SleepCheck SleepCheck checks a hormone called melatonin that helps regulate your sleep patterns, mood, and cell functions using a saliva sample. Abnormal melatonin levels can cause insomnia, cardiovascular & ovulation problems, immune disorders, irregular body temp

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Educational Guide

Michael T. Murray, N.D.

"Low melatonin levels can contribute to a poor nights sleep, but taking too much melatonin may create more problems. SleepCheck can help you get your body back in balance and you back to sleep."

Introduction

You should ALWAYS consult with a healthcare provider concerning the attached results and before taking ANY supplement.

This Educational Guide was written by Dr. Michael T. Murray, N.D., a renowned authority in the natural health field and author of over 20 books on health. Information and recommendations provided by Dr. Murray are for informational purposes only and are not intended to be a substitute for consultation with a healthcare provider or other medical professional. Only your healthcare provider should diagnose any health problems you may be experiencing and prescribe treatment as necessary.

BodyBalance, Great Smokies Diagnostic Laboratory, and/or Dr. Michael T. Murray are not responsible or liable for any effects or consequences that may come about as a result of the recommendations contained in this Educational Guide, or BodyBalance health screens. None of the aforementioned parties makes any guarantee, expressed or implied, towards the claims, benefits, or safety of the recommendations and information included in this Educational Guide.

Recommendations from Dr. Murray
If you have trouble getting a good night's sleep, you are not alone. At some point during the course of a year, more than one-half of Americans will experience difficulty falling asleep. For about one-third of the population, insomnia is a regular problem. Each year about ten million prescriptions are written for sleeping aids.

If I could wave a magic wand and provide every one of my patients with one gift, it would a good night's sleep. Although scientists don't completely understand the physiological process of sleep, they do know that it is essential for a fully functioning body and mind. Many of the problems that cause people to seek medical care--depression, chronic fatigue, overall joint and muscle aches (fibromyalgia)--are in fact the result of, or at least worsened by, poor sleep. In my practice, I found that if I could help patients achieve sound, restful sleep, many of their health-related complaints disappear.

SleepCheck is designed to evaluate the secretion of melatonin--a hormone manufactured from the neurotransmitter serotonin and secreted by the pineal gland--a small pea-sized gland at the base of the brain. The sole function of the pineal gland is to manufacture and secrete melatonin.

What is the role of melatonin in the body? 
While the exact function of melatonin is still not completely understood, we do know it plays a critical role in synchronizing your body's hormone secretion. The human body is governed by an internal clock that signals the secretion of various hormones at different times to regulate body functions. This natural biorhythm of hormone secretion is referred to as a "circadian" rhythm. Melatonin plays a key role as the biological time keeper of hormone secretion and also helps regulate sleep/wake cycles. Release of melatonin is stimulated by darkness and suppressed by light via a complex pathway which connects the pineal gland to the retina.1

Why should I measure my melatonin levels? 
SleepCheck can help determine if low or high melatonin levels may be harming your health. It has been shown that low melatonin levels may contribute to insomnia, sleep/wake disorders, disturbed mood, and other health disorders. High levels may bring about inhibition of ovulation, mood disorders, or a decreased body temperature. SleepCheck can also be used to monitor the dosage of supplemental melatonin.

How do I interpret the results of the SleepCheck? 
Here are five basic patterns of melatonin secretion along with my recommendations. Please note that these recommendations are for informational purposes only. You may want to discuss the appropriateness of these recommendations with your primary healthcare provider.

