Sleep

Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or the presence of non-restorative sleep.

It is the most common sleep disorder in the United States affecting about one-third of the general population.

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The symptoms of insomnia occur despite the presence of adequate opportunity and circumstance for sleep and result in mild to severe daytime dysfunction.

Insomnia, especially when chronic, can adversely affect the health, quality of life and academic performance of the individual, as well as increase the risk of motor vehicle accidents, decrease productivity at work, create mental health disturbances, irritability and increase daytime sleepiness.

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Insomnia is also considered a contributing risk factor for medical problems like cardiovascular diseases, chronic pain syndrome, depression, anxiety, cognitive decline, diabetes, obesity, and asthma.

According to the third edition of the International Classification of Sleep Disorder, insomnia is classified as:

Chronic Insomnia Disorder

The sleep disturbances occur at least three times a week and have been present for the last 3 months.

Short-Term Insomnia Disorder

The sleep disturbances have been present for over a period of 3 months.

Other Insomnia Disorder

Difficulty in initiating or maintaining sleep that does not meet the criteria of chronic insomnia or short-term insomnia disorder.

Epidemiology

Symptoms of insomnia are common, with about one in three people reporting some symptoms of the disorder.

Concerning formal diagnoses, insomnia is prevalent in 10% to 15% of the general population.

Despite it affecting all age groups, insomnia is more prevalent in women of peri-menopausal and post-menopausal transitions and older adults.

The male‐to‐female ratio is 1:1.4 for insomnia symptoms and 1:2 for insomnia diagnosis [21].

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Causes

Individuals who have difficulty coping with stressful situations or those who report being habitual light sleepers have an elevated propensity to develop chronic insomnia.

There is a high rate of association between insomnia and psychiatric disorders such as depression, anxiety, and post-traumatic stress disorder (PTSD) [1].

Comorbid medical issues like restless legs syndrome, chronic pain, gastroesophageal reflux disease (GERD), respiratory issues, and immobility are also associated with an increased risk of chronic insomnia.

Developmental issues during childhood, such as separation anxiety, may predispose a child to develop sleep problems.

People with certain personality traits like perfectionism, ambitiousness, neuroticism, low extraversion, and susceptibility to depression, pensiveness and worry are more likely to develop insomnia over time.

Insomnia is also more commonly seen in individuals with psychosocial stress, like disrupted family life, divorce, financial problems, the death of a loved one, alcohol or substance abuse.

Additionally, changes in hormone production and neurotransmitter levels in the brain are also known to be involved.

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Common reasons that people might develop insomnia include:

  • Not having healthy “sleep habits”, such as staying up late to work, watch TV or play video games. Consuming alcohol and stimulants, such as caffeine, as well as eating sugary / processed foods close to bedtime can also disrupt sleep.
  • Not sleeping in a completely dark, quiet or cool enough room. Artificial lights in the bedroom and heat can both keep someone up at night.
  • Dealing with chronic or acute stress due to certain life changes or circumstances.
  • Changes in the environment, such as from moving or traveling.
  • Not having a regular sleep-wake routine. For example, shift work can disrupt sleep because it interferes with the body’s circadian rhythm. Typically, we get the best sleep when we wake up and go to sleep at roughly the same time each day.
  • Having a mental health disorder, such as anxiety or depression. Chronic insomnia is considered a comorbidity, meaning a disorder that happens at the same time as another, and is commonly linked to other medical or psychiatric issues.
  • Being sick or dealing with a health problem that causes digestive issues during the night, such as GERD.
  • Chronic pain that makes it hard to get comfortable, such as low back pain, arthritis or neck pain.
  • Sleep apnea and other breathing problems.
  • Limb movement disorders, such as restless leg syndrome or periodic limb movement disorder.
  • Taking certain medications (like psychotropic drugs), such as those that stimulate the sympathetic nervous system and cause increased heart rate, nervousness, frequent urination at night (nocturia), etc. These may also include drugs used to treat colds (i.e., acetaminophen), nasal allergies (i.e., pseudoephedrine), high blood pressure (i.e., diuretics, beta-blockers), heart disease (i.e., benazepril), thyroid disease (i.e., levothyroxine), birth control (i.e., progestin), asthma (i.e., albuterol) and depression (i.e., citalopram).

