Nevertheless, many experts believe that in diurnal species melatonin may antagonize the alerting process, thus facilitating sleep. Proper double-blind studies on humans still have not been performed.

In summary: the first half of the night is dominated by growth-hormone-releasing hormone. This is the time of maximum slow-wave sleep, maximum growth hormone secretion, and low cortisol. The second half of the night is dominated by corticotropin releasing factor. However, when cortisol rises in response to CRF, through feedback suppression it leads to more slow-wave sleep.

It could also be said that the first half of the night is more orchestrated by serotonin, while during the second half norepinephrine increasingly asserts itself.

How do estrogens, progesterone, and other more familiar hormones fit into this picture?

At the same time, estrogens increase the levels of acetylcholine, which may be one reason for more REM sleep in estrogen-sufficient women.

In daytime, estrogens inhibit the conversion of serotonin into melatonin; after dark, estrogens increase the production of melatonin.

Correct levels of THYROID help insure good sleep.

Hypothyroidism may result in constant sleepiness; on the other hand, sometimes we see depression and insomnia due to low production of neurotransmitters.

Hyperthyroidism may also lead to insomnia. One way that thyroid hormones are involved in sleep is seen in the drop of T3 levels close to bedtime, resulting in slower metabolism and lower body heat.

All this may sound complicated, but dont despair. There is really no reason to worry about Neuropeptide Y. Here is my oversimplified but hopefully reasonably accurate capsule summary.

We build up adenosine by getting tired out. Thats one reason why exercise is so helpful (another reason is that, like a hot bath, vigorous exercise raises body temperature; in self-defense, the body will then "chill out.")

To preserve adequate serotonin levels, use optimal rather than minimal hormone replacement (for most women, 1mg of Estrace is not enough; for many women, .625mg of Premarin, once called the "half-dose," also falls short), and get enough relaxation and pleasure in your life (the older you grow, the more it is a health necessity to make time for relaxation and pleasure).

Slow rhythmic exercise such as strolling and Qi Gong are excellent serotonin raisers, as is listening to slow music. Minimizing stress is crucial. This may be true even for "good stress," such as an interesting movie. For some people (I am one of those unfortunates), even wonderful activities such as reading an absorbing book or nighttime chatting on the phone with a lively friend, are already too stimulating (call it adrenergic; with some practice, you learn to discriminate between adrenergic books and friends vs serotonergic ones; likewise, with age you may come to prefer to a serotonergic type of husband/boyfriend/spouse equivalent over the adrenergic type you probably favored in your youth).

Thus, first you need to be active enough; then you need to be as relaxed as possible. And while you are active, try not to get overaroused. Above all, dont get anxious. "Dont sweat the small stuff and its all small stuff." The older you get, the more crucial it is to avoid toxic thoughts and emotions because aging makes it more difficult to detox from the harmful chemicals those emotions produce.

Forgive everyone "seventy times seven" your well-being is more important than holding grudges, no matter how justified. My great-grandmother made it a point never to go to bed "on an angry mind." Before her evening prayers, she forgave everyone, and asked their forgiveness, if not literally, then mentally.

If its at all possible, schedule your "arousing" activities for early in the day, and your relaxing activities for later in the day. To most people this comes naturally, but some of us are such night owls that we have to consciously train ourselves to quit working sooner and start unwinding.

I have been struggling with the sleep question for at least two years now, and have in the end come up with this solution:

1. work hard, but not too many hours
2. exercise EVERY DAY. At least some of the workout should be vigorous.
3. take plenty of time to relax and engage in pleasurable calming activities, such as listening to slow music and light reading.

Sleep was very simple when we were younger, and we didnt have to work at it. But with aging, stress hormones stay in the body longer, sleep deteriorates, and we have to pay more attention to "sleep hygiene" if we are to preserve the kind of vitality that is the gift of a good nights sleep.

Main sources:

Steiger A et al. Effects of hormones on sleep. Horm Res 1998; 49:125-30;

Vgontzas A et al. Chronic insomnia and activity of the stress system. Psychosom Res 1998; 45: 21-31;

Vliet E, Screaming to be Heard.

