We do not intend the information that we provide here to be used as a diagnostic tool. Do not use it to arrive at or exclude a diagnosis. Our intention in providing information about a psychological-emotional ailment is so you can recognize some of the features of this ailment.

Do not use this as a substitute for professional evaluation or professional treatment.

If you have a problem, you should first consult a licensed mental health professional to assess the severity of the problem. Try to find a mental health professional who is sympathetic or at least not opposed to the concept of using alternative medicine for psychological-emotional ailments. Then, seek a licensed practitioner for the particular form of alternative therapy, e.g. herbalist, acupuncturist, naturopath, etc. Stay in consultation with the mental health professional to monitor your progress.

Traditional psychiatric treatment must be sought if a mental disorder is so severe that the sufferer is suicidal or dangerous to others or his or her ability to function at home or work is severely impaired.

Use alternative medicine as a temporary aid to give you the symptomatic relief. As your symptoms are lessened and stress is reduced, learn the coping skills you need. Make appropriate emotional changes. Do not use alternative medicine in lieu of coping skills and emotional education. You must learn how your thoughts, feelings, attitudes, perceptions, and behaviors contribute to your psychological-emotional ailments.

Psychological techniques and self-help measures are alluded to, but not discussed in detail in order to keep this presentation brief. Refer to other books, tapes, and magazines to learn about how you can make use of such psychological techniques and self-help measures to benefit you.

Make your goal to reach the state of self-sufficiency and self-reliance, that is, that eventually, you will not be needing a traditional medicine specialist, alternative therapist, or a counseling professional. For example, you will have the necessary skills to handle your tendency for depression, anxiety, or addiction.

THE ELDERLY

We look forward to week-ends and holidays, not always for that big vacation in the dreamland. Often, its the joy of getting up late or to sleeping in as long as we desire. In the same way, for years and years of our working life, we look forward to retirement. Retirement stands for freedom, freedom to go to bed anytime and get up any time we want to. Oh what a golden period that is, when you don’t have to follow any external requirements, rules, or regulations; at last you are "routine free."

Like it or not, sleep follows its own laws which have no consideration or respect for man-made systems, whether that is a short week-end or the big retirement. The fact is, sleep illudes us when we have all the time in the world to sleep. We progressively sleep less as we age. When we reach the seventies and eighties, our dream-sleep is drastically reduced and deep-sleep is almost gone.

Sleep-laboratory studies point out that an 80-year old takes 18 minutes to fall asleep, has dream sleep for about an hour. With only a few minutes, if any, in the deep sleep stage, total time of sleep is reduced to about six hours. note that about 85% of the sleep-time is spent in light sleep. Elderly people wake up many times in the night and stay awake for long hours. When my father was in his nineties, he hardly slept in the night. Whenever I woke up in the night, I saw him either sitting quietly, praying, or groping for some personal article under his pillow and mattress.

Compare this with the sleep pattern of a 20-year old. This young person takes about 8 minutes to fall asleep, spends only 5% of the sleep time in light sleep, dream-sleeps about two hours, deep-sleep for three hours --total sleep time about eight hours. That quality of sleep is only a "dream" for the elderly.

No sleeping pill can provide a long-term solution to the problem of sleeplessness. Moreover, sleeping pills can make a problem callled "sleep apnea" worse. Sleep apnea is a condition that is often present in the elderly which causes the breathing to stop for brief periods during the night. Older people on sleeping pills may wake up confused in the middle of the night and may fall and hurt themselves as a result of that. Certain types of sleeping pills may complicate problems of high blood pressure, heart disease, and other medical conditions that are typical of old age.

In the case of long-term medication for chronic sleeplessness, a low-dose antidepressant may be more suitable than sleeping pills in some cases. Those who take sleeping pills over two weeks, should discuss with their doctor if they can skip taking sleeping pills for a night or two. Elderly persons on sleeping medication should monitor themselves for any daytime "fogginess" "cloudiness" or "hangover" feeling. Many doctors are of the opinion that sleeping pills should not be used for more than a month.

