Insomnia is the chronic inability to sleep or to remain asleep through the night. The condition is caused by a variety of physical and psychological factors. These include emotional stress, physical pain and discomfort, disturbances in brain function, drug abuse and drug dependence, neuroses, psychoses, and psychological problems that produce anxiety, irrational fears, and tensions. Conventional medical treatments may include giving sedatives, tranquilizers or hypnotics, psychotherapy, and exercise. However, there are also a variety of natural substances, which may help. These are discussed below.

MELATONIN

Melatonin is a hormone produced by the small, pea-shaped pineal gland located in the brain. During daylight hours, light entering the eye stimulates neurons to transmit impulses to the pineal gland that inhibit melatonin secretion. But at night, the pineal gland is able to release melatonin, which causes relaxation and initiates the sleep cycle.

As the body ages, it produces less melatonin—which may explain why elderly people often have difficulty sleeping¹ and why melatonin supplements improve sleep in the elderly.² This does not mean that the use of melatonin should be limited to the elderly. Other research has shown that non-elderly adults with insomnia can also have lower melatonin levels.³ Also, research has demonstrated that melatonin even helps facilitate sleep in young adults.⁴ An appropriate dose would be 3–6 mg melatonin taken one hour before bedtime.

VALERIAN ROOT

HOPS

PASSION FLOWER

SCULLCAP

GRIFFONIA SIMPLICIFOLIA (5-HTP)

5-Hydroxy-L-Tryptophan (5-HTP) is a natural peptide, which the human body uses to make the neurotransmitter serotonin. Serotonin is important for normal nerve and brain function, and plays an important role in sleep. In fact, your body can convert serotonin into melatonin.¹³ The concept is that by taking supplemental 5-HTP your body should be able to make serotonin, which ultimately, should help promote sleep. In fact, in one placebo-controlled trial 5-HTP was able to improve the duration and depth of sleep in individuals with insomnia.¹⁴ In addition, 5-HTP was able to improve sleep quality in a preliminary trial of people with fibromyalgia.¹⁵ Commercially, 5-HTP can be derived from the seeds of a West African plant called Griffonia simplicifolia. Some Griffonia extracts are standardized to 10 percent 5-HTP.

GABA

Gamma-Amino Butyric Acid (GABA) is a natural peptide, which is manufactured from the amino acid glutamine and glucose. In the central nervous system, GABA exerts anticonvulsant, sedative, and anxiolytic effects at the cellular level.^16,17 GABA supplements appear to promote relaxation and sleep.¹⁸ GABA itself does not cause drowsiness. Instead, by easing anxiety, it simply makes it easier to fall asleep.

DIET AND/OR OTHER CONSIDERATIONS

For many insomniacs, avoiding caffeine may be an absolute necessity. After all, caffeine is a well-known stimulant, which can keep you awake.¹⁹ Now if you're thinking, "Fine, I'll just make sure not to have any coffee in the evening," you may be in for a disappointment. The effects of caffeine can last up to twenty hours,²⁰ so you may need to stop drinking coffee altogether. Now besides regular coffee, black and green tea, cocoa, chocolate, some soft drinks, and many over-thecounter pharmaceuticals also contain caffeine, so be sure to limit or avoid the intake of these items as well. Another dietary consideration is that eating high-carbohydrate food before bedtime, such as a slice of bread or some crackers, can significantly increase serotonin levels in the body—and the neurotransmitter serotonin is known to reduce anxiety and promote sleep.

Non-dietary considerations include stress and smoking. Insomnia can be triggered by, or exacerbated by psychological stress. Dealing with that stress through counseling has helped in many studies.²² Another method of intervention, which has helped is listening to relaxation tapes.²³

In addition, research has shown that smokers are more likely to have insomnia than non-smokers,²⁴ which is one more good reason for smokers to quit.

