Melatonin is a naturally occurring hormone found in most animals, including humans, and some other living organisms. I n humans, melatonin is produced by the pineal gland, a gland about the size of a pea, located in the center of the brain. During the day, the pineal is inactive. When it becomes dark, the pineal is "turned on" by an area of the brain called the supra-chiasmatic nucleus (SCN) and begins to actively produce melatonin, which is released into the blood. Usually, this occurs around 9 pm. As a result, melatonin levels in the blood rise sharply and you begin to feel less alert. Melatonin levels in the blood normally stay elevated throughout the night, then with daylight they fall back to daytime levels (which can barely be detected).
Products containing melatonin have been available as a dietary supplement in the United States since 1993, although over-the-counter sales of melatonin are illegal in many other countries. But can melatonin supplements actually help you sleep better? And are melatonin supplements safe. According to MedlinePlus, (a service of the National Library of Medicine and the National Institutes of Health), there are five uses of melatonin for which there is either good or strong scientific evidence. The first of these is for treatment of jet lag:
“Several human trials suggest that melatonin taken by mouth, started on the day of travel (close to the target bedtime at the destination) and continued for several days, reduces the number of days required to establish a normal sleep pattern, diminishes the time it takes to fall asleep ("sleep latency"), improves alertness, and reduces daytime fatigue. Although these results are compelling, the majority of studies have had problems with their designs and reporting, and some trials have not found benefits. Overall, the scientific evidence does suggest benefits of melatonin in up to half of people who take it for jet-lag. More trials are needed to confirm these findings, to determine optimal dosing, and to evaluate use in combination with prescription sleep aids.”
One such study published in the Mar. 18, 1989, British Medical Journal reported that taking synthetic melatonin tablets can help travelers restore normal sleeping patterns. In that study, 20 volunteers traveling back and forth between New Zealand and England took daily doses of either 5 milligrams of melatonin or a placebo (a blank, or sugar pill) before, during, and after their flights. Those taking melatonin returned to their normal sleep patterns in 2.85 days on average compared with 4.15 days for those taking a placebo. And in 2005, MIT released the results of a meta-analysis of 17 peer-reviewed studies using melatonin. It showed that melatonin was effective in helping people fall asleep at doses of 0.3 milligrams (mg). Larger doses of melatonin seem to be less effective after only a few days' use.
The second use is for delayed sleep phase syndrome (DSPS), also known as delayed sleep-phase disorder (DSPD) or delayed sleep-phase type (DSPT). According to the International Classification of Sleep Disorders (ICSD), diagnostic criteria for Delayed Sleep-Phase Syndrome are:
1. There is an intractable delay in the phase of the major sleep period in relation to the desired clock time, as evidenced by a chronic or recurrent complaint of inability to fall asleep at a desired conventional clock time together with the inability to awaken at a desired and socially acceptable time.
2. When not required to maintain a strict schedule, patients will exhibit normal sleep quality and duration for their age and maintain a delayed, but stable, phase of entrainment to local time.
3. Patients have little or no reported difficulty in maintaining sleep once sleep has begun.
4. Patients have a relatively severe to absolute inability to advance the sleep phase to earlier hours by enforcing conventional sleep and wake times.
5. Sleep-wake logs and/or actigraphy monitoring for at least two weeks document a consistent habitual pattern of sleep onsets, usually later than 2 a.m., and lengthy sleeps.
6. Occasional noncircadian days may occur (i.e., sleep is "skipped" for an entire day and night plus some portion of the following day), followed by a sleep period lasting 12 to 18 hours.
7. The symptoms do not meet the criteria for any other sleep disorder causing inability to initiate sleep or excessive sleepiness.
8. If any of the following laboratory methods is used, it must demonstrate a delay in the timing of the habitual sleep period: 1) Twenty-four-hour polysomnographic monitoring (or by means of two consecutive nights of polysomnography and an intervening multiple sleep latency test), 2) Continuous temperature monitoring showing that the time of the absolute temperature nadir is delayed into the second half of the habitual (delayed) sleep episode.
Although there are studies suggesting the use of melatonin for DSPS is promising, additional research with larger studies is needed before a stronger recommendation can be made.
The third use is for insomnia in the elderly:
“Several human studies report that melatonin taken by mouth before bedtime decreases the amount of time it takes to fall asleep ("sleep latency") in elderly individuals with insomnia. Improved sleep quality and morning alertness has also been reported. However, most studies have not been high quality in their designs and some research has found limited or no benefits. The majority of trials have been brief in duration (several days long), and long-term effects are not known.”