Normal--If your melatonin levels are in the normal range, no additional action is needed. 
Low nighttime, high daytime--This pattern represents what is referred to as a "sleep-wake disturbance."  More than likely, if you have this pattern, you probably experience difficulty in sleeping at night (perhaps even insomnia) along with excessive daytime sleepiness. Here are the key recommendations: 

• Be aware that certain drugs can lead to this pattern, most notably: caffeine, alcohol, tobacco, non- anti-inflammatory drugs (NSAIDS) like aspirin and ibuprofen, anti-anxiety drugs like Valium and Halcion; antidepressant drugs like Prozac, Zoloft, and Paxil; high blood pressure medicines (beta-blockers, adrenergics, and calcium channel blockers), and steroids like prednisone. If possible, avoid use of melatonin-lowering substances at night. 
• Evening supplementation with melatonin (usually 3 mg 45 minutes before sleep) will often help improve sleep quality, but will often create morning sleepiness. If this situation occurs, taking 1.5 to 3 mg of methylcobalamin (the active form of vitamin B12) orally the first thing in the morning can reset proper melatonin secretion, improve mental function and eliminate daytime sleepiness (discussed in more detail below). 
• If you exercise in the evening, switch to the morning. Evening exercise can decrease melatonin levels up to three hours after the end of exercise. To reduce daytime melatonin levels, it is wise to avoid melatonin-containing foods such as oats, corn, rice, Japanese radish, ginger, tomatoes, bananas, and barley. It is also a good idea to avoid foods high in tryptophan (melatonin precursor) such as milk and all dairy products, chicken liver, pumpkin seeds, turkey, chicken, watermelon seeds, almonds, peanuts, and brewer's yeast. Conversely, these same foods can be used to increase nighttime melatonin production. Increase morning exposure to bright light to lower daytime melatonin production and decrease evening exposure to bright light to increase nighttime melatonin production.
• Do not use electric blankets. Electromagnetic radiation can suppress melatonin secretion. 

Low nighttime, normal or low daytime--You likely suffer from insomnia with this pattern. Try increasing the intake of melatonin and tryptophan-containing foods (see above). If after 4 days this approach does not improve your sleep, try taking 3 mg of melatonin 45 minutes before sleep. Be sure to follow all of the other recommendations given above and be sure to take a high potency multiple vitamin and mineral formula to provide the necessary nutrients (vitamin B6, magnesium, B12, vitamin C, and folic acid) necessary for proper manufacture of melatonin. 

High nighttime, high daytime--This pattern is usually the result of taking too much melatonin. Cut back the dosage and reevaluate. If you are not taking melatonin and you have this pattern, more than likely, you have significant hormonal disturbances. These sorts of disturbances are more obvious in women and may include menstrual abnormalities or even infertility. Taking 1.5 -3 mg of methylcobalamin (the active form of vitamin B12) orally the first thing in the morning may help reset proper melatonin secretion. 

High nighttime, normal or low daytime--This pattern is usually the result of taking too much melatonin. Cut back the dosage and reevaluate. If you are not taking melatonin and you have this pattern, it is important to increase your daily exposure to sunlight or bright light.

Why should I avoid bright light at night if I have low nighttime melatonin levels? 
Exposure to bright light at night for more than just a few minutes rapidly reduces melatonin production.2,3 We can use this same effect during the day to help reset proper melatonin synthesis and secretion by the pineal gland.

Is melatonin really an effective treatment of insomnia?
Yes, but only if melatonin levels are low. Melatonin plays an important role in the induction of sleep. Several double-blind trials have shown melatonin supplementation to be very effective in promoting sleep and relieving insomnia.4-8   However, the sleep-promoting effects of melatonin are most apparent when melatonin levels are low.9   In other words, melatonin is not like taking a sleeping pill. It will only produce its effects in individuals with a melatonin deficiency. When melatonin is given just before going to bed to healthy subjects or to patients with insomnia who have normal melatonin levels, it produces no sedative effect. That is because, normally, just prior to going to bed, there is a rise in melatonin secretion. Melatonin supplementation is only effective as a sedative when the pineal gland's own production of melatonin is very low. However, low melatonin levels are thought to be an extremely common cause of insomnia in the elderly.10