Symptoms

The most common symptoms of insomnia include:

  • Difficulty falling asleep (also called initial insomnia) or waking up frequently during the night (also called late insomnia).
  • Feeling stressed when trying to sleep, which usually results in you laying in bed with racing thoughts or experiencing physical symptoms.
  • Feeling exhausted / fatigued during the daytime. This can cause poor concentration and focus, difficulty with memory and impaired motor coordination.
  • Low mood, irritability, emotional reactivity and difficulty with social interactions.
  • Reduced quality of life and increased risk of developing mental disorders, obesity, diabetes and cardiovascular disease. In fact, some studies show that adults with insomnia are almost four times as likely to become depressed compared to those who don’t have insomnia.
  • Short attention span and inability focusing on tasks
  • Decreased learning ability and memory problems
  • Decreased job performance and higher risk for motor vehicle crashes, work-related accidents and other occupational errors. All of these increase the odds of experiencing some type of disability.

Testing & Sleep Studies

There is no one definitive test for insomnia that doctors use, but signs and clues that can lead to a diagnosis.

If you find that you repeatedly can’t sleep, first discuss potential insomnia causes with your doctor and/or therapist.

Let your doctor know about all insomnia symptoms you’re experiencing, including those that are emotional and physical.

He or she will likely want to perform a medical exam, talk to you about any recent life changes and discuss your medical history.

Your doctor might also suggest that you take part in a sleep study test.

Sleep studies/sleep tests are used to determine if insomnia is caused by conditions such as breathing problems, sleep apnea or limb movement disorders (like restless leg syndrome).

An insomnia test (which is called polysomnography) is conducted at a sleep laboratory that has rooms for you to sleep in for 1–2 nights.

During your sleep, you will be connected to an electroencephalogram (EEG) and monitored at different stages of sleep in order to indicate how long you spend in the deep, restful stages of sleep.

It is a non-invasive test that is used to indicate the extent of your sleeping difficulty.

Your body movements, breathing patterns, heart rate and oxygen levels overnight will also be assessed.

However, you can also help determine if you may have insomnia by taking an online assessment at home, such as the ones offered by the London Sleep Center or Sleep Education website.

If you are not ready to be monitored for insomnia, but you want to keep track of your sleeping patterns, you can keep a sleep log.

A sleep log tracks your bedtime and wake-up time.

You can also note how many times you woke up and how you feel throughout the day.

This may help your healthcare provider to determine the cause of your insomnia and the extent of your sleep disturbance.

There are also devices that you can wear that will monitor your sleep from home.

Although the results won’t be as accurate as what you would receive after an insomnia test in a lab, this can serve as a useful tool if you are unsure about how many hours of sleep you are getting every night [2].

Conventional Treatment

According to conventional medicine, there isn’t a “cure” for insomnia, but rather ways to help prevent and manage it.

Insomnia treatments can be both non-pharmacologic (non-medical) and pharmacologic (medical, such as using prescription drugs).

Many experts feel that combining medical and non-medical treatments results in the most successful outcomes.

Some treatment approaches that doctors and therapists may use to manage insomnia symptoms include:

  • Cognitive Behavior Therapy (CBT), a type of psychotherapeutic treatment that helps people learn how to identify and change destructive or disturbing thought patterns that have a negative influence on their world perception, behavior and emotions.
  • Lifestyle changes to promote better sleep patterns. Most doctors usually agree that some of the best insomnia remedies include exercise, eating a healthy diet and decreasing caffeine, alcohol and drug use.
  • In some cases, when deemed necessary, use of medications including benzodiazepine hypnotics and non-benzodiazepine hypnotics. If your doctor or healthcare provider determines that you would benefit from medications for insomnia, he or she may prescribe one of the following types of drugs.
    • Benzodiazepines: Benzodiazepines bind to GABA and GABAA receptors, acting as agonists. They increase sleep time and improve sleep quality by reducing sleep-onset latency and wakefulness after sleep onset and by increasing sleep efficiency [34567]. Possible side effects of these kinds of drugs include withdrawal symptoms, drowsiness during the day, unsteadiness, confusion and memory impairment. Examples of benzodiazepines include Ativan, Valium and Doral [8].
    • Non-benzodiazepine hypnotics: Non-benzodiazepines (also referred to as “Z drugs”) are sedatives used to treat insomnia that also act on the GABA and GABAA receptors, but are much more selective than the older benzodiazepine sedatives. These types of medications have become the most common prescribed hypnotic agents in the world. Possible side effects of Z drugs include memory loss, physical and psychomotor effects, such as falls or car accidents, fatigue and withdrawal symptoms. Examples of non-benzodiazepines include Lunesta, Sonata, Ambien, Edluar and Intermezzo [9].
    • Melatonin receptor agonists: These types of drugs are used to treat insomnia, sleep disorders and depression. They bind to and activate the melatonin receptor, helping to improve your circadian rhythm and sleeping patterns. A common type of melatonin receptor agonist is Ramelteon (Rozerem), which as a side effect may cause dizziness and drowsiness during the day [10].
    • Use of melatonin: Melatonin is a hormone that is released naturally by the pineal gland in response to darkness that helps regulate the circadian rhythm and sleep-wake cycle.
    • Short-term use of antihistamines: Antihistamines are drugs that treat allergic rhinitis and other allergic conditions. Many antihistamines exert sedative effects, and thus used as an over-the-counter drug to include sleep and battle insomnia, although their use is suggested to be occasional. Examples of sedating antihistamines include diphenhydramine (Benadryl), chlorphenamine, clemastine and ketotifen.

Natural Insomnia Remedies

Natural solutions in battling insomnia include the following:

1. Change Your Diet

Step No. 1 in overcoming insomnia and sleep deprivation is to change your diet.

It’s surprising to a lot of people to hear that their diets are keeping them from falling asleep; but your diet plays a pivotal role in normal hormone and neurotransmitter production, which is key in allowing you to feel relaxed and sleepy.

When your body is nutritionally imbalanced your biological clock can become altered and that means sleep disruptions, whether temporary or on a more chronic basis.

Meal timing can also impact your sleep — try not to go to bed feeling hungry, which may wake you up in the middle of the night due to low blood sugar.

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On the other hand, you also don’t want to eat right before you go to bed.

Most people should aim to eat about 2–4 hours before going to sleep.

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  • Before you go to bed, it is highly recommended for you to drop your carbohydrate and sugar consumption. If you’re consuming too many sugars and carbs at night, your body is burning through those (releasing heat) and getting warm, which prevents you from comfortably falling asleep. That means you must lower your sugar, grain and overall carbohydrate intake before bed, being also careful to avoid desserts and processed grain products (like ice cream, cookies, cake, bread, etc.).
  • For long-lasting insomnia relief, it’s also key to get some healthy fats into your system to help you fall asleep soon after your head hits the pillow. For example, both avocado and organic yogurt (without sugar) can work extremely well here, as those foods are high in healthy fatty acids, plus the relaxation minerals magnesium and potassium.
  • Many people aren’t aware that they suffer from low potassium or have signs of a magnesium deficiency, as both are crucial necessary nutrients that help your body feel relaxed so you can sleep.

These are the top foods we recommend eating if you struggle with insomnia:

  • Foods high in tryptophan —This amino acid stimulates the production of the inhibitory neurotransmitter serotonin that is involved in emotion and mood. Serotonin balances excessive excitatory neurotransmitter effects in your brain which helps promote relaxation. Tryptophan foods include those high in protein, such as turkey, chicken or tuna. However, it’s best to not over-consume protein to increase your tryptophan uptake — the best way to increase levels in your brain is to eat balanced meals that include some complex carbs, protein and fat [11]. Having these types of foods at dinner may help you feel sleepier afterwards.
  • Complex carbohydrates — Carbohydrates can also help with the production of serotonin, but you don’t want to have simple carbs and sugar that can spike your energy levels at night. Starchy veggies like butternut squash or sweet potatoes are an excellent addition in your dinner to help release serotonin.
  • Raw milk — Although dairy, especially cow dairy, can be problematic for some, a glass of raw milk before bed does help many individuals to get better sleep. Organic and preferably raw dairy products that are unsweetened are best. A2 dairy is recommended from goats, sheep or A2 cows.
  • Foods high in magnesium — Magnesium is known as the “relaxation” mineral for a good reason, plus it fights muscle cramps and headaches that might keep you up. Green leafy vegetables, sesame and sunflower seeds, raw cocoa, fermented/raw dairy, bananas, avocados and oats are all foods that you can incorporate into your diet to boost your magnesium intake.
  • B vitamins — Organic meat, brewer’s yeast, liver, egg yolks and green leafy vegetables are all high in B vitamins, including vitamin B12. B vitamins support the nervous system and some people report that their insomnia symptoms diminish noticeably once they begin supplementing with B-complex vitamins.

These are the foods and beverages we recommend to limit or avoid in order to get better sleep:

  • Caffeine — Don’t consume caffeine after noon or at all if you are having difficulty sleeping. Try switching from coffee to green tea if possible, since tea has a lower caffeine content and much more health benefits.
  • Alcohol — Stop drinking alcohol at least 2 hours before bed and drink in moderation. Try drinking no more than 1 alcoholic drink per hour and ideally not more than 1-2 drinks per day.
  • Any potential food allergens — Food allergies can cause restlessness, irritability, depression, GI issues and other symptoms that contribute to insomnia. Avoid common irritating food groups like dairy, gluten, shellfish or nuts, if they contribute to any discomfort.
  • Sugar — Variations in blood sugar levels can cause symptoms of anxiety/nervousness and trouble sleeping. Avoid high-sugar foods and switch to using organic stevia extract to sweeten foods instead.
  • Processed fats — Too much fat at night can slow down gastric emptying and digestion and may lead to indigestion. This is especially true if you deal with heartburn/acid reflux at night. Limit fried foods, processed meats like bacon or salami, low-quality cheeses and other fatty meals before bedtime. Have healthy fats instead like coconut oil, extra-virgin olive oil, ghee or grass-fed butter, avocado, nuts and seeds; spread your fat intake out throughout the day to help control your appetite and energy levels.

2. Reduce Stress

One of the greatest insomnia remedies is reducing stress and promoting relaxation.

For most people, along with diet, this is a major culprit for keeping you up at night — your mind starts racing with ceaseless thinking and you’re seemingly unable to shut your brain off.

There are several ways in which stress may be keeping you up.

You might not even feel very stressed, but your body and mind are reacting negatively to your environment.

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On top of our article about stress, here are some useful tips that can help in dealing with this insidious enemy:

  • Avoid watching TV and using electronics that are visual stimulants, especially those that emit blue light. This doesn’t just include the TV screen; it also includes your computer, your iPad or your smartphone, which too often reside next to your bed. That blue light actually tells the pineal gland in your brain that it needs to keep running, so it messes with your circadian rhythms and cortisol levels, keeping you from falling asleep. We recommend that for at least 30 minutes, ideally an hour, before bed, you need to shut off all electronics with no exception. Many devices also feature a mode or an app (such as f.lux) that reduce emitting blue light, which can be a good option during the several hours before bed. On top of that, you may also wear blue-light-blocking glasses a few hours prior to bedtime.
  • Start reading something that helps you relax or start journaling. The simplest step can be reading a novel, a devotional, your Bible or anything that helps you relax and wind down at least 30 minutes before bed. For journaling, get out a notebook and start writing things down; you can even look at your schedule for the next day and write that down. If you have something that’s really stressing you out and keeping you from sleeping at night, we recommend you start writing those items down. Work on addressing those the best you can, and then start scheduling things into the week that you love to do. That is very important and may prove extremely helpful.
  • Practice gratitude before bed. If you’ve had a great day and been feeling happy, it actually creates certain hormones in your body known as endorphins that help you fall asleep at night.
  • Exercise is one of the most natural ways to create endorphins, so consider including at least 30 minutes of daily walking, ideally outdoors (if the weather allows) for a good night’s sleep. That applies especially to children and teenagers who have trouble sleeping, as their bodies naturally desire action and movement.