Here are a few self-help suggestions to get some relief from sleeping troubles:

1. Follow a regular routine. Set a specific time for waking, eating, and exercise, and then follow it consistently.

2. Resist the urge to nap during the day. If you must take a nap, limit it to a maximum of 30 minutes. Longer naps during the day make it harder to sleep in the night.

3. Do something relaxing prior to going to bed such as, soaking in a warm tub, back massage, listening to soft music, etc.

4. Stay out of bed until you are ready to sleep, but get up in the morning at the usual fixed hour. Don’t go to bed too early. Let your body determine when it’s time to sleep. This way, you will probably wake up less often in the night and the quality of sleep might be better.

5. Limit your bedtime to about seven hours. Staying in bed for longer hours compromises the quality of sleep. In the morning, when you get up at the usual hour but don’t feel like doing anything, go sit in the porch. Listen to the radio or do anything, but stay out of that bed.

6. Exercise in the day is important for a good night’s sleep and for general health. Light exercise promotes the feeling of general well-being and helps one to stay active. Exercises to strengthen muscles are being touted these days as means to reverse the process of aging. A gym specifically designed for the elderly has a slogan, "Flex your muscles and take years off you."

7. Eating light nutritious meals and cutting down on nicotine, caffeine, and alcohol, are helpful for better sleep.

8. What one does in the day determines what kind of night one has. Stay mentally and physically active in the day, have some social activities and other activities you enjoy, and the night is likely to be more pleasant.

Insomnia is rarely diagnosed as a disorder in its own right, so it's impact on our society is not fully noticed. Insomnia is generally seen as part of some other disorder. Chronic insomnia can decrease productivity at work, impair concentration and attention, and may cause accidents while driving or operating machinery. Insomnia affects twenty to forty percent adults. Women and elderly are more likely to be the victims of insomnia. There are three types of insomnia: 1. "Initial" insomnia, that is, after turning out the lights, it takes longer than 30 minutes before one can fall asleep. 2. "Middle" insomnia, that is, after going to sleep, one has difficulty in maintaining sleep and remains awake for more than 30 minutes before the morning waking time. 3. "Late" or "terminal" insomnia, that is, premature awakening in the morning with less than 6.5 hour of sleep. A minimum of 6.5 hours of sleep is considered standard requirement because two thirds of adults report between 7 to 8.5 hours of sleep per night. However, some people may need more or fewer hours of sleep. One third of adults are either "short sleepers," needing 4 to 5 hours of sleep or "long sleepers" needing 9 to 10 hours of sleep. We first determine how much sleep one requires and how much sleep he or she is actually getting. A person with insomnia may have one or all the three problems, the initial , middle, and late insomnia or, a combination of any two. Insomnia is also evaluated by the "sleep efficiency." Sleep efficiency is computed by the number of sleep hours over the total hours in bed. The sleep hours should be 85% of the total time in bed. If a person was in bed for eight hours, of which he was awake 2 hours, his sleep hours filled only 75% of the total time in bed. Sleep efficiency in this case was poor.

Insomnia is treated inadequately and generally limited to a prescription of sleeping pills. Sleeping pills work for a short time as the patient develops a tolerance for the pills and requires more and more medication. Other factors, such as, a physical or a mental disorder, family, health, and work-related stress, divorce, separation, and grief, may cause insomnia, and need to be dealt with first. Treatment of a long-term insomnia, includes giving up faulty sleeping habits and developing good sleeping habits. Faulty habits that contribute to insomnia: 1. Going to bed when you are wide awake and your body and mind do not want to do anything with sleeping. 2. Staying in bed awake too long, even though you can't fall sleep. Occupying the mind with problem solving, thinking, worrying, etc., makes mind more awake. 3. Lying in bed awake and trying harder and harder to go to sleep only increases anxiety and frustration which makes the sleeping problem worse. 4. Oversleeping in the morning hours on weekdays or weekends may not be a problem for others but it has a harmful effect on a person with insomnia. 5. Reading a book or watching TV in bed induces sleep in some people, but if you do not fall asleep in 30 minutes, it can make your sleep problem worse. 6. If you fall asleep in places, other than bed, you get out of the habit of sleeping in bed.

