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Insomnia

5-HTP for a calm brain, and a racing mind at night: questions and answers

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5-HTP q and a

5-HTP is an amino acid, made from the seeds of an African plant, Griffonia simplicifolia, and used as a supplement to ease low serotonin symptoms. With low levels of serotonin you’ll experience the worry-type of anxiety with ruminations, obsessing, panic attacks, insomnia (often lying awake worrying). This type of anxiety is different from the low GABA physical/tension type anxiety. Other low serotonin symptoms include low mood/depression, late afternoon and evening carbohydrate cravings, pain, digestive/IBS symptoms, PMS, irritability, rage and anger, TMJ, low confidence, imposter syndrome and perfectionism.

When I share my low serotonin blogs on Facebook I receive so many great questions about 5-HTP. Today I’m going to share some of these questions and my answers so you can get the benefits too.

Gail asks why 5-HTP stopped working for her when it had been working so amazingly well:

I took 5-HTP and it worked amazingly….for about 6 months. Then it did nothing. Any idea why?

I took 100 mg per day. It’s hard to explain, but it calmed my brain down. I wasn’t so quick to blurt things out during the day and at night I was able to sleep because my mind wasn’t racing. Nothing else changed at that time. That was a few years ago, I think I’ll buy more and try again

I would guess that something did shift around the 6 month mark and would try and identify what it was so you know for the future. It could have been accidental gluten exposure (from the diet or even cosmetics), hormonal shifts (perimenopause or menopause), adding collagen or gelatin on a regular basis (this can lower serotonin in susceptible folks) and/or changes in thyroid health.

If you have pyroluria and were exposed to major stresses (life stresses or toxic mold etc.) you’d lose vitamin B6 and this could affect serotonin production. The addition of the birth control pill and antidepressants can also deplete vitamin B6. I share some possible reasons for low serotonin on this blog on imposter syndrome (as mentioned above, imposter syndrome is a common sign of low serotonin).

With these wonderful benefits Gail experienced, trialing 5-HTP again is worth considering. Because 5-HTP works so quickly she’ll feel that sense of calm right away and she won’t blurt things out during the day (possibly caused by lack of confidence and/or irritability and/or anger?). Also, her mind won’t race at night, she’ll fall asleep quickly and will stay asleep, waking rested, calm, happy, confident and optimistic.

And in future if something like this happens again, I’d try to identify the cause and bump up 5-HTP temporarily.

Wendy asks about headaches as an adverse effect:

What do you recommend if 5-HTP gives you headaches?

Headaches are not a common adverse effect with 5-HTP (compared to the amino acid tyrosine which is recognized to cause headaches and migraines in susceptible folks).

Even if you are seeing benefits – for the worry-type anxiety and other low serotonin symptoms – with 5-HTP you don’t ever want to push through with something like headaches and continue to take it. I have clients use less 5-HTP and observe if they still see the benefits with no headaches.

We also make sure low serotonin is the issue. If it’s not then any amount of 5-HTP will either do nothing or cause adverse effects. If the issue is low serotonin then I have clients do a trial of  tryptophan.

If the 5-HTP is being used to ease low mood/depression caused by low catecholamine or low endorphins depression then neither 5-HTP or tryptophan is going to help and may cause adverse effects. And tyrosine and/or DPA are better choices.

Gerry asks this question after my interview on Your Best Sleep Ever Summit:

Great talk Trudy. When you want to increase serotonin, do you take both 5-HTP & tryptophan or just one or the other?

They can be used alone or both can be used together. I like to have clients add one new amino acid supplement at a time so we know what is working before confounding things with another one. I typically start with tryptophan for low serotonin support simply because I have such good results with it and because 5-HTP can raise cortisol in some folks.

We start with tryptophan mid-afternoon and evening (after doing a trial earlier in the day to make sure it helps).  If tryptophan causes adverse effects or doesn’t work then we do a trial of 5-HTP and then use it afternoon and evening (when serotonin levels tend to drop).

If tryptophan is working in the afternoon and evening, and additional support for worry or ruminations or panic or anxiety is needed earlier in the day, we may consider 5-HTP which can often also help improve focus. We may also consider tryptophan earlier in the day too.

It’s very individualized and we may mix and match to find the ideal combination and dosing based on trials and symptom resolution. It’s important to be aware that some folks do better on 5-HTP and some do better on tryptophan.

