The first question I ask new patients is “How are you sleeping at night?” If you don’t get a good night’s sleep, you’re not going to get well. It really is that simple.
A Good Night's Sleep
We've all heard that we need 8 hours of restful sleep each night. The amount of sleep an individual actually needs will vary from person to person. A 5 year old may need 11-12 hours of sleep, an adult, 7-9 hours of sleep a night. But why is a good night's sleep so important? Poor sleep has been linked to various health problems including depression, fatigue, CFS, FMS, and headaches. Several studies have shown that a lack of sufficient sleep will cause a host of unwanted health issues.
This is not news to those who suffer with FMS and CFS. They already know that their symptoms get worse when they don't get a good night's sleep.
- One study showed that college students who were prevented from going into deep sleep (REM sleep) for a period of a week develop the same symptoms associated with FMS and CFS: diffuse pain, fatigue, depression, anxiety, irritability, stomach disturbances, and headaches.
( P.Koch-Sheras and A. Lemley, The Dream Sourcebook
(Los Angeles: Loweel House).
Fibromyalgia and Chronic Pain: The Endless Cycle
A study conducted by the University of Connecticut School of Medicine compared the sleep patterns and associated symptoms of fifty women with FMS. The study showed that a poor night's sleep was followed by an increase in the subject's symptoms' including increased pain.
Unfortunately, the study also showed that a poor night's sleep, followed by an increase in symptoms, then went on to prevent the person from getting a good night's sleep even though they were exhausted. This cycle continues and creates a pattern of declining health.
Chronic localized pain leads to sleep disturbance, which leads to a constant state of fatigue and causes the individual to become inactive. When muscles aren’t used they become even more sensitive to pain. Decreased activity increases the pain and insomnia which further causes fatigue. Ultimately, many suffers become depressed and develop headaches and flu like symptoms caused by the chronic inflammation.
Fibromyalgia sufferers have a lower than average pain threshold. They perceive pain that would normally not be felt by healthy individuals. There are various mechanisms in a lowered pain threshold (allodynia). These include dysfunctional neurotransmitters, neuropeptides, and pain receptors.
There are two types of sleep
The first type of sleep is known as rapid eye movement or REM. The second is non-REM sleep. Non-REM sleep is further divided into four stages. During the REM cycle the eyes, while still closed, rapidly move back and forth. This is where dreaming takes place. The deeper Non-REM stage of sleep is crucial for overall well being. Stages 1 and 2 of Non-REM sleep, while important in maintaining the correct sleep cycle, don’t provide the restorative powers as compared to stages 3 and 4.
The Non-REM sleep cycle begins soon after we start to fall asleep. The first two stages of non-REM have a faster brain wave pattern (as measured with electroencephalogram or EEG) and are considered the lighter stages of sleep. As the brain activity begins to slow down we enter into stages 3 and 4 of non-REM sleep. This usually occurs one and a half hours after falling to sleep. The non-REM cycle is then interrupted by ten minutes of REM sleep.
REM sleep elicits a flurry of brain activity. These cycles occur 5 to 6 times a night. The time spent in REM continues to grow and may last up to an hour in the last cycle of sleep. We dream during the REM cycle. It's our dream cycle.
If you’re not dreaming, you're not going into deep sleep.
Many of my patients are taking prescription medications that don't allow a person to go into deep restorative sleep. So really they only have their eyes closed while they're knocked out for 8 hours. They don't receive the health benefits of deep restorative sleep.
Medications That Don’t Promote Deep Restorative Sleep
(I recommend you working with your medical doctor when discontinuing any medication)
Benzodiazepines or Tranquilizers
Xanax (Alprazolam), Ativan (Lorazepam), Klonopin (Clonazepam), Valium (Diazepam), Tranxene (Clorazepate dipotassium), Serax (Oxazepam), Librium (Chlordiazepoxide), Restoril (Temazepam)
These drugs are usually used as an antianxiety medication. They’re all addictive and patients may build up a tolerance so that the medicine eventually loses it effectiveness as a sleep-aid. These medications have so many side-effects that contribute to poor health. They should be (slowly) weaned off as soon as possible (with the help of your doctor).