Good sleeping habits induce sleep. 1. Avoid caffeine and alcohol in any form, four to six hours before bed time. 2. Avoid nicotine near bedtime and upon awaking during night. 3. Avoid a heavy meal in the evening. On the other hand, a light snack before bed time may be sleep inducing. 4. Avoid vigorous exercise within 3-4 hours of bed time. On the other hand, regular exercise in the late afternoon may deepen sleep. 5. Minimize noise, light, excessive temperature during sleep by using ear plugs, window blinds, electrical blanket/ air conditioner, etc. 6. Spend no more than 8 hours in bed per night. 9. If you must take a daytime nap, keep it less than an hour and complete it before 3 p.m. 10 Go to bed only when sleepy. 11. Get out of bed when unable to fall asleep for more than 30 minutes and return to sleep within 30 minutes. During this time, do only a manual activity or count your breaths while breathing abdominally. 12. Repeat this procedure as often as necessary. 13. Arise at the same time every morning. 13. Practice relaxation technique 14. Do not use your bed and the bedroom for non-sleeping activities, such as eating, paying bills, talking on phone, etc. Bed/bedroom should be used for sleeping purposes only. I need to clarify something here real quickly. When I ordain this last rule, I am not suggesting celibacy is the cure for insomnia. I mean, with reasonable exceptions, use your bed and bedroom for sleeping activity only!

Scientific Evidence For Valerian as a Sleeping Pill

European manufacturers of phytomedicines (plant medicines) have petitioned the FDA to allow claims for valerian as an over-the-counter nighttime sleeping "aid," defined as an agent that relaxes and mildly sedates. More than 200 scientific studies on the pharmacology of valerian have been published in the scientific literature, mostly in Europe in the last thirty years.

Six controlled clinical trials in Europe show that valerian is particularly effective for sleep problems, as follows:

Shorten the time to fall asleep

Prolong sleep time

Increase deep sleep stages

Increase dreaming

Reduce nighttime awakenings

Improve the quality of sleep in both normal sleepers and insomniacs.

In an impressive study, 128 volunteers participated at the Nestle( Research Laboratories in Switzerland in the mid-1980s. For three nights at time they took either valerian extract or a sugar pill without knowing what they were taking. Valerian won out. Thirty-seven percent on valerian said they fell asleep faster, compared with 23 percent on placebo. Further, 43 percent said they slept better versus 25 percent on placebo. Even 45 percent of good sleepers said they "slept better then usual" on valerian. But habitually bad sleepers got the most benefit.

In another study, a double-blind Swedish study, Valerian was the winner. Forty-four percent of poor sleepers said they had "perfect sleep" after taking a product with 400 milligrams of valerian. Eighty-nine percent said their sleep improved.

In another study, Valerian equaled the powerful drug Halcion as a sleeping pill. A 1992 German study compared a combination valerian pill (160 milligrams of valerian and 80 milligrams lemon balm) with Halcion (0.125 milligrams triazolam) in twenty people, ages thirty to fifty. Over a period of nine nights, the valerian combination put subjects to sleep just as fast and produced the same sound sleep as Halcion. It was most effective in so-called bad sleepers. However, unlike the valerian takers, the Halcion users suffered hangovers and loss of concentration the next day.

