Sleep and Insomnia part 1 - The Way Up Newsletter from Dr Slagle

"Sleep is the Best Meditation" - Dalai Lama

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SLEEP AND INSOMNIA - PART 1

Sleep is a huge topic about which many books could be written. Therefore the "sleep" newsletter will be in three parts which will be sent at more frequent intervals than usual.

We sleep approximately one third of our lives so it is a significant part of our experience of “being”. Good sleepers usually think of sleep as an inviting & enjoyable experience.

Many are not so lucky and on any given night 32-40 million people in our country are having trouble sleeping. Over a year’s time 35-45 % of the adult population have periodic issues with insomnia. In fact insomnia is one of the most common medical complaints.

Unfortunately sleeping medications are a common part of our society. Most are intended for temporary use at times of physical or emotional stress, and illness. Yet numerous people chronically use these medications for years. For more on the complications of long term sleeping pill usage see “The Dark Side of Sleeping Pills” by Daniel F. Kripke, M.D.

The use of sleeping pills in children & young adults has increased dramatically, though the FDA has not approved sleep medications for use in those under 18 years of age.

An article published September 2010 in the Canadian Journal of Psychiatry reported on a study of 14, 117 people aged 18-102 years from 1994-2007. The study concluded sleeping pills & minor tranquilizers are associated with a 36% increase in overall mortality risk. What isn’t clear to me relates to the old chicken-egg dilemma. Namely, were they already very ill & therefore using these meds or did the meds somehow contribute to their demise?

The overall United States population use of sleeping meds is 3-10%, and 20% among the elderly. Since the elderly are far more drug sensitive & susceptible to adverse side effects this degree of usage likely is a contributor to negative outcomes.

Sleeping pills do not “cure” insomnia. Most prescription sleeping medications interfere with REM sleep (a very important part of sleepl) & when used chronically can disrupt the deeper stages of sleep as well. I will discuss REM sleep in greater detail in part II of this newsletter.

There are also pharmaceutical over the counter sleep aids, which work for some but can cause side effects such as confusion, agitation, depression, dry mouth, worsened sleep & enlarged prostate gland in men.

Sleep depends upon precise chemical messengers produced in the body & brain. Many things can interfere with the production & balance of these chemical messengers.

Nutritional deficiences &/or hormone imbalances are common contributors to the chemical issues causing insomnia. These are easily correctable, but rarely considered as the cause of sleeping problems.

Nutritional & hormonal imbalances become more common with aging & contribute to the increased insomnia in the older age group. Certain nutrients are critical to creating the proper brain & body physiology for sleep. Deficiencies of the following may lead to insomnia: the B vitamins (B3 , B5, B6, B12 and Folic Acid), Biotin, Inositol, Vitamin A , Vitamin D , Vitamin K, Calcium , Magnesium, and the amino acids Tryptophan, GABA (Gamma Aminobutyric Acid), Taurine . Excess potassium may contribute to insomnia, as well.

If you don’t sleep well, you can begin by taking a high potency multi vitamin mineral with meals in the dosage directed on the label, together with a combination calcium/magnesium product. Should that not be enough, you can add a breakfast dose of Co Enzyme B Complex and the previously mentioned amino acids to be taken at bedtime. There are also numerous natural sleep aids on the market, which I will discuss in one of the upcoming newsletters. If you are someone who feels more confident with blood test confirmation, I suggest the micronutrient test from Spectracell which analyzes the functional levels of 28 nutrients in your blood cells. For the amino acid testing, I suggest the Amino Acids, Plasma from Genova Diagnostics.

When hormone related issues are causing loss of sleep, hormone therapies can be both more efficient & more appropriate than sleep medications. The insomnia of menopause is a well-known phenomenon. But men can also develop insomnia as a symptom of decreased testosterone. Though low levels of hormones are more often the culprit in sleep problems, keep in mind that high levels of hormones can also contribute to insomnia.

Dr. Thierry Hertoghe, an internationally renowned endocrinologist developed the following screening questionnaire for hormone deficiencies. You can find much more in his book “The Hormone Solution: Stay Younger Longer with Natural Hormone and Nutrition Therapies”.

The following self-test helps you determine if your hormones are below normal. This is designed to help you and your doctor select the correct treatment for you. Circle the score for each line, and then total the score at the bottom of each hormone. Bring this form to your doctor after you have filled it out.

