As anyone who has experienced insomnia knows, it is one of the most debilitating things to go through.

You’re exhausted and so ready for a good night’s sleep, but when you get in bed and close your eyes, nothing happens. For hours and hours, and perhaps all night.

Or, maybe you can drift off, but wake up in the middle of the night and can’t go back to sleep.

It can make a person feel so powerless, because getting enough quality sleep is essential for healing, maintaining health, and preventing a flare up of chronic illness symptoms.

When you have untreated insomnia, you have no control over the amount or quality of sleep you get. No matter how sick, exhausted, and desperate you feel.

Before age 24, I did not ever have insomnia, except for the very rare night when it might take a bit longer than usual to fall asleep.

Since then, I have experienced two extremely severe bouts of insomnia.

The first bout happened after I contracted Tick Borne Relapsing Fever at the same time as black mold exposure from flooding in our crawlspace and developed chronic meningitis.

The second bout happened as part of a series of post-Covid complications and long Covid symptoms. You can read more about my Covid-19 story here.

Both times, I could only get 1-2 hours of light, restless sleep a night no matter what I tried, week after week.

I still have insomnia flare ups when I’m sick, stressed, or having a surge of chronic illness symptoms. Blue light, exercise, caffeine, sugar, and stress/emotions affect my ability to sleep as well. Nowhere near the severity or frequency of the above two scenarios, though. Other times, I’m sleeping well.

So, what causes insomnia?

Before you can make any headway with treating the root cause of your insomnia, you have to understand why it is happening.

To understand why it is happening, we have to look at how we fall asleep in the first place.

Our body makes melatonin from our “happy” neurotransmitter, serotonin, that regulates our circadian rhythm (tells us when it’s time to fall asleep).

Our “calm” neurotransmitter, GABA, starts taking over so it can suppress excitatory neurotransmitters like adrenaline, norepinephrine, glutamate, and histamine.

Cortisol, a primary stress stress hormone, drops to its lowest production level in the evening and at night.

In response, our heart rate and breathing slow, and we drift into stage one sleep.

With all the details involved, a lot can go wrong with this process and lead to insomnia.

• Chronic stress
• Poor sleep hygiene
• Inflammatory conditions and chronic pain
• Certain autoimmune diseases
• Adrenal fatigue
• Adrenal disease (Cushing Syndrome and Addison’s Disease)
• Neurological diseases like Multiple Sclerosis and neuro-Lyme and coinfections
• Disorders of the autonomic nervous system like POTS
• Psychiatric conditions like PTSD, anxiety, and depression
• Blood sugar fluctuations (hypoglycemia, prediabetes)
• Hormone imbalances

– can all contribute to disruptions in the process of falling asleep.

Of course, the best long term solution is to address the root cause of your insomnia.

Finding and treating the root cause of insomnia can take a long time, and even more to make significant healing progress. Getting enough quality sleep is essential for healing, so –

For that reason, it’s often necessary to get temporary relief for sleep problems before they improve through overall healing.

But, how can you get relief from insomnia quickly?

Every article about insomnia on the internet talks about the importance of good sleep hygiene and Cognitive Behavioral Therapy for Insomnia (CBTI). If you’re here, you’ve probably already tried that and you need a combination of stronger methods to improve your sleep.

That being said, sleep hygiene has been important for me – it just doesn’t help on its own. I keep a consistent bedtime, use a blue light filter on my phone and computer, wear blue light blocking glasses 2 hours before bed, use grounded and shielded ethernet instead of WiFi, practice relaxation techniques, don’t exercise in the late afternoon or evening, don’t consume caffeine at all, and don’t consume sugar in the late afternoon or evening.

First, let’s talk about sleep medication options.

Disclaimer: I am not a doctor and do not recommend any of the below medication options. This post is for educational purposes only. Please talk with your doctor if you want to try a new medication for insomnia or any health condition.

1. Antihistamines

First generation antihistamines like Benadryl and Atarax (hydroxyzine) block histamine and acetylcholine in the body, and cause drowsiness as a side effect. Over the counter sleep aids and a couple of prescription sleep medications fall into this category.

Generally, they’re not addictive, but you can build up a tolerance to Benadryl-containing medications with regular use. Doctors don’t recommend Benadryl for treating insomnia, in general, but some prescribe Atarax.

Benadryl makes me drowsy and woozy, but doesn’t help me fall asleep or stay asleep. Atarax has a similar effect.

2. Antidepressants

Physicians sometimes prescribe certain older antidepressants like Trazodone and Amitriptyline for insomnia, especially when mental health conditions like Major Depressive Disorder, PTSD, or Generalized Anxiety Disorder are also present. They increase the amount of serotonin and norepinephrine in the brain, and in low doses cause drowsiness as a side effect. They’re not considered addictive either.

Trazodone helps a lot of people with chronic insomnia, especially in the Lyme Disease and coinfections community.

Unfortunately, I had a bad reaction to Trazodone. It kept me awake all night long, and gave me tachycardia that lasted all night, hot flashes, night sweats, numbness and tingling in my arms and hands, an extremely dry mouth (I’m talking like, been in the desert for a week without water level dry mouth), and made my lack-of-sleep headache worse.

