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The AANP and the INM would like to acknowledge Amy Rothenberg, ND, for her contributions to the content of this FAQ.

If you struggle to fall asleep or stay asleep, you are not alone. Forty percent of Americanadults get less sleep than the nightly seven hour minimum recommended by the American Academy of Sleep Medicine. Good quality sleep is essential to whole-person health—mind, body, and spirit—and sleep deprivation can increase the risk of chronic disease, impact metabolism and hormone production, worsen cognitive and motor performance, and wreak havoc on your overall health. Licensed naturopathic doctors (NDs) are trained rigorously to identify and treat the numerous underlying causes of insomnia, and to address the psychological and biological impacts of not having enough sleep. With advanced training in therapeutic nutritionbotanical medicine, and behavioral medicine, NDs lead with safe, natural, and effective treatments to restore good sleep.

Why is sleep important for overall health?
The right quantity and quality of sleep is necessary to help optimize your mental health, physical health, quality of life, and safety. During sleep, your body is working to support healthy brain function and emotional well-being. While you’re sleeping, your brain is forming new pathways to help you learn and remember information. Studies show that a goodnight’s sleep improves learning and problem-solving skills. Sleep also helps you pay attention, make decisions, and be creative. Sleep deficiency has been linked to risk-takingbehavior, depression, and suicide.

Sleep deprivation has been shown to have an adverse effect on heart health. Helping to maintain a healthy balance of the hormones that make you feel hungry or full, sleep affects how your body reacts to insulin, the hormone that controls your blood sugar level. Ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, hypertension,diabetes, and stroke. Sleep deficiency also increases the risk of obesity. Your immune system relies on sleep to stay healthy, and ongoing sleep deficiency can make it harder for your body to fight common infections. Sleep also plays a role in puberty and fertility, and helps support growth and development in children.

People who are sleep deficient take longer to finish tasks, have a slower reaction time, and make more mistakes. Studies show that sleep deficiency harms your driving ability as much as, or more than, being drunk.

What are the underlying causes of insomnia?
Lifestyle and environmental factors, psychosocial issues, and medical conditions can all influence sleep problems. Naturopathic doctors spend an hour or more assessing the wholeperson, exploring a wide variety of underlying causes for sleep disruption, including: Nutrition. Alcohol, caffeine, and nicotine may all contribute to insomnia. Refined sugar in desserts, sodas, and simple carbohydrates like white bread and barbecue sauce have also shown negative effects on restful sleep. When, what, and how much you eat can also interfere with your sleep.

Studies show that partial sleep deprivation alters the gut microbiome. Lower proportions of microbiota (specifically phyla Verrucomicrobia and Lentisphaerae) was associated with poor sleep quality. In simpler terms, this implies that increasing your gut microbiota should help improve your sleep. The easiest way to do this is through diet. Eat foods high in fiber, such as lots of vegetables, legumes, beans, and fruit to help stimulate gut bacteria, or biota, digestion.

Environment. Noise, light, room temperature, and other environmental irritants often affect sleep. NDs look for and address environmental exposures that may cause irritation, inflammation, and negatively impact Circadian rhythms. Common irritants include pollen, dander, noise, and blue light from phones and screens. Sufficient exposure to full spectrum light outdoors is also important to maximize melatonin production.

Emotional + psychological causes. The relationship between sleep and mood is complex, because disrupted sleep can lead to emotional changes, clinical depression or anxiety (as well as other psychiatric conditions), but these conditions can also compound or further disrupt sleep. Research shows that people with insomnia have greater levels of depression and anxiety than those who sleep normally.

Hormone imbalances. Imbalances in serotonin, cortisol, melatonin, estrogen, and testosterone can all contribute to sleep problems. Additionally, individuals with hypothyroidism, a condition where the thyroid gland does not make enough thyroid hormone to keep the body running normally, are also at higher risk of developing insomnia.

Medication side effects. Medications such as those taken for the common cold and nasal allergies, high blood pressure, heart disease, thyroid disease, birth control, asthma, and depression can cause insomnia. The side effects are often dose-dependent. Other drugs commonly prescribed for sleep problems, such as Ativan, can affect quality of sleep.

Individualized Naturopathic Treatments for Sleep
Whole-person treatment is individualized and focused first on lifestyle changes including optimizing diet, environment, and sleep hygiene, removing stimulants, increasing physical activity, and creating routines.

NDs carefully investigate and address microbiome imbalance with clinical nutrition, including probiotics and fermented foods. When emotional and/or psychological factors are involved, NDs work with patients and mental health professionals to identify and address depression, anxiety, and stress. They utilize behavioral medicine including mindfulness, breathing techniques, and meditation. When appropriate, NDs may prescribe botanical medicine to address stress, anxiety, and depression, including GABAL-theaninepassionflower, and adaptogens such as Ashwaghanda. They will order lab testing if hormonal imbalances are suspected, and address them with nutraceuticals when possible, including melatoninglycine, and tryptophan, as appropriate. NDs will also help identify prescription medications that may be negatively impacting sleep and, when possible and in communication with prescribing physicians, support patients reducing or discontinuing such drugs.

Naturopathic doctors appreciate that insomnia is both the cause the effect of many serious health conditions. By looking at the whole person, addressing underlying causes and supporting your self-healing capacity, naturopathic doctors have many tools to help in the treatment of sleep problems.

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