By Aviva Romm, MD
Not only do sleep-aid medications not help to reset your circadian rhythm, but they also pose unique safety hazards for women, and surprisingly, they don’t work that well. A study by Best Buy Drugs found that these drugs add just three to thirty-four minutes to total sleep time. Their effectiveness is so limited that as of late 2014 they were no longer considered a first-choice treatment for chronic insomnia by the American Academy of Sleep Medicine (AASM).
Even when taken as directed, sleep aids pose risks. OTC sleep aids can cause daytime drowsiness, confusion, constipation, dry mouth, and problems urinating. Sleeping pills increase dizziness and, with this, falls and fractures.
A study published online in June 2015 by the American Journal of Public Health found that people prescribed sleeping pills were around twice as likely to be in car crashes as other people—and because of how women metabolize these drugs, the risks for us are greater. One sleep medication had to be issued with a black box warning because it was associated with over six hundred car accidents in women who had used the drug properly before bed, but in the morning had so much in their system that they were essentially driving as if drunk. The researchers estimated that people taking sleep drugs were as likely to have a car crash as those driving with a blood alcohol level above the legal limit.
As an alternative, I turn to nutritional supplements and herbal remedies, many of which work well and are much safer.
Melatonin: If you have trouble specifically with falling asleep, melatonin can be a great choice. It can also be helpful for improving ovarian function in anovulation, fertility challenges, and primary ovarian insufficiency, and perimenopausal hot flashers may also get some relief and sleep from using this remedy. It can be taken 30 minutes before bedtime, though it’s ideal to take melatonin two to three hours before sleep. If taken too close to your evening meal it can keep blood sugar elevated, so allow at least an hour, ideally two, after you’ve eaten. Start with the lowest doses and work your way up as needed.
Vitamin B6: Vitamin B6 is necessary for melatonin production; it’s also one of the most important supplements we have for preventing and reversing PMS and period problems. It can be taken before bed specifically to relieve night waking by reducing nocturnal cortisol spikes.
Vitamin B12: Plays an important role in allowing your body to reset its circadian rhythm, possibly also due to its effects on melatonin production, and improves quality of sleep, leading to feeling refreshed when you wake up. I recommend taking it before noon as many people find it slightly stimulating.
Calcium and Magnesium: Calcium and magnesium in combination can promote relaxation and sleep. Magnesium may also help if restless leg syndrome or muscle cramps interfere with your sleep, including during pregnancy.
Glycine: Taking this amino acid one hour prior to sleep can help you fall asleep and sleep more deeply.
(5-HTP): 5-hydroxytryptophan (5-HTP), a product of the amino acid tryptophan, is converted into serotonin in the brain. Serotonin helps to regulate sleep and reduces nighttime awakenings.
Herbs for Sleep
Lavender Oil: One of my favorite products for sleep and anxiety, Lavela is a proprietary lavender oil product so look for this brand. (I have no conflict of interest.) It’s easy to take—one pill about an hour before bedtime. It’s also helpful if you suffer with anxiety that keeps you awake, performance anxiety, or test anxiety. I’ve even had several patients come off long-term benzodiazepines (you have to work with your doctor to taper off these medications!).
Passionflower: This herb has been used traditionally to promote sleep, and some evidence shows that it can improve sleep quality; thus, it can help you stay asleep and feel more rested when you wake. There is also some evidence that drinking passionflower tea increases the production of GABA, a brain chemical that works to inhibit other brain chemicals that induce stress, such as glutamate.
California Poppy: California poppy is widely used by herbalists for its gentle sedative effects. It is also a gentle analgesic and muscle relaxant. It is strong and should not be taken during the day or before driving.
Hops: With a long traditional history as a sleep herb, this mildly estrogenic herb is a common beer ingredient and is wonderful for promoting deep sleep. I recommend the tincture (liquid extract) one hour and again thirty minutes before going to sleep. It’s too strong for daytime use, should not be taken with alcoholic beverages, and should not be used if you suffer from moderate to severe depression or have a history of estrogen receptor positive breast cancer.
Ashwagandha: With roots in Ayurvedic medicine, this herb is specific for the “tired and wired” and as such not only helps sleep in the short run but helps relieve “adrenal fatigue” and burnout when taken for at least three to six months or longer. ?
Aviva Romm, MD, is a Yale School of Medicine-trained, board-certified family physician with a specialty in women’s health and obstetrics, a midwife, herbalist, and the mom of three daughters. A founder of the Yale Integrative Medicine Program, faculty at the Center for Mind Body Medicine, author of The Adrenal Thyroid Revolution (HarperOne, 2017) and the award-winning textbook Botanical Medicine for Women’s Health. She lives and practices medicine in Massachusetts. More at https://avivaromm.com/
Excerpted from Hormone Intelligence by Aviva Romm, MD, reprinted with permission from HarperOne/HarperCollins Publishers. Copyright 2021.