Change Your Brain Every Day - Sleep Strategies: Which Supplements & Medications are Best for You? with Dr. Shane Creado

Episode Date: May 23, 2019

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.

Welcome to the Brain Warriors Way podcast. I'm Dr. Daniel Amen. And 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. The Brain Warriors Way podcast is brought to you by Amen Clinics, where we have been transforming lives for 30 years using tools like brain spec imaging to personalize treatment to your brain. For more information, visit amenclinics.com. The Brain Warriors 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. Welcome back. Thanks so much. We've had such a good time with Dr. Criato. 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 routine. Yes. 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. 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 in support of their use for people with insomnia. One of them is 5-HTP, and it's in serotonin mood support, brain MD, and supplements. What I like about 5-HTP is that it gets converted to serotonin.

And 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 not really taken in the right amounts and the right duration by the right people. And therefore, they may over-medicate with melatonin and they may have actually bad effects or paradoxical effects. So what dosages do you like of melatonin?

0.5 to 1 milligram, which is 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, the 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, may 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. 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? They can take less because there's no terrible withdrawals from the higher dose of melatonin. Depends on how much you've been taking as well. It's going to 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. I tell people the same thing, right? Exactly. What are you most proud of? Very true. So low-dose melatonin.

Low-dose melatonin. 5-HTP. 50 milligrams, 100 most proud of? Very true. So low dose melatonin, low dose melatonin, 50 milligrams, a hundred milligrams of five HTP. Yes. You know, start low, go slow, see whatever you need. And that's, that's how you go with that. Also GABA is a really great supplements to help you sleep better. You can calm down the nervous system a little bit. It helps you more get into state of relaxation.

Could help calm down some excitatory neurotransmitters. So like 500 milligrams of GABA, 750. 500, and then you try 750. 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. That's really interesting. And you and I had a little conversation a while back, just a little while ago, about tea. Yes. 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 anytime past. 11. Right. Okay. So that would not be one of your supplements. Most definitely not. But so, so if it's in the evening, I will have, 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. Yeah. The top two would be chamomile tea and valerian tea. So you're doing it right. Clearly, Tana. Okay.

Chamomile tea is really helpful because it's rich in a flavonoid called apigenin, which binds to the benzodiazepine receptors in the brain, the same receptors in the brain that will calm down and relax. So it's not just sort of a myth. It actually works. No, it does work. Okay. So valerian root as just sort of a myth. It actually works. No, it does work.

Okay. So valerian root as well can be very helpful. Theanine 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 postmenopausal women. A lot of people put it in sleep formulas.

So what do you think about theanine? I'm confused. I love L-theanine. It can be extremely effective because it can help regulate your dopamine, your serotonin, your GABA as well. There are studies that looked at ADHD in kids and L-theanine, have them calm down and relax and sleep better. I'm a fan of L-theanine.

Just not the caffeine that's in the green tea. Not the caffeine. Okay, and valerian is a good one. We are not a fan of caffeine. Valerian is a good one as well. Unless you have a sore throat and it constricts blood flow to your throat. Question though, some people say they get weird dreams on valerian. I don't, but is that something that's common?

It could be possible. It depends on the dose and the shaking and the duration as well. As I said, if you are sleep deprived, your 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. But then it will calm down. Exactly. That's the way it should work.

Okay. So we have low-dose melatonin, 5-HTP, L-theanine, GABA, hypnosis, meditation. So I just want you guys to hear. Magnesium is like my go-to. The first thing is not Ambien. Right. 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?

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 be certain sleep medicines that might worsen things like sleep apnea or restless leg syndrome. So if you have sleep apnea, one of the worst medications you could give someone is clonopin or benzodiazepine like Ativan. But they do it all the time. They do. And then what happens? Their sleep is worse. They're suffocating. They have more depression. And then they increase the dose. If you're not sleeping well, let's increase the dose. It worsens the sleep apnea. It's a

disaster. So the cleanest medications. Okay, so you don't like those. Which ones do you like? If we're just talking about pure insomnia and supplements, natural strategies, and then looking at a 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 slowly titrating gabapentin. What I like about it is even if someone has low iron levels in their body, they don't know about it. There's a 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. So they don't have the same side effects that Ambien has. No, Ambien is also associated with sleepwalking, sleep talking. Oh, interesting. There are a few sleep, forensic sleep cases there where someone has done something in their sleep. And it's a crime. It's usually a serious crime.

And then... And is the depression that I experienced, is that a common thing or is that just sort of a weird... No, it's definitely possible with Ambien too. Okay. You know, on the labels, there are so many different side effects for each medication but the reason they're all there is because they're one person might be affected even if it may affect one percent of the population what if you're my

patient within that one percent then it's a hundred percent for you right and that's really important right and a lot of my patients take seroquel and they actually get a good response for that for sleep. What's been your experience? Sedating antipsychotic medications like Seroquel or Olanzapine or 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 going to do? It's going to 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. Um, Lunesta.

So low iron goes with insomnia. Yes. Oh, that's not good. And giving iron can actually help. Yes. Insomnia. and giving iron can actually help yes insomnia now does does their iron have to be low in order for it to work for insomnia so they don't have low iron well it depends on whether you're talking about the iron levels or the storage form or the ferritin levels right what i like to test and we all test our patients for this is a favorite in levels of storage form of iron, and it doesn't have to

necessarily be within normal limits. I want to see it 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. Wow. I've just learned so much during this. This is so interesting.

Cause your iron level came back terrible. Always. It's chronically low. So I've upped my ferritin. Yeah. So what's going to happen when you have low iron levels? You'll have less dopamine or your dopamine is not going to work as well. So you'll have more anxiety.

You'll have concentration problems. Yeah, I was like not concentrating as well. And I was feeling kind of funky, just not happy as like, I normally am bubbly. So I increased my baritone. So if you have found this helpful, Dr. Criotto has a brand new course. It's 21 lessons. So interesting.

And it can change your life because change your sleep, change your life. If I miss a half an hour of sleep sleep, change your life. If I miss a half an hour of sleep, it changes my life. So if you're chronically, it changes my life. So if you are chronically sleep deprived, it's just a terrible thing.

So, you know, as the saying goes, we are inundated with, with, with information, but thirsting for wisdom. Yes.

This is the course for people who have been shooting the dark all along, trying to find solutions, struggling with this by themselves. This will give them tailored, directed information and how to improve their sleep in a meaningful way. Well, you are a wealth of information and wisdom on this topic. It's been fascinating. 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. Thank you for being here. If you want to learn more about this course, actually, you want to learn more about this course, go to amynuniversity.com. If you're enjoying the Brain Warriors Way podcast, please don't forget to

subscribe so you'll always know when there's a new episode. And while you're at it, feel free to give us a review or five-star rating as that helps others find the podcast. If you're interested in coming to Amen Clinics, use the code PODCAST10 to get a 10% discount on a full evaluation at amenclinics.com. For more information, give us a call at 855-978-1363.