Getting a Good Night’s Sleep

By John R. Lee, M.D.
From the John R. Lee, M.D. Medical Letter – January 2000

Look for the Simplest Solutions First

In sorting through my e-mail, I often notice some that are sent between midnight and 4 a.m. -- a telltale sign of a woman going through menopause. Not being able to get a good night’s sleep is a common problem as we age, but menopausal women in particular tend to be up at all hours, pacing the house, cleaning the kitchen floor, surfing the Internet or through endless infomercials on late night TV. I hate to sound like a broken record, but in many cases it’s simply a matter of estrogen dominance, a problem easily solved with a little progesterone cream.

One physician told me the story of a new patient who hadn’t slept for longer than four hours in more than a decade, since the start of menopause. He gave her some progesterone cream and she excitedly called him the next morning to report that she had slept for eight hours. This was a major turning point in her recovery from a long list of health problems.

You will find details on how to use progesterone cream in any of my hormone books.

If It’s Not Hormones, What Is It?

On the other hand, there are those of you – of both sexes – who just can’t seem to get a good night’s sleep even with a little progesterone cream. When I was in medical practice I looked for the simplest, commonsense causes for insomnia first and that usually solved the problem.

A frequent cause of insomnia may be food intolerance. One of my insomnia patients woke up every night about 2 a.m. feeling anxious and wide-awake. Her problem was her habit of eating chunks of cheese just prior to going to bed. Her cheese of choice happened to contain high amounts of tyrosine, a precursor for the synthesis of noradrenalin (a stimulant made by the adrenal gland). After discontinuing the bedtime cheese, she slept fine.

Another patient had reactive hypoglycemia. Her habit of eating sweets at bedtime led to a hypoglycemia episode 90 minutes later that resulted in a surge of adrenaline that kept her sleepless for several hours. Stopping the sweets and good exercise during the day helped considerably.

Drugs are Not the Answer to Insomnia and May be the Cause

I also regularly saw patients who had been prescribed sleeping pills or anti-anxiety drugs by another doctor, and who felt they had developed an unhealthy dependency on the drugs, or were woozy during the day, and wanted to get off them.

Unless you’re going through a major life trauma such as the death of a loved one, drugs are almost never the answer to insomnia, and then they are only a stopgap measure. They create more problems than they solve, sometimes with life-threatening consequences.

Many prescription and over-the-counter drugs can cause insomnia. These include antidepressants, cold and allergy medications, asthma medications (including the cortisone-like drugs such as prednisone), painkillers, some of the heart drugs, and thyroid medication.

One elderly patient of mine had been put on the diuretic Lasix twice a day, and she was up and down all night to urinate. Reducing the dose and changing the dosage times to avoid taking it in the evening helped her considerably.

If you’re tossing and turning at night, visit your pharmacist and ask for the information inserts for any drugs you’re taking, buy a magnifying glass, and read them. If insomnia is listed as a possible side effect, talk to your doctor, and don’t accept a sleeping pill as a solution! Taking the drug at a different time during the day, or taking a lower dose, will often solve the problem.

Treating a drug side effect with another drug can start a vicious cycle of drug side effects and interactions that can land you in the hospital or even kill you.

Other Commonsense Causes of Insomnia

The causes of our insomnia are usually sitting right in front of us, in plain view. Here are some of the most common culprits.

Caffeine is without a doubt the number one cause of insomnia among Americans, especially those who can’t resist an afternoon cappuccino.

My cousin drank two six-packs of Coca-Cola daily, ate pastries all day, and couldn’t sleep. Her doctor had put her on a bedtime tranquilizer, Dalmane (similar to Valium) that gave her bad dreams and made her groggy in the morning. She drank more Coca-Cola during the day to revive from the effects of the Dalmane. Despite my arguments, she never changed her lifestyle. She developed serious osteoporosis, had several strokes and died prematurely.

Another woman had a 10-cup coffee maker. She went through three of these a day – 30 cups of coffee! She was anxious all day and couldn’t sleep. She had been to numerous doctors and apparently none of them had asked about her coffee intake. It took about two months to get her off of the coffee. After that she was fine.

If you’re drinking any coffee, tea, caffeinated soft drinks or ingesting any other type of caffeine after noon, and you have insomnia, this is likely to be the culprit. Most soft drinks are loaded with caffeine. Try holding off on the caffeine after noon for a few weeks, and see what happens.

Diet and “energy” pills and supplements often contain caffeine, ephedra, amino acids and other stimulants that can keep you awake at night.

Too much alcohol. A glass of wine with dinner can be relaxing, but too much alcohol will keep you tossing and turning.

Sedentary lifestyle. Couch potatoes often find themselves clutching the remote into the wee hours. Exercise is one of the best sleep remedies I know of. A brisk 20-minute walk, or any type of enjoyable exercise (preferably outdoors) sometime before 9 p.m. can be just the ticket. Exercise is also a good remedy for stress-induced tension, which can leave you lying awake worrying instead of sleeping.

(By the way, if you’re a worrier or have a lot going on in your life, writing your thoughts and feelings down in a journal before bed can put things in perspective and help you sleep.)

An enlarged prostate. Older men with benign prostate hypertrophy or BPH who have to get up many times during the night can often get relief with a saw palmetto supplement combined with zinc and selenium (follow directions on the container). If that doesn’t do the job, try a pea-sized dab of progesterone cream every day. (Using a progesterone cream that contains 450 to 500 mg of progesterone per ounce.) I believe that most men over the age of 65 can benefit from a little bit of progesterone cream.

What About Melatonin?

Melatonin is a hormone secreted by the pineal gland in the brain in response to darkness. Its message to the body is, “time for sleep.” As we age we produce less and less melatonin, and this may be a primary cause of the sleep problems so common among older people. If you’re past middle age and you’ve eliminated the commonsense causes of your insomnia, you can try taking a melatonin supplement an hour before bed. You don’t need much melatonin to have an effect – anywhere from 0.5 to 5 mg is plenty. If melatonin deficiency is your problem, you may sleep better the first night you take it. I don’t recommend melatonin supplements for healthy middle-aged (or younger) people.

Thank you for reading this article by Dr. Lee! If you’re suffering from insomnia and sleep loss, consider taking one of the at-home hormone tests below. These tests can help you identify hormonal imbalances that may be causing your sleep problems, and give you helpful advice for how to correct the imbalances. Click on the tests below to learn more and to order them, or go to our Sleep Disorders test kit page for more information!