The Nutrient Fix

Have you ever experienced a bad night of sleep? If you're a new parent the answer is without a doubt yes. If you suffer from anxiety your answer is probably also a yes. If you're a new parent with anxiety you're probably wondering what sleep is at this point. Sleep and anxiety have a bidirectional relationship, meaning that anxiety can cause you to take longer to fall asleep and decrease the quality of your sleep. At the same time sleep is essential to preventing and dampening the hyper alert state of anxiety and other mental health challenges. Talk about a toxic relationship. I'm going to offer 4 nutrients to consider to help you break free from the negative cycle anxiety manifests over your sleep.

Sleep is crucial for mental health and the association of sleep quality and anxiety levels probably doesn't come as a surprise. Sleep problems affect more than half of adults with generalized anxiety disorder. In children and adolescents that suffer from anxiety sleep may also be an issue but can be a little more difficult to understand and diagnose due to the lack of communication skills when it comes to worries and anxious thoughts. Multiple studies have shown that youngsters with an anxiety disorder sleep less deeply, take longer to fall asleep and unfortunately are also at a higher risk of depression than children who don't have sleep or anxiety issues (1,2).

Insomnia has also shown to be a pretty strong risk factor for developing an anxiety disorder. Studies have shown that sleep problems can fairly accurately predict anxiety disorders and other mental health issues (3). Insomnia has also been shown to worsen the symptoms of anxiety disorders or prevent recovery (4). On the extreme side some may even begin to develop anxiety around their ability to fall asleep, which further adds to both problems. Building some positive associations around a bedtime routine can help tremendously.

Sleep hygiene, just like brushing our teeth and taking a shower, are commonly overlooked but just as important to overall health and relationships if not more. You've probably heard of sleep tips such as maintaining a regular bedtime and wake schedule, keeping the bedroom free of television and electronic devices (avoiding blue light), adding extra coverings over windows, using a sleep mask, using a white noise device or fan, and keeping the bedroom reserved for sex and sleep activities only. All of these can be very beneficial in improving sleep quality and lessening anxiety. Incorporating other proven lifestyle changes, such as diet and exercise, on top of these are also key.

Exercise is one proven way to help you fall asleep faster, spend more time in deep sleep, wake up less often throughout the night and consistent long-term exercise may even help prevent a sleep disorder from developing. When it comes to exercise just getting it in is better than not. The general trend in the research also shows that aerobic and resistance exercise both have benefits on sleep quality (5), and one hasn't proven drastically better than the other. The goal should be to aim for at least 30 minutes of daily exercise of your preference, preferably more than a brisk walk, to where your heart rate is elevated consistently as a generally higher fitness level is associated with better sleep (6). Timing of day is a highly individual response with some people seeing more benefits with an early morning or evening workout. In general try to finish your workout at least one hour before you plan on going to bed to avoid the elevated alertness you'll experience from endorphin release and elevated core body temperature. Also, while typically not considered exercise, physical modalities such as yoga, chiropractic, massage therapy, and deep breathing exercises can relieve muscle tension and contribute more comfortable sleep.

Nutrition also plays a key role in reducing anxiety and improving sleep. The basic things to avoid to improve sleep and reduce anxiety are caffeine, nicotine, alcohol and over consuming sugar especially right before bed. Studies have shown that certain dietary patterns may affect not only daytime alertness but also nighttime sleep (7). In a study published in the Journal of Occupational Health female Japanese workers were given lifestyle questionnaires. The results gathered showed that a high intake of deserts and noodles was associated with poor sleep quality, whereas a high intake of fish and vegetables was associated with good sleep quality. Researchers noted a significant trend toward worse sleep quality with increasing carbohydrate intake, with the quality of the carbs playing a very important role in that association (8). A diet high in meat in vegetables would definitely be advised with Paleo and Mediterranean Diets being a good place to start.