ESTROGEN

	Signs & Symptoms	Never	Sometimes	Regularly	Often	Constantly
1.	I am losing hair on top of my head	0	1	2	3	4
2.	I’m getting thin, vertical wrinkles above my lips.	0	1	2	3	4
3.	My breasts are droopy.	0	1	2	3	4
4.	My face is too hairy.	0	1	2	3	4
5.	My eyes are dry and easily irritated.	0	1	2	3	4
6.	I have hot flashes	0	1	2	3	4
7.	I feel tired constantly	0	1	2	3	4
8.	I am depressed.	0	1	2	3	4
9.	My menstrual flow is light. (0=moderate/ 1-3=low/ 4=none)	0	1	2	3	4
10.	Women with periods: My cycles are irregular, too short (<27 days), or too long (>31 days).	0	1	2	3	4
11.	Women without periods: I do not feel like making love anymore.	0	1	2	3	4

Add up your Overall Score ________:
Overall total of 10 or less is satisfactory level. Between 11-20 -- possible estrogen deficiency. 21 or more: probable estrogen deficiency.

If this test suggests estrogen deficiency, ask your doctor for the blood tests, serum estradiol & FSH or you can order directly from Life Extension.

If the estradiol is below 50 &/or the FSH is above normal, you may need bio-identical estrogen replacement to help with sleep.

For more information see my MENOPAUSE & HORMONE REPLACEMENT THERAPY newsletters.

PROGESTERONE

	Signs & Symptoms	Never	Sometimes	Regularly	Often	Constantly
1.	My breasts are large.	0	1	2	3	4
2.	My close friends complain I’m nervous and agitated.	0	1	2	3	4
3.	I feel anxious	0	1	2	3	4
4.	I sleep lightly and restlessly	0	1	2	3	4
	The following questions are for women who have not yet reached menopause, and menopausal women who are taking hormone replacement therapy (estrogen or estrogen and progesterone.).
5.	My breasts are swollen and tender or painful before my period…	0	1	2	3	4
6.	And my lower belly is swollen…	0	1	2	3	4
7.	And I’m irritable and aggressive…	0	1	2	3	4
8.	And I lose my self -control.	0	1	2	3	4
9.	I have heavy periods…	0	1	2	3	4
10.	And they are continuously painful.	0	1	2	3	4

Add up your Overall Score ________:
Post-menopausal women not treated with hormone replacement therapy (estrogen or estrogen and progesterone): 4 or less: Satisfactory level. Between 5 and 8: Possible progesterone deficiency. 9 or more -- probable progesterone deficiency.

Menstrual women and menopausal women taking hormone replacement therapy (estrogen or estrogen and progesterone): 10 or less: Satisfactory level. Between 11 and 20 -- possible progesterone deficiency. 21 or more -- probable progesterone deficiency.

If the test suggests progesterone deficiency, you can verify with a serum progesterone blood test. A level less than 3, suggests you may need “natural” yam or soy based not synthetic progesterone. I never recommend you use any synthetic progesterone.

THYROID

	Signs & Symptoms	Never	Sometimes	Regularly	Often	Constantly
1.	I’m sensitive to cold.	0	1	2	3	4
2.	My hands and feet are always cold.	0	1	2	3	4
3.	In the morning my face is puffy & my eyelids are swollen	0	1	2	3	4
4.	I put on weight easily.	0	1	2	3	4
5.	I have dry skin.	0	1	2	3	4
6.	I have trouble getting up in the morning.	0	1	2	3	4
7.	I feel more tired at rest than when I am active.	0	1	2	3	4
8.	I am constipated.	0	1	2	3	4
9.	My joints are stiff in the morning.	0	1	2	3	4
10.	I feel like I’m living in slow motion.	0	1	2	3	4

Add up your Overall Score ________: Overall total is 10 or less is satisfactory level. Between 11-20 -- possible thyroid hormone deficiency. 21 or more -- probable thyroid hormone deficiency.

If this questionaire suggests a problem, get the blood tests Free T3, T4, TSH, and Reverse T3. Low thyroid (Hypothyroid) or high thyroid (Hyperthyroid) may contribute to sleep problems. With Hypothyroid excessive sleeping is more likely, though it can create insomnia in some. High Thyroid (Hyperthyroid) leads to insomnia.

For more information see my LOW THYROID FUNCTION newsletter.

