for them to fall asleep. [6]  Results for adults, at least with moderate exercise, have yielded excellent results as well. [7]  Some researchers argue that there is no more safe and effective sleep aid than good ol' fashioned exercise.
  2. Lose Weight.  Being overweight is associated with a variety of sleeping disorders and often dropping those pounds will help substantially. Weight gain has been strongly associated with Apnea. And one set of researchers wrote that "A weight gain of as little as 10% has predicted a six-fold increase in the odds of developing moderate to severe sleep-disordered breathing" [10] based on the results of this study. [11]
  3. Melatonin.  Melatonin has been shown in numerous studies and a variety of populations/cohorts to help with sleep. [1]  I have friends, as perhaps to you, for whom melatonin has been a life saver.  But we should keep in mind that this is a hormone and should be treated as such.  If you are getting very poor quality or limited sleep, this is probably whacking your testosterone, neurotransmitters, raising your stress hormones and so on.  So, in this case, Melatonin may be a godsend in the short term to get your sleep rhythm back on track. Melatonin is now frequently sold in doses less than a mg - 300 micrograms is now quite common - and most experts recommend these lower doses. The reason is that the 1 mg and above dosages that were so common for years delivered was a megadose, i.e. it much exceeded your body's normal levels. I have a friend who was a quasi-insomniac:  Melatonin gave her her life back.  But please read the following cautions as well: CAUTION: There is also a study on quail that shows that Melatonin increases GnIH which in turn will turn off GnRH.  This is potentially bad for us vertebrate males since GnRH effects Leutenizing Hormone and Follicle Stimulating Hormone. However, Melatonin has been extensively studied and, as far as I know, there is no correlation between lower testosterone and melatonin (except in Quail). CAUTION 2: Melatonin is associated with lower seratonin levels.  Of course, if you are low on melatonin from caffeine usage, aging, etc., then a small amount of melatonin may be beneficial.  But this issue has not, as far as I know, been extensively studied. (See NOTE on tasimelteon below.)
  4. Magnesium.  Many people are low on Magnesium and this can cause sleep disturbances. If you eat well, low magnesium is probably not an issue for you, but many people swear by taking supplemental Magnesium right before bed. 
  5. Green Tea.  CAUTION:  Studies have shown that Green Tea, primarily through the action of an unusual amino acid called L-Theanine, raises dopamine and seratonin levels all the while inducing alpha (deep wave) activity in the brain.  This produces a calming effect, an almost "meditative" state of mind.  In fact, you will read on the web that some are even suggesting that green tea be taken to induce better quality sleep. And it's true that caffeine does not seem to cause wakefulness in daily caffeine users as a certain "tolerance" seems to be built up.  But I know of no study that shows that green tea or any other product taken right before bed gives one better sleep.  There is a Japanese study that shows that L-Theanine taken before bed gives better quality sleep, but this is a far cry from pumping your blood stream with a 100 mg of caffeince shortly before bed!
  6. Stretching.  Stretching the major muscle groups before sleep relaxes the entire body. 
  7. Yoga.  Regular yoga practitioners were found in one study were found, not necessarily to fall asleep more easily, but to have improved "sleep architecture". [8] As you age, your slow wave and REM cycles shorten and (male) yoga practitioners showed significantly better results in this area.  In fact, in the case of slow wave sleep, yoga actually completely eliminated the age related decline. (fyi: Vipassana meditation helped with REM cycle maintenance but not slow wave preservation.) Slow wave sleep is the restorative, non-REM part of your sleep and it has been found to be key to blood sugar control. [9]
  8. Glycine. Glycine is an amino acid that the body can manufacture from other amino acids or, alternatively, can be obtained through diet, mostly meats.  Several studies [4] have shown that 2 or 3 grams consumed before bedtime induces deepened sleep.  Glycine appears to be involved, for example, in disconnecting the body from outside stimulus during sleep.
  9. Benadryl.  Generic Benadryl is cheap and will knock (most of) you out cold.  If you're sensitive, it may even leave you feeling groggy the next morning.  This is NOT something I recommend every night as any drug, no matter how safe, can be psychologically addictive.  CAUTION:  These older style medications cross the blood-brain barrier and decrease acetylcholine levels.  (Acetylcholine is a key brain neurotransmitter.)  Although no long term effects have been noted, it is better safe than sorry.  Again, this is just to get your sleep cycle back on track.
  10. Lavender.  Lavender has been shown in numerous studies to be a mild sedative with no side effects.  For example, the prestigious journal Lancet (9/9/1995) published a preliminary study showing that patients smelling Lavender had both longer and deeper sleep. Caution:  Do not apply lavender directly to the skin. You want to vaporize it or put it onto the four corners of the mattress, etc.
  11. Socks.  I know it sounds weird but Dutch researchers found that putting socks on at night triggers much more restful sleep.  Roy Raymann, lead researcher of the study, wrote that "increases in the temperature of your feet signal neurons in your brain that cause you to fall asleep".  [2] 
  12. Caffeine and Alchohol.  Be careful about these two.  Common sense tells you, and your common sense would be right, that too much caffeince (which is highly variable among individuals) can keep the Z's away.  Alchohol, on the other hand, will put you to sleep but has been shown to lead to poorer quality sleep. 



NOTE:  There is a new drug, tasimelteon, supposedly with few side effects, that is a melatonin agonist, i.e. a chemical that mimics melatonin. As of this writing in October of 2009, it had successfully passed Phase III trials and seems to have the "green light".  Of course, this begs the question:  why not just take melatonin?  I don't have a good answer for that, except to say that some critics of the supplement industry point out that melatonin supplements are not controlled and some tested samples did not even contain the quantity of melatonin shown on the label.  Personally, I do not see this as much of an issue, especially if you are taking melatonin short term, but my job is to inform.

REFERENCES:

1) Sleep,Sep 1995,18 (7) p598-603;Lancet,Aug 26 1995,346(8974):541-4;Eur J Pharmacol,Mar 6 1995,275(2):213-6;Clin Pharmacol Ther,May 1995,57(5):552-8

2) Am J Physiol Regul Integr Comp Physiol, 2005,288: R1589-R1597

3) Med and Sci in Sports & Exerc,1999, 31:483

4) Neuroscience Let, 2001 Feb 16, 299(1-2):93-6; J Neurosci, 1989 Mar, 9(3):743-51

5) He, Y. Science, Aug. 14, 2009; vol 325: pp 866-870. Hor, H. And Tafti, M. Science, Aug. 14, 2009; vol 325: pp 825-826

6) Arch Dis Child, Sep 2009, 94(9):686-9, Epub 2009 Jul 24, "Falling asleep: the determinants of sleep latency"

7) JAMA, Jan 1 1997, 277(1):32-7, "Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial"

8) Sleep and Biological Rhythms, 4(3):207 - 214, Published Online: 19 Sep 2006, "Evaluation of sleep architecture in practitioners of Sudarshan Kriya yoga and Vipassana meditation"

9) PNAS, January 22, 2008, 105(3):1044-1049, "Slow-wave sleep and the risk of type 2 diabetes in humans"

10) Journal of the International Society of Sports Nutrition, Published: 9 December 2005, Volume 2, "Obesity: Prevalence, Theories, Medical Consequences, Management, and Research Directions"

11) JAMA, 2000 Dec 20, 284(23):3015-21, "Longitudinal study of moderate weight change and sleep-disordered breathing"

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