Sleep. We each have a different relationship with it. Some find it an inconvenience which eats up time they could otherwise be using to get things done; others find it to be one of the most enjoyable aspects of being alive. Whatever your take, when sleep becomes elusive we get into trouble.
At one point or another, most patients struggling with insomnia have tried melatonin. I usually hear one of two things: "I think it's working, but I'm not sure" or a simple "Didn't work." Melatonin can be a phenomenal help – when taken correctly, that is. The magic lies within the timing, the dose, and your great-great-grandmother's bedtime routine.
The pituitary gland sits about three inches behind where your third eye would be. It's an amazing feat of nature that the gland is able to measure the available amount of light via what the eyes take in through the optic nerve. The pituitary gland then releases the hormone melatonin in reaction to a decrease in sunlight. Melatonin is the hormone that sets our diurnal clock, helps keep our system in tune with the stars, and tells our body to begin winding down when the sun sets. However, it can't distinguish between sunlight and the light from your Kindle, television, iPad, or computer.
BLUE LIGHT SPECIAL
It's been discovered that the pituitary gland is reacting to a specific short-wavelength light found within sunlight known as blue light. If blue light is present, the pituitary holds on tight to melatonin and won’t release it as a means of keeping you awake. Unfortunately, this is also the type of light emitted by most Apple devices as well as televisions, computer screens, cellphones, and some alarm clocks. By reading the news on your iPad before bed then staring at your blue light alarm clock in the dark, you're inadvertently suppressing your endocrine system from releasing melatonin. It's also why Vegas casinos keep their lights on at a certain voltage and pump oxygen onto the casino floor – your body doesn't know when to shut off or what time it is, so you keep going.
APPROPRIATE SLEEP VS. EXHAUSTED SLEEP
It takes about 2 hours for melatonin to go into full effect once it's been released. Prior to the Industrial Revolution and the invention of 24/7 light sources, once the sun started to set your body would have been programmed to know that you had just enough time to wrap up your work, eat the last meal of the day, listen to a story around the fire, and conk out.
Today, our schedules are never-ending, disrupting the pituitary gland’s natural melatonin cycle. We often return home well after sundown, watch TV for a while or get on the computer, then lie in bed until 2 am reading one of our devices. We're taking in unnatural light that our pituitary is reading as sunlight, which means it's not releasing the message to shut down at the right time.
Instead of reaping the benefits of the restorative sleep that comes with a healthy diurnal clock, we're passing out exhausted. We're forcing ourselves awake with stimulants, sugar, and carbohydrates. Our adrenal glands are shot and unsure of when to turn off, so we're left anxious, a little jumpy, on edge, and with weird food cravings. We turn to Ambien to knock us out, coffee to wake us up, and Zoloft to help with resulting anxiety due to overstimulation.
GRANNY'S BEDTIME ROUTINE
The body likes routine; when it knows what's coming, it can adapt. You need to give yourself at least 3 weeks of a solid routine to retrain your entire hormonal system for sleep. I've seen it take as little as four days, but it's important to be disciplined and fake it ’til you make it.
A proper wind-down routine is one that mimics the natural process as much as possible and gives the body both time and space to do its own thing:
Set a feasible "light's out" time you can stick with for at least 3 weeks
No caffeine or sugar at least 8 hours before bed
No food at least 3 hours before bed
No light-emitting devices for at least 2 hours before bed (see below on how to break this rule)
Minimize light in the bedroom
Minimize ambient sound
SET A FEASIBLE "LIGHT'S OUT" TIME YOU CAN STICK WITH FOR AT LEAST 3 WEEKS
Your body needs to be given wind-down training, which starts with a consistent bedtime. Give yourself a time that's realistic for your schedule – even if it's 1 am – and stick to it. This allows both your body and endocrine system to adapt to the routine.
NO CAFFEINE OR SUGAR AT LEAST 8 HOURS BEFORE BED
Once you're able to establish a set bedtime for yourself, calculate a hard cut-off time for caffeine and sugar. If bedtime is 11 pm, no Starbucks or office cookies after 3 pm. Central nervous system stimulants take a while for the body to metabolize, so plan accordingly.