No one has an antianxiety drug deficiency. Increasing low serotonin levels with 5HTP and, if needed, using gamma-amino-butyric-acid (GABA) helps prevent anxiety (rather quickly).
GABA is available here
There are numerous withdrawal symptoms associated with these drugs so when weaning off these medications the slower the better. A big problem with these medications is that they don’t promote deep restorative sleep.
Side-effects associated with these medications include: Sleep disturbances, seizures, neuropsychiatric disturbances, tinnitus (ringing in the ears), transient memory loss, dizziness, agitation, disorientation, hypotension, nausea, edema, ataxia (muscular incoordination), tremors, sexual dysfunction, asthenia (weakness), somnolence (prolonged drowsiness or a condition resembling a trance which may continue for a number of days), dizziness, and headaches.
Zanaflex (Tizanidine) A muscle relaxant that has gained some popularity among physicians treating FMS. It is sedating and like other muscle relaxers can help with insomnia. But, it doesn’t produce deep restorative delta wave sleep. It doesn’t help increase serotonin levels, it only tranquilizes the nervous system. For this reason alone it should be avoided. It is associated with numerous side-effects including liver failure (at least 3 individuals have died from taking this medication), asthenia (weakness), somnolence (prolonged drowsiness or a condition resembling a trance which may continue for a number of days), dizziness, UTI (urinary tract infections), constipation, liver injury, elevated liver enzymes, vomiting, speech disorder, blurred vision, nervousness, hypotension, psychosis/hallucinations, bradycardia (slow heart action), pharyngitis (sore throat), and dyskinesia (defect in voluntary movements).
Gabitril (Tiagabine), Neurontin (Gabapentin) These anticonvulsant medications were originally used to control seizures. These medications are now being used to block nerve related pain (neuralgia) including herpes zoster. These medications are also being prescribed for chronic headaches (with some success). I have not found them to be helpful for the diffuse extremity pains associated with FMS. They don’t promote deep restorative sleep and can cause many of the same symptoms associated with CFS and FMS. Most patients can wean off these medications with no problems. There are several side-effects associated with their use, including: somnolence (prolonged drowsiness or a condition resembling a trance which may continue for a number of days), dizziness, weakness, fatigue, double vision, edema, ataxia (muscular in coordination), thought disorder, in coordination, possible long term ophthalmic problems (abnormal eyeball movements), tremors, weight gain, back pain, constipation, muscle aches, memory loss, asthenia (weakness), depression, abnormal thinking, itching, involuntary muscle twitching, serious rash, and runny nose.
Sounds like some of the symptoms associated with FMS and CFS!
Topamax (Topiramate) Used primarily for adjunctive therapy for tonic-clonic seizures. It is also used for anxiety disorders.
The side-effects associated with this drug, especially the fatigue and low blood pressure, prevent the patient from having any extra energy.
Topamax: A drug used to control epilepsy. An off-label drug for anxiety or insomnia which may cause serious eye damage and/or blindness. As of August 17, 2001 there have been 23 reported cases: 22 in adults and one in a pediatric patient. It is generally recognized that post-marketing data are subject to substantial under-reporting.
Letter from the manufacturers of Topamax (Ortho-McNeil Pharmaceutical, Inc.) to doctors.
Deep Restorative Sleep is the Key to Getting Well
5HTP plus B vitamins, Vitamin C, and Magnesium is What Makes Serotonin.
Serotonin Turns into Melatonin and Promotes Deep Restorative Sleep.
My Special "Jump Start" Package is Available Here
My CFS/FMS Formula is Available Here
5 Hydroxytryptophan (5HTP)
One of the most important amino acids for Fibromyalgia and CFS patents is Tryptophan or 5HTP.
This amino acid produces the neurotransmitter serotonin. Serotonin is involved in regulating proper sleep, reducing pain, and depression.
