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Nutritional Influences on Sleep with scientific references SleepDrops

Nutritional Influences on Sleep with scientific references SleepDrops

In this month’s column, we will review both how marginal nutritional deficiencies may interfere with sleep, and how supplementation (even in the absence of evidence of deficiency) may improve it.
Vitamins
Folic acid Deficiency
A deficiency of folic acid may interfere with sleep by promoting the sensorimotor form of restless legs syndrome in which pain, numbness and lightning stabs of pain in the limbs are relieved by movement or local massage. (1)

Niacinamide
Animal studies suggest that niacinamide supplementation has effects similar to that of the benzodiazepines. These include hypnotic and muscle relaxant qualities. (2)

Thiamine Deficiency
In a double-blind study of healthy elderly who were likely to be marginally thiamine-deficient, supplementation improved sleep patterns and general well-being, while it reduced Daytime sleep time and fatigue. (3)

Vitamin B12
Disturbances in the usual sleep-wake rhythm are a cause of insomnia, especially as patients with this disturbances are often only able to sleep at inappropriate times. Some respond to oral supplementation with vitamin B12 with normalization of sleeping patterns and of hormonal circadian rhythms. (4)

Vitamin E
There are several case reports that suggest that supplementation with perhaps 300 IU of vitamin E may provide relief from restless legs syndrome. (5)

Minerals
Chromium: A Warning

A group of 16 healthy volunteers (average age of 40 years) were provided

with either a commercial chromium yeast containing 50 [micro]g chromium or a brewer’s yeast placebo nightly for 6 nights. They were asked to discontinue any vitamin or mineral supplements for one week prior to the study.

While, with 2 exceptions, no effects were attributed to the placebo, all chromium-supplemented volunteers noted increased and more vivid dreams, 75% noted increased sleep interruption, and half noted difficulty falling asleep. There were also complaints of unrefreshing sleep and fatigue. (6)

Iron Deficiency
A deficiency of iron has been found to be yet another cause of sleep disturbance from restless legs syndrome. (7)

Magnesium Deficiency
Insomnia is one of the central, or neurotic, symptoms of chronic magnesium deficiency. (8) A number of parasomnias (night terrors; nocturnal verbal and motor automatisms; restless legs syndrome) may be related to magnesium deficiency. (9), (10)

Sleep in magnesium deficiency is usually agitated with frequent nocturnal awakenings. Nocturnal instrument monitoring reveals major disorders of sleep organization. The deficiency may be severe enough to be diagnosed on the basis of clearly low blood magnesium levels. (10)

Conversely, a high magnesium, low aluminum diet has been found to be associated with high-quality sleep time and few nighttime awakenings, (11) and magnesium supplementation has been reported to reduce sleep latency and result in uninterrupted sleep. (12)

Potassium Deficiency
Evidence that a marginal potassium deficiency interferes with sleep comes from a double-blind crossover study of normal young men. While on a low-potassium diet, they randomly received either oral potassium chloride or placebo. Potassium supplements were found to improve sleep consolidation. (13)

Other Nutritional Factors
L-Tryptophan
The nutritional precursor to serotonin, L-tryptophan has been extensively studied and has been found to be an effective hypnotic. For younger insomniacs suffering purely from extended sleep latency, it is effective starting the first night of supplementation. For more chronic and severe insomniacs with both extended sleep latencies and problems in sleep maintenance, it may take several days or longer before improvement occurs. Sometimes, in these cases, improvement occurs only after supplementation is discontinued; for such patients, intermittent treatment may be most effective. (14)

Supplementation with L-tryptophan does not impair visuomotor performance, cognition or memory, does not elevate the threshold for arousal from sleep, and does not distort sleep stages. Tolerance does not develop and there is a negligible to low incidence of side effects. (14) It is unavailable in many countries, however, ever since a contaminant introduced by one manufacturer resulted in an epidemic of eosinophilia myalgia syndrome several years ago.

L-5-Hydroxytryptophan
While much less studied than L-tryptophan, L-5-hydroxytryptophan, the immediate precursor to the neurotransmitter serotonin, also appears to be effective in promoting sleep. Moreover, it may be more effective than L-tryptophan in improving sleep patterns as it increases the amount of time spent in REM sleep (during which dreaming occurs), (15) while L-tryptophan decreases the time spent in this important sleep stage. (16)

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Modified from Werbach MR with Moss J. Textbook of Nutritional Medicine. Tarzana, California, Third Line Press, Inc., 1999.

References

(1.) Boutez MI et al. Neuropsychological correlates of folic acid deficiency: Facts and hypotheses, in MI Botez, EH Reynolds, Eds. Folic Acid in Neurology, Psychiatry, and Internal Medicine. New York, Raven Press, 1979

(2.) Mohler H et al. Nicotinamide is a brain constituent with benzodiazepine-like actions. Nature 278:563-65, 1979

(3.) Smidt LJ et al. Influence of thiamin supplementation on the health and general well-being of an elderly Irish population with marginal thiamin deficiency. J Gerontol 46(1):M16-M22, 1991

(4.) Okawa M et al. Vitamin B12 treatment for sleep-wake rhythm disorders. Sleep 31(1):15-23, 1990

(5.) Ayres S, Mihan R. “Restless legs” syndrome: response to vitamin E. J Appl Nutr 25:8-15, 1973

(6.) Schrauzer G et al. Somatopsychological effects of chromium supplementation. J Nutr Med 3:43-8, 1992

(7.) O’Keeffe ST, Gavin K, Lavan JN. Iron status and restless leg syndrome in the elderly. Age Ageing 23(3):200-3, 1994

(8.) Durlach J et al. Magnesium and therapeutics. Magnes Res 7(3/4):313-28, 1994

(9.) Popoviciu L et al. Parasomnias (non-specific nocturnal episodic manifestations) in patients with magnesium deficiency. Rom J Neurol Psychiatry 28(1):19-24, 1990

(10.) Popoviciu L et al. Clinical, EEG, electromyographic and polysomnographic studies in restless legs syndrome caused by magnesium deficiency. Rom J Neurol Psychiatry 31(1):55-61, 1993

(11.) Penland J. Effects of trace element nutrition on sleep patterns in adult women. Fed Am Soc Exp Biol J 2:A434, 1988

(12.) Davis W, Ziady F. U. of Pretoria, S. Africa–presented at the Second International Symposium on Magnesium, Montreal, 1976

(13.) Drennan MD et al. Potassium affects actigraph-identified sleep. Sleep 14(4):357-60, 1991

(14.) Schneider-Helmert D, Spinweber CL. Evaluation of L-tryptophan for treatment of insomnia: a review. Psychopharmacology (Berlin) 89(1):1-7, 1986

(15.) Wyatt RJ et al. Effects of 5-hydroxytryptophan on the sleep of normal human subjects. Electroencephalogr Clin Neurophysiol 30(6):505-9, 1971

(16.) Wyatt RJ. The serotomin-catecholamine-dream bicycle: A clinical study. Biol Psychiatry 5:33-64, 1972

by Melvyn R. Werbach, MD

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