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Thursday, 6 February 2014

Insomnia and Homeopathy: safer and more effective treatment

What is insomnia?
As defined by NHS Choices, Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning, even though you've had enough opportunity to sleep. It describes the most common symptoms of Insomnia as:
  • difficulty falling asleep
  • waking up during the night
  • waking up early in the morning
  • feeling irritable and tired and finding it difficult to function during the day
Conventional Medical Treatment of Insomnia
Discussing treatment, NHS Choices talk first about discovering if there is any ‘underlying medical condition’ for sleeplessness, and some very simple and sensible self-help, or sleep hygiene measures, such as:
  • establishing fixed times for going to bed and waking up (avoid sleeping in after a poor night's sleep)
  • trying to relax before going to bed
  • maintaining a comfortable sleeping environment (not too hot, cold, noisy or bright)
  • avoiding napping during the day
  • avoiding caffeine, nicotine and alcohol late at night 
  • avoiding exercise within four hours of bedtime (although exercise in the middle of the day is beneficial)
  • avoiding eating a heavy meal late at night
  • avoiding watching or checking the clock throughout the night
  • using the bedroom mainly for sleep and sex if possible
This is all sensible advice, and this is followed by suggestions for the use of Cognitive and behavioural treatments.

The advice then moves on to sleeping medication “if the symptoms are particularly severe” or to “help ease short-term insomnia”. However it supplies a warning here.

“.... doctors are usually reluctant to prescribe sleeping tablets as they relieve symptoms but don't treat the cause of your insomnia. If you have long-term insomnia, sleeping tablets are unlikely to help. Your doctor may consider referring you to a clinical psychologist to discuss other approaches to treatment”.

It goes on to say that sleeping pills can cause a feeling that you are ‘hungover’, and drowsiness during the day. The drugs mentioned are as follows:
  • Benzodiazepine Drugs. These drugs, which include Valium, Librium and Atavan, have a long history of very serious adverse reactions, and their use is now supposed to be heavily restricted. One of the main problems was dependence or addiction, and they should not be prescribed for more than 4 weeks, but apparently often are. People who have taken Benzodiazepines have reported blackouts, epileptic seizures, memory loss, brain damage, insomnia (!) and personality change. A fuller description of the serious dangers of Benzodiazepine drugs can be read here.
  • More modern ‘Z medicines’, such as Zopiclone, Zolpidem and Zalepion, which NHS Choices suggest are similar to the Benzodiazepines, and it is stated that they are unlikely to work if Benzodiazepines fail to do so.
  • Melatonin (Circadin), which NHS Choices states cause adverse reactions such as irritability, dizziness, migraines, constipation, stomach pain and weight gain. Moreover, a study on Melatonin, which revisited a number of small studies, was reported in the British Medical Journal in 2006 (332: 385-8). It found that the drug did not do much to help establish a healthy sleep cycle.
More recent studies have suggested that sleeping medication can triple the risk of death (British Medical Journal, 2012; 2: e000850, reported in ‘What Doctor’s Don’t Tell You’, July 2012 and June 2013), and that it can increase the risk of fatal pneumonia by half again (What Doctor’s Don’t Tell you, February 2013). Canadian research found that the risk of death increased by 40% when patients were taking sleeping pills (Canadian Journal of Psychiatry, 2010; 55: 558-67).

Whilst Homeopathy would also look at the kind of self-help measures mentioned above, and try to find if there is an ‘underlying cause’ of the insomnia, treatment is much more straightforward, and uses a variety of remedies. A useful description of some of these remedies, together with useful tips to get a good night’s sleep, is found on the Homeopathy Plus website (click here to read in full), with the main remedy descriptions being reproduced here

Arsenicum Album (Ars)
Key Symptoms: Those who need Arsenicum will nearly always be anxious and restless. Anxiety, fear, or worry prevents sleep. Frequent starting or jumping which wakens from sleep. Sleeplessness from physical exertion. Worse for: after midnight. Better for: warmth; warm drinks.
Supporting Symptoms: Disturbed, anxious and restless sleep. Lying awake with restlessness, tossing and turning. Cannot lie still in bed – has to get up and wander around from restlessness. Going from bed to bed to try and sleep. Can only sleep with head raised. Hard to fall asleep after waking.

Coffea Cruda (Coff)
Key Symptoms: Coffee is well known for producing sleeplessness but because of homeopathy’s ‘like treats like’ effect, it will relieve insomnia when given in crude, or especially homeopathic form. The type of symptoms it relieves are those produced by coffee. They are: sleeplessness from rapid thoughts or an active mind; constant flow of ideas; physical restlessness; nervous energy; excitement. Can also be used to counteract the effects of a caffeinated product that has been taken too close to bed-time. Worse for: surprises; strong emotions; narcotics.
Supporting Symptoms: Unable to sleep from the excitement of a surprise, or good or bad news. Palpitation with sleeplessness. Waking with every sound. Waking from frequent starting. Sleeplessness from an itching anus. Minor pains seems intolerable.