Most of my FMS/CFS patients will be prescribed a natural supplement known as 5 Hydroxytryptophan (5HTP). This is a derivative of the amino acid Tryptophan. 5HTP, when taken correctly, turns right into serotonin.
Serotonin is the neurotransmitter, or brain chemical, that is responsible for regulating your sleep (getting you to sleep), raising your pain threshold (decreasing your pain) and elevating your moods. It also corrects the symptoms associated with IBS.
Years of poor sleep create an imbalance with a person's sleep regulatory system which is known as the circadian rhythm. The longer someone’s sleep cycle has been compromised, the longer it usually takes for them to experience lasting symptom relief. But just a few nights of consistent deep sleep will provide a tremendous amount of improvement for most patients.
Tryptophan and 5HTP as Sleep Aids
One study found that 55% of FMS patients suffered from sleep disturbances and that these sleep disturbances were not caused by pain. Alleviating insomnia with antidepressant medication, melatonin, and/or prescription sleep-inducing drugs could alleviate pain.
Antidepressant drugs have been used with varying degrees of success in treating Fibromyalgia.
Read More About Depression, Anxiety, and Mental Fatigue Here
Therapeutic administration of 5HTP has been shown to be effective in treating a wide range of health problems including depression, Fibromyalgia, insomnia, binge-eating, pain, and chronic headaches.
Studies (including double-blind) comparing SSRI and tricyclic antidepressants to 5HTP have consistently shown that 5HTP is as good, if not better, than prescription medications. Further more, 5HTP doesn’t have some of the more troubling side-effects associated with prescription medications. Side-effects such as sedation, fatigue, tremors, decreased sex drive, and weight gain.
Take antidepressants? What You Should Know
5HTP has been shown to be beneficial in treating insomnia, especially in improving sleep quality by increasing REM sleep (deep sleep).*
5HTP has been used to successfully treat and prevent chronic headaches of various types, including migraine, tension headaches, and juvenile headaches.*
Clinical trials have, in obese (overweight) individuals, demonstrated decreased food intake and subsequent weight loss with 5HTP supplementation. *
5HTP and Fibromyalgia
Double-blind placebo controlled trials have shown that patients with Fibromyalgia were able to see the following benefits from taking 5HTP:
Less tender points.
Less morning stiffness.
Moods in general were improved including those with clinical depression.
Studies comparing 5HTP to prescription antidepressants generally used to treat fibromyalgia including, ticyclic (amitriptyline) and SSRI’s showed 5HTP to as effective (or more effective) as prescription medications.5.
* above from (Altern Med Rev 1998;3(4):271-280)
Tests done in Europe show L-Tryptophan to be just as effective in treating depression as the prescription drugs (which have side effects), Elavil and Tofranil.
J. Brawly, pg. 130.
5HTP can be Found at Most Health Food Stores
Remember the supplement industry is not regulated at this time. Unlike the German nutritional industry, supplements in the United States receive little, if any, scrutiny. It’s best to consult a health-care professional who is familiar with supplements. I usually recommend pharmaceutical grade supplements only available through physician's office. If a patient is counting on 5HTP to get them to sleep, I want them to use the very best product out there. Otherwise, as has happened in the past, patients may take an inferior brand and, after not getting the desired results, give up on my recommendation. They falsely assume that the supplement won’t work.
Exercise Helps Increase Serotonin Utilization
From Dr. Batmanghelidj’s book “Your Body’s Many Cries for Water,” comes this quote, “There is a direct relationship between walking and the build-up of the brain Tryptophan (5HTP) reserves. There are several amino acids that compete for crossing the naturally designed barrier system into the brain… These competitors to Tryptophan are grouped under the title, branched-chain amino acids (BC amino acids). During exercise, these BC amino acids, along with fats, are used as fuel in the larger muscles. The muscles begin to pick up these amino acids from the circulating blood. As a result, the odds are changed in favor of Tryptophan for its passage across the blood-brain barrier”
Dr. Batmanghelidj goes on to write about the importance of Tryptophan. “The brain Tryptophan content, and its dependent neurotransmitter systems, is responsible for maintenance of the 'homeostatic balance' of the body." Normal levels of Tryptophan in the brain maintains a well-regulated balance in all functions of the body, in other words, homeostasis. With a decrease in Tryptophan supply to the brain there is a proportionate decrease in the efficiency of all functions in the body.”