In one of the most interesting studies, 26 elderly insomniacs with lower than normal melatonin levels were given 1-2 mg of melatonin two hours prior to the desired bedtime for one week. Rapid and slow release melatonin preparations were used. Both the time required to achieve sleep and sleep quality were evaluated. While there was no discernible difference in sleep onset and sleep efficiency (percent of time asleep of total time in bed) between the two forms, the timed-release form yielded better results on sleep maintenance (fewer nighttime awakenings).11

Why do you recommend vitamin B12 for high daytime melatonin levels?
Actually, I recommend B12 with both high and low melatonin levels, as it plays a major role in normal melatonin secretion.12   Low levels of melatonin (especially in the elderly) may be a result of low vitamin B12 status. Vitamin B12 is available in several forms. The most common form is cyanocobalamin. However, vitamin B12 is most active in the form of methylcobalamin. While methylcobalamin is active immediately upon absorption, cyanocobalamin must be converted to methylcobalamin by the body removing the cyanide molecule (the amount of cyanide produced in this process is extremely small) and adding a methyl group. Cyanocobalamin is not as actively effective as methylcobalamin in improving melatonin secretion.13,14

Several studies have shown methlcobalamin (dosage 1.5 to 3 mg) is an effective treatment of sleep-wake disorders (shift workers, excessive daytime sleepiness, restless nights, and frequent nighttime awakenings) attributed to abnormal melatonin secretion.13,14   Subjects taking methylcobalamin experience improved sleep quality, increased daytime alertness and concentration, and in some cases improved mood. Much of the benefit appears to be a result of the methylcobalamin influencing melatonin secretion. However, benefit may also be a result of unmasking low brain levels of methylcobalamin. A low level of methylcobalamin is one of the most common nutrient deficiencies, especially in the elderly. The low levels of melatonin in the elderly may be a result of low vitamin B12 status.

How much melatonin should I take?
At this time, it appears that melatonin therapy is most appropriate for use when low melatonin levels are suspected, as in some cases of insomnia and jet lag. Evaluation of salivary melatonin levels can provide valuable diagnostic insight as to the likely success or failure of melatonin in the treatment of insomnia. A dosage of 3 mg at bedtime is more than enough, since dosages as low as 0.1 mg and 0.3 mg have been shown to produce a sedative effect when melatonin levels are low.15

Are there any side effects with melatonin?
Although there appear to be no serious side effects at recommended dosages to adults, conceivably, too much melatonin supplementation could disrupt the normal circadian rhythm. In one study, a daily dosage of 8 mg a day for only four days resulted in significant alteration in circadian rhythm.16   Children and adolescents should not use melatonin unless under direct medical supervision.

Do you have any other recommendations for getting a good night's sleep?
Yes. Here are ten tips to improve your quality of sleep.

• Avoid sleep inhibitors, especially caffeine and alcohol.
• Go to bed the same time every night: 10 p.m. is best, as the mind is naturally drowsier at this time.
• Bed and bedroom should be comfortable. Wear bedclothes of natural fibers. The room temperature should be comfortably cool.
• Avoid using the bedroom for activities such as reading, working, watching TV. Bedroom should be associated with sleeping, not activity.
• Sensory input just before sleep should be soothing: soft music, soft lights, incense or aromatherapy oils.
• If you eat bedtime snacks, choose whole grain cereals and breads to keep blood sugar levels steady throughout the night and to increase serotonin levels within the brain.
• Avoid all focused work at least 30 to 60 minutes before bedtime.
• Take a hot bath or shower 30 to 60 minutes before bedtime to relax you, as well as to stimulate the release of melatonin.
• Get regular exercise, but avoid exercising two hours or less before bed.
• Some people benefit by taking plant products known to promote sleep, such as passionflower (300-450 mg of dry powdered extract) or valerian (150-300 mg of dry powdered extract), 45 minutes before bedtime.

Glossary

Circadian rhythm--In regards to your sleep/wake cycle, circadian rhythm is the 24-hour cycle of light and dark that your body runs upon.