Here are some useful blogs related to low serotonin and the amino acids:

As always, it’s not only the low serotonin we need to address. 5-HTP offers quick relief but we must always do a full functional workup looking at diet, nutritional deficiencies, digestion, all hormones, toxins and infections (and so on) so we can address all possible root causes – and why serotonin is low in the first place.

Thanks to these folks for asking good questions and for allowing me to share here.

What questions do you have about 5-HTP?

Which low serotonin symptoms can you relate to and has 5-HTP or tryptophan helped? Or have you found success with a combination.

Feel free to post your questions and feedback in the comments below.

Night eating syndrome: is low serotonin a root cause and is tryptophan a solution?

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night eating syndrome

According to this paper, Circadian Rhythm Profiles in Women with Night Eating Syndrome, “Patients with night eating syndrome (NES) – first described in 1955 – demonstrate a phase delay in the circadian pattern of food intake, manifested by evening hyperphagia, nocturnal awakenings with food intake, and morning anorexia.”

I would start by asking this question: is low serotonin a root cause and is tryptophan a possible solution? I’ll share why below and where to start in order to find a solution.

Before I do that let me explain the terminology used in the above quote: Circadian means it happens every 24 hours, hyperphagia is obsessive food-seeking behavior, nocturnal awakenings are waking in the night and anorexia refers to restricted eating in the morning.

There is no research supporting the use of serotonin support with either tryptophan or 5-HTP for night eating syndrome but I would still start here for the following reasons:

  • this behavior happens in the evening and at night and it’s well recognized that serotonin levels are lower later in the day and at night
  • carbohydrate cravings and addictions occur with low serotonin and cravings are most intense later in the day (typically afternoon and evening)
  • obsessive behaviors are common with low serotonin
  • insomnia or night-time waking is a common symptom with low serotonin
  • doing a trial with either of these amino acids will very quickly confirm if low serotonin is a contributing factor or will rule it out

I would also have my client look at other low serotonin symptoms which would help confirm that low serotonin may be a factor for them: worry-type of anxiety, ruminations, PMS, irritability, rage or anger, TMJ, panic attacks, perfectionism, depression, low self-esteem and so on. You can see all the low serotonin symptoms here.

We typically start with a trial of tryptophan simply because so many of my clients do so well with it. The other reason is that 5-HTP can raise cortisol and cause a wired-tired feeling. That being said, some folks do better on one vs the other so if tryptophan doesn’t help then we trial 5-HTP.  You can see the products I use with my clients here on the supplements blog.

I would love to see tryptophan or 5-HTP being more extensively – because it works so effectively and quickly, and is addressing the root cause – but also because there is research that does support the serotonin connection to night eating syndrome:

  • Night eating syndome has been associated with “depression, emotional eating, sleep problems, and food addiction as well as with being overweight or with having obesity (especially as people age)” – all low serotonin symptoms.
  • Night eating patients are “responsive to selective serotonin reuptake inhibitor treatment” (antidepressant/SSRI treatment)
  • Bright light therapy may help with night eating because of it’s “serotonergic antidepressant mechanisms of action.” Night eating syndrome also shares features with seasonal affective disorder (SAD) and it’s not uncommon to experience both. The winter blues or SAD is common with low serotonin. I write more about SAD and bright light here.

I’d also consider low blood sugar as a contributing factor. We would need to rule out the use of the sleep medication Ambien/Zolpidem which has been shown to cause amnesia and sleep related eating disorders which resolves when the medication is stopped.

As always, it’s not only the low serotonin we need to address. Tryptophan or 5-HTP offer quick relief but we must always do a full functional workup looking at diet, nutritional deficiencies, digestion, all hormones, toxins and infections (and so on) so we can address all possible root causes – and why serotonin is low in the first place.

I share some possible reasons for low serotonin on this blog on imposter syndrome. Imposter syndrome is another common sign of low serotonin.

Have you been diagnosed with night eating syndrome or do you feel you possibly fit the profile? Does it happen every night and what foods are you drawn to? Which low serotonin symptoms can you relate to and has tryptophan or 5-HTP helped? What about light therapy? And was an  antidepressant prescribed?

Feel free to post your questions and feedback in the comments below.

