I mean really, really good? So good, you woke up without an alarm clock, refreshed, and ready to take on any challenge? Sleep deprivation is one of the fastest ways to create chaos in anyone’s life; just ask new parents. But how many patients are you seeing who are prescribed drugs that either cause sleep disturbances or do not allow for restorative sleep?
Right now, one in three adults is not getting enough sleep. The CDC has found that adults who get less than seven hours of sleep per 24-hour period are more likely to report being obese, physically inactive, and current smokers compared to people who get seven or more hours per 24-hour period. Adults in this group are also more likely to report 10 serious health conditions, including heart attack, coronary heart disease, stroke, asthma, COPD, cancer, arthritis, depression, chronic kidney disease, and diabetes.2 Thismay be a direct result of the changes in inflammatory cytokines (Il-1b, Il-6, Il-17 and CRP), which can happen with only five days of sleep deprivation. Current literature notes that the U.S. will lose$411 billion per year due to impact of insufficient sleep. In terms of working days lost due to insufficient sleep: 1.23 million work days in the U.S. per year, and 78,000 in Canada!
So the question is: What are we doing to keep ourselves and ourpatients healthy by ensuring enough proper, restorative sleep? Sometimes, it’s easier said than done.
Normal sleep patterns see an intricate balance of hormones that are released not only during sleep, but also during the daytime. These hormones are involved in all metabolic rates (growth hormone, insulin), hunger (leptin, ghrelin) and the release of cortisol. The circadian rhythm is largely controlled by the release of melatonin over a 24-hour period and can be affected by many incoming stimuli. Depending on the patient, sleep issues can have multiple sources, or just one. Stress, food choices and timing, job timing, external disruptions, age, obesity, and other health complications all play major roles in impacting hormoneproduction and sleep patterns. So the next question is: How canwe be involved as health care professionals?
Life Style and Supplementation
A proper assessment to understand the needs of the patient is crucial because we can mitigate some factors with small lifestyle changes, such as controlling the use of electronics at night and having a set bedtime. Losing weight, increasing activity and stress-relief techniques are other helpful changes, but certainly harder.
One of the best functional approaches is to address food timing and choices. A high-sugar, low-protein, low-fat diet with high stress and decreased activity can limit the production of serotonin in the gut, which is key to proper melatonin production. So the reverse will help boost production: low sugar, moderate protein, moderate fats (slow sugar absorption), probiotics and activity will increase melatonin production. Another option is to supplement with tryptophan, magnesium and other sleep-support products directly. Ask your compounding pharmacist about the Sleep Perfect Formula and the Sleep Support formula.
Melatonin has been studied for a variety of applications, and some patients may need it to be compounded for various reasons.The optimum dose is patient-specific, ranging from 0.1–3 mgnormally, with doses as high as 20 mg in cancer patients for both sleep and antioxidant effects. Pediatric patients have been dosed safely to 10 mg, with some clinical observations of 12 mg. There is no known upper toxicological limit on melatonin, with the predominant side effect being drowsiness.
One formula that works well contains (Theanine (L) /Magnesium Glycinate Polyglycol Troche (Tablet Triturate Mold)) with melatonin added in a patient-specific dose. Another contains (Melatonin Slow ReleaseCapsules) for modified-release capsule composition and use the capsule calculator for a patient-specific melatonindose. Also, (Melatonin Sublingual Suspension (MucoLoxTM)) is a sublingual dosage form for dose titrations and is a great way to determine a patient’s best dose. I have also been asked if we can compound a topical/transdermal form in Lipoderm® for patients who will not take medication by mouth, and the simple answer is yes, just ask your pharmacist about it!
This molecule, like others I have discussed, seems to have a much larger use in the future, with increased immunomodulatoryeffects that complement the decrease in inflammatory conditionsthat are so prevalent today. I believe melatonin may be very useful in combination with other chemicals we use currently in compounding therapies, and I look forward to sharingthis information with you in the future. For questions about compounding with melatonin, contact your pharmacy.