ALTERNATIVES || Dr. Scott Theirl suggests biomarker testing before you take an Ambien

Guest post by functional neurologist, Dr. Scott Theirl, DC, DACNB, FACFN
Approximately half of us have trouble falling asleep, staying asleep or simply never feel rested or refreshed. Before seeking help in a doctor’s office, I suggest people make all the sleep hygiene changes they can and see if that eases their situation.

Dr. Scott Theirl, DC, DACNB, FACFN

But sleep is surprisingly complex and many times, sleep hygiene is not enough to resolve what may be at the core of our sleep trouble. The good news is that we have more than sleep hygiene, behavioral therapy and pharmaceutical sleep aids. New advances in biomarker testing allow clinicians and patients alike insight into the nervous system and hormone functions involved in sleep/wake cycles.

Over the last 15 years, urinary neurotransmitter and saliva hormone testing has been developed. Two key hormones are involved in sleep. Melatonin is key to initiating sleep and helping to sustain sleep the first part of the night. Melatonin levels should begin rising approximately two hours prior to bedtime, so long as the light of the room is dim and tranquil. (Melatonin levels can be greatly reduced by too much light, especially blue spectrum light or screen light.)

Cortisol is a hormone released by the adrenal glands that promotes wakefulness and energy. Under optimal circumstances, it follows a diurnal rhythm, meaning it should be significantly higher during the day than it is at bedtime. Elevated cortisol at bedtime can make it difficult to fall asleep. To make matters worse, under chronic stress—which may include chronic sleep loss—daytime cortisol levels deplete further, contributing to daytime sleepiness.
Neurotransmitter test results can be helpful in driving the treatment plan tailored to an individual’s needs. The clinician can then see a patient’s current state of balance in both excitatorybiomarkers (those which excite and motivate us) and inhibitory biomarkers (those that calm us down) to more accurately choose how and when to supplement these hormones and neurotransmitters. Serotonin, GABA, glycine and taurine are all inhibitory (calming) neurotransmitters. Dopamine, norepinephrine, epinephrine (adrenaline), glutamate and histamine are excitatory neurotransmitters.
The beauty of an at-home test lies in its customization. If you have difficulty falling asleep, you simply collect the urine and saliva samples prior to going to sleep. If you have difficulty staying asleep, then you collect the samples in the middle of the night when you wake up. Think of these results as a snapshot of your unique physiology at the particular time of the night when your symptoms are the worst.
There are 5 common imbalances discovered after testing:
  1. Melatonin levels are low
  2. Cortisol levels are high
  3. Inhibitory neurotransmitters are low
  4. Excitatory neurotransmitters are high
  5. Inflammatory markers are elevated (such as histamine and glutamate)
Testing provides a baseline for each patient. A patient can have one or all five of these findings. Couple this information with observed and reported symptoms and you achieve a more complete picture of an individual’s neuroendocrine function.
The experienced and integrative clinician uses all this gathered information to prescribe targeted amino acid supplements that can rebalance neurotransmitters. They can also prescribe calming herbal remedies to quiet overexcited hormone/neurotransmitters and/or a low inflammatory diet to take the load off the immune system.
This more holistic approach may work better than prescriptions for pharmaceutical sleep aids such as Ambien (zolpidem), which tend to affect only the GABA receptors. Instead, integrating these other therapies may help achieve more stability in the neuroendocrine system, which can lead to better support for your best overall sleep.

Dr. Scott Theirl is the creator of Insomnia Insight, a 3-part clinician training series, is a physician educator for NeuroScience, Inc. and practices privately in southeastern Wisconsin. 800.385.1655, || Twitter @HolisticNeuroDr 

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SleepyHeadCENTRAL strongly encourages people with ongoing sleep health problems to approach a medical professional to determine appropriate differential diagnoses and treatment. This post, like all other posts on SHC, is not intended to substitute for medical advice.  

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