Thailand cave rescue: yes to calming meditation and GABA, no to antianxiety medication

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The cave rescue of 12 teens and their soccer coach in Thailand is such a beautiful story of hope, courage, resilience, volunteerism and the whole world coming together! I’ve been following the news about this from day 1 (as I’m sure you were) and felt such relief and joy on hearing they had all been safely rescued and appear to be physically and mentally fine.

I’m weighing in on the fact that meditation seems to have played a major role in keeping them calm, using GABA or theanine instead of antianxiety medications and B vitamins for ongoing psychological support.

Meditation seems to have played a role in keeping them calm

Meditation seems to have played a role in keeping them calm, according to this report from the UK

The 12 Thai boys and their football coach who were trapped in a cave in Thailand got through the ordeal by practicing meditation, family members have said.

According to a mother of one of the boys, the team were meditating in the widely shared video of their discovery by two British divers.

Look at how calm they were sitting there waiting. No one was crying or anything. It was astonishing.

The coach who was rescued from the cave on Tuesday, trained as a Buddhist monk for 12 years before he decided to coach the Wild Boars soccer team.

‘He could meditate up to an hour,’ said his aunt, Tham Chanthawong. ‘It has definitely helped him and probably helps the boys to stay calm.’

Here is the video of their lovely smiling calm faces when they were first found.

 

In this paper, Meditation Programs for Psychological Stress and Well-Being, they report that

Meditation programs, in particular mindfulness programs, reduce multiple negative dimensions of psychological stress [such as anxiety, depression, stress, distress, well-being, positive mood, attention]

Meditation has also been shown to improve dopamine and serotonin transporter binding, which appears to have reduced fatigue and improved mood in this study, likely because there are higher levels of these neurotransmitters available.

In a study done with young adults, Effects of mindfulness meditation on serum cortisol of medical students, meditation lowered cortisol levels, suggesting reduced feelings of stress.

Meditation and GABA/theanine instead of antianxiety medications

It was clearly an extremely difficult rescue and the Australian doctor, Adelaide anaesthetist Dr Richard Harris, risked his life to go into the cave and stayed with the boys and their coach for several days. He assessed their health and made sure they were ready for the rescue.

He used his medical expertise and rescue diving experience to decide to have each of them use antianxiety medication for the arduous 8-hour plus rescue (I suspect it was Dr. Harris’ decision). It was confirmed by Thai Prime Minister Prayuth Chan-ocha – to help calm their nerves – and it’s likely they were given a benzodiazepine, hopefully only the one time.

Even though very short term acute situations like this, is actually the intended use of benzodiazepines, it concerns me that these young boys were medicated, especially since adverse paradoxical reactions can be caused by benzodiazepines and are difficult to predict and diagnose.

The following adverse reactions can occur: “unanticipated restlessness and agitated episode,” sometimes aggression, hostility, and rage, as well as “an increased state of anxiety.” An adverse reaction during the actual rescue would have been very serious.

There were also reports of elevated white blood cells (WBC) and signs of a lung infection in some of the boys, and one boy had low blood pressure. These are all be side-effects of benzodiazepines. It’s difficult to know what caused any of this – was the medication, the rescue itself and the fact that were under water or spending all that time in the cave?

My intention is not to be critical of the medical decisions that were made in these very dire circumstances. I’ve done caving or spelunking as it was called in England and it’s pretty scary being underground and in the dark, wading through running water – and we were safely in control of things!

I’m sharing about benzodiazepines simply to raise awareness about other options and some of the many risks. And we haven’t even explored the fact that long-term use of benzodiazepines do more harm than good. More than a week to 2 weeks is considered too long, and for some this is even too long.

I really do look forward to the day when benzodiazepines are not the first approach but rather that:

  • meditation is recognized as being as effective, if not a more effective calming approach (I suspect the mediation benefits these boys had been experiencing would likely have carried them through the rescue)
  • the amino acids GABA or theanine are recognized for the calming benefits they offer (especially since the “mechanism of benzodiazepine action is through the gamma-aminobutyric acid [or GABA] receptors.”

B vitamins and other nutrition solutions after psychological stress

Thailand’s Department of Mental Health shared that

People who endure such an intense and dangerous event can go on to suffer lasting anxiety, depression and other symptoms of post-traumatic stress disorder.