Another non-dietary approach to insomnia can include lavender oil. The volatile or essential oil of lavender contains many medicinal components, including perillyl alcohol, linalool, and geraniol. The oil is calming²⁵ and thus can be helpful in some cases of insomnia. One study of elderly persons with sleeping troubles found that inhaling lavender oil was as effective as tranquilizers.²⁶ The German government approves lavender for people with insomnia.²⁷

References

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2. Singer C, et al, J Am Geriatr Soc (1996) 44:51 [abstr #A1].
3. Attenburrow MEJ, et al, BMJ(1996) 312:1263–64.
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6. Leathwood PD, et al, Pharmacol Biochem Behav (1982) 17:65–71.
7. Dressing H, et al, Therapiewoche (1992) 42:726–36.
8. Blumenthal M, et al. (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines (1998) Austin: American Botanical Council and Boston: Integrative Medicine Communications, pp. 147.
9. Foster S, Herbs for Your Health (1996) Interweave Press, Loveland, Colorado, pp. 68–9.
10. Meier B, Zeitschrift Phytother(1995) 16:115–26.
11. Wolfson P, Hoffmann DL. An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers. Alternative therapies in health and medicine 2003; 9(2):74-8.
12. Foster S. Herbs for Your Health. Loveland, CO: Interweave Press, 1996, 86–7.
13. Guyton AC, Hall JE. Textbook of Medical Physiology, 9th ed. Philadelphia: W. B. Saunders, 1996.
14. Soulairac A, Lambinet H. Etudes cliniques de líaction du precurseur de la serotonine le L-5-hydroxy-tryptophane, sur les troubles du sommeil. Schweiz Bundschau Med (PRAXIS) 1998;77(34a):19–23.
15. Puttini PS, Caruso I. Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90 day open study. J Int Med Res 1992;20:182–9.
16. Kalant H, Roschlau WHE, Eds. Principles of Med. Pharmacology. New York, NY: Oxford Univ Press, 1998.
17. Bloom FE, Kupfer DJ. Psychopharmacology: The Fourth Generation of Progress. New York, NY: Raven Press, Ltd., 1995.
18. GABA. WholeHealthMD.com. Accessed on December 1, 2005 from http://www.wholehealthmd.com/refshelf/substances_view/1,1525,10027,00.html.
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27. Blumenthal M, et al, (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines (1998) Austin: American Botanical Council and Boston: Integrative Medicine Communications, pp. 159–60.

In the natural products industry, glucosamine and chondroitin are probably the most popular dietary supplement for the treatment of osteoarthritis. The emphasis here should be on osteoarthritis (OA), since there is no data indicating that these dietary supplements will be of benefit in the treatment of rheumatoid arthritis (RA). There are, however, dietary supplements which can be effective in the treatment of rheumatoid arthritis. Before discussing these supplements, let’s first take a closer look at RA. Arthritis is characterized by an inflammation and/or pain in a joint or joints of the body. Symptoms of chronic arthritis are pain, swelling, stiffness, and deformity of one or more joints.

Rheumatoid arthritis

The American College of Rheumatology reports that rheumatoid arthritis (RA) is a chronic disease that causes pain, stiffness, swelling, and loss of function in the joints and inflammation in other body organs. Unlike OA, RA is an autoimmune disease where the body’s immune system attacks its own joint tissue. While the cause of RA remains unknown, recent studies show that certain people inherit a tendency to develop RA. RA affects about two million Americans.

In the case of RA, supplementation with certain natural ingredients may help the situation—often significantly. Following is a discussion of these natural ingredients.

Undenatured Collagen Type II
UC-II™ is a proprietary brand of undenatured type II collagen derived from chicken sternum cartilage and is particularly valuable for RA sufferers. Here’s why: Type II collagen administered orally works with the immune system to promote healthy joints by a process called oral tolerization. This process helps the body to differentiate between foreign invaders, such as bacteria, and elements that are good for the body, such as nutrients. The process of oral tolerization takes place in the small intestine where food is absorbed. Through a complex series of immunological events, patches of lymphoid tissue surrounding the small intestine screen incoming compounds and serve as a “switch” to turn the body’s immune response to foreign substances on or off, depending upon what that substance is. In the case of UCII, small amounts (typically 10 milligrams or less¹ ) taken orally at bedtime have been shown to turn off the immune response targeted at the type II collagen present in bone joint cartilage.^2,3

UC-II is supported by six human clinical studies, including research at Harvard University Medical School. Here is a review of three of those studies.