Research assistant for this feature: Pamela Macon

INVERT AND CHILL OUT:
ADVICE FROM OUR READERS ON HOW TO FALL ASLEEP AND STAY ASLEEP

I just recently read that cold was the trigger for a good nights sleep. This article was also in HEALTH 10/98. Sleep scientists said that its the sudden drop in body temp - like cold air hitting you after a hot bath that triggers sleepiness (for how long they didnt say). Also, they noted that people who went to bed at the first yawn slept better, too. That one I believe because I can remember that the boys always had a hard time falling and staying asleep as toddlers if they got over-tired or missed a nap. The scientists may have something with the cold effect, too, because I was always much colder before I started with coconut oil and EFAs - I would struggle to stay awake just driving in daytime.

One more thought on sleep and body tempbeing overwarm at night will cause most people to wake up, showing again that cool is more conducive to sleep. Also, hibernating animals . . . During and after menopause, many women I know become the hotties. In early years their husbands were turning down the heat and now they are and the hubbies are cold! Is that why these guys can fall asleep so fast while their wives toss and turn?

Did you ever try a slant board? Ive used one for about 25 years - ever since I read about it in Gaylord Hausers book. The feet are elevated 14" higher than the head. For me 15 mins in that position with a blanket on top equals a 2-hour nap (without the drowsiness upon waking). Plus you get up with pink cheeks and sparkling eyes!

I just remembered another sleep trick thought up by Dr. J. Brooks Hoffman, MD: A natural way to induce sleep is to force yourself to yawn (and keep yawning) . . . by the 6^th yawn or so, you should notice a feeling of drowsiness. (Of course, by then every one around you will, too!)

I read that lavender is used to induce sleep, too. I remember in "the old days" people used to scent their bed sheets with lavender. I thought it was just to smell nice, but apparently there was more to it.

Well, chill out and have a good nites sleep!!

Louie makes some excellent points. The drop in body temperature does seem to be a crucial part of the metabolic slow-down and the onset of sleep. Hence the sleep-inducing effect of a hot bath if it is timed just right. First you induce hyperthermia by staying in the hot water; then, when you get out, the body compensates by using its temperature-lowering mechanism, and you are likely to feel sleepy.

Id also like to comment on one other point: INVERSION. Putting your feet up higher than your head is known to facilitate relaxation. One fairly extreme version of it is putting your legs up on a wall while your head and trunk rest on the floor. First, sit on the floor in parallel to the wall and pretty close to it. Then scoot around so that your legs are resting against the wall while you lie flat on the floor.

A less extreme and more comfortable version of it is lying on the floor at the foot of the bed, your calves and legs resting on the bed.

Louie mentions the health benefits of using a slant board. I havent tried it myself yet, but, encouraged both by her long-time experience and the success of my own "legs-up-the-wall" practice, I intend to get one in early November. The place that makes slant boards, BodySlant, can be reached by calling 800-443-3917. The slant board is padded, it folds up into an ottoman (or call it a large hassock), and also folds out flat, so it can be used as a spare bed. The cheaper but perfectly adequate model sells for $168.

There is a book on the benefits of using a slant board: "Slanting for Health," by Charlene Lesley. Among those benefits is the quick induction of the alpha state, increased blood flow to the brain, and better nourishment of the thyroid and the pituitary, hopefully resulting in improved hormonal health.

(Please note: using a slant board is not for people with reflux, glaucoma, or high blood pressure.)

Let me point out here that simply lying down and staying in the horizontal position lowers norepinephrine, while staying upright raises it. Some people can fall asleep in the sitting position, but it is not deep sleep.

JUST SAY AAAAAH

Louie also suggests forced yawning. This is excellent advice. While yawning probably works best because of its conditioned association with sleep, one can also think of yawning as a special form of deep breathing.

Prolonging the exhalation phase of breath induces relaxation. To enhance this effect, you can also chant "aaaaah" while exhaling. The sound of your own low-pitch chanting will add to the relaxation. New Age sages tell us that "aaaaah" is the sound of creation, so if you visualize something pleasant that you want to invite into your life, thats all the better. The more blissful you feel, the more the technique works at least for relaxation.