I was so pleased to hear that the boys and their coach are being given B vitamins. There is evidence-based research on the psychological benefits of B vitamins after a trauma (like an earthquake or flood), thanks to my colleagues Julia Rucklidge, PhD and Bonnie Kaplan PhD​.

I do hope the B vitamins are continued and is offered to worried family members and all the wonderful rescuers who must be exhausted and stressed too.

Hopefully the boys will also continue to meditate with their soccer coach and share some of the benefits they experienced with family and friends.

How did you feel when you heard the rescue was over? Good news gives us such feel-good warm emotions doesn’t it!?

Do you meditate and have you used calming GABA or theanine?

Let us know if you have questions too.

Melatonin improves sleep quality and reduces anxiety after a TBI (traumatic brain injury)

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New research shows that melatonin improves sleep quality and reduces anxiety after a TBI (traumatic brain injury). The study, Efficacy of melatonin for sleep disturbance following traumatic brain injury: a randomised controlled trial was completed in Australia and used a prolonged-release (also called timed-release) melatonin product.

The study participants, 67% of whom were male, had mild to severe TBI and sleep disturbances as a result of their injuries (most of which were from car accidents). There were 2 study groups, with one group given 2mg of prolonged-release melatonin for 4 weeks and then switched to a placebo for 4 weeks (with a 48-hour window in between). The other group did the opposite.

The prolonged-release melatonin was made by Sigma Pharmaceuticals Australia and called Circadin. Each night 2 hours before bedtime, 2mg of Circadin was taken by study participants. They received a reminder text message each night.

These are the study results for sleep:

Melatonin was associated with a significant and moderate reduction in PSQI [Pittsburgh Sleep Quality Index] global scores, indicating improved sleep quality.

There was no significant reduction in sleep onset latency with melatonin compared to placebo.

What this means is that overall quality of sleep improved but there was no change in the time it takes to fall asleep (sleep onset latency). The latter is to be expected with prolonged-release or timed-release melatonin.

The study concluded that:

The present results, therefore, suggest that melatonin may be useful in treating sleep disturbances in patients with TBI.

With better sleep quality you would expect reduced fatigue and improved vitality – both were reported by study participants.

Melatonin associated with a small decrease in self-reported anxiety

What is interesting is that melatonin was also associated with a small decrease in self-reported anxiety (no differences in depression were reported.) The authors suggest that one possible mechanism of this may be that melatonin acts a muscle relaxant. In this commentary: Potential action of melatonin in insomnia, the authors equate the beneficial effects of melatonin to benzodiazepines:

many of the actions of melatonin on sleep propensity, anxiety, thermoregulation, and convulsions resemble those reported following administration of benzodiazepines. It is possible that some of these actions of melatonin may be mediated via peripheral benzodiazepine receptors

They are suggesting that with melatonin we get the sleep improvement (sleep propensity is the readiness to transit from wakefulness to sleep, or the ability to stay asleep if already sleeping), relaxation effects and antianxiety benefits of benzodiazepines.

But you get none of the side-effects, tolerance issues and withdrawal nightmares with a benzodiazepine which do more harm than good. On a side notes: this month World Benzodiazepine Day is celebrated to create awareness and offer support for benzo sufferers.

I would have picked something more inert for the placebo ingredients

I would have picked something more inert for the placebo ingredients: mannitol (106mg), acacia (11 mg) and pure icing sugar (106 mg). Mannitol, a sugar alcohol, can cause bloating and diarrhea in some individuals and although the amount is tiny (5g of sugar equals 1 teaspoon), sugar consumption is not ideal before bed. As I would expect adverse symptoms:

were more frequently reported during placebo treatment. The most commonly reported symptoms were neurological, followed by bodily pain, gastrointestinal and dermatologic.

In Australia, melatonin cannot be purchased over the counter (OTC) at health stores or via online retailers, unlike in the USA, and is only available by prescription. I’m all for melatonin being available OTC but the silver lining to this is that companies that make melatonin, such as Circadin, have a vested interest in the research. Research is expensive and time-consuming and we get to benefit too.

Keep in mind that this research is applicable to anyone with low melatonin, whether or not a prior TBI has occurred.

