Monday May 21, 2007

Sleepless in the Suburbs
Can’t sleep? Local health and wellness experts provide
innovative strategies for coping with a pervasive problem

Marjorie Solomon writer

It’s 2:41 am, and middle-aged eyes are popping open all over town. We’re wide awake! We’re ready to send email, watch TV, read the paper, even make breakfast for the family! Unfortunately, it’s still dark outside and most folks are sound asleep. Eventually, if we’re lucky, we may catch a quick nap before the alarm clock sounds.
Why us? What’s causing our lack of sleep? What’s within the range of normal sleeplessness — the kind that affects everyone once in awhile — and what’s insomnia? More importantly, should we take the sleeping pills some physicians are proffering, or wait for our sleeplessness, like a bad senior moment, to pass?

Many Choices for Improving Sleep
Simply put, insomnia is the inability to fall and/or stay asleep. Fortunately for those of us who are up and surfing the Net for much of the night, the MetroWest area is teeming with holistic practitioners, wellness counselors, and others, many of whom offer a broad range of holistic solutions and lifestyle strategies for insomnia. Some of their offerings are well-studied, like massage therapy, light therapy, relaxation therapies (including meditation, breathing techniques, and visualization), acupuncture, and yoga. Other offerings are less studied, but have met with good anecdotal success (hypnosis and many herbal remedies, for example). There’s a large body of anecdotal evidence describing how our eating and drinking habits can affect sleep patterns, too.
When holistic methods and lifestyle changes don’t work, pharmaceutical sleep medications, although controversial, may be needed. Sleep medications carry with them some pretty obvious risks though, like dependency and addiction, a “hung over” feeling during the day, and even, in extreme cases (usually, say doctors, when patients increase their own dosages, or include alcohol with their medications) amnesia, including episodes of sleep walking or sleep eating. Additionally, withdrawal from certain types of sleep medications can cause “rebound insomnia,” and when the patient stops taking the medication, insomnia may recur.
Dr. Ken Sassower, staff neurologist at the Sleep Disorders Unit of the Massachusetts General Hospital, explains. “Sleep is a complicated issue. Treatment involves more than just ‘knocking someone out.’ We need to address what might be the underlying issues, like pain or stress. Sometimes these can take awhile to uncover.”
Holistic health practitioners agree, and many of them devote significant parts of their practice to helping us get back to sleep, naturally. Natural remedies for pain and stress carry with them far fewer side effects than conventional sleep medications, but require more motivation on the patient’s part than does simply taking a pill.

A Range of Holistic Approaches:
Where to Start?
Marcy Balter, a whole-health counselor who practices in Weston, advocates keeping a journal to note patterns of food, activities, and sleep, from the middle of the day onward. The usefulness of such a journal is two-fold: first, it will enable you (and later, perhaps your doctor) to note patterns and see what might be disrupting your sleep. Second, you can optionally use the journal as a place to “dump” your worries or troubling thoughts, so that they don’t necessarily haunt your nights.
Geoff D’Arcy, an acupuncturist and Doctor of Oriental Medicine who, with his wife Po, co-founded the D’Arcy Wellness Clinic in Natick, agrees that worries and troubling thoughts, that is, emotional stress, is a significant culprit for insomnia. “This area, the Eastern corridor, is incredibly busy. The stresses of modern life make for deficiencies in the parasympathetic nervous system; that’s the part of our anatomy that enables us to relax. We can make up for these deficiencies with things like yoga, family, and a connection to nature. But if we rush to the gym to do weightlifting, aerobics, running - these are things that actually worsen it!”
D’Arcy cautions, “Long ago, we needed our fight-or-flight impulse, regulated by the sympathetic nervous system, to hunt, or to escape danger. Today we need it to kick in for emergencies, but since our daily lives are so stressful, it functions constantly at a low level, rather than on demand, as it was designed. Stress is a toxin that, like other toxins, can disrupt sleep. We need to create a relaxation response, not maintain the fight-or-flight response, in order to redress the imbalance. You don’t necessarily want to use a powerful pharmaceutical that’s going to overwhelm the whole system.”
Po D’Arcy suggests trying herbal remedies, like kava kava, passionflower, lemon balm, chamomile, and valerian root. But, she cautions, “It’s not about taking an herb and instantly feeling sleepy. Herbs are calming and nourishing. They’re useful because they can stimulate the parasympathetic nervous system gently, over time.”
Both the D’Arcys and Marcy Balter advocate a multi-pronged approach that can include relaxation techniques, acupuncture, herbals, vitamins, dietary changes, and stress reduction. In fact, all advocate adopting a balanced diet consisting of whole foods (the more organics included the better), no nicotine, and a minimized intake of alcohol, caffeine, sugar, and processed “junk” foods. Balter says “I believe in synergy. Do it all. You don’t need to know which one is helping. Some cost nothing, like meditation. You need to buy food anyway, so help yourself by buying and preparing high-quality whole foods, greens and grains. Drink plenty of water. And by all means, practice portion control. Bring in the healthy and crowd out the bad.”
Going Deeper: Acupuncture, Yoga, Massage, and Hypnosis
Li Zheng, a licensed acupuncturist whose office is in Needham, explains that acupuncture can stimulate the body’s own secretion of certain hormones, including sleep-inducing melatonin, produced by the tiny pineal gland at the center of the brain. Acupuncture can also optimize the body’s production of serotonin, which decreases depression; doctors often see a connection between depression and insomnia. “Acupuncture treats without side effects, and allows the body to use its own, natural chemicals in a more efficient way.”
Zheng advocates combining acupuncture with Chinese herbal formulations. She says that once patients are “rebalanced,” they won’t need treatments forever. “Maintenance is beneficial for people who are very sensitive to environmental changes, or under a lot of stress. Acupuncture needs time and patience to work; it’s a gentle adjustment of the body that promotes healthy sleep.”
But, Zheng cautions, acupuncture won’t work on insomnia related to internal organ damage, like arterial sclerosis. It works on hormone imbalances in the nervous system, and alleviates pain. For patients whose pain is keeping them awake, Sassower reinforces the value of the acupuncturist’s role. Sassower also advocates using yoga and massage therapy to alleviate muscle tension and stress, as an alternative to opiates.
“Yoga strengthens and calms the nervous system,” explains Jennifer Harvey, owner and director of the Laughing Dog Yoga Studio in Wellesley. “In fact, Restorative Yoga (a style of yoga that uses props and supported positions) is an incredibly powerful tool to use for sleep. It’s calming, very relaxing, pain-relieving, and not effortful. It brings blood back into the organs that chronic stress has pushed to the extremities, in preparation for fight-or-flight. Yoga enables you to learn practical ways, through poses and controlled breathing techniques, that can relax areas that are tense and tight. It stretches out and aligns your body so that even deep-seated tensions disappear. After just a few yoga sessions, many people say they get a better, more restful sleep.”
Like yoga, massage can release tension in the musculoskeletal system, and for the treatment of insomnia, it is frequently coupled with controlled breathing techniques. Bonnie Watson, a massage therapist whose practice is in Wellesley, says “Along with massage, I use guided imagery and breath work. If clients experience insomnia due to stress, I’ll ask them to visualize releasing their stress with each exhale.”
Steve Carter, a Newton massage therapist, incorporates counseling, breath work, and even meditation to help those clients with insomnia who are open to a multi-disciplinary approach. Steve says: “I sometimes use Craniosacral therapy; it’s a deeply relaxing and very powerful massage technique that’s particularly soothing to the nervous system. I also show clients how to practice self-care methods for insomnia at home. I try not to create a dependency. A good massage therapist should be able to help you sleep better over time, not just after a session.”
Norma Star Auerbuck, a clinical hypnotherapist whose South Natick practice emphasizes the connection between mind, body, and spirit, uses hypnosis as one treatment for insomnia. “A trained hypnotherapist knows how to provide a therapeutic, healing outcome for clients who have sleep problems. I use Reiki (a healing, life-force energy technique developed in Japan) first, to create trust and comfort in my clients. Then I use hypnosis to help them focus on, control, and really manage their own well-being, which helps bring healthy sleep to the fore. I think people need to pray, meditate, do yoga…and connect to a divine inner source…whatever it may be…as an antidote to our modern day, hectic, rapid-paced culture.”

