Author Ken Singleton, M.D.
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Sleep and Sleep-Related Problems
Sleep problems are nearly universal among persons with Lyme and most other tick-borne diseases. Such problems are a major contributor to symptoms such as “brain fog,” chronic fatigue, depression, and impaired immune function that are associated with Lyme and other
TBDs. Restoring adequate quality sleep for Lyme/TBD patients is therefore one of the highest priorities, even if it involves the temporary use of sleep medications.
To understand why restful sleep is so important to health, let’s take a moment to discuss sleep in more detail. Most adults spend one-third of their lives sleeping, during which time a variety of self-repair mechanisms take place in the body. Unless proper sleep is attained (at least 7.5 hours each night, and for some people as much as 9 hours), we inevitably wake up to start the day feeling fatigued. Lack of sleep also makes it impossible for your body to properly manufacture hormones, including
cortisol, endorphins, and growth hormone.
Restful sleep has also been shown to provide many psychological benefits, all of which diminish when sleeping problems occur. Recent research shows that both memory and our ability to learn are greatly influenced by the amount and quality of our sleep. Sleep experts divide sleep into two types, rapid eye movement (REM) sleep and non-rapid eye movement
REM sleep comprises approximately 20 percent of sleep and is where dreaming occurs. For most people, NREM sleep comprises approximately 80 percent of the total amount of sleep they get each night, assuming they are sleeping properly. NREM sleep is further divided into two stages, stages 1 and 2 (light sleep) and stages 3 and 4 (deep sleep). Deep sleep is also known as slow wave sleep
(SWS). These most important deep sleep stages of NREM sleep (stages 3 and 4) actually begin soon after you retire.
Slow wave sleep is the deepest and most refreshing type of sleep and accounts for between 10 percent and 20 percent of the total amount of sleep people get each night. It is essential for proper cell and musculoskeletal tissue regeneration, optimum performance of the cardiovascular system, normalized blood pressure, hormonal balance (including growth hormone production), and proper maintenance of the metabolic system. Slow wave sleep is most prominent in youth and declines with normal aging. Alcohol consumption can also diminish slow wave sleep. The decline in levels of slow wave sleep in proportion to overall sleep that occurs as a result of aging is likely related to the increase in sleeping problems that are more common among older people.
Primary Causes for Sleeping Problems
In addition to infections of Bb and other tick-borne bacteria, all of which can disturb healthy sleep patterns, the primary causes of sleep disturbances include the following:
-- Normal aging (especially with regard to slow wave sleep)
-- Poor sleep planning. People with
Lyme/TBDs need to go to bed at the same time every night and wake up at the same time every morning. This is critical for Lyme sleep recovery.
-- Shift work. Working late shifts and/or alternating between day and night shifts can significantly disrupt normal sleep patterns. If at all possible, patients with
Lyme/TBDs need to avoid shift and evening work until they get their illness under control.
-- Caffeine and other stimulants. People with
Lyme/TBDs need to avoid coffee, black tea, and other stimulants until their illness is under control. Care should also be taken when eating dark chocolate and/or drinking green tea, both of which should be avoided after noon or so.
-- Alcohol and nicotine. Both alcohol and nicotine can significantly interfere with healthy sleep and should be avoided altogether.
-- Eating too close to bedtime. Doing so can lead to fitful sleep as the digestive process takes place.
-- Exercising too close to bedtime. Although for some people, exercising in the evening helps to promote restful sleep, for many others late evening exercise produces stimulating effects that make falling asleep difficult.
-- Lack of darkness. Prior to sleep, your body starts producing the hormone
melatonin. Melatonin is essential for restful sleep. Melatonin then continues to be produced while you are sleeping, with peak production usually occurring between 2 a.m. and 4 a.m. For the full effects of melatonin to occur, however, sleep experts say that you should attempt to sleep in a room of total darkness.
-- Electronic devices in the bedroom. Electric alarm clocks, computers, televisions, and other electronic devices located too close to your bed can disrupt sleep because of the electromagnetic frequencies they emit. Known as
LEFs, these frequencies have been shown by researchers to disrupt the body’s own electromagnetic field. Ideally, you should avoid placing electronic devices in your bedroom. If you must keep them located there, be sure they are placed at least eight feet away from your bed.