Do you think that getting your serotonin stores back up to optimal levels is important? Absolutely!
Replacing and building optimal serotonin stores is the first thing that must be done. Once this has occurred, and again it may take months, your body starts to normalize its homeostatic systems.
Other Natural Sleep Aids
The pineal gland is located at the base of our brain. Melatonin is the primary hormone of the pineal gland and acts to regulate the body’s circadian rhythm, especially the sleep/wake cycle. Over the last two decades, scientists have learned a great deal about the hormone melatonin. Once a curiosity, melatonin is now known to slow down or perhaps even reverse the effects of aging. Melatonin is also a powerful antioxidant that, unlike other antioxidants, is able to cross the blood-brain barrier and attack any free-radicals floating around in the brain. Melatonin protects the cells nucleus and the DNA blueprint of each cell. This is a major reason melatonin is able to fend off the adverse affects of cancer.
Dr. Joan Larson in her book “7 Weeks to Emotional Healing,” discusses how melatonin and the immune system are connected. She states “Melatonin rejuvenates the thymus gland to protect our immunity... Melatonin will “reset” your immune system when it has been under siege from infections, cancer, stress, and so on. Such attacks disrupt its rhythms and diminish its effectiveness. Any disruption in our immune system’s twenty-four-hour rhythm lowers our immunity, leaving us prone to more illness.”
It’s easy to put two and two together. If you’re deficient in melatonin you can’t get to sleep at night. If you don’t sleep, you won’t make melatonin. It’s a viscous cycle. A deficiency of restorative sleep leads to accelerated aging, lowered immune function, and susceptibility to cancer and brain oxidation.
When administered in pharmacological doses (1-3mgs), melatonin acts as a powerful sleep regulating agent that controls the circadian rhythm. A low dose of melatonin has also been shown to be effective in treating insomnia and jet lag. In a recent study, volunteers were either given a .3 mg or a 1 mg dose of melatonin or a placebo. Both levels of melatonin were effective at decreasing the time needed to fall asleep.
*This is a study by Zhdanova IV, Wurtman RJ, Linch HJ, et al. Sleep inducing effects of low doses of melatonin ingested in the evening. Clinical Pharmacological Therapeutics, 1995; 57; 552-558.
The same area of the brain that releases melatonin also regulates serotonin production. Serotonin helps to produce melatonin. If you are deficient in serotonin, you’ll also be deficient in melatonin (can’t sleep).
Melatonin is affected by a person’s exposure to light. Melatonin levels start to rise as the sun goes down and drop off as the sun comes up. The retina (eyes) are extremely sensitive to changes in light. An increase in light that strikes the retina triggers a decrease in melatonin production. Conversely, limited exposure to light increases melatonin production. This explains why some individuals suffer from Seasonal Affective Disorder. Seasonal Affective Disorder (SAD) is triggered by the onset of winter and the reduction of sunlight. As their melatonin levels increase and their serotonin levels decrease, depression sets in. One in 10 people, including children, suffer from SAD. Symptoms associated with SAD can include depression, fatigue, lethargy, anxiety, and carbohydrate cravings.
One to two hours of exposure to bright light (ultraviolet light) will usually decrease melatonin levels to a normal level. Special ultraviolet (full spectrum) bright lights can be found in various stores and catalogs. Individuals with SAD should use these lights one to hours every day during the winter months.
MELATONIN is available here
Magnetic Field Effects on Melatonin
Synthesis of melatonin from the amino acid Tryptophan has been shown to be decreased by exposure to magnetic fields, stress, and by the aging process.