3.Take Quality Supplements

Step No. 3 is to take quality supplements, especially a quality magnesium supplement, such as Magnesium Breakthrough, to cure insomnia without drugs.

In addition, supplements like melatonin can help, or valerian root, but we don’t recommend using those on a long-term basis.

  • Calcium and magnesium (500 mg calcium / 250 mg magnesium) — These minerals work together for relaxation. Taking a magnesium supplement, about 400 to 500 milligrams a few hours before bed, can help you naturally reduce stress and really improve sleep [12].
  • Melatonin (1–3 mg half an hour before bed) — Helps promote sleep, best used for a short period of time [13]. If you have jet lag, or you’re not able to sleep just for a day or two, taking melatonin on occasion, about three grams, is fine. But you just want to do a small amount of melatonin on occasion, not on a regular basis, for it can be habit-forming.
  • Passionflower (500 mg before bed, or in tea form) — Helps relax the nervous system and doesn’t cause drowsiness [14].
  • Valerian Root (600 mg before bed) — Increases your brain’s GABA levels to induce sedation, but doesn’t typically result in the morning drowsiness of many sleep-inducing medications or supplements [1516].
  • Vitamin B12 (1500 mcg daily) — Vitamin B12 supports cellular function and neuronal health, and a deficiency in it can cause problems with circadian rhythms [17]. We like the B12 Tri-Blend from Global Healing as it is: 1) Certified Organic 2) Mix of the 3 most bioavailable forms 3) Provides sustained release 4) Enriched with energized trace minerals.

4. Use Essential Oils

The next step to truly help you improve your sleep is using essential oils, especially lavender essential oil and chamomile essential oil.

Chamomile, whether in tea, tincture or essential oil form, is one of the best medicinal herbs for fighting stress and promoting relaxation [18].

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Inhaling chamomile vapors is often recommended as a natural remedy for anxiety and general depression, which is one reason why chamomile oil is a popular ingredient in many candles, aromatherapy products and bath-soaking treatments.

Lavender oil is another sleep-promoting natural insomnia remedy [19].

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You can diffuse lavender by your bed at night or just take a few drops and rub it on your neck.

The benefits of lavender oil include having certain aromatic compounds that help relax your body.

Also, you can take a warm bath with lavender oil and Epsom salts, which may work due to the presence of magnesium.

If you’re going to go to bed at 10 p.m. or 10:30 p.m., do a detox bath by starting the process at around 9 p.m.

Take about 20 drops of lavender oil, rub it all on your body and get into a warm/hot bath with Epsom salts, and relax there for about 20 to 30 minutes.

When you get out, go and read a book for 30 minutes in bed and then fall asleep there at night.

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5. Change Your Lifestyle and Improve Sleep Hygiene

Last but not least, you probably need to change your lifestyle and adjust the environment in your bedroom (lights, temperature, noise, air quality, etc.) in order to find insomnia relief.

For example, sleep experts as well as we recommend a few things to do around your bedroom/home to help improve your sleep [20]

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  • Keep a regular sleep and awakening schedule. This trains your body to feel sleepy or energized at certain points in the day.
  • Try not to oversleep certain days of the week (more than 9 hours), which can throw off sleep on other nights. Also, avoid taking long naps in the daytime.
  • Keep your bedroom very dark. Use blackout blinds/shades if you need to, get rid of all light-emitting devices and clocks, and consider wearing a sleep mask.
  • Keep the temperature in your house a bit cold, definitely below 70 degrees and possibly into the mid-60s if necessary. In the winter, make sure the heat source has been turned down. A cold but comfortable house should help improve your sleep.
  • Make sure your mattress is comfortable and supportive to your body. If there is a big dip in your mattress or it makes you sleep in any way uncomfortably or creates back pain, it’s time to pick a new mattress. Invest in a comfortable, high-quality mattress that molds to the curves of your body and supports the natural curvature of your spine. We recommend Puffy or Comfy as their mattresses are designed for all body types and sleeping positions, provide both durability, support and pressure relief, and are high-quality, lasting strong for many years down the road. As a more budget-friendly alternative, we recommend Idle Sleep. Idle allows you to buy a queen-size memory foam mattress + 2 free pillows for $550 (The Idle mattress). They also offer the longest free trial of all brands (18 months) and free returns if things don’t work out. In case you are looking for a more natural, green, eco-friendly option made with organic latex we recommend Plushbeds; they are the top when it comes to all-natural, sustainable sleep products at a good price. Plushbeds is both a retailer and a manufacturer, meaning that when you order from them you are getting your mattress directly from the factory, which allows for a better price.
  • Do not smoke, since nicotine is a stimulant that can mess with hormone production.
  • Don’t exercise or do anything that increases cortisol or your heart rate too close to bedtime.
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Precautions