3. Rozeram

Rozeram is a unique sleep medication, the only one in its class. It increases the amount of melatonin in the brain, similar to but acting more specifically than melatonin supplements. It does not cause a “hangover” after effect, unlike most sleep medications, and it is not addictive.

4. GABAergic Agents

Most prescription sleep medications fall into this category, and it is also home to some of the most addictive drugs on the market – only surpassed by opioids. In essence, they increase the effect of GABA (the calming neurotransmitter) in the brain and body and suppress the central nervous system.

The first subcategory includes non-benzodiazepine sedative and hypnotic drugs (Z-drugs) like Lunesta, Sonata, and Ambien.

They can be life saving as a short term remedy for insomnia, for some – but come with a serious risk for addiction. It’s not recommended to take one of these medications for longer than three weeks, or you risk addiction and withdrawal symptoms like panic attacks and rebound insomnia when you try to stop taking the drug.

The second subcategory includes benzodiazepines (benzos) like Ativan, Xanax, Valium, and Klonopin.

These drugs are controlled substances that can cause severe addiction even when used appropriately, but they can be life saving as a short term remedy for insomnia for some, like Z-drugs. Most frequently, physicians prescribe benzodiazepines to treat Panic Disorder and seizures, but they also prescribe them for insomnia off-label due to their intense sedative effects. It is not recommended to take one of these medications for longer than two weeks, or you risk addiction and withdrawal symptoms like panic attacks and rebound insomnia when you try to stop taking the drug. If you take one for longer, it is essential to taper off and not to stop cold turkey, or you risk seizures or even death.

I took Klonopin (my PCP prescribed for me) for eight days when my insomnia was at its worst, and it worked when nothing else did. But after getting a week of relief, it was time to find a more long-term solution without such a severe risk of adverse effects.

The third and last subcategory includes Gabapentin, a drug that mimics the neurotransmitter GABA molecularly and crosses the blood brain barrier, unlike most GABA supplements.

Physicians typically prescribe Gabapentin for seizures and neuropathy, but in low doses for insomnia as well. It is not addictive like benzodiazepines and Z-drugs are, but you can develop a tolerance to its sedative effects over time. You can also become dependent on its effects and it is necessary to taper off rather than stopping the drug cold turkey because of that.

You can also consume herbal tinctures with traces of alcohol while taking Gabapentin, which you cannot do with benzos or Z-drugs. It is still recommended to avoid consuming larger amounts of alcohol with Gabapentin.

For about 5 months, I took 100 mg of Gabapentin before bedtime to help with my severe insomnia (prescribed by my sleep specialist). Taken in addition to my sleep supplements, it helped fairly well. I got 6-7 hours of sleep most nights, although some nights I still didn’t get into a deep sleep and woke up a lot. Still, it was quite the improvement on 1-2 hours of light, restless sleep a night. In July, 2021, I transitioned from Gabapentin + sleep supplements to supplements only.

Disclaimer: Again, I am not a doctor and do not recommend any of the above medication options. This post is for educational purposes only. Please talk with your doctor if you want to try a new medication for any health condition.

That covers sleep medication options for relief of insomnia, but what about non-medication treatment options for insomnia?

Which sleep supplements help relieve insomnia the most? It depends on the cause of your insomnia, and your specific sleep problems.

To help you in finding and treating the root cause of your insomnia – you can purchase your own 4-point cortisol test here and neurotransmitter panel here.

1. Lack of Serotonin and Melatonin

Serotonin is a hormone and neurotransmitter that is responsible for stabilizing mood, feelings of well being, happiness, and sleep (source). Deficiencies are strongly linked to major depressive disorder (source). It converts to melatonin, a hormone which regulates our circadian rhythm, telling us when it’s time to sleep.

The body makes serotonin from an amino acid called tryptophan that we get from protein sources, converting it first to 5-HTP and then serotonin.

When we’re not making enough serotonin, the body may not have enough reserve to make the ideal amount of melatonin. Or, sometimes the body is not converting serotonin to melatonin effectively even if serotonin levels are sufficient.

If your serotonin or melatonin levels are diminished, or you have a disrupted circadian rhythm from shift work or traveling through time zones, or any other reason – serotonin and/or melatonin support might be helpful for your insomnia.

• Tryptophan and 5-HTP supplements can help increase serotonin levels by giving the body more building blocks to make serotonin with.
  
  It’s important not to take both of these together. Or either with medication that increases serotonin. To do so can cause serotonin syndrome, a serious, possibly life-threatening condition.
  
  
• Melatonin supplements can help boost subpar levels and regulate a disrupted circadian rhythm.

2. Lack of GABA and Excitatory Neurotransmitter Dominance

GABA, known as the “calming neurotransmitter“, is responsible for inhibiting neuronal firing. This suppression of the CNS results in feelings of peace and calm (source). Problems in GABA production are strongly linked to anxiety disorders (source).

Since GABA is responsible for inhibiting excitatory neurotransmitters, it is also essential for sleep.

