Insomnia

Case study: Insomnia 

Client: 27-year-old female 

Initial presentation: 

The client, a 27-year-old female, presents with sleep onset and maintenance concerns.  She experiences an inability to fall asleep at night even when tired, she finally falls asleep in the early hours of the morning to only be woken again.  In total she gets just 4-5 hours of sleep most nights.  She finds her mind racing with thoughts about work, family, and her personal life, which prevents her from relaxing sufficient to fall asleep. 

The client experiences persistent feelings of anxiety throughout the day.  She also mentioned that her anxiety exacerbates her sleep problems, as her mind remains active long after she has gone to bed and tried to fall asleep. 

Due to her lack of sleep and ongoing anxiety, the client experiences symptoms of emotional and physical fatigue.  She often feels irritable and unable to focus during the day, which affects her work performance.  At times, she finds herself feeling emotionally drained by the end of her shift and struggles to engage with social activities or hobbies.  Her anxiety manifests in physical symptoms including headaches, increased heart rate, and occasional stomach discomfort. 

Her diet consists of mostly of smoothies for breakfast, a wrap and apple for lunch and sushi picked up from the store next to her work.  She feels too tired to cook dinner and tries to pick up something healthy.  She doesn’t drink alcoholand she drinks 2L of water most days.  

Naturopathic assessment: 

27-year-old female presenting with insomnia, anxiety, and fatigue.  Likely caused by HPA-dysregulation, poor sleep hygiene, dietary imbalances, and possible nutrient deficiencies. 

Key factors considered: 

HPA-axis dysregulation: A dysregulated HPA axis can lead to elevated cortisol levels, causing increased anxiety and difficulty relaxing, which disrupts sleep by preventing the body from winding down at night.  This imbalance also affects melatonin production, further hindering the ability to fall and stay asleep, creating a cycle of poor sleep and heightened stress. 

Poor sleep hygiene: Inconsistent sleep schedule, overactive mind at bedtime, and inadequate sleep duration are contributing to her inability to fall and stay asleep. 

Dietary imbalances: The client’s diet lacks adequate protein and healthy fats, which are essential for stabilising blood sugar levels and reducing fatigue.  Additionally, her meals may be lacking key nutrients that support mental and physical relaxation, such as magnesium. 

Nutrient deficiencies: Her diet may be insufficient in magnesium, omega-3 fatty acids, and certain B vitamins e essential for supporting sleep, reducing anxiety, and promoting overall well-being. 

 

Herbal formula: 

Lavender (Lavandula angustifolia): Known for its calming properties, lavender helps reduce anxiety and supports relaxation, which helps both sleep onset and maintenance. 

Passionflower (Passiflora incarnata): Used to ease anxiety and support sleep without the sedative effects, making it a good option for daytime use. 

Lemon Balm (Melissa officinalis): Mildly sedative and calming, it can help with anxiety and promote better sleep. 

Ashwagandha (Withania somnifera): An adaptogen that helps manage stress and anxiety, while supporting energy levels and reducing fatigue. 

Oats (Avena sativa): A calming and relaxing herb, it helps with muscle tension and supports deeper sleep. 

Herbal formula: 

Lavender: 60 mL 

Passionflower: 80 mL 

Lemon Balm: 80 mL 

Ashwagandha: 80 mL 

Oat Straw: 100 mL 

Total: 400 mL 

Dosage: 5mL 3x daily  

 

Additional recommendations: 

Dietary modifications: 

Breakfast: Add protein and healthy fats to smoothies (e.g., chia seeds, flaxseeds, almond butter, or protein powder) to ensure balanced blood sugar levels and sustained energy throughout the morning. 

Lunch: Focus on incorporating lean proteins (chicken, turkey, tofu), healthy fats (avocados, olive oil) and a variety of colourful vegetables (leafy greens) into her wrap to help stabilise energy and improve nutrient intake. 

Snacks: Include protein-rich snacks such as boiled eggs, hummus with vegetables, or a handful of nuts to maintainenergy levels and prevent blood sugar dips. 

 

Sleep hygiene: 

Evening routine: Establish a relaxing evening routine that involves calming activities such as reading, light stretching, or warm shower.  Avoid screen time for at least 30–60 minutes before bed to reduce blue light exposure. 

Sleep environment: Ensure the bedroom is cool, dark, and quiet.  If necessary, use white noise to block disruptive sounds.  Invest in comfortable bedding that promotes relaxation. 

Consistent sleep schedule: Encourage the client to go to bed and wake up at the same time every day to help regulate her circadian rhythm and promote better sleep quality. 

 

Stress management: 

Mindfulness meditation: Practice daily mindfulness or guided meditation for 10–15 minutes to promote relaxation and reduce anxiety. 

Breathing exercises: Use deep breathing techniques such as diaphragmic to activate the parasympathetic nervous system and reduce anxiety. 

Exercise: Incorporate regular physical activity, such as walking, yoga, or swimming, to reduce stress and improve sleep quality.  Start slow and increase the time each day when energy increases.  

Work-related stress: 

Time management: Help the client develop better time management strategies, such as task prioritization and taking regular breaks, to alleviate work-related stress. 

Setting boundaries: Encourage the client to set boundaries at work and seek support from colleagues or supervisors when feeling overwhelmed. 

Social support: Suggest regular check-ins with a trusted friend or therapist to help manage stress and process emotions related to work. 

Follow-up: 

After 4 weeks of following the recommended herbal formula and lifestyle modifications, the client reported some improvement in her symptoms.  She experienced better sleep, falling asleep more easily, though still waking up intermittently.  Anxiety levels were also reduced, especially during the day, and she noted an improvement in focus and energy levels during work hours. 

Adjusted plan:  

Continue with lifestyle recommendations. Swap out formula for a day and night mix and plan to follow up following 2 weeks.  

During the day: 7.5mL 2x daily 

Lemon Balm: 60 mL 

Ashwagandha: 60 mL 

Oat Straw: 80 mL 

200mL 

 

Before bed: 10mL 1x daily 

Kava: 80mL 

Lavender: 40mL 

Passionflower: 80 mL 

200mL