Strategies for a Better Sleep
“We pay homage to everything we do during the day…preparing for meetings, for example,” Sassower points out. “But sleep is expected to just ‘happen’ at night. People who have insomnia really need to ready themselves for sleep, just like they do for daytime activities.”

Some basics to avoid:
Caffeine If you simply must have it, curtail your intake by the afternoon. Sassower cautions that for those who are sensitive, caffeine, even when taken in the morning, can contribute to insomnia.
Sugar, nicotine, salt, and “excito-toxins” D’Arcy says that excito-toxins include monosodium glutamate (MSG), and artificial sweeteners, such as aspartame.
Alcohol near bedtime While alcohol makes it easy to fall asleep, all of the practitioners agree that it can frequently make us wide-eyed in the middle of the night.
Large, filling meals near bedtime Balter recommends having a small snack rich in complex-carbohydrates (a whole wheat cracker and some cheese or almond butter for example), or a banana.
Stimulating activities near bedtime “Exercise even five to six hours before bedtime can unmask restless legs syndrome,” says Sassower. “Don’t work on your taxes before bedtime, either.” Television and work at the computer involve light and stimuli, both antithetical to sleep. Watching the news can add to an already stressful day.

Some basics to incorporate into your late-night routine:
Drink warm milk Even more than turkey — which contains a sleep-inducing amino acid called tryptophan — milk has a soporific chemical quality. Balter suggests warm, organic milk, and calls calcium “mother nature’s natural relaxant.”
Develop a schedule Try to go to bed and awaken at the same time every day. Be as consistent as possible, even on weekends.
Get into a quiet place Use low light and aromatherapy to create a soothing environment, conducive to rest and relaxation. Make your bedroom into a refuge or haven. Take out the desk; don’t bring the stresses of the day there. If there’s time, take a warm bath, perhaps with essential oils, before getting into bed. Make sure the room is cool. “White noise” may be helpful.
Get into a dark (but not depressing) place Make sure the room will remain darkened even in the early morning, when it’s light outside, but not yet time to get up. Darkness optimizes the body’s production of melatonin. Use room-darkening shades, thick drapes, or a sleep mask to keep out morning light.
Try melatonin If you’re going to take melatonin in pill form, Sassower recommends that for greatest efficacy you take it 12 hours after your last wakeup time, and preferably in the early evening, rather than just prior to bedtime.
Practice deep breathing Inhale deeply, retain the breath, and exhale slowly, for a natural calming effect. Alternatively, focus on individual parts of the body, and take a long inhalation, then an exhalation, for each part. Start at the feet (or head) and work up (or down). Visualize a favorite, and very restful place.



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