PREGNENOLONE

	Signs & Symptoms	Never	Sometimes	Regularly	Often	Constantly
.1	I have memory loss.	0	1	2	3	4
2.	My joints hurt (fingers, writs, elbows, feet, ankles, knees).	0	1	2	3	4
3.	I’m feeling a bit drained and I have a hard time handling stress.	0	1	2	3	4
4.	I don’t see colors as brightly as before.	0	1	2	3	4
5.	I have lost interest in art; I don’t appreciate art as much anymore.	0	1	2	3	4
6.	I don’t have much hair under my arms or in the pubic area. (0=plenty of hair / 4= hairless).	0	1	2	3	4
7.	My muscles are flabby.	0	1	2	3	4
8.	I have abundant, light-colored urine during the day.	0	1	2	3	4
9.	I have low blood pressure.	0	1	2	3	4
10.	I crave salty foods.	0	1	2	3	4

Add up your Overall Score ________:
Overall total is 10 or less is satisfactory level. Between 11-20 -- possible pregnenolone deficiency. 21 or more -- probable pregnenolone deficiency.

Pregnenolone is a precursor to DHEA, progesterone, estrogen, testosterone and cortisol. It is synthesized directly from cholesterol.

The optimal serum pregnenolone level for women is 200 nanograms per deciliter (ng/dL) & for men 180 ng/dL.

If the above test suggests low get serum pregnenolone blood test.

For more information I suggest the article “Pregnenolone

A Critical Hormone for Emotional and Physical Health” By Armond Scipione

MELATONIN

	Signs & Symptoms	Never	Sometimes	Regularly	Often	Constantly
1.	I look older than I am.	0	1	2	3	4
2.	I have trouble falling asleep in at night.	0	1	2	3	4
3.	I wake up during the night…	0	1	2	3	4
4.	And I can’t get back to sleep.	0	1	2	3	4
5.	My mind is busy with anxious thoughts while I’m trying to fall asleep.	0	1	2	3	4
6.	My feet are too hot at night.	0	1	2	3	4
7.	When I get up, I don’t feel rested.	0	1	2	3	4
8.	I feel like I’m living out of sync with the world, going to bed late and waking up late.	0	1	2	3	4
9.	I can’t tolerate jet lag.	0	1	2	3	4
10.	I smoke, drink, and/or use a beta-blocker or a sleep aid.	0	1	2	3	4

Add up your Overall Score ________:
Overall total is 10 or less is satisfactory level. Between 11-20 -- possible melatonin deficiency. 21 or more -- probable melatonin deficiency.

If the above suggests low, you can either take melatonin or first check your levels with the Comprehensive Melatonin Profile saliva test.

As with most other hormones, melatonin production declines with age & is also shifted to later hours. Melatonin has a broad range of effects with regulatory influence over many physiologic functions. Melatonin is a CNS depressant, an anxiolytic, with mild hypnotic & anti convulsant actions. Melatonin is produced in darkness & helps with sleep onset & maintainence. It also signals the time of day & time of year.

For more information on melatonin see my melatonin newsletter.

CORTISOL

	Signs & Symptoms	Never	Sometimes	Regularly	Often	Constantly
1.	My face looks thinner.	0	1	2	3	4
2.	My friends call me skinny.	0	1	2	3	4
3.	I have eczema, psoriasis, urticaria (“nettle rash”), skin allergies, or other rashes.	0	1	2	3	4
4.	My heart beats quickly.	0	1	2	3	4
5.	My blood pressure is low	0	1	2	3	4
6.	I crave salt or sugar (to the extent of bingeing).	0	1	2	3	4
7.	I have digestive problems.	0	1	2	3	4
8.	I have allergies (hay fever, asthma, etc.).	0	1	2	3	4
9.	I’m stressed out.	0	1	2	3	4
10.	I’m easily confused.	0	1	2	3	4

Add up your Overall Score ________:
Overall total is 10 or less is satisfactory level. Between 11-20 -- possible cortisol deficiency.

If tests suggest low cortisol or you think you may have high cortisol, get the saliva Adrenocortex Stress Profile

Those with primary insomnia may have increased evening & nighttime cortisol levels. But low cortisol can also be associated with sleep disorders secondary to the hypoglycemia which is often seen with low cortisol levels.

Further information is available in my HYPOGLYCEMIA-SUGAR IS NOT SO SWEET! newsletter.

Symptoms of high cortisol are: fatigue, depression & anxiety, weight gain, low libido, high blood pressure and high blood sugar.