There are many root causes of insomnia – how I work with clients

In those with TBI, sleep disturbances are common, and the authors do report reduced evening and overnight melatonin production in this population. However, there are many root causes of insomnia, with low melatonin being one possible root cause – in TBI and in those who have not had a TBI.

One study limitation is that they didn’t measure melatonin levels or circadian rhythm (salivary cortisol) in all of the study participants so we can’t be sure everyone did have low melatonin.

And melatonin isn’t going to work in all instances of insomnia. It’s one root cause I look at.

This is how I work with clients who have insomnia:

  • I start with low serotonin and address this with tryptophan observing improvements in sleep and easing of worry and anxiety (on a side note, low serotonin is common after a TBI so this makes total sense)
  • Then I have my client use sublingual melatonin if they have issues falling asleep AND timed-release melatonin if they have issues staying asleep (you can see some of the melatonin products I recommend here)
  • When saliva results come back, we address the adrenals as needed, often adding Seriphos when cortisol is high
  • Other factors are addressed based on each person’s need: gluten issues, SIBO, parasites, candida, EMFs, sex hormone imbalances, medication side-effects, sleep habits

We’d love to hear if timed-release melatonin has helped you improve your sleep quality? And if it also helped with easing anxiety?

What about tryptophan or sublingual melatonin for helping you fall asleep? And the other root causes?

If you’re a practitioner, do you use tryptophan or sublingual or timed-release melatonin with your clients? And address the other root causes of insomnia?

Feel free to post your questions too.

GABA, 5-HTP and melatonin isn’t working anymore for my insomnia and tryptophan gives me a migraine – what should I do?

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Today I’m addressing a great question I received on a recent tryptophan blog about insomnia and the use of the amino acids GABA and 5-HTP in a combination product together with melatonin, and what the next steps should be when you are not getting the expected results. And if continuing with tryptophan is a good idea when it seems to be causing a migraine and isn’t leading to a whole night’s sleep. Here is the question:

I have suffered from insomnia for most of my life. I just got your book and am loving it! Thank you for all that you do. My symptoms seem to be high for both low GABA and low serotonin [here is the questionnaire].

I also believe I have a blood sugar problem, so I’m starting to follow your suggestions for that.

I’ve been taking a supplement for sleep that has both GABA and 5-HTP in it, along with melatonin. It worked for a year, however it just recently stopped working.

I thought maybe I should try tryptophan. After taking only 220 mg per night, along with 5 mg of melatonin, I was able to sleep, but not through the entire night. However, the next day I woke up with a horrible headache/migraine. I know it was the tryptophan because I did a trial and tried a night without it and then again with it and the nights I took it, sure enough, the migraine would return.

I must add that I had bloodwork done and tested low for melatonin, which is why I was adding the melatonin into my protocol.

My question is: do I continue with a higher dose of GABA, 5-HTP and melatonin, since it worked for a year i.e. do I up the dosage of the supplement I’ve been taking? Or do I continue trying different doses of tryptophan?

I shared this response in my comment (with some additions for this blog post).

Always first address the nutritional foundational aspects

Firstly, I was glad to hear she is loving my book The Antianxiety Food Solution (my Amazon link) and implementing dietary changes. This is so foundational to any protocol for both anxiety and insomnia. Too often, someone hears me talking about the amazing amino acids and forgets the nutritional basics of real whole food, quality animal protein (like wild fish, pastured eggs and chicken, grass-fed red meat), organic veggies and fruit, healthy fats (like olive oil, coconut oil and butter), fermented foods and broths, and no gluten, caffeine or sugar.

I don’t ever have clients push through

With regards to her trial of tryptophan I shared that I don’t ever have clients push through on a product that is causing any adverse effects, and especially when it’s a migraine. She was smart and trialed the tryptophan twice to make sure it was the tryptophan that caused the migraine and not something else.

Capitalize on what has worked and increase one at a time

With regards to the GABA, 5-HTP and melatonin I shared that I always like to capitalize on what has worked in the past (or is currently working) and would rather increase the 5-HTP and/or melatonin and/or GABA one at a time.

Notice that I said increase these products one at a time. She is taking a combination product so it’s impossible for her to do this. Maybe her GABA levels are now good (because her progesterone levels have improved due to be on a regular zinc supplement or because she has been doing regular yoga sessions) and maybe she needs more serotonin support (because her estrogen levels are off because of recent exposure to xenoestrogens in plastics).