The herb does not produce morning hangovers of drowsiness, reduction in concentration, and impaired physical performance. Nor does it interact with alcohol to accentuate impairment as do prescription drugs. A 1995 German Study found no interaction between alcohol and valerian that lessened concentration, and impaired physical performance in driving a car. In short, valerian is okay to take when you are awake and active, as well as when you are going to sleep, making it much more desirable, especially in cases when a person simply wants to put a mild damper on anxiety or stress during the day. However, valerian is only for mild to moderate anxiety problems.

How Does It Work?

The mechanism of valerian in the brain appears similar to that of the benzodiazepine drugs-Halcion and Valium. These tend to sedate by stimulating activity of the nerve transmitter GABA (gamma-aminobutyric acid), which dampens the brain’s arousal system. In animals, valerian does the same thing, triggering release of GABA from the brain cortex. In mice, both valerian and Valium prolong sleep. Research at the Institute of Pharmaceutical Biology in Barburg, Germany, showed that sedating constituents in valerian can bind to the same receptor sites on brain cells as barbiturates and benzodiazepines. In fact, valerian bounced benzodiazepines off the receptor sites of anima brain cells.

Which constituents in valerian sedate the central nervous system is still a matter of dispute. Several have been identified, including valerenic acid and valepotriates, chemicals unique to valerian. Valerenic acid is a prime constituent in European products and is often combined with other mildly sedating herbs, such as lemon balm, passion flower, and chamomile. According to naturalist Stephen Foster, more that 120 active chemicals have been detected in valerian. Foster suggests that a combination of valerian’s compounds work together synergistically to promote sedation.

Usages:

To help you relax, sleep better, calm down in moments of mild anxiety and stress-even before giving a speech or before getting on an airplane if you are afraid to fly-or as a muscle relaxant. You can take it during the day or at night for sleep. Valerian can also ease the symptoms of withdrawing from Xanax, Valium, and other benzodiazepines and can serve as a substitute for these drugs in people with mild to moderate anxiety and insomnia.

Dosage:

Start out with a low dose and, if needed, work up to a higher dose. For use as a sleeping pill, Dr. Donald Brown recommends taking 300 to 500 milligrams of a standardized valerian extract about an hour before bedtime. Cut that dose in half when taking valerian as a mild tranquilizer to quiet anxiety during the day, he says. On hundred fifty to 300 milligrams translates into one-half to one teaspoonful as a fluid extract, and one to one and a half teaspoons as a tincture. You should notice effects within thirty to forty-five minutes.

Side Effects:

Side effects at recommended doses are minor. Most common is occasional stomach upset. However, in large doses valerian could cause headache, restlessness, nausea, and morning grogginess. (If you are sleepy or groggy the next morning, the dosage may be too high for you; simply reduce the amount you are taking. Valerian, unlike prescription sleeping pills, is not addictive or a cause of any mental disturbances. There are no reports in animals or humans of serious poisoning or death from overdoses of valerian. However, some clinicians have noted that some individuals have an idiosyncratic (opposite to what is expected) response to valerian; they become more excited and revved up instead of relaxed and calm.

Valerian, at an overdose of 20 grams (20,000 milligrams) is not acutely poisonous. The Food and Drug Administration lists valerian as GRAS (generally recognized as safe).

Cautions:

Use valerian for mild anxiety and sleep problems. If you have serious anxiety or insomnia or have been diagnosed with or treated for psychiatric problems, or are taking other psychiatric drugs of any kind, consult your doctor before self-treating with valerian. Because of the possibility of withdrawal symptoms, switching from prescription drugs to valerium should be done under the supervision of a doctor. Valerian is not advised for pregnant or lactating women, children under age two, or in combination with other over-the-counter or prescription tranquilizers or sedatives.

Important: If you have chronic insomnia, you should also go easy on caffeine; high doses of caffeine can neutralize some of the sedating effects of valerian.

Most of the European research has been done on standardized valerian products. To get this research-grade valerian, look for labels indicating water-soluble extracts "standardized" for valerenic acid content (0.8 percent valerenic acid).