Although CBT for insomnia is the most effective treatment method for sleep-related issues, for some people it may not be enough. Certain supplements and medications can certainly help, but it’s important to be armed with the right information. In the last episode of this series on sleep issues with Dr. Shane Creado, Dr. Amen and Tana Amen fill you in on the proper supplements and meds (and dosages!) you should be using to get those Z’s.
Dr. Daniel Amen: Welcome to the Brain Warrior's Way podcast. I'm Doctor Daniel Amen.
Tana Amen: I'm Tana Amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body.
Dr. Daniel Amen: The Brain Warrior's Way podcast is brought to you by Amen Clinics, where we have been transforming lives for 30 years using tools like brain SPECT imaging to personalize treatment to your brain. For more information, visit AmenClinics.com.
Tana Amen: The Brain Warrior's Way podcast is also brought to you by BrainMD, where we produce the highest quality nutraceuticals to support the health of your brain and body. To learn more, go to BrainMD.com.
Dr. Daniel Amen: Welcome back. Thanks so much. We've had such a good time with Doctor Creado. He's a treasure for us, and a wonderful resource for you. So, in this last session, and we did this purposefully that medications are not the first thing you should do. The first thing you should do is really understand why you're having trouble, and then fix that if you can. Fix the structure, fix your thoughts, fix your routines, but supplements can actually be very helpful and we like to do supplements first, and then medications. So, walk us through your thought process on supplements and medications for sleep related issues.
Dr. Shane Creado: Okay. Now, if we first of all address these behavioral strategies, the sleep hygiene, the bedroom, and we're making sure that there's no serious underlying issues like sleep apnea, restless leg syndrome, then we talk about some helpful supplements. Usually patients come to me on a boatload of medications, and I'm in the process of eliminating medications rather than adding more. That's the first step you do, because medications can disrupt your sleep. Talking about supplements, there are a few supplements I would say 10 to 12 supplements I really like that also have the best evidence and support of their use for people with insomnia. One of them is 5-Htp, and it's in Serotonin Mood Support, BrainMD and supplements.
What I like about 5-Htp is that it gets converted to Serotonin. Serotonin regulates your mood as well as your sleep, so it can help you sleep better. Also, 5-Htp is necessary for serotonin and melatonin production, and as we know, melatonin is extremely helpful for helping us sleep better. However, melatonin is naturally taken in the right amounts and the right duration by the right people, and therefore, they may overmedicate with melatonin and they may have actually bad effects or paradoxical effects.
Dr. Daniel Amen: So, what dosages do you like of melatonin?
Dr. Shane Creado: 0.5 to 1 milligram, which people might think is really low because typically in pharmacies you get three, five, 10, 15 milligrams, but that's way too high. When we think about melatonin, levels rise at night around bedtime, so it helps nudge your brain into sleepiness. It's as effective as switching the lights off. It's not supposed to knock you out, and it's only helpful in helping you fall asleep, and it needs to be taken 90 minutes or 60 minutes before your bedtime. So, people may take a higher dose, they lie in bed tossing and turning, wondering why it's not working for them. Well, they've taken it too late. Then they start associating the brain with tossing and turning and wakeful worry at bedtime, which will even perpetuate the insomnia.
Tana Amen: So, what if they've been doing what most people do, and taking higher doses, three to four milligrams or five milligrams? Can they just automatically back off and take less, or do they need to wean down?
Dr. Shane Creado: They can take less because there's no terrible withdrawals from the higher doses of melatonin. Depends on how much you've been taking as well. It's gonna be rough. I always tell my patients, "If you want to get this right, you've suffered from insomnia for a long time, months, years, you need to put in some effort." If you think about it, if there's anything you're proud of, anything you've achieved in life, you've put in a lot of hard work.
Tana Amen: I tell people the same thing.
Dr. Shane Creado: Exactly.
Tana Amen: What are you most proud of?
Dr. Shane Creado: Very true.
Dr. Daniel Amen: So, low dose melatonin.
Dr. Shane Creado: Low dose melatonin.
Dr. Daniel Amen: 5-Htp.
Dr. Shane Creado: 5-Htp.
Dr. Daniel Amen: 50 milligrams, 100 milligrams of 5-Htp?
Dr. Shane Creado: Yes. You know, start low, go slow, see whatever you need and that's how you go with that. Also, GABA is a really great supplement to help you sleep better. You can calm down the nervous system a little bit, helps you more get into a state of relaxation. It could help down some anxiety [crosstalk 00:04:46]-
Dr. Daniel Amen: So, 500 milligrams of GABA, 750?
Dr. Shane Creado: 500 and then you try 750.