Even though is research showing that a combination product containing GABA and 5-HTP improved sleep and sleep duration more than the use of either of the two amino acids alone, based on her feedback, if we were working together I would have her do each of the GABA, 5-HTP and melatonin separately. This way it’s easy to mix and match and increase one and possibly lower the other, until the ideal combination is found for her unique needs at this time in her life.

She may even find she only needs GABA or only needs 5-HTP or only melatonin. She may also find she needs sublingual melatonin for helping her fall asleep and timed-release melatonin for helping her stay asleep.

She mentions the amino acid questionnaire so it sounds like she is clear on her symptoms: low GABA physical anxiety affecting her sleep and low serotonin mental worry-type of anxiety affecting her sleep. So as she trials the individual amino acids she can see how she does symptom-wise in order to find the ideal amount.

Other factors to consider with insomnia

It’s often straight-forward with the amino acids and the great thing is that one you have the correct combination you will see results in a few days to a few weeks. But There are other factors we may need to consider with insomnia:

  • Keep in mind that 5-HTP can raise cortisol and low blood sugar can indicate adrenal issues so looking at high cortisol as a factor in the sleep problems would be something to consider. A 4-collection saliva test will measure this and my favorite product for lowering high cortisol is Seriphos. Other nutrients for adrenal support may be needed too.
  • Just addressing low blood sugar can often improve insomnia. Eating to support blood sugar swings, early morning sunlight and no blue light after dark can make a world of difference.
  • Other sleep factors we always want to consider: sex hormone imbalances, parasites (they are more active at night and can keep you awake and play a role in high cortisol), accidental gluten exposure, SIBO (small intestinal bacterial overgrowth), candida, sleep apnea and mouth breathing, EMFs (WiFi in the home, commuting with the iphone on, a new cordless phone etc.) and medication side-effects (benzodiazepines are a common one).

I really appreciate questions like this being posted on the blog so others like you also get to benefit. This question also demonstrates just how our needs for certain nutrients can change over time and how we may to keep adjusting what we are doing.

In case you have questions about specific products that I use with clients, here is my supplements blog and more information on GABA for the physical type of anxiety and 5-HTP/tryptophan for the worry-type of anxiety.

Can you relate to this scenario? Feel free to ask your questions about sleep, GABA, 5-HTP, tryptophan and melatonin and share your experiences with these products and how they have helped you or if you’ve had issues with any of them.

I wake in the middle of the night with a jolt of fear, feelings of dread or feeling depressed

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Waking in the night feeling anxious and with a jolt of fear, having a panic attack, experiencing feelings of impending doom, with a pounding heart and even feeling depressed is a common issue I see with clients and it’s a common question that I’m often asked on my blog and on Facebook.

Here is a typical question you may relate to:

I usually wake between 5-6 am and have this overwhelming feeling of dread and start thinking of all the things I have to get done. And then I can’t fall back asleep. What is this?

Or this one:

Does anyone have severe depression when waking up in the middle of the night, but never during the day or before falling asleep. It doesn’t go away until after I’m fully awake and upright in the morning.

Low serotonin?

Serotonin is known to dip later in the day and at night and we know low serotonin can cause depression and insomnia/waking in the night, so my first thought would be to assess for low serotonin and address this if it is the case. I use the questionnaire and trial method.

I always start with tryptophan, but may switch to 5-HTP if that’s not working as expected as some people do better on one versus the other. We add melatonin if the tryptophan or 5-HTP isn’t quite enough to help with the waking.

There are many possible causes of low serotonin so over the course of the next few months these will be addressed too, on a case by case basis. Some of the causes in include: a poor diet, low stomach acid, malabsorption, low zinc, low B6, low iron, low magnesium, dysbiosis and/or parasites and/or candida, the birth control pill, MTHFR defects (with this defect expressing) etc.

Low GABA?

Low GABA levels may be a factor too as this can contribute to insomnia and waking, especially when there is physical tension. New research reports GABA’s involvement in unwanted thoughts and it’s a common factor in my community and clients. Again, I use the questionnaire and trial method to find the ideal amount of GABA for each person.

High cortisol?

