Chronic fatigue

The lack of restful sleep can affect your ability to carry out daily responsibilities because you are too tired or have trouble concentrating. All types of insomnia can lead to daytime drowsiness, poor concentration, and the inability to feel refreshed and rested in the morning.

Most adults do best with about 8 hours of sleep each night until age 60, after which 6 hours may be enough. Even though the elderly need less sleep, almost one-half of people over 60 experience some degree of insomnia.

The best measure of the amount of sleep needed is how you feel. If you awaken feeling refreshed, you are getting enough sleep. For some people, this may take only 4 hours. Others may need up to 10 hours to feel rested.

Using medications to treat insomnia can be useful in certain situations, but there are potential risks. Antihistamines (the main ingredient in over-the-counter sleeping pills) can lead to dependence, tolerance, and over time may affect your memory. Sedative medication should be used under the close care of a physician because they can also cause dependence and tolerance. Stopping these medications can cause rebound insomnia and withdrawal.

Dr. Jadali’s opinion is that the sleep cycle starts when we are awake. This process is called the sleep-wake cycle that is dependent on a diurnal pattern (a periodic alteration of condition with day and night) of hormonal secretions such as in the Cortisol system. Therefore a thorough evaluation of sleep dysfunction must include the time of sleep onset, the structure of sleep duration, restful feeling or lack of upon awakening, the time of awakening itself and fatigue, or lack of it during the day. Sleep dysfunction is a process of numerous systems involved and must be addressed by considering the entire system and not a partial correction via artificial sleeping aids medication.

It is rare for a life-threatening disease to be the cause of problems with sleep. For many people, poor sleep habits are the cause. However, because insomnia is a key symptom of depression, you should be checked for depression if you are having trouble sleeping.

Insomnia may cause:

• Dark circles under the eyes

• Disorientation

• Fatigue

• Irritability

• Posture changes

• Reduced energy level


Melatonin. Melatonin is a hormone that helps regulates the sleep/wake cycle, an internal pacemaker that regulates the timing and our drive for sleep in humans. It causes drowsiness, lowers body temperature, slows metabolic functions, and puts the body into sleep mode. Research on melatonin in people with insomnia is mixed. One study showed that taking melatonin restored and improved sleep in people with insomnia. Other studies show that melatonin does not help people with insomnia stay asleep. Melatonin is not regulated by the FDA and can have problems with purity. It is only advised for people with circadian rhythm issues, and it should never be given to children or taken by someone on other medications. You should only use melatonin under close supervision by a doctor.

L-Tryptophan. The turkey is often cited as the culprit in after dinner lethargy, but the truth is that you could omit the bird altogether and still feel the effects of the feast. Turkey does contain L-tryptophan, an essential amino acid with a documented sleep-inducing effect. L-tryptophan is used in the body to produce the B-vitamin, niacin. Tryptophan also can be metabolized into serotonin and melatonin, neurotransmitters that exert a calming effect and regulates sleep. However, L-tryptophan needs to be taken on an empty stomach and without any other amino acids or protein in order to make you drowsy. Before taking L-Tryptophan, talk to your doctor about possible drug interactions.

Warm milk. You can put a tasty spin on your grandmother’s natural insomnia remedy by sipping warm milk before bed. Almond milk is an excellent source of calcium, which helps the brain produce melatonin. Plus, warm milk may spark pleasant and relaxing memories of your mother helping you fall asleep.

Magnesium. Magnesium apparently plays a key role in the regulation of sleep. Research has shown that even marginal magnesium deficiency can prevent the brain from settling down at night. One of the most absorbable forms of magnesium is magnesium glycinate, You can also get magnesium from food. Good sources include green leafy vegetables, wheat germ, pumpkin seeds, and almonds.

Lavender. Research has shown that lavender oil is calming and can help encourage sleep in some people with insomnia. “Try taking a hot bath with lavender oil before bed to relax your body and mind,” Harris says.

Valerian root. The medicinal herb valerian root has been used to treat sleep problems since the time of ancient Rome and Greece. “Valerian can be sedating and may help you fall asleep,” Marks says. Research on the effectiveness of valerian for insomnia is mixed, however. Marks says if you try valerian as a sleep remedy, be patient. It can take a few weeks for its sedating properties to take effect. Talk to your doctor before taking valerian and follow label directions.

L-theanine. An amino acid found in green tea leaves, L-theanine can help combat anxiety that interferes with sleep. A 2007 study showed that L-theanine reduced heart rate and immune responses to stress. L-theanine works by increasing the production of the feel-good hormone serotonin. It also induces brain waves that correlate with relaxation. Before taking L-Theanine, talk to your doctor about possible drug interactions.


The following changes to your lifestyle and environment can also help combat sleep problems:

Turn off the TV.

In some people, nighttime light can inhibit melatonin and create “social jetlag,” which mimics symptoms of having traveled several time zones. To keep your sleep surroundings as dark as possible, Ahmed recommends moving the TV out of your bedroom and using a DVR or TIVO to record favorite late-night shows for later viewing.

Put other appliances to bed, too.

If you want a good, restful sleep, turn your appliances away from your bed. Or better yet, turn them off altogether. If you must use bedroom electronics, choose those illuminated with red light, which is less disturbing to melanin production than blue light.

Give it up. 

If you don’t fall asleep within 30 minutes, sleep specialists recommend you get up and leave your bedroom or read. Then return to your bed to sleep when you feel tired again

Exercise early. 

It’s no secret that exercise promotes restful sleep and good overall health. However, a study published in the journal Sleep showed that the amount of exercise and time of day it is done makes a difference. Researchers found that women who exercised at a moderate intensity for at least 30 minutes each morning, seven days a week, had less trouble sleeping than women who exercised less and/or later in the day. Morning exercise seems to affect body rhythms that affect sleep quality.

One of the reasons for this interplay between exercise and sleep may be body temperature. Your body temperature rises during exercise and takes up to 6 hours to drop back down to normal. Because cooler body temperatures are associated with better sleep, it’s important to give your body time to cool off before bed.

Depending on the severity of your sleeping difficulties and also its impact on your general health as well as fatigue and pain, Dr. Jadali always advises finding the root cause of the problem first then attempt to treat. As an example, sending select patients for “SLEEP STUDY” that may reveal lots of information about the architecture of your sleep.

Then, based on the result of the Sleep Study, Dr. Jadali would elaborate on the plan of action. In addition to the aforementioned behavioral modifications and natural remedies for a night of better sleep, you may need to use a CPAP mask or use Hypnotics and Sedatives as prescribed by Dr. Jadali. He also has years of experience of prescribing Xyrem (see below) for selective patients fitting the criteria for this drug.

Xyrem (sodium oxybate) oral solution is indicated for the treatment of excessive daytime sleepiness and cataplexy in patients with narcolepsy.