Funny, reading about forced yawning got me yawning! (It was late evening).

I started yawning even though it wasnt late evening yet. There is something marvelous about the word YAWN. Say it out loud, slowly, and see if you can stop yourself from actually yawning afterwards. Its an example of classic Pavlovian conditioning.

Yawning is apparently the bodys way of forcing you to take a deep breath to improve blood circulation and thus tissue oxygenation. (I cant stop yawning when Im writing about yawning.)

Cindy writes:

Ive been an insomniac for 10 years, and finally have it under control. I take 5HTP (50mg) and melatonin (1-3mg) when I go to bed. The melatonin GETS me to sleep, and the 5HTP KEEPS me asleep. Ive used these for over a year, and they helped immensely.

There are some documented dangers of using 5HTP too much. Have you read what Life Extension says about it? You particularly have to be careful not to take B vitamins close to the time you take 5HTP or all the 5HTP will go to you heart and lungs instead of your brain.

Ive also read that laughing increases serotonin - the harder the laugh, the more serotonin. A good joke break can help break those grim blues.

Ive been experimenting for over two years now, and my best results come with 3mg of a quick release melatonin lozenge so I can GET to sleep, with 50 mg. of any old 5HTP, and my melatonin cream. Yes, I just open 4 3mg capsules and pour the powder into the cream. At first its gritty to the touch, but over time it dissolves in. Ive had to use it when it was gritty because I forgot to mix it in advance, and it still worked - just didnt feel as good. I also put 4,000 mg of vitamin C in it to increase absorbency. I just grind it up and put it in too.

I have bad luck with slow-release or enteric-coated mel and 5HTP for some reason. They release so slowly my body doesnt even register or something. So far the skin release seems to work better for me, with a big surge at first from the pills to really get me to a sound sleep.

Do you realize that vitamins can give you terrible insomnia? It just occurred to me that maybe you havent thought of that? Ive taken vitamins all my life - my mother was into them. When I was in my 30s, taking a lot of B vitamins, I developed really bad nightly insomnia. I finally tried not taking the B vitamins for a few days, and bingo, I slept!

Over the years since then, I have scientifically added and dropped vitamins over and over one at a time, to see which ones keep me awake. The ones that are especially bad for me are B6, folic acid, iron, magnesium, selenium, zinc, and most other minerals. Calcium and potassium are the only minerals I can take regularly. Isnt that awful? Those are some of the most important vitamins, right? I just figure that my body is pretty well saturated with them and that I dont need them. I try to take tiny doses of them about once a month. Zinc I take daily in minute doses, and it usually works that way. The others I listed above are ones I can almost never take because their effect is so strong every time I take the tiniest dose.

You may already know all this, so I wont keep on. Just in case you hadnt thought of it, I thought Id tell you. Ive never seen insomnia listed as a side effect of taking too much of a vitamin, but I know it certainly is for me!

P.S. I tried aloe vera gel for my latest vitamin cream mix. It worked great. I put the vitamins in the gel for about 24 hours until they dissolved completely, then mixed in the lotion. I even make a morning mix with all kinds of vitamins just for the heck of it. Im like a kid playing with toys!!!

Always warned by my mother that B vitamins may cause insomnia, I generally do not take the Bs past lunch time. But B6, folic acid, and especially magnesium are typically on the recommended list of sleep-promoting supplements. Again, it shows we are all different, and may metabolize nutrients not quite the way that experts think. Niacinamide and inositol are probably big exceptions to the excitatory effects that B vitamins have for some people or at least they should be, considering these are always presented as calming, pro-sleep nutrients.

Zinc from supplements is poorly absorbed, particularly in the presence of fiber. The exception is OptiZinc, which is zinc methionine. So perhaps not just the dose but also the form of the supplement matters for sensitive individuals.

Also, magnesium aspartate is a waker-upper because of the aspartate, an excitatory compound, while magnesium citrate is soothing.