The synthesis of melatonin has been reported to be effected by the exposure to both electric and magnetic fields.
Exposure to both static and pulsed magnetic fields has been shown to significantly decrease NAT activity in melatonin levels in the pineal gland of experimental animals.
This was reported in the Alternative Medical Journal, Volume 1, No. 2, 1996, from research cited by Welker HA, Semm P, Willig RP, et. al. Effects of an artificial magnetic field on serotonin in acetyl transferase activity in melatonin content in the rat pineal gland. Exp. Brain Research, 1983; 50; 426-432. The other article cited is Lerchl A, Nonaka KO, Stokkn KA, Reiter RJ. Marked rapid alterations in nocturnal pineal serotonin metabolism in mice and rats exposed to wheat intermittent magnetic fields. Metalisized Biochemical Biophys. Research Communication, 1990; 169; 102-108.
Magnesium - A natural muscle relaxant which helps regulate neurotransmitters, including serotonin. FMS and CFS patients are usually low in magnesium. I recommend a minimum 500mg of magnesium a day. An additional 100-150mg at bedtime may be helpful. It’s best to use a chelated form of magnesium; magnesium citrate, taurate, or aspartate.
My Sleep Restoring Protocol
How to take 5HTP
It’s important to take 5HTP on an empty stomach, thirty minutes before bedtime, along with 4 ounces of grape juice. The juice helps 5HTP cross the blood-brain barrier and pass into the brain, where it turns into serotonin. You should start with 50mgs. Ninety-nine percent of those taking 5HTP will notice nothing on this dose. One percent will actually become more alert. If this happens, they shouldn’t take 5HTP at night. They can, however, take 100mgs once or twice a day with food. Individuals who don’t have an adverse reaction should add an additional 50mgs each night until they fall asleep within thirty minutes and sleep through the night. So start with 50mgs. If you don’t have a negative reaction, but don’t sleep, add an additional 50mgs (total of 100mgs) the next night. If you still don’t sleep through the night, add an additional 50mgs (total of 150mgs) the next night. Keep increasing dosage up to 250mgs or until you fall asleep within 30 minutes of taking it and sleep throughout the night. This natural amino acid will never leave you hung-over, make you feel dopey, or prevent you from waking up in the middle of the night. Contrary to well-meaning warnings, I’ve found 5HTP can be taken with anti-depressants like Paxil, Celexa, Prozac, Lexapro, Trazadone, and others. These medications are usually not working anyway because there is no serotonin to work with. 5HTP may cause a hang-over if taken with Neurontin, high doses of Xanax, Ativan, Restoril, Remeron, and Klonopin. Just start with 50mgs and slowly increase your dose. 5HTP can also be taken with Ambien, Sonata, Flexeril, or other sleep medications. Remember, start with 50mg. If you have a negative reaction, stop taking 5HTP at night and take it with food during the day. I’ve recommended 5HTP for years. Less than one percent couldn’t take it (it made them more alert at night) or it didn’t help improve their poor sleep.
One of Three Things Will Happen When Taking 5HTP
Starting with 50mgs of 5HTP...
1. The person will fall asleep with in 30 minutes and sleep through the night.
If so, this is their bedtime dose until they follow up with me in 1-2 weeks.
2. The person takes 5HTP and nothing happens. This is typical response to such a low dose. They’re instructed to add 50mgs each night (up to a max of 300mgs) until they fall asleep within 30 minutes and sleep through the night. The patient should stay at the minimum dose needed for deep sleep or at 300mg.
3. The person takes 50mgs and instead of making them sleepy it makes them more alert. This may occur in 1% of my patients and is due to a sluggish liver. If this happens the patient is instructed to discontinue taking 5HTP at bedtime and instead take 50mgs with food for 1-2 days. Taking 5HTP with food will slow it down and allow the liver to process it like any other food stuff. If they have no further problems with 5HTP then they should increase to 100mgs of 5HTP at lunch and 100-200mgs at dinner. This will allow the 5HTP to build up slowly. It will work when taken with food but will take a little longer for it to produce the desired results (2-3 weeks).