The fourth is sleep disturbances in children with neuro-psychiatric disorders:
“There are multiple trials investigating melatonin use in children with various neuro-psychiatric disorders, including mental retardation, autism, psychiatric disorders, visual impairment, or epilepsy. Studies have demonstrated reduced time to fall asleep (sleep latency) and increased sleep duration. Well-designed controlled trials in select patient populations are needed before a stronger or more specific recommendation can be made.”
In April of this year (2009) the study "The Efficacy of Melatonin for Sleep Problems in Children with Autism, Fragile X Syndrome, or Autism and Fragile X Syndrome" published in the Journal of Clinical Sleep Medicine suggests that melatonin may help children with autism or Fragile X syndrome sleep, decreasing the length of time it takes for these children to fall asleep, and increase the amount of time they slept. According to the senior author, Beth L. Goodlin-Jones, PhD of the M.I.N.D Institute at the University of California Davis Health System in Sacramento, Calif., treatment with over-the-counter melatonin supplements benefits children of all ages, which helps alleviate some of the additional stress that parents of special-needs children experience.
The final use is for sleep enhancement in healthy people:
“Multiple human studies have measured the effects of melatonin supplements on sleep in healthy individuals. A wide range of doses has been used often taken by mouth 30 to 60 minutes prior to sleep time. Most trials have been small, brief in duration, and have not been rigorously designed or reported. However, the weight of scientific evidence does suggest that melatonin decreases the time it takes to fall asleep ("sleep latency"), increases the feeling of "sleepiness," and may increase the duration of sleep. Better research is needed in this area.”
When taking melatonin supplements, it’s important to remember that it’s not categorized as a drug. Because of this, synthetic melatonin is made in factories that aren’t regulated by the FDA, so listed doses may not be controlled or accurate, and the amount of melatonin in a pill you take may not be the amount listed on the package. According to the National Sleep Foundation, most commercial products are offered at dosages that cause melatonin levels in the blood to rise to much higher levels than are naturally produced in the body. Taking a typical dose (1 to 3 mg) may elevate your blood melatonin levels to 1 to 20 times normal. Side effects do not have to be listed on the product's packaging.
In our next post, we’ll look at melatonin’s potential side effects.
Saturday, June 20, 2009
Wednesday, June 10, 2009
Are There Really Foods That Can Help You Sleep Better?
The answer appears to be yes. In published in The American Journal of Clinical Nutrition by Ahmad Afaghi, Helen O'Connor, and Chin Moi Chow at the School of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, in Sydney, Australia studied 12 healthy men who were 18-35 years old. The investigators studied the role of carbohydrates in sleep induction by examining the effect of glycemic index (GI) and meal time on sleep in healthy volunteers. The glycemic index, or GI, is a measure of the effects of carbohydrates on blood glucose levels. Carbohydrates that break down rapidly during digestion releasing glucose rapidly into the bloodstream have a high glycemic index; carbohydrates that break down slowly, releasing glucose gradually into the bloodstream, have a low glycemic index.
The men tried three varieties of cooked rice in their meals: plain rice, long-grain rice and jasmine rice - with steamed vegetables in tomato puree. Jasmine rice has a high glycemic index, while plain and long-grain rice have lower glycemic index. The researchers found that higher carbohydrates raised two brain chemicals involved in sleep, tryptophan and serotonin levels, making people sleepier. They also found that there was a reduction in sleep onset latency (SOL -- the time it takes to fall asleep) by nine minutes in the group that had a high carbohydrate meal four hours before bed time. In addition, there was no difference between a meal consumed four hours before bedtime and one consumed one hour before bedtime. It’s important to note that these findings were only for healthy sleepers -- meaning those who may have insomnia could have different results.
The men tried three varieties of cooked rice in their meals: plain rice, long-grain rice and jasmine rice - with steamed vegetables in tomato puree. Jasmine rice has a high glycemic index, while plain and long-grain rice have lower glycemic index. The researchers found that higher carbohydrates raised two brain chemicals involved in sleep, tryptophan and serotonin levels, making people sleepier. They also found that there was a reduction in sleep onset latency (SOL -- the time it takes to fall asleep) by nine minutes in the group that had a high carbohydrate meal four hours before bed time. In addition, there was no difference between a meal consumed four hours before bedtime and one consumed one hour before bedtime. It’s important to note that these findings were only for healthy sleepers -- meaning those who may have insomnia could have different results.
Wednesday, June 3, 2009
The Stages of Sleep
In order to understand about what you can do to help improve your sleep, you need to understand sleep itself. In mammals and birds, sleep is divided into two broad types: Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM or non-REM) sleep. Each type has a distinct set of associated physiological, neurological, and psychological features. During sleep, the body cycles between REM and non-REM sleep.
