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The Role of Nutrients in INSOMNIA

Several physical and psychological changes are known to occur with normal ageing; however, adjustment to changes in sleep quantity and quality can be among the most difficult. Although sleep disturbance is a common complaint among patients of all ages, research suggests that older adults are particularly vulnerable. A large study of over 9,000 older adults age of > 65 yr found that 42 per cent of participants reported difficulty initiating and maintaining sleep. Insomnia is a subjective report of insufficient or non-restorative sleep despite adequate opportunity to sleep.


There are two primary factors that control the physiologic need for sleep: the total quantity of sleep and the daily circadian rhythm of sleepiness and alertness. A National Institutes of Health consensus statement recently addressed the diagnosis, risks, consequences, and treatment of chronic insomnia in adults. The progression of sleep across the night is called sleep architecture, and it is displayed as a sleep histogram or hypnogram. Sleep architecture is composed of 3 segments.

Ø The first segment includes light sleep (stages 1 and 2),

Ø The second segment includes deep sleep (stages 3 and 4).

Taken together, stages 3 and 4 are referred to as delta sleep or slow wave sleep (SWS). SWS is believed to be the most restorative part of sleep. Stages 1 to 4 constitute non-rapid eye movement (non-REM). The third sleep segment includes the period of REM sleep. Stages 3 and 4 are generally observed during the first half of the sleep period, and REM sleep occurs most frequently during the second half.

Sleep Architecture in the Elderly

The sleep architecture changes significantly in the healthy elderly individual. Sleep initiation is more difficult, total sleep time & sleep efficiency are reduced; SWS decreases; sleep fragmentation increases; and more time is spent in bed awake after retiring. Natural physiologic changes in circadian rhythm influence many older people to go to bed earlier and to wake up earlier. These factors can contribute to deterioration in sleep quality and less total sleep. Older adults find it more difficult to stay awake during the day. Both the frequency and duration of daytime naps increases which can eventually lead to reversal of the sleep–wake cycle. Patients may report day– night reversal, in which sleep does not began until dawn and then continues until mid-afternoon. Daytime sleepiness can be evaluated using the Multiple Sleep Latency Test, which measures the ability of a subject to fall asleep during 4 to 5 20-minute periods throughout the day. The Epworth sleepiness scale is another helpful screening tool.


Insomnia is classified as:

· Transient (not more than a few nights) — Transient or acute insomnia usually occurs in people with no history of sleep disturbances and is often related to an identifiable cause.

· Acute (less than 3–4 weeks) — Precipitants of acute insomnia include acute medical illness, hospitalization, changes in the sleeping environment, medications, jet lag, and acute or recurring psychosocial stressors.

· Chronic (more than 3–4 weeks) — Chronic or long-term insomnia may be associated with a variety of underlying medical, behavioral, and environmental conditions, and a variety of medications.


Primary sleep disorders- There are three common primary sleep disorders frequently seen in older adults: sleep disordered breathing (SDB), restless legs syndrome (RLS)/periodic limb movements in sleep (PLMS), and REM sleep behaviour disorder (RBD).

Sleep-disordered breathing- Sleep-disordered breathing encompasses a spectrum of breathing disorders ranging from benign snoring to obstructive sleep apnoeas. They suffer from cessation of respiration (apnoeas) and/or partial or reduced respiration (hypopnoeas) during sleep. SBD is diagnosed when each event exceeds 10 sec and recurs throughout the night, resulting in repeated arousals from sleep as well as nocturnal hypoxaemia. Also SDB is more prevalent among institutionalized elderly adults, particularly those with dementia, compared to elderly people living independently. Risk factors associated with SDB include older age, gender, obesity, and symptomatic status. Older adults with SDB may also report insomnia, nocturnal confusion, and daytime cognitive impairment including difficulty with concentration, attention, and short-term memory loss. Patients with SDB are also at greater risk for cardiovascular consequences such as hypertension, cardiac arrhythmias, congestive heart failure, stroke, and myocardial infarction.