Can I take 5HTP (ANY OF THER AMINO ACIDS) with Prescription Medications?
Yes. 95% of my patients are already taking anti-depressants when they come to see me. Most individuals are on selective serotonin reuptake inhibitors (SSRIs); Paxil, Prozac, Zoloft, Lexapro, Celexa, etc. These medications are gasoline additives designed to help the brain hang on to the serotonin. They don’t make serotonin.
Can Patients Take 5HTP with Sleep Medications?
Yes, I recommend patients start taking 5HTP along with their sleep medications (as recommended above). I let my patients know that 5HTP never causes a hang over. However, when taken with certain sleep medications (Flexeril, Ambien, Sonata, Elavil, Doxepin, Resteril, and especially Xanax, Klonopin, Neurontin, and Ativan) it may cause a hang-over the next day.
I don’t recommend patients discontinue taking their sleep medications. Instead I suggest they start using 5HTP and increase the bedtime dose until they sleep through the night. At some point they should be able to work with their medical doctor and slowly wean off the prescription sleep medication.
What if Someone is Using Prescription Sleep Medications and They’re Sleeping Through the Night?
If a patient is taking Elavil (or other tricyclic anti-depressent), Trazadone, Ambien, or Flexeril and they’re falling asleep within thirty minutes, dreaming, and sleeping 7-8 hours, then they should continue taking on the sleep medication. They should add 5HTP 50mgs three times a day with food. If no problems after 2-3 days, they should then increase to 100mgs with each meal. If 5HTP makes them drowsy even when taking it with food, they should take 200mgs, minimums at dinner. The optimal dose is 300mgs a day.
Remember, the reason why they are taking these prescription drugs is because they have a serotonin deficiency, not a sleep-drug deficiency. You want to help them build up their serotonin levels so that eventually they won’t need prescription sleep medications.
A person may be taking a sleep medication that allows them to go into deep sleep. This helps them to build up their serotonin stores and make deposits into their stress coping savings account. However, they will use most of their deep sleep deposits up the next day (daily stress, homeostasis, etc). The key is to build up serotonin levels with 5HTP and the vitamin, mineral cofactors (B vitamins, magnesium, Essential Fatty Acids, and vitamin C).
What if Someone Has a Serotonin Syndrome Reaction?
You always want to be aware of serotonin syndrome. Serotonin syndrome occurs when a person gets to much serotonin. It may cause rapid heart beat, increased pulse rate, elevated blood pressure, agitation, and in its worst case scenario irregular heart beats (arrythmia).
I have thousands of individuals on 5HTP and have had only one person have a serotonin syndrome reaction. This person was not a patient. She had a history of irregular heart beats and chemical sensitivities. She also had CFS. I would have never recommended she take 5HTP at bedtime. Instead I would have had her start with 50mgs with food (if I would have recommended at all). She took 50mgs at bedtime first night it made her more alert ( a sign not to take at night) and then increased to 100mgs the next night. She then began having a serotonin syndrome which caused her to be anxious and to have arrythmia for the next few hours.
I write this here not to scare you. I use 5HTP with individuals with known heart conditions. Individuals with MVP and heart disease. I always start with a low dose 50mg and warn the patient to stop taking at bedtime if they have a funny reaction.
A lot of people are on incredibly toxic heart medications that increases their risk for heart failure, stroke, and death. If I don’t get them to consistently go into deep restorative sleep each night they’ll never get well. So I don’t worry about using 5HTP. Once you start reading about the medications and combination of medications your patients are on you’ll realize just how safe 5HTP is to use.
What are Some of the Other Potential Side-effects of 5HTP?
Other than some patients becoming more alert when taking it at bed time, I have very few complaints from patients. The literature says that individuals may have headaches and nausea from taking 5HTP. I have had less than half a dozen patients who have had one of these side-effects. The headaches and any nausea go away after a couple of days.
Can 5HTP Be Taken With Any Medications?