If excessive cortisol is a problem, melatonin, cortisol manager, and other approaches can help moderate cortisol levels.

TESTOSTERONE (for men and women)

	Signs & Symptoms	Never	Sometimes	Regularly	Often	Constantly
1.	My face has gotten slack and more wrinkled.	0	1	2	3	4
2.	I’ve lost muscle tone.	0	1	2	3	4
3.	My belly tends to get fat.	0	1	2	3	4
4.	I’m constantly tired.	0	1	2	3	4
5.	I feel like making love less often than I used to.	0	1	2	3	4
	(MEN ONLY)
6.	My breasts are getting fatty.	0	1	2	3	4
7.	I feel less self-confident and more hesitant.	0	1	2	3	4
8.	My sexual performance is poorer than it used to be.	0	1	2	3	4
9.	I have hot flashes and sweats.	0	1	2	3	4
10.	I tire easily with physical activity.	0	1	2	3	4

Add up your Overall Score ________:
For Women: 5 or less: Satisfactory level. Between 6 and 10: Possible testosterone deficiency. 11 or more -- probable testosterone deficiency.
For Men: 10 or less: Satisfactory level. Between 11 and 20 - possible testosterone deficiency. 21 or more -- probable testosterone deficiency.

If suggests low, get serum free & total testosterone test. Both women & men need certain levels of testosterone.

Symptoms of low testosterone include: sleep disturbances, fatigue, mood problems, increased abdominal fat, decreased muscle mass, more difficulty building muscle, and erectile dysfunction.

Studies show low testosterone levels in men are associated with an increased mortality risk from all causes within two decades. Also inflammatory markers in the body are more likely to be increased and there is a higher risk of metabolic syndrome (increased blood pressure, increased blood sugar, increased triglycerides & decreased HDL).

A study reported in the September 2010 issue of the Journal of Alzheimer’s Disease revealed the onset of Alzheimer’s Disease in older males is associated with low testosterone levels which creates an increased vulnerability to the disease. They concluded testosterone may have a protective value against Alzheimer’s.

GROWTH HORMONE

	Signs & Symptoms	Never	Sometimes	Regularly	Often	Constantly
1.	My hair is thinning.	0	1	2	3	4
2.	My cheeks sag.	0	1	2	3	4
3.	My gums are receding.	0	1	2	3	4
4.	My abdomen is flabby. / I’ve got a “spare tire”.	0	1	2	3	4
5.	My muscles are slack.	0	1	2	3	4
6.	My skin is thin and/or dry.	0	1	2	3	4
7.	It’s hard to recover after physical activity.	0	1	2	3	4
8.	I feel exhausted.	0	1	2	3	4
9.	I don’t like the world. I tend to isolate myself.	0	1	2	3	4
10.	i feel continuously anxious & worried	0	1	2	3	4

Add up your Overall Score ________:
Overall total is 10 or less is satisfactory level.

Between 11-20 -- possible somatoptropin deficiency. 21 or more-- probable somatotropin deficiency.

If suggests low, get a serum IGF-1 test or 24 hour urinary growth hormone level.

DHEA

	Signs & Symptoms	Never	Sometimes	Regularly	Often	Constantly
1.	My hair is dry.	0	1	2	3	4
2.	My skin and eyes are dry.	0	1	2	3	4
3.	My muscles are flabby.	0	1	2	3	4
4.	My belly is getting fat.	0	1	2	3	4
5.	I don’t have much hair under my arm.	0	1	2	3	4
6.	I don’t have much hair in the pubic area. (0=plenty of hair / 4=hairless).	0	1	2	3	4
7.	I don’t have much fatty tissue in the pubic area (flat “mound of Venus” in women). (0=padded / 4=flat).	0	1	2	3	4
8.	My body doesn’t have much of a special scent during sexual arousal.	0	1	2	3	4
9.	I can’t tolerate noise.	0	1	2	3	4
10.	My libido is low.	0	1	2	3	4

Add up your Overall Score ________:
Overall total is 10 or less is satisfactory level.

Between 11-20 -- possible DHEA deficiency. 21 or more.

If test suggests low, get a DHEA-S Assay (DHEA Sulfate) (Serum) test. I prefer DHEA sulfate levels be in the high normal range.

This information should provide beginning help for insomnia. More information will follow in the next newsletter.

Until then

Peace, Health & Restful Sleep,

Priscilla Slagle, M.D.