-- Nutritional deficiencies/imbalances. A lack or imbalance of various nutrients is quite common among many people with sleeping problems. Magnesium deficiency is especially common, resulting in muscle cramping and twitching, increased nervousness, and other sleep disruptions. Other nutrients that are necessary for restful sleep are calcium and various B vitamins, especially vitamins B6 and B12, folic acid, and
inositol. However, B vitamins taken just before bedtime can also disrupt sleep due to their ability to cause vivid dreams.
-- Hormonal changes. This is another common factor in sleep disorders, especially in men and women forty and older. In men, reduced levels of testosterone can disrupt sleep and cause problems such as sleep apnea. Higher than normal levels of testosterone can also interfere with healthy sleep. In women, reduced progesterone levels is the most common hormonal issue associated with sleeping problems. Progesterone levels can fall during the week before a woman’s menstrual period and also when a woman enters
perimenopause. Women on estrogen replacement therapy that is unbalanced with progesterone can also experience sleeping problems, although this scenario is much less common today than it was in the past. Estrogen-progesterone imbalances can also be caused by foods containing estrogen-like chemicals and pesticides. Another common hormonal imbalance related to sleeping problems is increased cortisol production due to stress. (For more on hormonal imbalances and how to correct them please see chapter 7.)
-- Low blood sugar (hypoglycemia). People with low blood sugar problems often experience a steep drop in blood sugar levels during the night, causing them to awaken due to hunger pangs and feelings of shakiness. Blood sugar levels will usually improve by following the Lyme Inflammation Diet discussed in chapter 5.
-- Medications. Many commonly used medications can also interfere with sleep, especially among the elderly. Such medications include those that produce daytime drowsiness, along with anticonvulsants, antidepressants, antihistamines, blood pressure medications, pain relief drugs, muscle relaxants, and drugs for treating Parkinson’s disease. Ironically, many sleeping medications can also cause sleep problems if they are used for long periods of time or abused.
-- Anxiety and depression. Both anxiety and depression (see above) are common in patients suffering with chronic Lyme disease, as well as other tick-borne conditions, especially Bartonella. The fears, worries, and racing thoughts associated with anxiety and depression can significantly disrupt and prevent healthy sleep.
-- Stress. Chronic stress causes your body to produce elevated amounts of epinephrine and
noreinephrine, both of which stimulate the sympathetic nervous system, creating a “fight or flight” state that is not conducive to restful sleep. Stress also results in higher than normal cortisol levels, which also interferes with sleep.
-- Other medical problems. Various other health problems can also prevent and interrupt restful sleep. These include anemia and iron deficiency, arthritis (especially rheumatoid), back and/or chronic pain, fibroids, gastrointestinal disorders (see above), kidney disease, neuromuscular disease, obesity, peripheral neuropathy, Parkinson’s disease, prostate problems (enlarged prostate,
prostatitis), respiratory conditions, and thyroid problems.
Treating Sleeping Problems
When it comes to treating sleeping problems there are a variety of options from which to choose, ranging from natural approaches to conventional medications. Effective treatment choices depend on the nature of the problem, as well as its severity. Here is a recap of tips that can help ensure a good night’s sleep.
-- Plan to go to sleep at the same time each night and to wake up at the same time each morning. Doing so helps condition your body to sleep and awaken at the same time each night and day, making it easier to fall asleep and awaken more refreshed.
-- Avoid alcohol, caffeine, and other stimulants.
-- Avoid eating late in the evening. However, also avoid going to sleep feeling hungry, as this can interfere with a restful sleep and cause a sharp drop in blood sugar, awakening you during the night.
-- Sleep in darkness to ensure adequate melatonin production.
-- Eliminate electronic devices from your bedroom or, at the very least, make sure they are placed at least eight feet away from your bed.
-- Exercise regularly but avoid late-evening exercise, as this can be too stimulating.
-- A warm bath before bedtime can be conducive for sleep, as well.
One of the most common sleeping problems is insomnia, or the inability to fall asleep once you’ve gone to bed. For insomnia, consider the following approaches:
Mild Insomnia: Take 1.5 mg of melatonin an hour before bedtime. Dr. Binyamin
Rothstein, author of Brain Fog, suggests using melatonin in the following way:
(1) open a capsule and put 1.5 mg of the powder under your tongue; take a small sip of water, swish in the mouth for a minute, and swallow;
(2) then lie down in a quiet, dark room, and you will probably fall asleep within 20 minutes;
(3) be sure that you don’t do any stimulating activity after taking the
melatonin, because if you do something (e.g., read or watch TV), then it will backfire and it will keep you up for hours. If melatonin does not help, a warm cup of valerian tea can also be helpful. Acupuncture can be very helpful for this problem. Moderate Insomnia: Take a glycine supplement (2,000–3,000 mg) before retiring.