Yes, 5HTP can be safely taken with all prescription medications. I wouldn’t recommend 5HTP be used for patients with manic depression or schizophrenia. These conditions are best referred to orthomolecular psychiatrist who specialize in these complicated disorders.
How Much 5HTP Should I Take?
Patients should be taking up to 300mgs a day. I have some who take more, but most are taking between 200300mgs a day.
I always ask (or have my nurse ask) how the patient is sleeping. This is the most important bench mark for how well they are doing. If they are sleeping through the night I know they are feeling much better. They’ll have less pain, less depression, less anxiety, improved energy, and increased mental clarity.
However, if they continue to have IBS symptoms, sugar cravings, low moods, or a lot of pain and they aren’t taking maximum dose of 5HTP, I’ll go ahead and ask the patent to increase their 5HTP dose up to 300mgs a day.
I have them continue to take the night dose that is putting them to sleep along with taking additional 5HTP (up to total of 300mgs a day) with food during day.
The patient is taking 200mgs of 5HTP at bedtime. They’re sleeping through the night but continue to have a good deal of pain. I’ll instruct the patient to take an additional 50mgs of 5HTP twice a day with food (lunch and dinner).
Patients who can’t take at bedtime should increase their dose to up a total of 300mgs taken with food.
NOTE- IBS SYMPTOMS SHOULD GO AWAY ONCE YOUR SEROTONIN LEVELS ARE RESTORED. In my practice this usually occurs within 2-3 weeks.
If IBS continues even with 300mgs of 5HTP, then I recommend patients start taking 3 probiotics a day on an empty stomach.
My PROBIOTIC FORMULA is available here
What do I do When I Still Can’t Fall Asleep and Sleep Through the Night After Doing the Protocol Above?
If, after 2 weeks, someone is not falling asleep and staying asleep through the night I add melatonin.
I make sure they are taking 5HTP as they should be and at the maximum dose of 300mgs.
Melatonin is the primary hormone of the pineal gland and acts to regulate the body’s circadian rhythm, especially the sleep/wake cycle. Serotonin turns into melatonin which then promotes deep restorative sleep. But remember all the wonderful things serotonin does; increases deep restorative sleep, boosts mental clarity, elevates mood, lowers anxiety, and reduces pain. 5HTP-Serotonin-Melatonin.
When I have patients not sleeping on 5HTP and can’t fall asleep try taking 3mgs of sublingually, dissolved under the tongue, for rapid absorption right before bed, along with 300mgs of 5HTP. Individuals who can’t take 5HTP at bedtime should continue taking up to 300mgs of 5HTP with food. I have as patients to try this for a few days. If they can’t fall asleep after a few days then they should add 500mgs of niacinamide three times a day. This special form of B3 will help raise serotonin levels.
You can also take extra magnesium (especially if you are not having a bowel movement each day) at dinner or at bedtime (discontinue if you get loose bowel movements). Most patients are already taking the CFS/Fibro or other high-dose broad-spectrum multivitamin/mineral formula with a minimum of 600mgs of magnesium.
If a person isn’t having a daily bowel movement then they are still deficient in magnesium.
Magnesium is a natural muscle relaxant and a deficiency can cause low serotonin states, muscles tightness, constipation, fatigue, anxiety, and insomnia. Make sure you’re taking the CFS/Fibromyalgia Formula or a multivitamin/mineral formula with at least 600mgs of magnesium.
I Can Fall Asleep After Taking 5HTP But I can’t Stay Asleep. What Should I do?
If you’re falling asleep but can’t stay asleep, try taking 2-3mg of timed-release melatonin along with your 5HTP dose.
Patients can increase their melatonin doses up to a total of 6mgs. Again, stay on the 5HTP.
Some patients have trouble winding down and can’t turn their minds off. Some seem to catch a second wind right before going to sleep. If this sounds like you then you may need to take GABA one and a half hours after dinner (on an empty stomach) along with 5HTP and perhaps melatonin.