But let us talk about Cindys most exciting discovery: THE DREAM CREAM. I proceeded to make it in two versions: in aloe vera base, and in coconut butter base (I use the organic, non-hydrogenated coconut oil from Omega Nutrition). Ive added a bit of lavender oil to the CC-based cream. Ive come to love both versions so much that I use them both every night, first putting on some of the aloe-vera and melatonin concoction, then the CC + melatonin. I must say that if apply the CC cream generously, not forgetting my arms and feet, it does seem to have an effect. But even if it didnt affect sleep, Id still love it for its benefits for the skin! It must be a wonderful antioxidant.

COMPOUNDING PHARMACIST PETE HUESEMAN ON SLEEP-AID PRODUCTS

Pete is a senior pharmacist at College Pharmacy, 800-888-9358 x116. What follows is a little email interview Ive conducted with Pete regarding various sleep products.

CH: I see you have a section in your product list called SLEEP AIDS. It lists tryptophan, 5-hydroxytryptophan, serotonin, time-release melatonin, and progesterone. The surprise here is the availability of serotonin. My concern, however, is that if we take serotonin orally, very little of it will end up in the brain. On the other hand, if blood levels of serotonin increase, there may be vasoconstriction, leading to a risk of cardiovascular problems and headaches in those who are prone to migraines. Would you like to comment on that?

CH: Have you had patient feedback on the effectiveness of HTP compared with ordinary tryptophan?

CH: How many hours of release can one count on when one uses your slow-release melatonin?

CH: Some men are probably not aware that they too can use progesterone as a sleep aid. Could you comment on that?

CH: Which of the sleep-aid products has produced the most "customer satisfaction"?

CH: What is the best way to use 5-HTP for sleep enhancement? Just at bedtime, or 3 times a day? In what dosage range? Should be it taken on an empty stomach?

CH: Do you think it makes sense to spend extra money on enteric-coated HTP?

CH: Some readers may have concerns about the safety of HTP, especially since it was announced that traces of the same contaminant that caused problems leading to the withdrawal of OTC tryptophan have also been found in HTP though no one has gotten sick. Would you comment on that?

Ivy comments:

As Pete points out, HTP is preferable to tryptophan because you dont need to depend on the enzyme tryptophan hydroxylase, a deficiency of which is one reason some people dont produce enough serotonin. As we age, we become enzyme-deficient; hence supplements that let us skip the intermediate step can be a godsend.

Please note Petes last comment. Considering that some people actually died of the contaminant in tryptophan, it makes sense to buy from a source you can trust.

Re: progesterone. My experience with progesterone has been that at first it was simply a wonder drug for sound sleep. If I woke up too early, Id just pop 100mg of sublingual progesterone and doze off again in no time. But with frequent use, the effect wore off. And indeed I read that chronic dosing with progesterone makes the benzodiazepene receptors shut down (these are the "Valium receptors").

HOLD THE TURKEY: FOODS, HERBS, AND SUPPLEMENTS FOR BETTER SLEEP

Would you believe that here and there in alternative health publications I still come across the same old erroneous suggestion that in order to improve sleep you are supposed to eat turkey or tuna at bedtime and drink warm milk? These are rich sources of tryptophan, the experts say. One time, abandoning common sense in favor of listening to the experts, I fixed myself tuna on rye and warm milk. Yummy! I ate the whole thing. Then I lay sleepless for hours, trying to digest the whole thing.

A little milk all by itself might work, since milk does provide calcium, known for its calming effects. Just dont make the milk too warm, since anything that raises your body temperature is going to be counterproductive. But milk, like fish and meat, contains the aminoacid TYROSINE, which is converted to dopamine and norepinephrine. As for tuna or turkey forget it, unless you are the kind of excellent sleeper who can drink coffee at bedtime and then be out in one minute.

Why? Tyrosine causes a release of dopamine, which is then converted into norepinephrine, an arousing, energizing neurohormone. Wonderful at breakfast and lunchtime, but not so desirable in late evening hours. If you are on a carb-restricted weight-loss diet, be sure you eat an early dinner. And consider eating most of your daily carbohydrate allotment at dinner. Men especially have found that high-protein diet makes it harder for them to fall asleep maybe because testosterone also increases the release of dopamine, causing an additive effect.