• In a 90-day, double-blind, placebo-controlled, follow-up study on patients with severe rheumatoid arthritis, Harvard scientists found that 28 patients taking undenatured type II collagen showed significant improvement compared to the placebo group, while four patients recovered completely.⁴
• In another double-blind, placebo-controlled trial, Harvard Medical School researchers showed that following treatment with undenatured type II collagen, 21 of 54 rheumatoid arthritis patients (39 percent) demonstrated significant improvement, while only 11 of 57 patients (19 percent) taking a placebo showed improvement.⁵
• A human clinical study at Harvard Medical School showed that after three months of treatment with undenatured type II collagen, eight out of 10 patients with juvenile rheumatoid arthritis had a reduction in both swollen and tender joints. The average changes a 61 percent and 54 percent respective reduction in swollen and tender joint counts for the eight responders at the end of the study. Six patients had greater than a 33 percent reduction in both swelling and tender joint counts.⁶

Since UC-II is taken at bedtime, we also recommend the use of two herbs to be taken concurrently. These herbs not only help promote healthy sleep, but may also help reduce RA-associated pain.

Valerian root (Valeriana officinalis)
Valerian root extracts have been used for over 1,000 years for extract to relieve muscle spasms, as a mild sedative, treatment for insomnia, hysteria, nervous tension, fatigue, and menstrual cramps. Research data indicates a rational scientific basis for mild sedative qualities, and spasmolytic activity. Additional studies show mild painrelieving qualities.⁷ It is also used orally for muscle and joint pain⁸, as well as to treat neuralgia.⁹

California poppy (Eschscholtzia californica)
California poppy has been used historically to treat insomnia, the need for sedation, aches and pains, nervous conditions, childhood enuresis, and bladder disorders.¹⁰ Its sedating effects are in themselves potentially valuable for pain relief, since tension can exacerbate pain. This sedating effect was demonstrated in a double-blind, placebo-controlled study where a preparation containing fixed quantities of Hawthorn, California Poppy and magnesium proved safe and more effective than placebo in treating mild-to-moderate anxiety disorders.¹¹ In one study, extracts of corydalis and California poppy inhibited a particular degradation process (dimerization) of certain pain-modulating peptides in the brain. This effect is thought to prolong the activity of these pain-relieving molecules.¹²

Omega 3 Fatty Acids
In a previous issue of HSR, we wrote an article about omega 3 fatty acids (O3FA). In that article we included a discussion of O3FA's value in the treatment of RA. Here is a brief review of that information.

Well-controlled clinical studies have clearly demonstrated that consumption of O3FA has resulted in an improvement in rheumatoid arthritis (RA) sufferers.¹³ As a matter of fact, a comprehensive review of medical literature by a board certified rheumatologist revealed that treatment with O3FA is associated with improvement in outcome measures in RA, and is able to help decrease the long-term requirements for nonsteroidal anti-inflammatory drugs (e.g., aspirin, ibuprofen) in some circumstances. Furthermore, an expert workshop reviewing a comprehensive review of medical literature by a board certified rheumatologist revealed that treatment with O3FA is associated with improvement in outcome measures in RA, and is able to help decrease the long-term requirements for nonsteroidal anti-inflammatory drugs (e.g., aspirin, ibuprofen) in some circumstances.¹⁴ Furthermore, an expert workshop reviewing the health effects of O3FA also concluded that these natural substances where able to help alleviate the symptoms of RA.¹⁵ It should be noted that these O3FA-related benefits were not limited to adult RA sufferers. A study conducted in the Czech Republic found that children with chronic juvenile arthritis were able to decrease their ibuprofen consumption by 17.3 percent over a period of five months when treated with a high-O3FA diet.¹⁶ Assuming that the O3FA product provides something in the 375 mg EPA and 250 mg DHA range, with 625 mg of total omega 3 fatty acids, an effective dose would be 1-2 capsules daily.