Restless legs syndrome(RLS) / Periodic limb movements in sleep (PLMS)-Restless legs syndrome (RLS) is characterized by dysesthesia in the legs which is usually described as “pins and needles” or a “creepy and crawly” sensation in the legs that is only relieved with movement. It occurs when the patient is in relaxed or restful state. RLS is about twice as prevalent among women compared to men. Approximately 70 per cent of patients with RLS also have co-morbid PLMS. PLMS is characterized by clusters of leg jerks causing brief arousal and/or awakening occurring approximately every 20–40 sec over the course of a night. PLMS is diagnosed with an overnight sleep recording which shows patients having at least 5 kicks per hour of sleep paired with arousal. Typically, PLMS and RLS are treated with dopamine agonists, which are effective at reducing leg jerks and the associated arousals.

Rapid eye movement sleep behaviour disorder (RBD) — It is characterized by complex motoric behaviours that occur during REM sleep. These behaviours are likely the result of intermittent lack of the skeletal muscle atonia typically present during the REM phase of sleep. Typically, RBD behaviours present during the second half of the night, when REM sleep is more prevalent. These behaviours/movements can include walking, speaking, eating, and can also be violent and may harm the patient or the patient’s bed partner. RBD is most prevalent among older adult males. RBD is often treated with clonazepam, a long-acting benzodiazepine which has been shown to reduce or eliminate abnormal motor behaviour in approximately 90% of RBD patients.


Proper treatment of insomnia has the potential to reverse insomnia-related morbidities, including risk of depression, disability, and impaired quality of life.


Insomnia is typically undertreated, and nonpharmacologic interventions are underused by health care practitioners. Management of insomnia that is secondary to medical illness, such as pain or shortness of breath, should start with treatment of the primary disease process. Nonpharmacologic “sleep hygiene” interventions that target the source of the problem can still be implemented first in this situation, and should be continued even when a medication is required. Physiologic interventions such as a daytime walk with correctly timed daylight exposure is useful for insomnia. Appropriate temperature control, adequate ventilation, and dark sleep environment may also lead to dramatic improvement in sleep quality. Sleep hygiene measures should be tailored and applied to every patient being evaluated for sleep disturbances.

Behavioural Therapy

Behavioral therapy aims to change maladaptive sleep habits, reduce autonomic arousal, and alter dysfunctional belief and attitudes that can perpetuate insomnia. Behavioral interventions include relaxation therapy, sleep restriction, stimulus control, and cognitive therapies. Progressive muscle relaxation aims to reduce somatic arousal, whereas attention- focusing techniques (imagery training, mediation) are intended to lower pre-sleep cognitive arousal.


Insomnia - Sleep Disorder

Ø Hot milk- Warm or Hot milk with turmeric is a common home remedy for sleeplessness. Milk contains four sleep-promoting compounds: tryptophan, calcium, vitamin D, and melatonin.

Ø Chamomile Tea- Chamomile tea has been used as a traditional remedy for treating insomnia. It has a flavonoid compound called apigenin that is responsible for chamomile’s sleep-inducing properties. Apigenin seems to activate GABA A receptors, a process that helps stimulate sleep. One can take a hot cup of chamomile tea 3–45mins before going to bed.

Ø Tart cherries- Tart cherries are one of the richest natural sources of melatonin and drinking one cup of tart cherry juice twice a day has been proven to reduce insomnia. Cherries are also rich in antioxidants, which help combat the oxidative stress caused by disordered sleep.

Ø Barley Grass Powder — Barley grass is a powerful sleep aid due to its calcium, potassium and tryptophan content. Gamma-Aminobutyric Acid (GABA), a chemical made inside the brain, is also present in the plant, which has been shown to promote sleep and prevent insomnia. To enjoy it as a snack, try adding the powder to smoothies, salad dressings, soups or just plain water.

Walnuts- Walnuts are another tree nut packed with over 19 vitamins and healthy omega-3 fats. Similar to almonds, walnuts are often suggested to improve the quality of sleep, as they are a natural food source of melatonin. They also provide ALA, a fatty acid that converts to DHA, which helps produce serotonin, another sleep-enhancing chemical.

If you are experiencing insomnia it is important to talk to your health coach, as they can help you to identify the underline cause and develop a treatment plan that is right for you. A dietician can be a valuable member heling you to make dietary and lifestyle changes that can promote better sleep and a healthier you!


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