My approach to this type of insomnia is to look for hypersensitivity (usually to food or drink) that causes no other symptoms. There is usually a six-hour delay between exposure to the offending ingredient and the wide-awake effect. In J.P-H.'s case, it was either the cigar or an aromatic agent in the tobacco. The 'wide-awake' effect is due to an outpouring of various thyroid- and neurohormones at the wake-up time (Paediatrics, 1985; 76: 880-4).
Insomnia is also strongly linked to depression, but many other factors such as tension, pain, changed or disruption of the surroundings, emotional arousal or hypnophobia (fear of sleep) may also impede sleep. An untimely waking up may be brought about by muscle cramps, menopausal night sweats and flushes, sleep apnoea, low blood sugar, a sudden need to urinate, sleepwalking or nightmares (Psychosomatics, 1982; 23: 129-37). A few of these problems are effectively tackled by acupuncture, biofeedback-assisted relaxation, hypnosis and psychotherapy (Forsch Komplement"armed, 1999; 1 [suppl]: 29-31; Psychol Rep, 1998; 82: 407-12; J Consult Clin Psychol, 1995; 63: 79-89; J Roy Soc Med, 1979; 72: 734-9).
Alcohol, in spite of its initial sedative effect, can significantly interfere with sleep (Electroencephalogr Clin Neurophysiol, 1980; 48: 706-9), as can the effects of caffeine (found in coffee, tea, chocolate, cocoa and cola) (Clin Pharmacol Ther, 1976; 20: 682-9).
For a safe and effective remedy from my armamentarium, try in the following order:
* Passiflora Lehning Drops, a homoeopathic remedy containing Avena sativa, Passiflora incarnata, Atropa belladonna, Secale cornutum and Valeriana officinalis, available over-the-counter in 30-mL bottles. Take 20 drops four times daily in water, away from meals, the last dose a half-hour before bedtime. In a study involving 30 women with insomnia linked to anxiety depression, this safe and non-addictive remedy significantly increased daily sleep duration compared with various conventional drugs (Carion V et al. Etude de l'Action de Passiflora Lehning sur Insomnie: Une Analyse Statistique. Metz: Editions Lehning, 1992: 1-16).
* Nicotinamide, a form of vitamin B3 that seems to have hypnotic effects comparable to those of the benzodiazepine drugs - albeit in animals, so not necessarily applicable to humans (Nature, 1979; 278: 563-5). Be sure to take magnesium and vitamin B6 along with the nicotinamide.
* Regular moderate exercise - but not immediately before retiring - which can noticeably improve sleep quality. It's recommended that the heart rate be raised by around 50 per cent for at least 20 minutes every day, though some suggest that moderate exercise (to a heart rate of 60-75 per cent of maximum, which is 220 minus age in years) for 20 minutes is sufficient (Sports Med, 1996; 21: 277-91; JAMA, 1997; 277: 32-7).
* Valerian root, frequently recommended for insomnia (Weiss RF. Herbal Medicine [English edn]. Gothenburg: Ab Arcanum, 1988: 282) as it contains two substances - valepotriates and sesquiterpenes - that have sedative effects.
A double-blind placebo-controlled trial using a preparation containing mostly sesquiterpenes resulted in perfect sleep for 44 per cent and improved sleep for 89 per cent of the study participants - with no adverse reactions (Pharmacol Biochem Behav, 1989; 32: 1065-6). Also, as valepotriates are cytotoxic, you should look for herbal valerian preparations without valepotriates (Forsch Komplement-"armed Klass Naturheilkd, 2000; 7: 79-84; Pharmacopsychiatry, 2000; 33: 47-53; Fitoterapia, 1999; 70: 221-8; Sleep, 2000; 1: 91-9).
The effects of acute and repeated treatments (for seven days) with valerian extract on objective and subjective measures of sleep was also studied in 14 elderly people who were poor sleepers.
Those taking valerian showed an increase in slow-wave sleep (stages 2 and 3), a decrease in stage 1 (light) sleep, and took longer to rouse from sleep by noise alone. REM sleep remained unaltered, with no effect on sleep onset time (Pharmacopsychiatry, 1994; 27: 147-51).
* Jamaican dogwood (Piscidia erythrina). Along with infantile hyperactivity, this herb helps overcome chronic insomnia in adults.
Once a normal sleeping pattern has been reestablished, supplementation with herbs should be slowly tapered away.
Harald Gaier, a registered naturopath, osteopath, homoeopath and herbalist, practices at The Health Equation, 11 Harley Street, London W1G 9PF (tel: 020 7612 9800/07917 662 042) and The Irish Centre of Integrated Medicine, Co. Kildare [tel: 00353 (0) 4588 3224]. Also see www.drgaier.com