Hi Sandra, I've been waking up most nights at about 2am and struggling to drop back off to sleep. When it didn't pass after a couple of months I saw my GP and I now have sleeping tablets to help me get some rest in the short-term. Is there anything natural I can take to sort this problem for good? Thanks, Bob.

Hi Bob, thanks for your question. If you've slept well in the past and this is a new challenge for you, then you must do some detective work to find out what has changed, from either a physiological or emotional perspective, since both can contribute to sleep problems. Here are some common scenarios that cause night-time waking and the natural solutions that may help resolve them.

Blood glucose fluctuations: Our blood glucose levels are tightly regulated since every cell in the body needs glucose to function. Blood glucose drops as our glucose stores are used overnight, and the body will release a stored form of glucose called glycogen from the liver to keep our cells supplied with fuel. Hormones released as part of this process include adrenalin, cortisol and glucagon that can stimulate the nervous system. This process should happen without effort but if it becomes impeded due to poor organ health or more severe imbalances in blood glucose, our sleep can be disrupted.

Get tested to make sure your blood glucose levels are well managed. Ensure that your evening meal contains both protein and healthy fats, which help to slow the absorption of carbohydrate and keep blood glucose stable. A small snack before bed or even at 2am on waking can often allow the body to get back to sleep more quickly whilst you work on long-term solutions. Plant medicines that have been clinically proven to help stabilise blood glucose levels include Nettle (Urtica dioica), Cinnamon (Cinnamomum zeylanicum) and Yerba Maté (Ilex paraguariensis). A combination of these consumed as a tea between meals throughout the day can help slow gastric emptying of food and prevent rapid spikes in glucose and insulin. Note that Yerba Maté contains a small amount of caffeine similar to regular tea, so avoid it too late in the evening.

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Poor liver health: Eastern medical systems have long known that body rhythms exist and that our major organs and systems have their own internal clocks that influence everything from body temperature to hormone production. If specific organs are working under par they can interfere with the quality and duration of sleep. In traditional medicine, a specific sign of an under-functioning liver is waking between midnight and 3am. If you notice too that your sleep is worse on nights you consume alcohol, or that you regularly wake overheated, these are signs that your liver may need support.

Consider avoiding alcohol for a time, since it prevents the body entering the deeper stages of sleep. The best option for improving your liver health is the wonderful plant St. Mary's Thistle (Silybum marianum). This herb has the rare ability to restore liver cells when damage has occurred, and it is often prescribed to protect the liver from the effects of pharmaceutical medications when required. For best results, consume daily for 6-12 weeks, however it can be safely taken long term.

Stress and emotional health: Historically, it was considered normal routine for people to wake at some stage of the night and stay awake for a time. Termed the 'night watch', it was a time used for contemplation or meditation. Clinically I have observed that major life changes or periods of stress will trigger this 'night watch'. Putting aside time to contemplate, journal or talk with others during difficult times may support more restful sleep at night. If you are still waking despite your best efforts at managing stress, the well-known medicinal plant Valerian (Valeriana officinalis) can help. It improves the quality and duration of sleep and is excellent for restlessness and anxiety. It is most effective when combined with medicinal preparations of Hops (Humulus lupulus).

Medicinal plants that nourish and relax the nerves such as Passionflower (Passiflora incarnata) and Licorice (Glycyrrhiza glabra) further complement a sleep formula and help to restore normal nervous system function, especially when taken regularly as a night cap. Their significant point of difference to sleeping tablets is that they do not cause sleepiness the following day and are non-addictive.

They are best taken in traditional forms such a medicinal tea or oral liquid, 30-60 minutes before bed. They can be repeated at night if needed and you may find it quite handy to have them ready made in a thermos next to your bed. Adding honey to a medicinal tea is not only delicious, but it helps to counteract insomnia by providing your liver and brain with necessary fuel during the night.

I hope these ideas assist you in finding restorative sleep once again. If this condition worsens or does not improve, see your leading healthcare professional.

References
Flora, K., Hahn, M., Rosen, H., & Benner, K. (1998). Milk thistle (Silybum marianum) for the therapy of liver disease. The American journal of gastroenterology, 93(2), 139-143.
https://www.ncbi.nlm.nih.gov/pubmed/9468229.

Hau, D.-P., Wong, R.-M., Cheng, G.-M., Wong, W.-Y., Tong, S.-W., Chan, K.-W., . . . Lau, F.-Y. (2010). Novel use of silymarin as delayed therapy for acetaminophen-induced acute hepatic injury. Forschende Komplementärmedizin/Research in Complementary Medicine, 17(4), 209-213. https://www.ncbi.nlm.nih.gov/pubmed/20829599

Klein, G. A., Stefanuto, A., Boaventura, B. C. B., de Morais, E. C., Cavalcante, L. d. S., de Andrade, F., . . . da Silva, E. L. (2011). Mate tea (Ilex paraguariensis) improves glycemic and lipid profiles of type 2 diabetes and pre-diabetes individuals: a pilot study. Journal of the American College of Nutrition, 30(5), 320-332. https://www.ncbi.nlm.nih.gov/pubmed/22081618

Koetter, U., Schrader, E., Kaufeler, R., & Brattstrom, A. (2007). A randomised, double blind, placebo-controlled, prospective clinical study to demonstrate clinical efficacy of a fixed valerian hops extract combination (Ze 91019) in patients suffering from non-organic sleep disorder. Phytotherapy Research, 21(9), 847-851. doi:10.1002/ptr.2167

Luangchosiri, C., Thakkinstian, A., Chitphuk, S., Stitchantrakul, W., Petraksa, S., & Sobhonslidsuk, A. (2015). A double-blinded randomised controlled trial of silymarin for the prevention of antituberculosis drug-induced liver injury. BMC Complement Altern Med, 15, 334. doi: 10.1186/s12906-015-0861-7