Insomnia

How homeopathy can help a good night’s sleep by Dr Keith Souter

Being unable to sleep can be one of the most frustrating  conditions. People often complain that they feel alone, isolated by  their wakefulness when everyone around them is deep in the arms of  Morpheus. Yet insomnia is very common. Sleep troubles affect 25 per cent  of people at some point, and over ten per cent of the adult population  have a chronic problem with insomnia.There have been many famous in­somniacs. Vincent Van Gogh apparently  used to douse his mattress and pillow regularly with a strong  concentration of camphor in an effort to deal with his sleep­lessness.  Marilyn Monroe was another regular insomniac who used hypnotics to get  off to sleep and whose sad death was thought to have resulted from an  overdose of sleeping tablets. Judy Gar­land’s problems with sleep seemed  to arise from an addiction to ampheta­mines, which kept her awake and  which she countered by taking sleeping tablets. Finally, Groucho Marx  developed in­tractable insomnia after the 1929 Wall Street Crash in  which he lost a fortune. Rather than turning to alcohol or sleep­ing  tablets he developed a unique method of easing his isolation during his  sleep­less nights. He randomly used to ring up total strangers and  insult them on the telephone. It did not help him to sleep, but it  apparently mellowed his temper.

Normal sleep 

Work in sleep laboratories extending back over the last four decades  has advanced our knowledge of the physi­ology of sleep. During a normal  sleep time we seem to go through several cycles of sleep composed of  four stages of non-rapid eye movement (NREM) and rapid eye movement  (REM) sleep, in an ebb and flow manner as depicted in the diagram in the  PDF version of this article.NREM sleep is divided into four pro­gressively deeper stages. Stage  I, light sleep, stage II, middle sleep, and stages III and IV, deep,  delta-wave sleep. REM sleep, when dreaming occurs, follows NREM sleep  and occurs in four or five episodes during a sleep time of about eight  or nine hours. Generally, the first REM burst lasts about ten minutes,  while the last may occur for over an hour or two. If you divide a sleep  time of nine hours into three periods of three hours, then the first  third will be predominantly NREM sleep and the last third will be mainly  REM sleep. If one wakens from a full and good night’s sleep then it is  usually from REM sleep or a short episode of stage I NREM sleep, when  you have a recollection of your last dream, before it disappears as you  grasp consciousness.Stage I NREM sleep occurs at the start of sleep and at potentially  wakeful times during the night. It makes up about five to ten per cent  of total sleep time. It is characterised by twitches and occasional  jerking movements. Some­times one may experience “hypnagogic  pseudo-hallucinations” at this time, such as when one imagines falling  off a gate and jerking awake. They are of no sig­nificance. Stage II,  when one becomes less aware of the external environment occurs  throughout the sleep cycle and makes up about 40 to 50 per cent of sleep  time. Stages III and IV occur mainly in the first third of the night  and account for about 20 per cent of the sleep time. Sleep-walking,  night terrors and bed-wetting all seem to occur in this part of the  sleep cycle. Stage IV is the hard­est sleep to be roused from. REM sleep  makes up the remaining 20 to 25 per cent of the sleep time.Even now we are not sure about the functions of the individual stages  of sleep, but it seems that the whole process is essential to brain  functioning and to general health of the body. It is thought that NREM  sleep is associated with growth and repair of the brain and body, and  that REM is associated with men­tal functions, dreaming and processing  of memory.

Changes in sleep patterns 

Infants sleep for about 14 to 16 hours a day, in several episodes. REM  sleep pre­dominates at the expense of stages III and IV NREM. Older  children develop a pattern more akin to an adult, with the noted  adolescence period being charac­terised by excessive somnolence. Then in  the elderly, there is a 10 to 15 per cent reduction in stages III and  IV NREM sleep, less REM sleep, and an increase in stage II NREM by about  five per cent. Physiologically, this means that to have the complete  restorative sleep, the total time in bed must increase. Unfortunately,  because more time is spent in the lighter stages of sleep there is more  opportunity for various medical conditions to impinge on the sleeper and  waken them to cause a complaint of insomnia.

Insomnia 

As with any human parameter, it is hard to lay down numbers about  ideal dura­tions of sleep. Some people may sleep efficiently for six  hours with no com­plaint, yet others need a full eight or nine hours of  unbroken sleep. Insomnia is therefore a highly subjective complaint.A reasonable working definition of insomnia could therefore be: a  complaint of difficulty in initiating and/or main­taining satisfying  sleep.Insomnia is one of those conditions where there is immense variation  in the sort of problem that it causes. There may be difficulty falling  asleep, difficulty stay­ing asleep, waking early, or just feeling  unrefreshed. And of course, there can be secondary effects, such as  daytime fatigue, poor concentration and irritability.There may be obvious causes of in­somnia, such as prostate problems  in men, bladder problems, heart failure, hormonal changes and various  arthritic or painful conditions. There may be underlying psychological  causes such as simple worry, more marked anxiety or depression. Habit  problems, such as too much caffeine, tobacco or alcohol, or side-effects  from medication may also play a part. And, of course, restless or noisy  bed-fellows may be keeping one awake. Finally, if the individual is a  snorer then sleep apnoea needs to be considered. In this condition the  respi­ratory drive is low during sleep, causing periods when the  individual stops breathing and either snores loudly or wakes up. If this  is suspected then a med­ical opinion should be sought.