The body makes GABA from glutamate, an excitatory neurotransmitter.

When a person has too little GABA activity and too much excitatory neurotransmitter activity (adrenaline, norepinephrine, dopamine, histamine, glutamate), this can lead to anxiety and stubborn insomnia.

Supplements like GABA and GABA cofactors, cannabis, and herbal sedatives increase GABA in the brain and body while decreasing excitatory neurotransmitter activity. This in turn, decreases wakeful activity in the brain and promotes sleep.

• Most GABA supplements (like Pharma GABA) do not cross the blood brain barrier very well, but do significantly increase GABA levels in the rest of the body – and thus have a calming effect. Liposomal GABA has been shown to cross the blood brain barrier more effectively, so it is a better option for increasing GABA in the brain. Supplementing with GABA cofactors like vitamin B6 can help, too.
  
  
• Herbal sedatives like chamomile and supplements such as L-Theanine also increase GABA and suppress the CNS. Some sleep supplements like Source Naturals Theanine Serene with Relora and MyKind Organics Sleep Well Spray combine L-Theanine and herbal sedatives into one product.

3. High or Low Cortisol

Cortisol, one of our primary stress hormones, greatly influences sleep. Or in certain situations, lack thereof.

Under normal circumstances, cortisol drops to its lowest production point in the evening and night to promote sleep. This drop in cortisol also allows melatonin to metabolize and regulate the circadian rhythm properly (source)

Prolonged stress, whether physical or mental, first causes cortisol levels to increase and remain too high while the stress goes on.

If stress levels continue to remain high or even increase, eventually cortisol levels will drop too low in the morning and spike at night. Low morning cortisol leads to excessive daytime fatigue, while high evening and night cortisol leads to stubborn insomnia, among other things.

Eventually, if the stress does not let up, cortisol levels will flatline, signaling the beginning of adrenal exhaustion. Very low cortisol like this doesn’t always cause sleep disturbances, but it can.

The body is not designed to thrive under chronic stress.

Cortisol imbalance from chronic stress (mental and/or physical) is what integrative medicine practitioners call adrenal fatigue. Keeping up with high cortisol production from stress taxes the adrenals, and eventually the adrenals are not be able to keep up any longer.

Modern medicine doesn’t believe in the term “adrenal fatigue”. But whether you call it adrenal fatigue or not, the physical process of cortisol dysregulation from prolonged stress is the same.

In stages 1 & 2 adrenal fatigue, the goal is to lower evening and night cortisol. In contrast, the goal in stage 3 adrenal fatigue is to increase flatlined cortisol (source).

Normalizing cortisol output can help resolve extremely stubborn insomnia when almost nothing seems to help.

• Some of the best supplements for lowering high cortisol include phosphatidyl or phosphorylated serine (Seriphos, Life Extension PS Caps) and Holy Basil (source 1, 2).
  
  
• Some of the best supplements for increasing low cortisol include Licorice Root (not the deglycyrrhizinated/DGL kind) (source) and adrenal glandulars (speak with a functional medicine doctor before beginning an adrenal glandular supplement).

4. Overproduction of Histamine

Disorders like Mast Cell Activation Syndrome, histamine intolerance, and allergies can cause chronically high levels of histamine in the body. Because histamine is an excitatory neurotransmitter, too much can cause wakefulness at the wrong times (source).

I share my favorite antihistamine supplements in this post. One of the best is Orthomolecular D-Hist.

Additionally, the enzyme DAO helps with breaking down histamine so the body can clear it (source). If you have a DAO deficiency, a DAO supplement can help with necessary histamine breakdown.

Some people find it necessary to take an antihistamine drug in order to keep their histamine levels at bay. As mentioned above, Benadryl is not a recommended option for this. Instead, second generation antihistamines like Zyrtec, Allegra, and Claritin block histamine without the risk of sedation or building up a tolerance.

I take Zyrtec at 9 pm every night to help control my histamine.

5. Acupuncture, Neuromodulation, and Neurofeedback

Sometimes for people with severe insomnia, supplements and lifestyle changes alone are not enough to improve sleep.

Alpha Stim, a neuromodulation device, delivers low-intensity electrical currents to the brain. This helps restore electrochemical balance in the brain so it can reach and go through all of the the brain wave patterns needed for a good night’s rest.

In studies and in many people’s anecdotal experience, acupuncture works quite well for insomnia. Theories about how acupuncture improves sleep vary dramatically between the Traditional Chinese Medicine interpretation and western medicine interpretation. For me, weekly acupuncture treatment has helped improve my sleep overall and always results in a good night’s rest the day of a treatment.

Neurofeedback works best for people who have brain damage and/or inflammation from a neurological condition that has resulted in stubborn insomnia, as well as for people with PTSD. It works by recording the pattern of a person’s brain activity and replaying the recording back so the brain can recognize and fix any errors. You can search for a neurofeedback clinic near you here, or do a Google search or check Psychology Today for even more results.

If you’re like me and have suffered from severe insomnia, don’t give up. There is hope.

Through treating the root cause of your insomnia and taking the right short term remedies, it is possible to restore your sleep and help your body heal.

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