Given the number of advertisements for the latest sleep aids, you'd think that just about no one gets a good night's rest these days. Although marketing does manage to make the problem seem worse than it is, a hefty one-third of Americans say they have trouble sleeping, according to the American Academy of Family Physicians.
Many of these millions of insomniacs would love to pop a pill and fall blissfully asleep, but alas, with pharmaceutical sleeping pills, there's that hangover feeling in the morning, not to mention the looming threat of addiction. That's why you're finding an increasing number of customers roaming your health and beauty aisles looking for a safe alternative to prescription sleeping pills. By learning what's causing their insomnia, and how different remedies work, you can help your customers get their Z's naturally.
Why can't I sleep?
"One of the most common causes of insomnia is what naturopaths call adrenal burnout," says Nancy Welliver, N.D., a professor of botanical medicine at Bastyr University in Seattle. "People these days have a lot of stress in their life, which makes their adrenal glands start to malfunction, often by the time they're in their early- to mid-20s." This, in turn, affects the pineal gland, which manufactures melatonin, the hormone that signals to the body that it's time to sleep. Many factors can cause stress to the adrenal glands, such as bad sleep habits, chronic pain, poor nutrition, over-stimulation and exposure to pesticides.
Though supplements and herbs can aid short-term sleep problems, Welliver suggests telling customers to contact an expert for more chronic issues. Dr. John Eickholt, a sleep specialist at the Columbus, Ohio-based Worthington Sleep Wake Center, agrees. "Occasional issues with insomnia should not be considered a bad thing. It's natural and can happen to anyone," he says. "But if it's happening night after night and you're sleepy during the daytime, if you are having sleep fragmentation and you're having trouble driving or staying awake, that's a huge red flag that you have more than garden-variety insomnia."
Start with sleep habits
Before popping a pill or herbal tincture for sleep problems, both Eickholt and Welliver say that creating a healthy sleep regimen is the first step in achieving healthy sleep—and may be the only one that many restless sleepers need. "Sleep is much like sex in that you can't force a high-quality response. But people tend to do just that," says Eickholt. "They'll try to force themselves to go to bed, and the bedroom then becomes something very different than a place of sleep and pleasure. It becomes a place of anxiety and torture."
To encourage healthy, fulfilling sleep, Eickholt suggests taking stimuli such as television and phones out of the bedroom (and for kids—toys); making sure the bedroom is dark and cool (both are triggers for the sleep-inducing hormone melatonin); waking up at the same time every day (to set your internal clock); drinking a warm beverage right before bed; and not drinking caffeine or alcohol for several hours before going to sleep.
Welliver also encourages patients with sleep problems to embrace better sleeping habits and to look at their diet. For example, "If people eat enough protein in the morning, they actually have better sleep," she says. When Welliver suggests natural remedies to her patients, she views them as a way to jump-start these healthy sleep habits by triggering sleep, rather than as a permanent solution.
Remedies that don't leave you groggy
Following are some common sleep remedies. One word of caution from Welliver: Ask your customers if they're taking pharmaceutical drugs before recommending a natural remedy. "If someone is already on antidepressants, for example, there may be a bad reaction."
Melatonin: Welliver says taking doses of this sleep-inducing hormone may be a way to help people stimulate the natural melatonin their bodies already produce. Several studies have suggested that melatonin is particularly good for people whose sleep schedule is abnormal, like late-shift workers, or for people who have had a major sleep schedule disruption, as with jet lag.
L-tryptophan: This amino acid, explains Welliver, is a biochemical precursor to serotonin, a neurotransmitter that promotes sleep. "L-tryptophan works well for individuals with insomnia who nothing else has worked for," she says. It was pulled from the market in 1990 when a synthetic version was associated with several cases of eosinophilia-myalgia syndrome, a potentially fatal blood disease. Though many natural health experts, including Welliver, say the EMS cases were caused by only one contaminated batch, not by L-tryptophan in general, it is now available by prescription only. A derivative of it, 5-hydroxy L-tryoptophan, is still sold over the counter, though Welliver says it may not be as effective.
Valerian: "This is the herb I would use for an all-around multipurpose insomnia aid," says Welliver. "The active constituent in valerian root works to calm the autonomic nervous system. Valerian helps to reduce the breakdown of GABA [gamma-aminobutyric acid] in the brain, so you feel calmer for a longer period of time." GABA is an amino acid that acts as a neurotransmitter, helping to keep stress-related nerve impulses at bay. Welliver cautions, though, that for approximately 10 percent of the population, valerian actually works as a stimulant. If a customer complains of a headache when taking the root, this may be the problem.
Passionflower: "Valerian and passionflower are the first two herbs that pop up into most herbalists' minds when you say insomnia," says Ed Smith, herbalist and co-owner of Herb Pharm of Williams, Ore. "They seem to have a very positive effect for a lot of people." Passionflower, says Welliver, is particularly good for people suffering from chronic pain. "This herb works by relaxing the muscular-skeletal system. It also elongates the sleep phase."
Skullcap: "The key indications for skullcap are nervousness, short temper and lack of patience," says Smith. "Someone who's so tired they can't sleep." Though Welliver says few studies have been done on skullcap, it appears to aid the central nervous system. "It seems to work on organic causes of anxiety," she says. "It's for people who have a lower threshold for stress, whose system is more susceptible to anxiety and stressful situations, people with chronic migraine headaches and adult onset seizures and epilepsy."
Kava kava: "This herb just helps calm people down, makes them feel like everything's right with the world," says Welliver. "It's not totally elucidated why it works. Some [experts] think it might actually supersensitize the GABA receptors, making those receptors more eager to grab on to GABA, which will help calm someone." She cautions, however, that some studies show that kava kava can cause liver damage, particularly if the stem, rather than the root, is ingested or if the dose is too strong.
Compounds: Many herbal companies make formulas that combine sleep-inducing herbs with relaxing herbs like chamomile and catnip. "These are great," Welliver says. "We haven't really figured out how all these things work, and they seem to potentially work on different mechanisms. So if you take a combination, you're coming at it from different directions, enhancing the chances that people will respond to the medication."
Create a sleep space
Smith suggests creating a distinct area in your HABA section focusing on sleep remedies. "Stores often highlight a cold and flu or joints section. Why not have a sleep section?" he says, though he cautions against calling it an "insomnia section" as some people may just be going through a brief phase in which they're unable to sleep, rather than suffering from chronic sleeplessness.
At Community Pharmacy, a worker cooperative pharmacy in Madison, Wis., that sells both natural and conventional medication, insomnia is one of the most frequent reasons that customers visit, says herb and supplement buyer Emily Light. "Unlike other things, it's a general complaint that doesn't go out of fashion or out of season," she says. "People are always, always coming in because they can't sleep." Community Pharmacy has a dedicated—and popular—sleep section that features various herbal remedies as well as sleep masks, aromatherapy oils, and books on sleep and relaxation.
In addition to stocking single herbs, Community Pharmacy carries various herbal sleep compounds and homeopathic formulas.
Oregon-based Ashland Co-op has a small sleep section, but HABA manager Elaine Deckelman says the store also has staff members who have dedicated a lot of time to researching natural insomnia remedies. "Within our customer base, we see an aging demographic, and it's a big problem for them. And I think in general, societal anxiety and stress have a lot to do with it, too," she says. "It's such a huge issue for people."
O'rya Hyde-Keller is a freelance writer based in Madison, Wis.
Natural Foods Merchandiser volume XXVI/number 9/p. 94, 96