What then are the sleep-friendly foods? The Wurtmans insist that we eat a plain bagel or a bowl of dry cereal (no milk) to cause an insulin surge in order to carry tryptophan into the brain. Apart from considerations of taste, I have had too much misery caused by insulin surges back in my hypoglycemic days to even touch such dead, processed, unopposed high-glycemic carbohydrates. I remember when I had to keep food in the bedroom because Id wake up before dawn so ravenously hungry I literally had to eat myself back to sleep again.

As for increasing brain serotonin close to bedtime, 5-HTP fortunately does not depend on insulin, since its entry into the brain is not affected by the presence of other aminoacids.

When it comes to 5-HTP, I prefer taking it in daytime rather than at bedtime during the day it seems to mellow me out a bit. If I take a dose at bedtime, it seems to disturb my sleep. I am still only experimenting with HTP.

It is interesting that DEPRESSED PATIENTS SHOW LOW LEVELS OF FOLIC ACID, and also typically suffer from sleep disorders. It is also interesting that in some ways folic acid acts like an estrogen mimic, conferring many of the same benefits.

As for MELATONIN, for a long time I lived with a gnawing suspicion that it was actually disturbing my sleep. There was this uncanny coincidence between the onset of my sleep difficulties and the time I first started taking melatonin. Switching to time-release melatonin did not help (though it seemed to for the first week or so).

Then I read that "night owls," people who have their best alertness and energy peak during the evening, and whose body temperature drops later at night than average, do indeed suffer from disturbed sleep if they take melatonin too early in the evening. Now I wait until I distinctly feel the pre-sleep drop in my body temperature, even if sometimes it means staying up past midnight, and only then take my melatonin. This honoring of my own temperature rhythms seems to work for me a lot better (but I have also finally disciplined myself to stop working sooner; that was much more difficult for me than losing weight).

I also want to remind you of the sad fact that neither the optimal dosage nor the optimal time of ingestion have been established for melatonin. The only consensus is that it is a "darkness hormone" not necessarily a sleep hormone. With melatonin, we are truly the guinea-pig generation, and have to learn by trial and error.

MOZART AT MIDNIGHT SLOWING DOWN WITH MUSIC

It has been suggested that modern life is too rushed and stressful and our brain waves are mostly too fast. We do not spend enough time in the creative and healing lower frequencies such as alpha, theta, and delta (delta waves indicate deep sleep or a trance state).

Fortunately there is a delightful way to remedy this "hurry up disease." Whether we call it the Mozart effect or music therapy, it has been well established that listening to slow music has a soothing effect particularly slow classical music, which is harmonious. Some soothing New Age music can also be very effective.

For more than a month now I have been listening to energizing music in the morning and soothing slow movements in the late evening, and feel that especially the evening music has added a blissful dimension to my life and improved my sleep.

I dont mean any expensive, esoteric brain wave entrainment discs. I mean "Mozart at Midnight," "Mozart for Meditation" (my greatest favorite), "Mozart for Massage" (exquisite chamber music). I am still to explore "Beethoven at Bedtime," "Brahms at Bedtime," and the like. Im sure these too will contain exquisite selections, but there is general agreement that Mozarts music is the most healing, singing as it does with the voices of angels.

New Age bookstores such as San Diegos Buddhas Light also carry New Age music design for specific healing effects, including sound sleep. Music therapy is really very ancient, if you consider shamanic chants and Taoist yin and yang music.

Many New Age stores have slow, quiet music designed to be very soothing. "Reiki Light" (music designed for massage and body work seems to work for sleep also) and "The Path of Silence" are worth exploring.

If neither classical nor New Age music is to your liking, there is always that old standby, "The Slow Ocean." The sound of the surf is, to say the least, oceanic.

"The Mozart Effect" is not the only book on music therapy. CyberHealth is privileged to have an internationally music therapist among its subscribers, Stephanie Merritt, Ph.D. She is the author of a delightful book about the effects of music on the psyche, "Mind, Music, and Imagery: Unlocking the Treasures of Your Mind," from Aslan Publishing, 1996. Highly recommended for those interested in the power of music to heal and transform.

