Daniel-J. Crisafi, ND.A., MH, PhD

Question: I have trouble sleeping. I have tried different approaches, but I still can’t sleep well. Do you have any suggestions for me?

The famous French nursery rhyme, Frère Jacques, (Brother John), asks this pertinent question, “Dormez-vous” "Are you sleeping? ". This is a question that more than 50% of North Americans can answer either by a definitive “no” or a "maybe". Indeed, according to more and more serious data, more than half of North Americans do not sleep well - they are insomniacs. An investigation undertaken on behalf of the popular program J.E. by the polling firm Léger revealed that "78% of those surveyed suffer from various sleep disorders”.¹ Your question is, therefore, quite relevant.

Sleep problems are obviously not new. Researchers have been studying the phenomenon of insomnia for hundreds, even thousands, of years. As for myself, I have been studying this phenomenon in my patients for 30 years and have drawn some interesting conclusions. I wrote a chapter called "Waking Up Younger" for the book Bio-Age: Ten Steps to A Younger You (Wiley, 2003).² The publisher describes me as "a Canadian specialist on sleep and the human body" ... Well, maybe that’s a bit over the top, but I mention it to emphasize my long-standing interest.

Several plants have been shown to have excellent effects on sleep. These include passionflower, oat straw, skullcap and valerian. Certain nutraceuticals - especially amino acids, their precursors and their derivatives - can also improve the quality of sleep. Some examples are tryptophan, 5-HTP (5-hydroxy tryptophan) and GABA (gamma-aminobutyric acid). B-complex vitamins also help reduce stress and produce neurotransmitters that improve sleep. All are well known and well documented. But in this article, I would like to highlight three things that are sometimes neglected that can have an important role to play in terms of insomnia - magnesium, exercise and light.

Magnesium

Magnesium is one of the most important nutrients when it comes to stress, for several reasons. First, it helps reduce the effects of stress on the nervous system. The psychiatrist Emily Deans emphasizes the calming effects of this mineral in an article published in the popular journal Psychology Today.³ One study has even shown that magnesium is as effective as some antidepressants in treating depression.⁴

But what interests us here is its effects on sleep. Indeed, magnesium is necessary for both serotonin synthesis and melatonin synthesis - the two most important neurotransmitters when it comes to inducing and maintaining sleep.⁵ Magnesium is required, together with pyridoxine, to synthesize the enzyme needed to produce serotonin - tryptophan hydroxylase or TPH.⁶ Lab studies have shown that magnesium deficiency can reduce melatonin production in animals.⁷ It has also been proven that it is essential in balancing the circadian rhythm through the production of melatonin, and perhaps in other ways as well.⁸

One of the causes of insomnia can, therefore, be magnesium deficiency. Unfortunately, blood tests are not reliable for measuring magnesium levels in the body. Indeed, the level of magnesium in the blood can be normal even in the presence of a deficiency in the body’s reserves.⁹ The only reliable ways to assess the need for magnesium are (1) to eliminate or reduce foods or substances that interfere with the absorption of magnesium or increase its loss through excretory agents from the diet; (2) increase consumption of foods that contain magnesium; (3) supplement with magnesium.

Elimination

Several dietary substances can either reduce the absorption of magnesium or increase its loss throughout the body. Coffee, soft drinks and alcohol can all increase the loss of magnesium. At worst, avoid consuming these beverages at night, at best, reduce your daily consumption of coffee and alcohol. As far as soft drinks are concerned, they should be avoided as much as possible, period!

Unfortunately, many medications - including diuretics and Protein Pump Inhibitors or PPIs  - can also increase magnesium loss. I would simply like to note here that PPIs (Dexilant, Nexium, etc.), when taken over the long term, can potentially cause the greatest deficiencies in this mineral.¹⁰ So, whenever possible, reduce your consumption of foods and substances that can increase the need for magnesium. Talk to your doctor about reducing or eliminating PPIs altogether. Finally, people with inflammatory bowel disorders do not absorb their magnesium adequately. Indeed, up to 88% of people with inflammatory bowel conditions do not absorb enough magnesium.¹¹ This is also true for celiac patients.

Increase Consumption

It is important to not only reduce the foods and substances that "steal" magnesium, but also to ensure adequate intake. Unfortunately, in many cases of insomnia, diet alone is probably not enough. In fact, the foods we eat have suffered a significant decline in their magnesium level. Researchers in the agri-food sector have been reporting a significant drop in magnesium levels in various agricultural crops over the last few years.¹² As far back as 1991, a study by McCance and Widdowson showed a significant drop of magnesium levels in food between 1940 and 1991. For example, they reported a 75% drop in magnesium levels in carrots.¹³ During the same period, Mayer has shown significant reductions in magnesium in a variety of fruits and vegetables. For example, according to his analyses, cabbage has gone from almost 17 mg (per hundred grams) of magnesium to 6 mg and parsley from more than 52 mg to 23 mg.¹⁴

When it comes to insomnia, magnesium supplementation is usually necessary, at least in the short term.