Conclusion
UC-II. may help reduce pain and promote healthy joints in those suffering from RA. Likewise, O3FA may help lessen RA symptoms. Finally, Valerian and California poppy may help promote sleep and pain relief for arthritis sufferers. The concurrent use of all of these natural substances may yield a better result than any one individually.

References

1. Sieper J, Kary S, Sorensen H, Alten R, Eggens U, Huge W, Hiepe F, Kuhne A, Listing J, Ulbrich N, Braun J, Zink A, Mitchison NA. Oral Type II Collagen Treatment in Early Rheumatoid Arthritis. A Double-Blind, Placebo-Controlled, Randomized Trial. Arthritis and Rheumatism 1996; 39:41-51.
2. UCII™ FAQ, 2004 InterHealth Nutraceuticals, Inc. Accessed October 14, 2004.
3. Bagchi D, Misner B, Bagchi M, Kothari SC, Downs BW, Fafard RD, Pruess HG. Effects of Orally Administered Undenatured Type II Collagen Against Arthritic Inflammatory Diseases: A Mechanistic Exploration. International Journal References of Clinical Pharmacology Research 2002; 22:101–10.
4. Trentham DE, Dynesius-Trentham RA, Orav EJ, Combitchi-D, Lorenzo C, Sewell KL, Hafler DA, Weiner HL. Effects of Oral Administration of Type II Collagen on Rheumatoid Arthritis. Science 1993; 261:1727–30.
5. Barnett ML, Kremer JM, St Clair EW, Clegg DO, Furst D, Weisman M, Fletcher MJF, Chasan-Taber S, Finger E, Morales A, Le-CH, Trentham DE. Treatment of Rheumatoid Arthritis with Oral Type II Collagen. Results of a Multicenter, Double-Blind, Placebo-Controlled Trial. Arthritis and Rheumatism 1998; 41:290–7.
6. Barnett ML Combitchi D, Trentham DE. A Pilot Trial of Oral Type II Collagen in the Treatment of Juvenile Rheumatoid Arthritis. Arthritis and Rheumatism 1996; 39:623–8.
7. Foster S. Valerian. 1996 American Botanical Council. Accessed October15, 20004 from http://www.herbalgram.org/default.asp?c=valerian.
8. Valerian monograph. Natural Medicines Comprehensive Database 2004. Accessed on October 15, 2004
9. Mills S, Bone K. Principles and practice of phytotherapy. Edinburgh: Churchill Livingstone; 2000:581-9.
10. Barker JE, Meletis CD. Naturopathic pain management. Alternative and Complementary Therapies 2004; 10(4):188–93.
11. Hanus M.; Lafon J.; Mathieu M. Double-blind, randomised, placebo-controlled study to evaluate the efficacy and safety of a fixed combination containing two plant extracts (Crataegus oxyacantha and Eschscholtzia californica) and magnesium in mild-to-moderate anxiety disorders. Current Medical Research and Opinion 2004; 20(1):63–71.
12. Reimeier C, Schneider I, Schneider W, Schafer HL, Elstner EF. Effects of ethanolic extracts from Eschscholtzia californica and Corydalis cava on dimerization and oxidation of enkephalins. Arzneimittelforschung 1995;45:132–6.
13. Alexander JW. Nutrition. 1998;14(7-8):627–33.
14. Ariza-Ariza R, Mestanza-Peralta M, Cardiel MH, Semin Arthritis Rheum. 1998;27(6):366-70.
15. de Deckere EA, et al. Eur J Clin Nutr. 1998;52(10):749–53.
16. Vargova V, et al. Cas Lek Cesk. 1998;137(21):651–3.