It’s in the REM stage of sleep that dreams generally occur. The first REM sleep period usually occurs about 70 to 90 minutes after you fall asleep. REM sleep begins with signals from an area at the base of the brain called the pons. These signals travel to a brain region called the thalamus, which relays them to the cerebral cortex – the outer layer of the brain that is responsible for learning, thinking, and organizing information. The pons also sends signals that shut off neurons in the spinal cord, causing temporary paralysis of the limb muscles. Breathing becomes more rapid, irregular and shallow, eyes jerk rapidly and limb muscles are temporarily paralyzed. Brain waves during this stage increase to levels experienced when a person is awake, heart rate increases, blood pressure rises, and the body loses some of the ability to regulate its temperature. REM sleep accounts for 20–25% of total sleep time in normal human adults, but infants spend much more time in REM sleep. Some experts believe that this greater time is due to the fact that REM sleep stimulates the brain regions used in learning, which may be important for normal brain development during infancy. The first period of REM typically lasts 10 minutes, with each recurring REM stage lengthening. The final REM period may last up to an hour.
According to the American Academy of Sleep Medicine standards, non-REM sleep consists of three stages: N1, N2, and N3 (prior to 2007, non-REM sleep was considered to have fours stage – Stage 1, Stage2, Stage 3, and Stage 4).
Stage N1 is the transition of the brain from alpha waves having a frequency of 8 to 13 Hz (common in the awake state) to theta waves having a frequency of 4 to 7 Hz. Sometimes referred to as somnolence or drowsy sleep, this stage lasts about five to 10 minutes. During this stage you may experience sudden muscle contractions called hypnic myoclonia, often preceded by a sensation of starting to fall. Some people may also experience hypnagogic hallucinations during this stage, and you lose some muscle tone and most conscious awareness of your external environment.
Stage N2 is a period of light sleep. During this stage, polysomnographic readings show bursts of brain activity ranging from 12 to 16 Hz and K-complexes. Mmuscular activity as measured by EMG decreases during this stage, you lose complete conscious awareness of your external environment, your heart rate slows and your body temperature decreases. At this point, the body prepares to enter deep sleep. This stage occupies roughly 45 to 55% of total sleep in adults.
Stage N3 is also known as slow-wave, delta, or deep sleep. This stage is characterized by delta waves ranging from 0.5 to 4 Hz (also called delta rhythms). This is the stage where parasomnias such as night terrors, bedwetting, sleepwalking, and sleep-talking occur, particularly in children. If you’re awakened during this stage, you won’t be able to immediately adjust to being awake, and will often feel groggy and disoriented for several minutes. During this stage the body repairs and regenerates tissues, builds bone and muscle, and appears to strengthen the immune system.
A complete sleep cycle takes 90 to 110 minutes on average. The first sleep cycles each night contain relatively short REM periods and long periods of deep sleep. As the night progresses, REM sleep periods increase in length while deep sleep decreases. By morning, people spend nearly all their sleep time in stages N1, N2, and REM.
If you’re awakened after sleeping more than a few minutes, you’re usually unable to recall the last few minutes before you fell asleep. This sleep-related form of amnesia is the reason people often forget telephone calls or conversations they've had in the middle of the night. It also explains why you often don’t remember your alarm ringing in the morning if you go right back to sleep after turning them off.
Hopefully you now have a better understanding of the different stages of sleep. By understanding how sleep is supposed to work, you can better understand the different problems that can interfere with proper sleep, which is the first step to help you correct these problems.
It’s in the REM stage of sleep that dreams generally occur. The first REM sleep period usually occurs about 70 to 90 minutes after you fall asleep. REM sleep begins with signals from an area at the base of the brain called the pons. These signals travel to a brain region called the thalamus, which relays them to the cerebral cortex – the outer layer of the brain that is responsible for learning, thinking, and organizing information. The pons also sends signals that shut off neurons in the spinal cord, causing temporary paralysis of the limb muscles. Breathing becomes more rapid, irregular and shallow, eyes jerk rapidly and limb muscles are temporarily paralyzed. Brain waves during this stage increase to levels experienced when a person is awake, heart rate increases, blood pressure rises, and the body loses some of the ability to regulate its temperature. REM sleep accounts for 20–25% of total sleep time in normal human adults, but infants spend much more time in REM sleep. Some experts believe that this greater time is due to the fact that REM sleep stimulates the brain regions used in learning, which may be important for normal brain development during infancy. The first period of REM typically lasts 10 minutes, with each recurring REM stage lengthening. The final REM period may last up to an hour.