When you consider other sleep aids, there is some worry about long-term use. Carbohydrates can make you fat; valerian, if overused, can supposedly damage certain brain receptors. But we have musical valerian, so to speak, that is pure bliss, and gets ever more blissful the more you surrender to it.

NUTRITION HOT TIP: THE BROCCOLI SPROUT EXTRACT IS HERE!

Hot Tip Time...

Trader Joes has Broccoli Sprout Extract and it just felt like a good deal to me! One would have to eat quite a lot of sprouts to get the same base as two capsules!

Ivy:

Cancer is rapidly gaining on heart disease, and some predict that in the next century it will emerge as the #1 killer. Yet for all we know, perhaps the humble Broccoli Sprout Extract can provide powerful protection.

Not that you should stop eating broccoli sprouts. They still provide what the capsules cant provide: ENZYMES. Sprouts are particularly rich in enzymes, and enzymes may turn out to be as important as sulfurophanes and isothiocyanates in providing protection against cancer and other diseases.

Jarrow now has capsules combining Vitamin C and rosemary extract. In animal studies, a fraction of a teaspoon of rosemary leaves added to the diet reduced breast cancer rate by as much as 76%. Of course you can always use fresh or dried rosemary, but since the taste is so sharp and it gets a tad monotonous day after day (I speak from experience), you may welcome the idea of an extract.

Oregano probably has similar anti-cancer benefits, and in addition it is supposed to be an excellent weapon against the common cold and other infections. If you cant find OIL OF OREGANO at your health food store, call 800-243-5242.

I also strongly recommend home-made cole-slaw (remember: shredded cabbage is a powerhouse of anti-cancer ingredients, and it also provides enzymes and fiber), and all forms of cabbage, including sauerkraut.

* * * CARE OF THE SOUL * * *
CONNECTING WITH OTHERS

One mark of maturity is that we drop the "I am separate, different, and superior" attitude of adolescence and become conscious of being part of a greater whole, the human family.

Right now:

Ivy comments:

The longer I live, the more I appreciate the value of being connected with others. Being the lone warrior woman does not really appeal to me because so much more can be accomplished when you join forces with other warrior women! But its also a matter of emotional fulfillment. C.G. Jung said, "The unrelated human being lacks wholeness, for he can achieve wholeness only through the soul, and the soul cannot exist without its other side, which is always found in a "You."

I was tempted to change "he" to "s/he," but in the end decided that "he" was more appropriate. Women typically are more related, at least to their women friends. The challenge for a woman in her power years is to expand relatedness, to create an air of nurturing warmth whenever she goes, whoever she interacts with.

Women are the chief nurturers, the givers of affection, and rather than complain about it (though I agree that men should work harder at developing those skills), they should glory in their role, in their mission to guide the world away from brutality and toward the path of connection and compassion.

Connecting with others, opening your heart to others, means recognizing the "innocence of others." With rare exceptions, they are not out to hurt you. They are too preoccupied with their own problems.

That rude clerk has not spent hours plotting how best to annoy you. She probably hates her stressful, low-paying job, is having PMS, her boyfriend has just left her, her car has broken down. If only you look below the surface, you can guess why people act crazy and sometimes fall apart at the slightest annoyance. You recognize that other peoples problems and frustrations are often far worse than your own. Then you begin to feel compassion rather than anger.

In situations like this, do something unexpected. Smile and show empathy. Say something like, "This must be a stressful job." We suffer not so much because bad things happen, but because we do not get enough empathy. Empathy and compassion are among the greatest gifts that anyone can give.

A smile. A gentle tone of voice. A simple "I hear you, I understand."

This newsletter is presented as a free service for women and health professionals interested in womens health.

Editorial and research assistants: Gail Peterson, Monica Smith, Pamela Macon The material contained herein is intended as information only, and not as medical advice.

Books by Ivy Greenwell:

• HORMONES WITHOUT FEAR (available from College Pharmacy, 800-888-9358 x116)
• A REFERENCE GUIDE TO NATURAL HORMONES FOR MEN
• HOW TO REVERSE OSTEOARTHRITIS (including extensive information on hormones and arthritis)
• HOW TO HELP PREVENT BREAST AND OVARIAN CANCER