That said, the form and dosage of magnesium are also important. Opt for magnesium supplements in the form of magnesium citrate, bisglycinate or glycinate as these forms are absorbed most effectively. Also, be sure to consume enough of this mineral – ideally 100-200 milligrams in the morning and between 150-300 milligrams in the evening or at bedtime. Note that excess magnesium has a laxative effect – an excessive intake of magnesium will cause loose stools. If this happens, reduce the dosage. A second warning, if you have a condition that causes chronic diarrhea, take small amounts of magnesium, 50 to 100 mg at a time, three to six times a day rather than larger doses twice a day.

Light

We are all aware of the effects of light on psychological well-being. Studies have already highlighted the effects of the decline in natural light on what is described as seasonal affective disorder. The Mental Health University Institute of Montreal mentions on its website that "Lack of sun and light ... causes a decrease in the production of serotonin ...".¹⁵ Light has many effects on our biochemistry as well as on our physiology - effects that can be negative as well as positive. In this section, I would like to focus on the phenomenon of over-excitement due to excess light.

In most homes, it is rarely "pitch dark." Indeed, our society is bathed in light. Even when the lights are out, most of our bedrooms can let in light. Also, we have devices that continue to emit light even while we sleep. However, the presence of light can be a factor that affects the quality of our sleep due to three important parameters: the circadian rhythm, photosensitivity and the type of light we are exposed to.

The circadian rhythm is the sleep/waking rhythm that ensures the maintenance of our daytime life, i.e., our ability to be active during the day and sleep at night. When this rhythm is disturbed, sleep quality is affected. Unfortunately, this rhythm must be reset every 24 hours.¹⁶ Several factors play a role in this reset, including magnesium levels in the body.¹⁷ But one of the most important is the alternation of periods of light and darkness.

Sleep and your skin

Let's start with a well-established phenomenon. Our body is "programmed" to wake up with the light and lie down with the darkness. And it's not just an adaptation to social convenience - we are physiologically programmed to sleep when it's dark. We already know that the brain strives to maintain a waking state in response to the sight of blue light - we will come back to that when we talk about the light emitted by various electronic devices. But what few people know is that we have a photosensitive protein in our skin. Indeed, human skin, like that of other diurnal mammals, contains a protein (OPN5) that reacts to the presence of light.¹⁸ This protein seems to perform several functions, including protecting us from the effects of UV rays on the skin.¹⁹ Another function that justifies more and more research is that these cutaneous proteins keep us in a wakened state - they react to the absence or presence of light by modifying melatonin and serotonin levels.²⁰ Their impact on the quality of sleep is revealing. Indeed, even when our eyes are closed or covered, proteins on the skin indicate to the brain the level of light or darkness. The brain then responds by altering the levels of melatonin and serotonin.



People who are affected by insomnia should make sure to sleep in a place with as little light as possible if they want to enjoy deep, restorative sleep.

Artificial brightness

Imagine your great-grandparents and their relationship with light. Back then, they were generally not very active during the evening or at night because of a lack of sufficient light. We went to bed with the sun and we got up with it. In addition, any change in brightness was gradual, giving the body time to adapt.

Nowadays, we can significantly change the brightness level, almost instantly. Indeed, you can go from darkness to intense brightness just by flipping a switch. But what has changed the most is the use of intense lights in the evening. Let me explain. 

Blue light is associated with awakening and activation. Sleep experts at Harvard University have demonstrated that the use of blue light-emitting electronics has a negative impact on sleep.²¹ According to these researchers, the use of this type of device reduces the production of melatonin and disrupts the circadian rhythm, even when used up to an hour before bedtime. What is telling is that individuals exposed to blue light were also much less alert next morning. According to some statistics, 90% of North Americans use an electronic device at least an hour before going to bed, several times a week.

Should we be surprised by the increase in sleep problems when more and more people use blue light-emitting electronic devices in the evening? Not according to experts at Harvard University.²² Indeed, the increased use of laptops, e-readers, tablets and smartphones could be a major factor in the increase in insomnia we are witnessing today.

Reducing light levels where you sleep and not using light-emitting electronic devices can be two effective ways to dramatically improve the quality of your sleep.

Muscles

The last point I would like to emphasize here is the unexpected impact muscles have on sleep. Indeed, researchers at the University of Texas Southwestern Medical Center have discovered that a protein found in the muscles, BMAL1, helps regulate sleep. Although these studies are in their initial stages, it is reasonable to assume that resistance exercise, by improving muscle mass and the amount of muscle, can probably have a positive effect on sleep. Conversely, lack of muscle mass in sedentary people may be a contributing factor to sleep problems.