Diagnostic--Testing that is related to the determination of the nature of a disease in a person. BodyBalance health screens are processed by Great Smokies Diagnostic Laboratory, which strongly follows diagnostic principles of healthcare.

Double-blind trials--A clinical trial or experiment in which neither the subject, nor the administrator of the testing knows which treatment a subject may be receiving.

Passionflower--A classification of plants originating in warmer climates that are medicinally used for their natural sedative effects. One of the contents of passionflower is harmine, which was often used by the Germans during World War 11 as a "truth serum."

Pineal Gland--A tiny gland located in the base of the brain which controls the regulation of serotonin and melatonin into your system. Serotonin and melatonin are responsible for nerve transmission and sleep patterns.

Ovulation--The discharge of a mature egg (the female reproductive cell) from the ovary in the process of fertilization, and eventually, impregnation.

Retina--An inner sensory membrane of the eyeball which functions as the immediate instrument of vision by converting visual stimuli into signals which the brain receives and then transmits to the appropriate locations in the body.

Serotonin--An initiator of melatonin, serotonin inhibits gastric secretion and serves as a central neurotransmitter in the body.

Valerian--A plant mostly used medicinally as a sedative and to reduce high blood pressure. A study showed that an extract of valerian greatly improved sleep quality.

References

1. Yu HS and Reiter RJ (eds.). Melatonin biosynthesis, physiological effects and clinical applications. CRC Press, Boca Raton, USA, 1993.

2. Illnerova H. Entrainment of mammalian circadian rhythms in 	melatonin production by light. Pineal Res Rev 1988; 6:173-217.

3. Reiter RJ. Action spectra, dose response relationships and temporal aspects of light's effects on the pineal gland; The Medical and Biological Effects of Light. Ann NY Acad Sci 1985; 453:215-230.

4. Waldhauser F, Saletu B and Trinchard-Lugan I. Sleep laboratory investigations on hypnotic properties of melatonin. Psychopharmacology 1990; 100:222-6.

5. Zhdanova IV, et al. Sleep-inducing effects of low doses of melatonin ingested in the evening. Clin Pharmacol Ther1995; 57:552-8.

6. Dahlitz M, et al. Delayed sleep phase syndrome response to melatonin. Lancet 1991; 337:1121-4.

7. MacFarlane JG, et al. The effects of exogenous melatonin on the total sleep time and daytime alertness of chronic insomniacs: a preliminary study. Biol Psychiatry 1991; 30:371-6.

8. James SP, et al. Melatonin administration in insomnia. Neuropsychopharmacology 1990; 3:19-23.

9. Nave R, Peled R and Lavie P. Melatonin improves evening napping. Eur J Pharmacol 1995; 275:213-6.

10. Haimov I, et al. Sleep disorders and melatonin rhythms elderly people. BMJ 1994; 309:167.

11. Haimov I, et al. Melatonin replacement therapy therapy of elderly insomniacs. Sleep 1995; 18:598-603.

12. Honma K, et al. Effects of vitamin B12 on plasma melatonin rhythm in humans: Increased light sensitivity phase-advances the circadian clock? Experentia 1992; 48:716-20.

13. Okawa M, et al. Vitamin B12 treatment for sleep-wake rhythm disorders. Sleep 1990; 13:1-23.

14. Mayer G, Kroger M and Meier-Ewert K. Effects of vitamin B12 on performance and circadian rhythm in normal subjects. Neuropsychopharmacol 1996; 15:456-64.

15. Dollins AB, et al. Effect of inducing nocturnal serum melatonin concentrations in daytime on sleep, mood, body temperature, and performance. Proc Natl Acad Sci USA 1994; 91:1824-8.

16. Mallo C, et al. Effects of a four-day nocturnal melatonin treatment on the 24 h plasma melatonin, cortisol and prolactin profiles in humans. Acta Endocrinologia 1988; 119:474-80.

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