If GABA doesn’t work, then use L-Theonine. Both are available at your local health food store.
MELATONIN-SR (timed released) is available here
GABA is available here
What If Nothing Works?
If all this fails then it is time to use prescription medications. You should continue to take 5HTP along with these medications. Hopefully you’ll build-up your serotonin levels and will be able to eventually wean off these medications with the help of your physician.
You have to consistent deep restorative sleep or you’ll never get well or feel better.
Remember you don’t have an Elavil, Ambien or Flexeril deficiency. You have a serotonin deficiency. These medications don’t make serotonin, 5HTP along with the vitamins discussed earlier make serotonin.
If you do need to take a prescription medication for sleep make sure it is one that promotes deep restorative sleep.
Medications That Promote Deep Restorative Sleep
Ambien (Zolpidem) A short-acting drug that usually lasts for 4-6 hours. Even though the literature on Ambien suggests patients don't build up a tolerance, many do. Some patients do well on Ambien and some build up a tolerance over a period of time needing higher and higher doses until the medicine no longer works.
Side-effects include Flu like symptoms, short-term memory loss, headache, dizziness, chest pain, fatigue, nervousness, anxiety, insomnia, and diarrhea.
Sounds like some of symptoms associated with FMS and CFS… flu-like symptoms, including achy muscles.
Trazadone (Desyrel) An anti-depressant that increases serotonin levels, reduces anxiety, and promotes deep sleep. I’ve found this drug to be quite helpful when 5 HTP or melatonin doesn’t work. It can cause early morning hangover.
Side-effects associated with this tricyclic anti-depressant include upset stomach, constipation, abdominal pains, diarrhea, palpitations, rapid heartbeat, rash, swelling in arms and legs, dizziness, difficulty sleeping, confusion, fatigue, headache, ringing in the ears, loss of sex drive, weight gain or loss, and other unwanted symptoms.
Elavil (Amitriptyline) A tricyclic anti-depressant that has become synonymous with treating FMS. It was one of the first drugs to be studied in the treatment of FMS. It can be very helpful in reducing the pain associated with FMS but it has several potential unwanted side-effects such as weight gain, “early morning hangover” neurally mediated hypotension (low blood pressure), muscle spasms, tremors, seizures, convulsions, constipation, anxiety, nervousness, fatigue, numbness and tingling in the hands and feet, fluid retention, decreased sex drive, and irregular heartbeats.
Flexeril (Cyclobenzaprine) Another muscle relaxant that is quite sedating and unlike other muscles relaxants (Znaflex) it does promote deep-restorative sleep. It acts similar to Elavil. Some of the side-effects associated with this medication include drowsiness, dizziness, dry mouth, muscle weakness, fatigue, headache, unpleasant taste, nervousness, and confusion.
Turn Down the Lights
Our biological clocks, or circadian rhythm, is controlled by the pineal gland. The pineal gland releases hormones, including melatonin, based on our sleep-wake cycles. These cycles are largely influenced by sunlight. Our bodies are designed to wake-up when light hits our eyes and to get sleepy (increased melatonin) when exposed to darkness. Our ancestors who lived before the invention of electricity were usually in bed soon after the sun went down and up with the morning sunrise.
With the invention of electricity, modern man can have light 24hrs a day. This can keep the body confused.
Good Sleep Promoting Habits
I recommend that before bed you turn off the TV and find a quiet room (not your bedroom) where you can use a soft low voltage (75 watts) lamp to read by. After 30 minutes to an hour, take your bedtime supplement or medication and then move to your bedroom. Keep the lights on low and avoid any stimulation, including the TV. In fact take the TV out of your bedroom! You may want to try a warm Epsom salt bath 30 minutes to an hour before bed. Simply pour 1 cup of Epsom salts (magnesium sulfate) into a warm bath. Soak 20-30 minutes. Again use low-light and no stimulus.
The herb lavender is calming. It can be used as a bath gel, lotion, and soap, sprinkled along with Epsom salts directly in the tub.
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