According to the American Academy of Sleep Medicine standards, non-REM sleep consists of three stages: N1, N2, and N3 (prior to 2007, non-REM sleep was considered to have fours stage – Stage 1, Stage2, Stage 3, and Stage 4).
Stage N1 is the transition of the brain from alpha waves having a frequency of 8 to 13 Hz (common in the awake state) to theta waves having a frequency of 4 to 7 Hz. Sometimes referred to as somnolence or drowsy sleep, this stage lasts about five to 10 minutes. During this stage you may experience sudden muscle contractions called hypnic myoclonia, often preceded by a sensation of starting to fall. Some people may also experience hypnagogic hallucinations during this stage, and you lose some muscle tone and most conscious awareness of your external environment.
Stage N2 is a period of light sleep. During this stage, polysomnographic readings show bursts of brain activity ranging from 12 to 16 Hz and K-complexes. Mmuscular activity as measured by EMG decreases during this stage, you lose complete conscious awareness of your external environment, your heart rate slows and your body temperature decreases. At this point, the body prepares to enter deep sleep. This stage occupies roughly 45 to 55% of total sleep in adults.
Stage N3 is also known as slow-wave, delta, or deep sleep. This stage is characterized by delta waves ranging from 0.5 to 4 Hz (also called delta rhythms). This is the stage where parasomnias such as night terrors, bedwetting, sleepwalking, and sleep-talking occur, particularly in children. If you’re awakened during this stage, you won’t be able to immediately adjust to being awake, and will often feel groggy and disoriented for several minutes. During this stage the body repairs and regenerates tissues, builds bone and muscle, and appears to strengthen the immune system.
A complete sleep cycle takes 90 to 110 minutes on average. The first sleep cycles each night contain relatively short REM periods and long periods of deep sleep. As the night progresses, REM sleep periods increase in length while deep sleep decreases. By morning, people spend nearly all their sleep time in stages N1, N2, and REM.
If you’re awakened after sleeping more than a few minutes, you’re usually unable to recall the last few minutes before you fell asleep. This sleep-related form of amnesia is the reason people often forget telephone calls or conversations they've had in the middle of the night. It also explains why you often don’t remember your alarm ringing in the morning if you go right back to sleep after turning them off.
Hopefully you now have a better understanding of the different stages of sleep. By understanding how sleep is supposed to work, you can better understand the different problems that can interfere with proper sleep, which is the first step to help you correct these problems.
Friday, May 29, 2009
Welcome to the Cuddle Ewe™ Sleep Blog
Hello, and welcome to the Cuddle Ewe™ sleep blog! Cuddle Ewe™ is a company devoted to developing and manufacturing products to help people sleep better, especially those with chronic diseases that make restful sleep more difficult, such as fibromyalgia, arthritis, and polymyostis, and for those who simply want to get a good night’s sleep. Our flagship product is the Cuddle Ewe™ pure wool Underquilt. Placed between your mattress and bottom sheet, Cuddle Ewe™ Underquilts support and distribute your body weight, providing gentle, effective support and simultaneously distribute your body weight away from painful tender points and sensitive joints to promote a more restorative night's rest. Our Underquilts have been featured in a number of publications, including “Living Well with Chronic Fatigue Syndrome and Fibromyalgia” by Mary J. Shomon, “From Fatigued to Fantastic” by Jacob Teitelbaum, M.D, and “Home Safe Home” by Debra Lynn Dadd.
The purpose of this blog is to provide you with information on sleep and sleep disorders to help you get the best rest possible. Sleep, like diet and exercise, is important for our minds and bodies to function normally. Rats deprived of sleep die within two to three weeks, a time frame similar to death due to starvation. Short term effects of sleep deprivation include decreased performance and alertness, memory and cognitive impairment, relationships stress, occupational injuries, and auto accidents. Long term effects of sleep deprivation include high blood pressure, heart attack, heart failure, stroke, obesity, psychiatric problems including depression and other mood disorders, Attention Deficit Disorder (ADD), mental impairment and fetal and childhood growth retardation.
We also want to point out that the information provided on this blog should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.
The purpose of this blog is to provide you with information on sleep and sleep disorders to help you get the best rest possible. Sleep, like diet and exercise, is important for our minds and bodies to function normally. Rats deprived of sleep die within two to three weeks, a time frame similar to death due to starvation. Short term effects of sleep deprivation include decreased performance and alertness, memory and cognitive impairment, relationships stress, occupational injuries, and auto accidents. Long term effects of sleep deprivation include high blood pressure, heart attack, heart failure, stroke, obesity, psychiatric problems including depression and other mood disorders, Attention Deficit Disorder (ADD), mental impairment and fetal and childhood growth retardation.
We also want to point out that the information provided on this blog should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.
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