Conclusion

There are several natural tools, including an impressive number of plants and nutraceuticals that will help improve sleep.23 But despite their usefulness in the short or medium term, it would be better to work on the causes of insomnia rather than simply dealing with the problem after the fact. In this article, I pointed out three factors that affect the quality of sleep which can be changed easily: magnesium intake, excess light at night and lack of exercise. If you suffer from insomnia, these are factors to consider. My wish is that in a few months, when you are asked the question "Are you sleeping?” you can answer ... "absolutely! "

Your action plan

Magnesium

Make sure you eat green vegetables every day. They are an excellent source of magnesium. Also, reduce or eliminate your coffee and alcohol consumption.



If you are taking diuretics or PPIs, talk to your doctor or pharmacist about your concerns regarding their effects.


Take a magnesium supplement daily to make sure you get enough.

Light

Make sure the place where you sleep is as dark as possible. Remember to use very opaque curtains and turn off all sources of light.


Set fire to your computer, your tablet and your smartphone ... I'm kidding! But seriously, make every effort not to use electronic devices such as these for at least 1 to 2 hours before going to bed.

Exercise

If you are not doing it already, try adopting a program of resistance exercise to improve your muscle structure. A simple program which takes only 30 minutes, three times a week, is enough for beginners. It goes without saying that you must adopt a program that is adapted to your current level of physical fitness, your age, your level of health and your budget.

References

1. http://www.tvanouvelles.ca/2017/10/12/les-quebecois-victimes-des-troubles-du-sommeil.
2. King, Brad et Michael À. Schmidt Bio-Age: Ten Steps To A Younger You, Macmillan (2001)
3. Deans, Emily Magnesium and the brain : The original chill pill, Psychology Today 12 June (2011)
4. Eby GA, Eby KL. Magnesium for treatment-resistant depression: a review and hypothesis. Med Hypothesis. 2010;74(4):649-60.
5. Yoshiki Nishizawa, Hirotoshi Morii, Jean Durlach, New Perspectives in magnesium research, Springer Science & Business Media, Mar. 6, 2007
6. MICHEL HAMON, SYLVIE BOURGOIN, F. HÉRY and G. SIMONNET, Activation of Tryptophan Hydroxylase by Adenosine Triphosphate, Magnesium, and Calcium, Molecular Pharmacology January 14 (1) 99-110 (1978)
7. Billyard AJ, Eggett DL, Franz KB, Dietary magnesium deficiency decreases plasma melatonin in rats. Magnes Res. 2006 Sep;19(3):157-61.
8. Columbus, Frank H., Trends in Chronobiology Research, Nova Publishers (2006)  
9. Adel A.A. Ismail et al., The underestimated problem of using serum magnesium measurements to exclude magnesium deficiency in adults; a health warning is needed for “normal” results, Clinical Chemistry and Laboratory Medicine, Volume 48, Issue 3, Pages 323–327 (2010)
10. Jeffrey H William, John Danziger Proton-pump inhibitor-induced hypomagnesemia: Current research and proposed mechanisms, World J Nephrol  March 6; 5(2): 152-157 (2016)
11. Galland, L. Magnesium and inflammatory bowel disease. Magnesium.7(2):78-83. (1988)
12. Wanli Guoa, Hussain Nazimc, Zongsuo Lianga, Dongfeng Yang Magnesium deficiency in plants: An urgent problem, The Crop Journal 4:83-91 (2016)
13. Robert Alexander McCance, Elsie May Widdowson, McCance and Widdowson's The Composition of Foods, Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food (1991) 
14. Mayer, Anne-Marie Historical changes in the mineral content of fruits and vegetables, British Food Journal 99/6 : 207–211 (1997)
15. http://www.iusmm.ca/sante-mentale/depression-saisonniere.html
16. Jeanne F. Duffy  and  Charles A. Czeisler Effect of Light on Human Circadian Physiology, Sleep Med Clin. June ; 4(2): 165–177 (2009)
17. Kevin A. Feeney et al. Daily magnesium fluxes regulate cellular timekeeping and energy balance, Nature 532, 375–379 (21 April 2016) 
18. Kojima D, Mori S, Torii M, Wada A, Morishita R, Fukada Y UV-Sensitive Photoreceptor Protein OPN5 in Humans and Mice. PLoS ONE 6(10): e26388. (2011)
19. Zukerman, W. Skin ‘sees’ the light to protect against sunshine The New Scientist 4 Nov. (2011)
20. Iyengar, B. The melanocyte photosensory system in the human skin. SpringerPlus 2:158 (2013)
21. Anne-Marie Changa, Daniel Aeschbacha, Jeanne F. Duffy and Charles A. Czeisler Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness Proceedings of the National Academy of Sciences Vol. 112, No. 4 1232-1237 (2015)
22. Exposure to blue light at night, emitted by electronics and energy-efficient lightbulbs, can be harmful to your health. Harvard Health Letter, 30 Dec., 2017 (https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side)
23. Ehlen et al. Bmal1 function in skeletal muscle regulates sleep eLife 2017;6:e26557