Insomnia

 

CASE STUDY: Insomnia

SUBMITTED BY: Phil Rasmussen

PATIENT: Female, age 39

INITIAL PRESENTATION:

Patient presented complaining of a lack of sleep and wanted to explore herbal options rather than using too many pharmaceutical treatments. She was a pleasant and health-conscious person, who lived alone and informed me that she put high standards on herself. She was a part-time yoga teacher and actively pursued an ideal work-life harmony but had a history of debilitating anxiety and sleeping problems, secondary to PTSD and a dysfunctional relationship that ended nearly 3 years ago.

The patient had recently begun studying at university but found it very challenging. Covid-19 related lockdowns had meant an end to her usual yoga classes, and there was some financial stress. This, combined with her university course shifting online, meant less contact with other people, and she was struggling with the workload. While she was still exercising and eating well, and was generally still positive, some anxiety had returned, along with disturbed sleep. The main problem was frequent waking around 3.30am – 4am, and she found it very difficult to go back to sleep. She had tried different dietary supplements for sleep, listening to relaxing music, reading, and burning some lavender oil, but none of these seemed to help. Her sleep had been particularly ‘terrible’ for the last 3 weeks.

The patient started taking melatonin 10mg tablets, and while she initially thought this helped, it did not seem to be working lately. She recently obtained a prescription for the sleeping tablet zopiclone from her GP. While this improved sleep, she didn’t feel great the next morning and was worried about developing dependency.

No caffeine was being consumed, and rarely alcohol. Apart from increased anxiety and fatigue associated with sleep disturbance, and food aversion during stress, she seemed otherwise in good physical health.

HERBAL TREATMENT

Main Mix

Withania (Withania somnifera) 3:2 std 60mL

Ginkgo (Ginkgo biloba) 3:2 std 50mL

Lemon balm (Melissa officinalis) 1:2 80mL
Liquorice (Glycyrrhiza glabra) 1:1 10mL

Total 200mL

Dosage

8mL twice daily, with water or juice. Shake well before dispensing.

Sleep Mix

Kava (Piper methysticum) 1:2 std 60mL

Passionflower (Passiflora incarnata) 1:2 35mL

Liquorice (Glycyrrhiza glabra) 1:1 5mL

Total 100mL

Dosage

10-15mL at night if required, with water or juice. Shake well before dispensing.

ADDITIONAL TREATMENT RECOMMENDATIONS

We discussed the potential benefits of joining a study group to obtain some peer support and provide opportunities for more socialisation. I also suggested regular massage from a colleague, and perhaps offering yoga tuition in exchange for this.

The Main Mix was to be taken twice daily on a regular basis, while the Sleep Mixture should be taken just at night, shortly before bed. She should start with a 10mL dose the first evening, and if her sleep did not improve after a couple of nights of this, she should increase the dose to 15mL. If this did not seem to help after trying for 2-3 nights, she should let me know and we would try a different mixture.

I also advised her to take a break from melatonin while she pursued the herbal treatment.

FOLLOW-UP

2-weeks later: She was starting to feel a bit better only waking 2-3 times a week now, instead of most nights. She had not found 10mL of the sleeping mix to help much but thought 15mL was really good. She had run out a few days ago and decided to wait until our next consultation to request more. She had not slept well the previous night, waking just after 3am. Patient had not taken further zopiclone but took melatonin intermittently.

She had met face to face with other students doing the same course, and they decided to get together regularly to support each other with study and assignments. She was feeling less stressed by her situation, and her parents had provided financial support to help her. She also decided to take a break from yoga teaching but booked a massage for the following week and intended to discuss an exchange arrangement with the practitioner for this.

We repeated the Main Mix for 4 weeks and repeated the Sleep Mix at 200mL.

6 weeks later: The patient was continuing to feel a bit better. She had recently sat a test and felt she had done OK and was keeping up with assignments. She expressed that she found it challenging to concentrate at times. The study group was going well, and she had developed friendships. She also had a couple of massages, which she really enjoyed, and she was in a much better space. Her early morning waking was now occurring only once or twice every couple of weeks, and she was not particularly stressed by this.

She had reduced the Sleep Mix to 10mL most nights, and occasionally took none, but still took 15mL on occasion.

I have increased Ginkgo in her Main Mix and repeated the Sleep Mix. I reiterated the importance of continuing the Main Mix as a preventative and support tonic and using the Sleep Mix as needed.

Main Mix

Withania (Withania somnifera) 3:2 std 150mL

Ginkgo (Ginkgo biloba) 3:2 std 150mL

Lemon balm (Melissa officinalis) 1:2 175mL

Liquorice (Glycyrrhiza glabra) 1:1 25mL

Total 500mL

Dosage

8mL twice daily, with water or juice. Shake well before dispensing.