Dr. Daniel Amen: So, a lot of people go, "But GABA doesn't cross the blood-brain barrier," and I don't know whether or not that's true. We've actually done quantitative EEG studies that show GABA elevates theta activity, slow brainwave activity. So, maybe what it's doing is it's calming the vagal nerve, which is then sending a signal to your GI tract to calm everything down, and people don't get the gut-brain connection, but there's actually a study on probiotics being helpful to induce sleep. Which, I thought that was pretty interesting.
Tana Amen: That's really interesting, and you and I had a little conversation a little while ago about tea. So, I like to take valerian tea. I also like chamomile tea. So, if it's evening I'm one of those people, I'm highly sensitive to caffeine any time other than in the morning. So, I cannot have caffeine any time past 11.
Dr. Daniel Amen: Okay, so that would not be one of your supplements.
Tana Amen: Most definitely not, so if it's in the evening, I can't have green tea, nothing like that. So, I will have chamomile tea if I'm out at dinner or something like that, but I like valerian tea at bedtime. So, talk to us about tea and why they work, and which ones are good, which ones are not good.
Dr. Shane Creado: Yeah, the top two would be chamomile tea and valerian tea. So, you're doing it right clearly, Tana. Chamomile tea is really helpful because it's rich in a flavanoid called apigenin, which binds to the benzodiazepine receptors in the brain. Same receptors in the brain that calm down and relax.
Tana Amen: So, it's not just a myth, it actually works.
Dr. Shane Creado: No, it does work. So, valerian root as well could be very helpful-
Dr. Daniel Amen: [crosstalk 00:06:27] works as well. So, you wonder about decaffeinated green tea because it has theanine, or you can just take theanine by itself. There's actually a study on post menopausal women.
Tana Amen: But doesn't that make you focus more?
Dr. Daniel Amen: A lot of people put it in sleep formulas.
Dr. Shane Creado: Yes.
Dr. Daniel Amen: So, what do you think about theanine?
Tana Amen: I'm confused.
Dr. Shane Creado: I love L-theanine. It can be extremely effective because it can help regulate your dopamine and serotonin, your GABA as well. There are studies that looked at ADHD in kids and L-theanine. Helped them calm down and relax, and sleep better. I'm a fan of L-theanine. It's in my top-
Tana Amen: Just not the caffeine that's in green tea.
Dr. Shane Creado: Not the caffeine.
Dr. Daniel Amen: Not the caffeine.
Tana Amen: Okay, and valerian is a good one. We talked about.
Dr. Daniel Amen: We are not a fan of caffeine.
Dr. Shane Creado: Valerian is a good one as well.
Dr. Daniel Amen: Unless you have a sore throat and it constricts blood flow to your throat.
Tana Amen: Question, though. Some people say they get weird dreams on valerian. I don't, but is that something that's common?
Dr. Shane Creado: It could be possible. Depends on the dose they're taking and the duration as well. As I said, if you are sleep deprived, the brain will try and make up for it by more dream sleep. So, they're sleeping better with the valerian. They might actually have more dream sleep initially, and then [crosstalk 00:07:32]-
Tana Amen: But then it'll calm down.
Dr. Shane Creado: Exactly. That's the way it should work.
Dr. Daniel Amen: Okay, so we have low dose melatonin, 5-Htp, L-theanine, GABA, hypnosis, meditation. So, I just want you guys to hear [crosstalk 00:07:48]-
Dr. Shane Creado: Magnesium.
Tana Amen: Magnesium is my go to.
Dr. Daniel Amen: The first thing is not Ambien.
Dr. Shane Creado: Right.
Dr. Daniel Amen: Now, if the lifestyle and supplement things are not working, what are the medications you go to in the order that you might use them?
Dr. Shane Creado: Okay. The first step is, eliminate any meds that are disrupting your sleep. So, you need to work with your doctor or look into the research and look at what meds may be damaging your sleep, because there might certain sleep medicines that might worsen things like sleep apnea, restless leg syndrome. So, if you have sleep apnea, one of the worst medications you could give someone is Klonopin or benzodiazepine like Ativan.
Dr. Daniel Amen: But they do it all the time.
Dr. Shane Creado: They do, and then what happens? Their sleep is worse, they're suffocating, they have more depression, and then increase the dose. You're not sleeping well? Let's increase the dose. It worsens their sleep apnea. It's a disaster. So, [crosstalk 00:08:40].
Dr. Daniel Amen: Okay, you don't like those. Which ones do you like?