(Glycine is an amino acid.) Valerian tea can also help. Severe Insomnia: In cases of severe insomnia, a sleep medication is often necessary short-term and possibly longer. Most of the time, the benzodiazepine medications (relatives of valerian) are helpful, such as Ambien or
Klonopin. At times, it is necessary to use short-acting barbiturate medications, with caution, because they are potentially very habit-forming. Another common sleeping problem is difficulty staying asleep. If you suffer from this problem, consider the following approaches:
Mild Symptoms: The amino acids
L-tryptophan (500–1,000 mg) or 5-HTP (50–100 mg) taken before bedtime can help promote lasting sleep because of their ability to increase serotonin production. Serotonin is a neurotransmitter that is associated with calm, restful sleep, as well as improved mood. Supplementing with glycine (2,000–3,000 mg) can also help with this type of sleep problem in addition to insomnia.
Moderate Symptoms: For moderate difficulties staying asleep, a sleep medication may be required. Helpful drugs to choose from include Rozerem (8 mg), Ambien (10 mg), Lunesta (2–3 mg), or Sonata (10 mg), all of which are common, effective sleep medications. Neurontin (100–900 mg), an anticonvulsant drug originally developed to treat seizures, has also been shown to help sleeping problems, including difficulty staying asleep at night. Neurontin
(gabapentin) has the added benefit of helping with pain control. Certain tricyclic antidepressant drugs, such as amitriptyline (10–25 mg), can also help with both pain control and sleep. All these prescription drugs have certain precautions and can cause potential side effects. They are also contraindicated in certain circumstances, such as specific health conditions, allergies, and the use of certain other medications. Your Lyme-aware physician is in the best position to evaluate this for you.
Severe Symptoms: In the situation where other aforementioned sleep remedies are not effective, I recommend considering the controlled prescription drug,
Xyrem. Because of its potency and potential to cause harmful side-effects and abuse, its use and dosage must be determined by your physician, and its usage carefully monitored. Despite its downside, Xyrem is a very effective sleep medication and deserves consideration.
Improving Slow Wave Sleep
As I mentioned above, slow wave sleep is the deepest, most restful phase of sleep and one that promotes a wide variety of health benefits. Many patients with
Lyme/TBDs have decreased levels of slow wave sleep, compounding the many other problems caused by their illness. Therefore, increasing the amount of slow wave sleep you get during the night should be a high priority so that your body will become better able to heal. Supplementing with glycine (2,000–3,000 mg just before bedtime) is a safe and often effective way to increase slow wave sleep. In addition, glycine helps to increase REM activity (dream sleep). Researchers believe that having adequate amounts of REM sleep also plays a vital role in our overall health, especially with regard to our mental and emotional health. Conventional sleep medications can also be used to increase slow wave sleep. These include tricyclic antidepressants,
gabapentin, and Xyrem. Gabitril, like gabapentin, was originally developed as an anticonvulsant drug for the treatment of seizures. It can also help increase slow wave sleep. To learn more about these drugs, consult with your physician and only use them under his or her supervision.
If you would like
to learn more about the book before ordering it, feel free to browse
these excerpts, which are available online, free of charge:
of Contents • Introduction
and Diagnosis • Natural
Killer (NK) Cells
Diet • Medical
History and Physical Exam
Dose Naltrexone (LDN) • Food,
Diet, and Omega Fatty Acids
and Positive Outlook • Index
"What I have accomplished with this 500+ page book, The Lyme Disease Solution, is to share my everyday knowledge and practical experience of 10 years as a Lyme-enlightened practitioner (who also is himself a Lyme-survivor). Although I hesitate to use the “cure” word in relation to chronic Lyme, the principles in this book have resulted in a greater than 90% response rate in my patients. At least 60% of my patients achieve long-term improvement that allows them to get off of antibiotics completely."
— Ken Singleton, M.D.
THE LYME DISEASE SOLUTION
By Ken Singleton, M.D.
Foreword by James A. Duke, Ph.D.
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