Gelsemium Sempervirens (Gels)
Key Symptoms: Sleeplessness from anticipatory anxiety. Dull, drowsy mind – hard to think yet difficult to go to sleep. Insomnia from exhaustion. Hard to get fully asleep. Worse for: bad news; thinking about problems.
Supporting Symptoms: Yawning with tiredness. Sleeplessness with teething. Sleeplessness from itching on head, face, neck, and shoulders. Sleeplessness during delirium tremens (withdrawal from alcohol).

Ignatia Amara (Ign)
Key Symptoms: Intense, repeated yawning or frequent sighing. Sleeplessness from a recent disappointment or grief.
Supporting Symptoms: Waking easily from sleep. Waking from the jerking of a limb. Itching of arms with yawning. Yawning produces tears in the eyes or threatens to dislocate jaw. Child wakes from sleep with screaming and trembling after being reprimanded before bedtime. Worse for: Coffee.

Lycopodium clavatum (Lyc)
Key Symptoms: Waking from hunger – must get up and eat. Restless sleep and anxious dreams with frequent waking. Feeling unrefreshed in morning.
Supporting Symptoms: Unable to get comfortable in any position. Falling asleep late and waking early. Sleepy all day and sleepless at night from an active mind. Children who sleep all day and cry all night. Child wakes terrified with screaming – seems not to recognise anyone (sleep terrors).

Nux Vomica (Nux-v)
Key Symptoms: Frequent yawning. Irritability from loss of sleep. Falling asleep before normal bedtime and then waking at 3–4am. Waking at 3-4am with alert and active mind and then falling asleep as daylight approaches only to then wake with difficulty, feeling tired, weak, and not wanting to get up. Worse for: stimulants and narcotics
Supporting Symptoms: Sleeplessness from the excessive consumption of coffee, alcohol, or drugs (therapeutic or recreational). Tendency to lie on back with arms under head. Sleeplessness from mental strain and stress or excessive study. Drowsy after meals an in early evening. Grogginess on waking in morning. Weeping and talking in sleep.

Passiflora Incarnata (Pass)
Key Symptoms: Restlessness, exhaustion, and sleeplessness.
Supporting Symptoms: Restless sleeplessness from excessive work. Sleeplessness with exhaustion. Insomnia of infants and the aged. Convulsions with sleeplessness.
Other Comments: Has a long history of use in herbal medicine where its homeopathic effect in the treatment of insomnia has also been exploited. It is effective in either herbal doses or homeopathic potencies.

Phosphorus (Phos)
Key Symptoms: Short naps with frequent waking. Frequent waking from feeling too hot. Sleeplessness from excitement or anxiety.
Supporting Symptoms: Sleeplessness in old people. Sleepless before midnight. Sleepy all day, sleepless and restless at night. Sleeplessness with sensation of bubbling in blood. Worse for: lying on left side.

Sulphur (Sulph)
Key Symptoms: Waking between 2 – 5am and unable to go back to sleep. Difficulty in falling asleep from itchiness of skin or perspiration. Drowsy by day and sleepless at night. Worse for: becoming hot; atmospheric changes.
Supporting Symptoms: Wakes up singing from happy dreams. Waking at night from a rush of blood to the head. Sudden waking from sleep. Constant flow of thoughts that prevent sleep. Sleep disturbed by headache. Better for: dry, warm weather.

Whilst these remedies can be safely taken on a first-aid basis, if the remedy description fits the patient symptoms, assistance from the qualified Homeopathy should be sought in of serious or long-term insomnia.

Randomised Controlled Tests

The Homeopathy Research Institute undertook a review of the research evidence supporting the use of homeopathy to treat insomnia if their newsletter, dated Summer 2010. It is available at this link. Their conclusions were as follows:

“Homeopaths often treat insomnia, however, there is currently a lack of high-quality sufficiently powered studies assessing the effectiveness of either homeopathic medicines or treatment by a homeopath for this condition. There is a need for further well-conducted clinical trials of treatment by a homeopath in order to examine fully the clinical and cost effectiveness of the therapeutic system of homeopathy in the management of insomnia”.

However, this research, on Chronic Primary Insomnia, came to the following conclusion:

“The homeopathic simillimum treatment of primary insomnia was effective, compared to placebo. Homeopathy is a viable treatment modality for this condition and further research is justified.