NO FOOD AT LEAST 3 HOURS BEFORE BED
Asian medicine texts teach us that the liver's peak performance is from 1 am to 3 pm; Western medicine teaches us that the liver acts as a garbage disposal, metabolizing toxins and byproducts to be passed into the stool. When the body is lying flat in bed asleep, blood is able to pool in the liver where it's cleaned. It's important to allow the body to focus on restoring a healthy hormonal balance free of toxins rather than refocusing on activities such as digestion. The exception to this rule would be a glass of kefir before bed since it has tryptophan in it – the same chemical found in turkey and part of the reason you fall asleep on the couch after Thanksgiving dinner.
NO LIGHT EMITTING DEVICES FOR AT LEAST 2 HOURS BEFORE BED
The routine needs to mimic nature however possible. The elimination of light is meant to mimic sunset – the trigger for the pituitary to release melatonin. It's important not to use iPads, iPhones, Kindles, computers, or televisions 2 hours before bed since they inhibit the release of natural melatonin from the pituitary.
Since blue light is mostly what’s inhibiting our release of melatonin, it stands to reason that blocking this wavelength of light should reduce or eliminate the melatonin-suppressing effects of nighttime light exposure. There's a free online program you can download called f.lux which automatically adjusts your device's blue light output based on your time zone to mimic sunset. Admittedly, it takes a bit of getting used to because the hue is a bit strange; however, I now find myself unable to use the computer as late as I used to since the modified screen light makes me tired at night.
Another option would be wearing orange-colored goggles (laugh at me now, love me later), which cut blue light from all light sources – including ambient room light. The most popular option tends to be Uvex; however, if you wear glasses, you’ll need to get a wraparound pair like Solar Shield. Both can be ordered from Amazon and are an excellent option for retraining the pituitary. Just throw them on after sundown, and you’ll see what I mean.
MINIMIZE LIGHT IN THE BEDROOM
Bright alarm clocks or street lights outside the window can inhibit sleep. You need to give your nervous system as little stimulation to react to as possible. Blackout curtains are an easy fix and come in a variety of price ranges.
If your alarm clock emits either a blue-green light or a white light, retire it. Ideally, find a clock that emits little to no light. For many people, smart phones have replaced the alarm clocks that we grew up with and are a great alternative since there are plenty of apps designed to gently wake you up. The only word of caution is that the jury is still out on whether the electro magnetic frequencies emitted by the phone interfere with sleep patterns. Be sure to keep the phone a minimum of 3 feet from your head; you should need to lean out of bed in order to reach it.
MINIMIZE SOUND
If the adrenal glands are exhausted, it's common for the body to be on high alert. Noise cancellation devices create white noise to block out minor sound. I use a sound conditioner in the office outside treatment room doors because it cancels the sound of conversation coming from inside the room so it doesn’t reach the hallway. It's also a fantastic way to cancel noise that can make it to the bedroom, for example from traffic or loud neighbors.
THE MAGIC IS IN THE DOSE
How does one appropriately take melatonin? In the smallest dose possible at sunset.
Most people jump in with guns blazing and take the largest dose of melatonin they can find late at night in hopes it will knock them out. Your body wants to be seduced to sleep, not banged over the head. You can purchase melatonin in 1 mg tablets online from iherb; I often advise patients to cut the tablet in half so they're starting with approximately 0.5 mg.
The best time to take melatonin is at sunset, when it should naturally be released into your system. As with the other methods of retraining your pituitary gland, consistency is key. It may take 2 weeks for your body to get the message and remember what it's supposed to do, so be gentle with yourself and give it time. If it's winter and the sun is setting at 4 pm where you live, feel free to modify the protocol. Take the melatonin a few hours before bed – but be consistent and take it at approximately the same time each day. Any sort of hormone replacement therapy (e.g., birth control, thyroid medication, etc.) works best when it's taken at the same time, and melatonin is no different.
SETTING EXPECTATIONS
The above strategy will not work if you're suffering from long-term chronic travel exhaustion with no end in sight. If you have an extreme international travel schedule due to work where you're regularly crossing time zones, the above strategy won't work until you're able to be in a fixed location for at least 8 weeks. Our bodies and minds weren't designed to be crossing international date lines. Nor do we have the wiring to cross the equator and land in the long days of an Argentinean summer when we just left the winter solstice of New York. Your body needs the clock of terra firma as a navigation point in order to set its own internal diurnal clock. If you turn the external clock into a moving target, your body will never catch up.