Homeopathy & insomnia 

Homeopathy can often make a big dif­ference to insomniacs. The  approach is to consider the sleep disturbance as part of the overall  clinical picture. There is no such thing as a homeopathic  sleep-ing-tablet, just as there is no such thing as a homeopathic  painkiller. The well-selected remedy, if it includes the pat­tern of the  sleep disturbance, may solve the problem.Having an awareness of what hap­pens during the sleep cycle can be  help­ful, in that it might indicate a remedy or group of remedies. For  example, duti­ful types who tend to waken in the early hours with an  aggravation of some symptom or another between two and four may well  need one of the Kali salts.The following patterns may also help in the choice of a remedy.

Difficulty dropping off 

This is a common problem with anxiety states, so the remedies in  which an anx­iety component is prominent may help. Aconite may help the  person who pan­ics on going to bed. They may fear sleep; feel that they  might not wake up, so sleep could take on the spectre of death.  Arsenicum album may help the restless, meticulous type of person who  cannot get off to sleep because they have to get everything ordered in  their mind.

Light sleeping

Wakefulness from the least background noise is suggestive of a need  for Coffea with its heightened sensitivity and inabil­ity to get into  the deeper stages of sleep. Asarum also helps when any noise wak­ens the  sleeper, especially if they have great sensitivity to any noise during  the day. Insomnia after over-indulgence in stimulants, food, drink or  after over­exerting oneself late in the day may indi­cate Nux vomica.

Frequent waking 

In addition to those who are very light sleepers, the following  remedies may help those people who seem to wake fre­quently, and who may  find that they lie awake for an hour or so before getting off again.  Alumina might help, especially if in the morning the individual is slow,  dull and subject to awareness of symp­toms or aggravations of other  conditions on waking. Baryta carb may have this pattern, but also be  prone to waking from nightmares. And Hepar sulph, one of the most  sensitive of remedies, might suit the person who wakes if a toe or foot  somehow gets exposed in the night.

Restlessness 

Here we have to consider any physical condition that may be causing  the rest­lessness. Treating that with the appro­priate remedy may help,  but otherwise the following restless remedies may be useful. Ignatia is  useful in people who experience insomnia after a loss of some sort. They  may sigh and yawn a lot, yet find sleep difficult to come, and find it  fitful at best. They may twitch, toss and turn and be subject to  nightmares. Natrum muriaticum is also frequently indicated in insomnia  after bereavement, slight or loss. The pattern of insomnia here may be  associated with feeling isolated, feel­ing aggrieved and finally crying  them­selves off to fitful sleep.Zincum metallicum may help the nervous type of person prone to  twitchy feet and restless legs. Arnica may help when the individual  cannot get com­fortable, because the bed (whatever it is like) just  feels too hard.

Early morning waking 

By this I mean waking at 4 or 5am onwards and not being able to fall  off again. This is very common in sadness and depression. Aurum  metallicum needs to be considered when the indi­vidual feels totally  down, perhaps with thoughts of self-harm. Waking early and feeling angry  and down may be helped by Staphysagria, especially if there is a  tendency to feel sleepy throughout the waking day. Whereas those needing  Staphysagria might not actually vent their anger, people who wake  feeling down and cross, and who are decidedly prickly to those around  them may ben­efit from Nitric acid.

Too hot or too cold 

When someone often wakes up sud­denly, usually from an anxiety  dream, feeling hot with a sweaty head, then Silica may help. Others who  also wake up with their head bathed in perspira­tion, especially if  prone to be overweight, and who suffer from cold feet, may ben­efit from  Calcarea carbonica. By con­trast, people who wake with hot feet, who  feel that the bed has become too hot so that it makes them itchy and  irri­table, may be helped by Sulphur.

Too tired to sleep 

The remedy that one immediately thinks of when someone has been  deprived of sleep and wants to get back to sleep is Cocculus. We think  of this as the “carer’s remedy”. If a parent has to get up to see to a  child, a carer to look after a loved one or patient, then this remedy  will often do the trick. It is also useful if jet lag has produced a  short term problem with insomnia.

Bad dreams or no dreams 

If bad dreams waken the sleeper and pre­vent further sleep, then  Belladonna is a good choice, especially if the dreams have been of  falling. China may help those people who sleep lightly and who “day  dream” a lot, even as they are trying to get to sleep, about performing  acts of heroism or daring-do.Insomnia taking the form of poor, unrefreshing sleep associated with  an inability to recall dreams (perhaps even feeling that they have never  dreamed) may suggest Lycopodium, especially if they get accompanying  digestive troubles.

How to take the remedies 

I would suggest using a low potency 6c remedy for self-treatment  after working out the pattern of insomnia. Take a dose an hour before  bedtime and a dose before turning the lights out, having already worked  out a bedtime routine. If necessary take another dose if you wake up in  the night.It is entirely reasonable to try self-treatment for a couple of  weeks, but if there has been no improvement then it would be sensible to  have an opinion from a homeopath to elucidate the best remedy.

Preparing for sleep

Adopting good sleep preparations is worthwhile. The following may help:1. get into a bed-time routine;2. make your bedroom a place for sleep or love-making, not a study, computer or TV room;3. make your bedroom a quiet room without ticking clocks, etc;4. make it a dark room when the lights go off;5. avoid caffeine, tobacco or alcohol in the late evening;6. have the room temperature just right;7. if you can’t sleep after half an hour get up and do something pleasurable until you feel sleepy.

Keith Souter MB ChB FRCGP MFHom  MIPsiMed DipMedAc is a part-time GP in Yorkshire. He also has a private  holistic medicine practice and is a newspaper columnist as well as the  author of Homeopathy for the Third Age and Homeopathy: Heart & Soul.