ALTERNATIVES || Dr. Scott Theirl suggests biomarker testing before you take an Ambien

Guest post by functional neurologist, Dr. Scott Theirl, DC, DACNB, FACFN

Approximately half of us have trouble falling asleep, staying asleep or simply never feel rested or refreshed. Before seeking help in a doctor’s office, I suggest people make all the sleep hygiene changes they can and see if that eases their situation.

Dr. Scott Theirl, DC, DACNB, FACFN

But sleep is surprisingly complex and many times, sleep hygiene is not enough to resolve what may be at the core of our sleep trouble. The good news is that we have more than sleep hygiene, behavioral therapy and pharmaceutical sleep aids. New advances in biomarker testing allow clinicians and patients alike insight into the nervous system and hormone functions involved in sleep/wake cycles.

Over the last 15 years, urinary neurotransmitter and saliva hormone testing has been developed. Two key hormones are involved in sleep. Melatonin is key to initiating sleep and helping to sustain sleep the first part of the night. Melatonin levels should begin rising approximately two hours prior to bedtime, so long as the light of the room is dim and tranquil. (Melatonin levels can be greatly reduced by too much light, especially blue spectrum light or screen light.)

Cortisol is a hormone released by the adrenal glands that promotes wakefulness and energy. Under optimal circumstances, it follows a diurnal rhythm, meaning it should be significantly higher during the day than it is at bedtime. Elevated cortisol at bedtime can make it difficult to fall asleep. To make matters worse, under chronic stress—which may include chronic sleep loss—daytime cortisol levels deplete further, contributing to daytime sleepiness.

Neurotransmitter test results can be helpful in driving the treatment plan tailored to an individual’s needs. The clinician can then see a patient’s current state of balance in both excitatory biomarkers (those which excite and motivate us) and inhibitory biomarkers (those that calm us down) to more accurately choose how and when to supplement these hormones and neurotransmitters. Serotonin, GABA, glycine and taurine are all inhibitory (calming) neurotransmitters. Dopamine, norepinephrine, epinephrine (adrenaline), glutamate and histamine are excitatory neurotransmitters.

The beauty of an at-home test lies in its customization. If you have difficulty falling asleep, you simply collect the urine and saliva samples prior to going to sleep. If you have difficulty staying asleep, then you collect the samples in the middle of the night when you wake up. Think of these results as a snapshot of your unique physiology at the particular time of the night when your symptoms are the worst.

There are 5 common imbalances discovered after testing:

1. Melatonin levels are low
2. Cortisol levels are high
3. Inhibitory neurotransmitters are low
4. Excitatory neurotransmitters are high
5. Inflammatory markers are elevated (such as histamine and glutamate)

Testing provides a baseline for each patient. A patient can have one or all five of these findings. Couple this information with observed and reported symptoms and you achieve a more complete picture of an individual’s neuroendocrine function.

The experienced and integrative clinician uses all this gathered information to prescribe targeted amino acid supplements that can rebalance neurotransmitters. They can also prescribe calming herbal remedies to quiet overexcited hormone/neurotransmitters and/or a low inflammatory diet to take the load off the immune system.

This more holistic approach may work better than prescriptions for pharmaceutical sleep aids such as Ambien (zolpidem), which tend to affect only the GABA receptors. Instead, integrating these other therapies may help achieve more stability in the neuroendocrine system, which can lead to better support for your best overall sleep.

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Dr. Scott Theirl is the creator of Insomnia Insight, a 3-part clinician training series, is a physician educator for NeuroScience, Inc. and practices privately in southeastern Wisconsin. 800.385.1655 www.yourbestbrain.com, www.yourbestsleeping.com || Twitter @HolisticNeuroDr 

A friendly reminder that links to websites offering products does not imply endorsement by SleepyHeadCENTRAL.com.

SleepyHeadCENTRAL strongly encourages people with ongoing sleep health problems to approach a medical professional to determine appropriate differential diagnoses and treatment. This post, like all other posts on SHC, is not intended to substitute for medical advice.  

Introducing January's theme: ALTERNATIVES

The most common treatments for sleep health problems are:
  • Pharmaceutical (sleeping pills or antidepressants, in example)
  • Surgical (removal or reconstruction of the airway for better breathing, for instance)
  • Prescriptive devices (positive airway pressure machines or O2 therapy, in particular)

All of these, of course, require a doctor's prescription and this means that the patient must go through the medical system in order to receive differential diagnosis and traditional treatment.

And this is a good thing for many people who have serious sleep disorders. In fact, SleepyHeadCENTRAL still maintains that the gold standard approach to diagnosing and treating sleep health problems is to start that journey through traditional avenues which rely on evidence-based medicine. (See the SHC statement in bold, below.)

Sleep apnea is perhaps the sleep disorder which most requires the careful observation and direction of a host of medical professionals, such as primary care physicians, pulmonologists, allergy specialists and dentists; together, they can help patients recover from dangerous sleep breathing patterns that otherwise negatively impact their health directly over nearly a third of their lives (which is spent in sleep).

There are myriad other sleep disorders which equally require the expertise of sleep doctors, such as movement disorders of sleep, hypersomnias and neurological co-conditions like epilepsy or Parkinsonism. These are serious conditions which require solid, evidence-based diagnosis and treatment.

However, there has been a rise in alternative health practitioners which may also serve to meet a sleep health patient's needs, especially in the areas of naturopathy and functional medicine. It's not a dirty secret that some sleep problems may be treatable without going through the usual healthcare protocols. It may be that cognitive behavior therapy might be the best solution for managing anxiety for some insomniacs, for instance, or the employment of alternative pain management techniques which don't involve drugs at all in order for some patients to achieve necessary sleep in order to heal.

And in the end, this is what matters the most: healing.

The field of medicine is rapidly changing these days, and the focus is now on better patient outcomes and fewer returns to the hospital, which basically boils down to efficiencies in cost management and more proactive, educated patients.

In other words, doctors are now required to provide more value for their services, while patients are now required to take more responsibility for their lifestyle choices and treatment compliance.

If both doctors and patients don't hold up their end of the bargain, they can expect refusal of reimbursement by insurance companies.

A potential benefit of this shift in healthcare focus? It's no longer impossible to find MDs who are cognizant, even open-minded, to alternatives to traditional drugs, surgeries or device therapies, especially if these alternatives could result in long-term adherence and better patient outcomes.

Another potential benefit is that patients may, indeed, become far more health literate in order to be their own best advocates while participating in the healthcare system. And that is never a bad thing.

Insurance companies are also more open to covering complementary services as more studies are showing success with these techniques, which is good news for both quality practitioners and patients.

SleepyHeadCENTRAL remains firm in its belief that people with sleep health problems are best advised to approach a medical professional for an appropriate differential diagnosis for their problems. 

Evidence-based medicine should still be at the very forefront of individual healthcare as it relates to diagnoses, as it is never a good idea for patients to self-diagnose for ongoing sleep health problems. However, medical professionals they can approach may also include naturopaths or functional medicine practitioners as well as traditional MDs. 

Finally, all patients deserve to know they have treatment options that extend beyond traditional approaches. 

The best way for a patient to become their own best healthcare advocate these days is through mindful education and awareness about both traditional approaches AND alternatives to those pharmaceutical, surgical or device-driven treatments for sleep problems.

This is where SleepyHeadCENTRAL enters: ALTERNATIVES hopes to give you some food for thought as you examine how you can best approach your sleep health problems in the years to come.

Wishing you good sleep health in 2015!

~The Curator, SHC