If you’ve been dealing with insomnia symptoms for more than 2–3 weeks, especially if you’re unsure why, then talk to your doctor about potential treatment options.

It’s possible that your insomnia is the symptom or side effect of another problem, so it’s important to identify the underlying cause.

Before self-treating insomnia with drugs, alcohol or other medications, we strongly suggest you discuss with your doctor or therapist what types of insomnia remedies may help.

Takeaway Points

✔ Insomnia is habitual sleeplessness or the inability to sleep.

✔ There are many causes for insomnia which may include: stress, poor lifestyle habits, poor diet, mental health issues, illness, chronic pain, and use of some medications.

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✔ People who are more likely to deal with insomnia symptoms include women, older adults, people with stressful lifestyles, perfectionists / type-A personalities, alcoholics, people who smoke and use drugs, and those with psychiatric or mood-related problems.

✔ Lifestyle changes and an optimal sleep environment can greatly help to regulate sleep patterns and improve sleep quality / duration.

✔ Good sleep habits including exercising daily, a healthy diet, quality supplements, stress relief, essential oils as well as a high-quality mattress can all help make it easier for you to fall asleep and stay asleep.

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About George Kelly

George Kelly M.Sc is a Sports Nutritionist, Functional Nutritional Therapy Practitioner (FNTP), and Metabolic Type expert. He is the CEO and lead author of Metabolic Body.


References

[1] https://pubmed.ncbi.nlm.nih.gov/15600216/
[2] https://www.sleepfoundation.org/insomnia/diagnosis
[3] https://www.ncbi.nlm.nih.gov/books/NBK11906/
[4] https://pubmed.ncbi.nlm.nih.gov/10617176/
[5] https://pubmed.ncbi.nlm.nih.gov/7896994/
[6] https://pubmed.ncbi.nlm.nih.gov/8980207/
[7] https://pubmed.ncbi.nlm.nih.gov/10674059/
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4831601/
[9] https://www.bmj.com/content/345/bmj.e8343
[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200764/
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/
[12] http://www.jle.com/fr/revues/mrh/e-docs/magnesium_supplementation_improves_indicators_of_low_magnesium_status_and_inflammatory_stress_in_adults_older_than_51_years_wit_287101/article.phtml
[13] https://www.smrv-journal.com/article/S1087-0792(04)00060-7/abstract
[14] https://onlinelibrary.wiley.com/doi/full/10.1002/ptr.3400
[15] https://www.ncbi.nlm.nih.gov/pubmed/2678162
[16] https://www.researchgate.net/publication/8896806_Sedative_and_sleep-enhancing_properties_of_linarin_a_flavonoid-isolated_from_Valeriana_officinalis
[17] https://academic.oup.com/sleep/article/14/5/414/2742838
[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995283/
[19] https://www.ncbi.nlm.nih.gov/pubmed/12112282
[20] https://sleepfoundation.org/insomnia/content/what-causes-insomnia
[21] https://pubmed.ncbi.nlm.nih.gov/12531146/


MEDICAL DISCLAIMER

This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. Neither Metabolic Body nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content. All viewers of this content, especially those taking prescription or over-the-counter medications, should consult their physicians before beginning any nutrition, supplement or lifestyle program.