ALTERNATIVE HEALTH PRODUCTS & ALTERNATIVE MEDICINE

PRISCILLA SLAGLE, M.D. or Cathy Jones, Assisitant

Email: thewayup@dc.rr.com

Phone: 1 (760) 322-7797

Fax: 760-322-7608

Website: www.thewayup.com

In this Issue:

NOVEMBER 2010

SLEEP & INSOMNIA - PART 1

PROTEIN SMOOTHIES

HIGH PROTEIN WAFFLE

DRINK YOUR TEA!

WALKING TO LOSE WEIGHT

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PROTEIN SMOOTHIES

Protein smoothies can be a great addition to one's diet during weight loss, especially when you are also working toward fitness goals including having strong, toned muscles. The thing to know about incorporating smoothies is that you can control the caloric content of the smoothies and you can use them in place of a meal so as to not suddenly increase your total food intake. You certainly shouldn't add a protein smoothie to your diet without making other shifts as this could actually cause weight gain.

Since breakfast is already the ideal time to be eating fruit, you might start off by replacing your breakfast with a smoothie. Certainly there's no easier breakfast to have on mornings when you're hurrying out the door! If you tend to work out in the evenings and want to get your protein in closer to your workout, you can do a smoothie for dinner. However, since most of us are used to eating, solid foods for dinner you might instead have your smoothie as a late afternoon snack. Use water for the liquid, or ice for your frozen solid, then you can add a cup of any kind of berries, as your fruit because of the low glycemic index of berries.

Another good tip for weight loss is that one day a week, you make all your meals a protein smoothes & eat nothing else. Doing this regularly week after week will gradually drop your weight.

HIGH PROTEIN WAFFLE

Need more protein in your breakfast? You can transform a typically empty-carb meal into a high protein powerhouse with a few simple alterations.

Ingredients:

4 tablespoons farmer’s cheese

2 tablespoons oatmeal flour or other flour combo such as gluten-free

1 egg white

2 tablespoons whey protein

Directions:

Add whey protein and egg white to a bowl, mix until the liquid is smooth with no lumps. Then, add the farmer’s cheese and mix well. Next, gradually stir in the oatmeal flour. Cook the waffles on a non-stick waffle iron; serve with fresh berries

DRINK YOUR TEA!

Green Tea vs. Black Tea

Need caffeine? If you have a caffeine habit, it is easy to reach for coffee. While there are health benefits associated with coffee, it can lead to excessive jitters. You can reach for tea instead for a milder effect as well as additional health benefits.

Green tea is a powerful antioxidant which also reduces inflammation, helps prevent certain cancers, decreases cholesterol, improves memory, reduces the risk of cardiovascular disease, reduces blood pressure, helps control body weight, and helps increase bone mineral density.

In a metanalysis of various studies, researchers found that drinking 3 or more cups of green tea daily reduced the risk of ischemic stroke by twenty one percent.

A second metanalysis suggested 2 cups of green tea daily may reduce lung cancer risk by eighteen percent.

A Japanese study found that as little 1 cup of green tea daily reduced gum inflammation known as periodontal disease.

I suggest you use green tea as a basic drink throughout the day. Give up any sodas, or high carbohydrate drinks and use green tea freely, knowing you can receive multiple health benefits by cultivating this habit.

Black tea also has some health benefits, though not as many as in green Tea.

Black tea boosts immunity, reduces hypertension, and cuts your risk for some cancers , and also helps control diabetes.

WALKING TO LOSE WEIGHT

If you would like to lose a significant amount of weight, or have knee issues, running may not be the best choice for you. With walking, you can burn an equal number of calories, have a knee and joint friendly workout and be able to enjoy the scenery.

Start by walking three to five days a week for at least twenty minutes. Keep walking until you can walk three miles in 45-60 minutes.

ABOUT DR. SLAGLE

Priscilla Slagle, M.D. is in the private practice of Nutritional and Functional Medicine & Psychiatry in Palm Springs, California.

Dr. Slagle has incorporated vitamins, minerals, amino acids, herbs, natural hormones & other natural substances into her practice since 1975. She is one of the pioneers in the Alternative Medicine Field.

Her book "The Way Up From Down" presents her natural "precursor" methods for lifting low moods & relieving the negative effects of stress. The Way Up From Down by Dr Priscilla Slagle

The Way Up From Down by Dr Priscilla Slagle