High cortisol in the night can also be a factor and I suspect this when someone says they wake with a jolt of fear or feels what they describe as an adrenalin rush. Saliva testing can confirm cortisol levels and Seriphos is the best product I’ve found to lower high cortisol. Addressing low blood sugar and finding the root cause of the adrenal issues are also key. General adrenal support with B vitamins and adaptogenic herbs are often needed too.

Hormone imbalances and/or PMS?

Here is another typical question you may relate to:

I’ve had the worst week regards 3am panic attacks, lurid dreams and wake up aching. It always feels like the end of the world and yet I get up and stagger out to do my morning routines and all is right with the world (apart from physical aches and pains). I have often had bouts of this. It’s a week to go until my period.

If the anxiety or panic attacks are cyclical and tied to your menstrual cycle I will still start with a trial of tryptophan which has been shown to help PMS, tension, depression and mood swings. Serotonin support also helps with fibromyalgia-type aches and pains.

A trial of GABA is often needed too and can help with alleviating the panic attacks, waking and some of the aches. Other factors like a gluten sensitivities, adrenal issues and high oxalates may also play a role in physical aches.

Lurid dreams clues me into the possibility of low vitamin B6, which is an important co-factor for making both GABA and serotonin, as well as being important for alleviating PMS symptoms and the social anxiety condition called pyroluria. The pyroluria protocol, with vitamin B6, zinc and evening primrose oil, helps both the social anxiety as well as PMS symptoms and insomnia.

Address the basics

You may be looking for the perfect supplement to help and while the amino acids come pretty close to being that, it goes without saying that you want to always address the basics. This means making sure you are eating a real whole food diet with quality animal protein and getting that animal protein at breakfast in order to balance blood sugar. The following needs to be eliminated too: caffeine, gluten and sugar. Some individuals do even better on a ketogenic diet.

Looking at sleep hygiene factors fall under the basics too: a dark, cool and quiet room, no PC or iPhone late at night, no iPhone or other EMF sources close by, sunlight exposure in the early morning etc.

And we mustn’t forget stress reduction, exercise and nature.

Address other bigger issues

Medication side-effects must always be considered. Here are a few examples:

Hashimoto’s thyroiditis must also always be considered especially when there are fluctuations in mood, anxiety and sleep. These fluctuations in mood and anxiety can happen at any time of the day and not necessarily in the night.

If the insomnia and middle of the night anxiety and depression persists we continue to dig and look at dietary histamine and oxalate issues, SIBO, parasites and other digestive issues.

If we are still not seeing all the expected results then a referral for Lyme disease, mold toxicity, sleep apnea, TBI (traumatic brain injury) and heavy metals may be needed.  Current or past  trauma and support for PTSD must also be considered – this can be therapy-based and nutritional support.

My checklist

My checklist when I start when working with someone with issues similar to the above. This will be tweaked based on each person’s own biochemistry and where they are in terms of diet, supplements and lifestyle:

  • Low serotonin? Do a tryptophan or 5-HTP trial
  • Low melatonin? If tryptophan or 5-HTP trial isn’t quite enough then add melatonin
  • Low GABA? Do a GABA trial
  • Low blood sugar? Add quality protein at breakfast, plus glutamine
  • High cortisol? Support the adrenals and use Seriphos or something else to lower the high cortisol
  • PMS/sex hormone imbalances or Hashimoto’s? Address with diet, nutrients and hormone support as needed
  • Low magnesium, low zinc, low B6, low iron? Assess for these deficiencies and address them
  • Gut health issues like leaky gut, dysbiosis, candida, parasites, SIBO? Address these issues
  • Histamine, oxalate or other dietary issues? Address these issues
  • Medication side-effects? Figure out which one is an issue and work with the doctor to taper if needed and address why the medication was initially prescribed.
  • If the issue persists – a referral for Lyme disease, mold, sleep apnea and/or heavy metals etc

As you can see there are many overlaps with some of the 60+ root causes of anxiety.

Here is additional information on tryptophan for low serotonin, GABA for low GABA and glutamine for low blood sugar, plus the list of supplements I use with clients.

As always, if the amino acids are new to you, review the precautions and be smart about using them. My book The Antianxiety Food Solution (Amazon affiliate link) has an entire chapter on the amino acids, plus chapters on diet, gut health, caffeine, blood sugar and more.

We’d love to hear which of the above approaches have helped with your insomnia and waking with a jolt of fear or dread or pounding heart.