Dr. Shane Creado: If we're just talking about pure insomnia and supplements, natural strategies, and then the medication option, I'd actually go with low dose gabapentin. Low dose gabapentin, because it's such a huge therapeutic window. You can give 100 milligrams or 3,600 milligrams in a 24 hour period. So, slow [inaudible 00:09:04] gabapentin. What I like about it is, even if someone has low iron levels in their body, they don't know about it, or some mild restless leg, it can deal with that as well. It's one of the best medications for restless leg syndrome. I like Lunesta and Belsomra. They're more selective medications, less side effects.
Tana Amen: So, they don't have the same side effects that Ambien has?
Dr. Shane Creado: No. Ambien is also associated with sleepwalking and sleep talking.
Tana Amen: Oh, interesting.
Dr. Shane Creado: There are a few forensic sleep cases there where someone has done something in their sleep, and it's a crime. It's usually a serious crime.
Tana Amen: Is the depression that I experienced, is that a common thing or is that just a weird-
Dr. Shane Creado: No, it's definitely possible with Ambien too. On the label, there are so many different side effects for each medication, but the reason they're all there is because one person might be effective. Even if it may effect 1% of the population, what if you're my patient within that 1%? Then it's 100% for you, and that's really important.
Dr. Daniel Amen: A lot of my patients take Seroquel, and they actually got a good response for that, for sleep. What's been your experience?
Dr. Shane Creado: Sedating antipsychotic medications like Seroquel or olanzapine, Zyprexa, can help you sleep better but the reason they help you sleep better is because it's a very potent side effect of the medication. So, as I said, these are medications that have multiple effects. So if you have restless leg syndrome and you're giving them an antipsychotic like Seroquel, what's it gonna do? It's gonna block the dopamine receptors, probably make your restless leg syndrome worse. If you have sleep apnea, Seroquel and Zyprexa can cause weight gain and worsen the sleep apnea. So, they're definitely lower on my list of things to do. First, I'd go with boosting the iron and the natural supplement reserves. Then I'd go by the medications that I mentioned to you. Lunesta, Belsomra.
Dr. Daniel Amen: So, low iron goes with insomnia?
Dr. Shane Creado: Yes.
Tana Amen: Oh, that's not good.
Dr. Daniel Amen: And giving iron can actually help insomnia?
Dr. Shane Creado: Yes.
Dr. Daniel Amen: Now, does their iron have to be low in order for it to work for insomnia?
Tana Amen: So, they don't have low iron.
Dr. Shane Creado: Well, it depends on whether you're talking about the iron levels or the storage for more of the ferritin levels. What I like to test, and we all test our patients for this, is the ferritin levels. The storage form of iron, and it doesn't have to necessarily be within normal limits. I want to see in the higher range of normal because then you know someone has good iron reserves. Why is that important? Iron helps your brain produce dopamine.
Tana Amen: I've just learned so much during this. This is so interesting.
Dr. Daniel Amen: Right, because your iron levels come back terrible.
Tana Amen: Always, chronically. It's chronically low, so I've upped my ferritin.
Dr. Shane Creado: Yep, so what's gonna happen when you have low iron levels? You have less dopamine or your dopamine is not gonna work as well, so you'll have more anxiety, you'll have concentration problems.
Tana Amen: Well, I was in a funk. Yeah, I was not concentrating as well, and I was feeling funky. Just not happy like I normally am bubbly. So, I increased my ferritin and felt better.
Dr. Daniel Amen: So, you have found this helpful.
Dr. Shane Creado: And you had restless leg issues too.
Dr. Daniel Amen: Doctor Creado has a brand new course. It's 21 lessons, and it can change your life.
Tana Amen: So interesting. Yeah.
Dr. Daniel Amen: Because change your sleep, change your life.
Tana Amen: If I miss a half an hour of sleep, it changes my life, so if you're chronically-
Dr. Daniel Amen: Which in turn changes my life.
Tana Amen: Right. So, if you are chronically sleep deprived, it's just a terrible thing.
Dr. Shane Creado: As the saying goes, we are inundated with information but thirsting for wisdom. This is the course for people who have been shooting the duck all along, trying to find solutions, struggling with this by themselves. This will give them tailored, directed information on how to improve their sleep, in a meaningful way.
Tana Amen: Well, you are a wealth of information and wisdom on this topic. It's been fascinating.
Dr. Shane Creado: It's been fascinating. I'm so grateful for you guys, to come on the show and help people out. So, thank you so much for having me.
Tana Amen: Thank you for being here.
Dr. Daniel Amen: If you want to learn more about this course, actually, you want to learn more about this course, go to AmenUniversity.com
Tana Amen: If you are enjoying the Brain Warrior's Way podcast, please don't forget to subscribe so you'll always know when there's a new episode. While you're at it, feel free to give us a review or five star rating, as that helps others find the podcast.
Dr. Daniel Amen: If you're interested in coming to Amen Clinics, give us a call at 855-978-1363.