While diet is always advised first the benefits can lag behind the implementation sometimes by weeks. Combining lifestyle strategies are definitely apt to improve sleep and anxiety issues a bit quicker. Another option to consider is supplementing on the front end of lifestyle changes, or in a unique circumstance with evidence-based nutrients. Four nutrients worth trying are phosphatidylserine (PS), GABA, valerian root and L-theanine.

PS is a combo of the amino acid serine and a fat that is made in the body, and is a component of our cell membranes, with most of it being concentrated in the inner layer of our cells' lipid bilayer. PS is also primarily found in our brains and myelin (protective fatty layer) that surrounds nerve cells, and makes up most of the phospholipids in our brain. PS plays key roles in cognition, nerve health, cortisol and has been studied for ADHD, Alzhiemer's, attention, memory, stress and fatigue (9). PS has been shown to decrease the physiologic stress response (HPA-axis) after exercise and in general (10-12). The stress response is initiated in the brain (hypothalamus) and eventually signals the release of cortisol from the adrenal glands. Elevated and depleted levels of cortisol have been shown to be associated with anxiety and depression, and can play a role in poor sleep quality. PS is known to cross the blood-brain barrier. Emerging evidence shows that PS may blunt the rise in cortisol and ACTH following stress (10-12). A dose of 300 mg per day was shown to improve mood and feelings of stress during an intense mental stress test (13). Other studies using PS show doses ranging from 50-800 mg per day with benefits.

Gamma-aminobutyric acid (GABA) is a natural amino acid that is produced in the brain. In the central nervous system, GABA is the main inhibitory neurotransmitter. GABA as a neurotransmitter acts as a anticonvulsant, sedative, and has anxiety reducing effects. As a supplement, GABA does not cross the blood-brain barrier, and doesn't have the exact same effects (14), but has had positive clinical studies on stress and sleep. Research suggests that taking a single dose of GABA 100-200 mg by mouth 10-70 minutes prior to completing a mentally stressful task attenuates alpha wave reduction and reduces beta wave upsurge on the EEG during testing compared to placebo (15). In a recent animal study a GABA + L-theanine mixture (100/20 mg/kg) showed a decrease in sleep latency and an increase in sleep duration compared to GABA or theanine alone. The combo mixture led to a significant increase in rapid eye movement (REM) and non-REM compared to controls (16).

Valerian root as an herbal supplement has a lot research for its use as a sleep aid and for anxiety-associated restlessness. It has also been studied for depression, attention deficit-hyperactivity disorder (ADHD), and general anxiety and psychological stress (17). Most research shows that taking valerian reduces the time to sleep onset (sleep latency) and improves sleep quality. The greatest benefit is usually seen in those taking 400-900 mg of valerian extract up to 2 hours before bedtime (18).

L-theanine is an amino acid found in green tea and mushrooms, and as a supplement has been studied for reducing anxiety and stress, depression, schizophrenia, preventing Alzheimer's disease, ADHD, and improving cognitive performance and sustained attention. Multiple studies have been done on students taking exams that induced psychological stress, and a dose of 200 mg prior to the exam reduced tension-anxiety and prevented blood pressure increases caused by psychological stress compared to placebo (19, 20). L-theanine has been shown to promote positive mental health outcomes time and time again. Finally, L-theanine has been shown to improve sleep and may be a valid safe option to try with children as well. A double-blind placebo-controlled study published in the journal of Alternative Medicine Review showed that 400 mg daily of L-theanine is safe and effective in improving some aspects of sleep quality in boys diagnosed with ADHD. Since sleep problems are a common co-morbidity associated with ADHD, and because disturbed sleep may be linked etiologically to this disorder, L-theanine may represent a safe and important adjunctive therapy in childhood ADHD (21).

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2674333/

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2674333/

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144678/

4. https://nccih.nih.gov/health/sleep/ataglance.htm

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385214/

6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341978/

7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015038/

8. https://www.ncbi.nlm.nih.gov/pubmed/25168926

9. https://www.ncbi.nlm.nih.gov/pubmed/25933483

10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503954/

11. https://www.ncbi.nlm.nih.gov/pubmed/2170852?dopt=Abstract