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Ask the Doctor: April 2008

Question: Hi Dr. Lockwood. I am a 60 yr old female who is suffering from insomnia. Last year I visited a holistic physician who said that my Vitamin D reading was 14.5 but told me to take a good multi-vitamin. I have been taking two tablespoons of Cod Liver Oil daily. He is now giving me an intravenous feeding 6 times of Cortisol and B vitamins but I am not seeing much of a change. Can a Vitamin D deficiency cause a sleeping problem? I feel anxious and now worry about not sleeping so I am in a vicious cycle. I’m emotional because I’m tired. Ambien made me very groggy during the day. Benadryl doesn’t help. I would appreciate your thoughts on this. This has been going on for the last five years on and off but now it is severe. I’m not having hot flashes. Thank you for your input. – K.M.

Answer:Your question has multiple issues and I will try and address them all. First, if your vitamin D level is 14, it is well below the level of 32 that I try to get my patients to. You need more aggressive supplementation. Even well-known multivitamins don’t have enough to replace your level back to normal. Centrum Silver has 500 IU per tablet and One-a-Day Women 50-plus has 800 IU. Single tablet vitamin D supplements have about 1000 IU in each one. In order to get your level up to 32 you really should be more aggressive. If you take two over-the-counter supplements plus your vitamin you will probably get your levels back to normal soon. I still recommend the higher doses of 50,000 IU weekly for 8 weeks and then monthly. The 50,000 IU tablet is a little harder to find, however.

It is quite possible that the vitamin D level is affecting your sleep pattern because it does affect mood as well as anxiety. However, there is no direct link between insomnia and vitamin D deficiency to my knowledge. Many other aspects of your health are affected by vitamin D, you can only benefit from getting your level back to normal.

I am concerned about the IV treatments of cortisol and vitamin B that you are getting. If you are not getting better with treatment, I would stop both of the treatments. You should be getting adequate vitamin B levels from your multivitamin and your diet. Any of the B vitamins your body doesn’t use, you will filter them out through your kidneys, thus giving you very expensive urine if you have been getting high doses through the IV treatments.

My biggest concern for your health is the IV cortisol. If you are clinically deficient in cortisol, you should be seeing an endocrinologist because there may be other hormones you are deficient in that are made by the adrenal glands. If you are not clinically deficient and he is using the IV cortisol for other reasons, you are putting yourself at risk for side effects of having too much cortisol in your body, including osteoporosis. Excess cortisol increases the rate of bone loss. Increased cortisol can also raise your blood sugar and lead to diabetes, which sometimes resolves when the cortisol is stopped, but not always.

As for your insomnia, there are a couple of things that you can do to help break the cycle. It definitely gets harder to sleep if your insomnia is persistent because of the anxiety you mentioned and the fear of not being able to fall asleep.

The first thing you need is good sleep hygiene. This means no naps during the day so you are tired at night. Do not go to bed until you are completely tired, so if you need to read or watch TV, do it in another room so the brain is not confused about the purpose of the bedroom. The bedroom is only for sleeping and sex, so no eating, reading or watching TV in there if you are having trouble sleeping.

A warm bath or shower before bed may help you to relax. Meditation techniques can help you to relax when you are in bed, also. Try counting slowly backwards from 10. Count once for each breath in and out, make sure you fill up your lungs completely and exhale completely. While you are breathing, concentrate on relaxing each body part, starting with your toes and working your way up. This will help the anxiety component.

Another option is melatonin, which is an over the counter supplement. Melatonin is a substance produced naturally by your brain in response to lower levels of light, which is how your body tells when it is night. The over the counter supplement can help increase these levels. There are two prescription medications you might want to ask your doctor about, as they work differently than Ambien. Rozerem is a newer drug that increases melatonin levels in the brain (much like the supplement, only it is FDA approved). Rozerem takes a little time to kick in, so you have to be patient. The other drug that may help is Trazadone. Trazadone is an older antidepressant that can cause you to be sleepy. The insomnia dose is much lower then the dose used for depression and when taken at night, can really help. I have recently had good responses in my patients to Trazadone.

I hope you are able to resolve some of these problems you are experiencing.

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine. She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit. She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.