Breaking the cycle of poor sleep

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Everyone has experienced poor sleep. Maybe you’re too excited about something to fall asleep quickly. Perhaps you’re dreading the next day and are stressed about your job. Or maybe you just watched a scary movie that you can’t get out of your head. Either way, the sensation of lying in bed, awaiting sleep, but unable to achieve it, is a frustrating one. Sometimes even when you do fall asleep, you end up waking up multiple times, further disrupting an already short night of sleep.

Sleep aids like melatonin have been offering people reliable support for disruptive sleep for a long time. According to data from the market research firm SPINS, based on the 52 weeks ending December 3, 2023, melatonin was among the top-selling ingredients in the U.S. mainstream multioutlet channel with $753 million in sales, ranking just below protein and probiotics. In fact, within the sleep category, melatonin makes up the bulk of the sales, with the whole category amounting to $801 million.

While safe and effective, as of late melatonin is experiencing a bit of a public relations problem. In some ways, it has become a victim of its own success, making it way into so many products that it is becoming much more scrutinized. This is particularly the case when melatonin finds its way into gummy formulations, marketed for either adults or children. For example, research from the Centers for Disease Control (CDC) found that calls to poison control for pediatric ingestion of melatonin increased 530% between January 1, 2012, and December 31, 2021. As industry advocates point out, these statistics do not indicate adverse events or poisoning, but rather concerned parents making sure their kids are safe after accidentally ingesting melatonin. However, it does indicate just how many households contain and rely on the ingredient to support sleep.¹

Some studies have even called into question the quality and consistency of melatonin products on the market. The Council for Responsible Nutrition (CRN; Washington, D.C.) has therefore adopted voluntary guidelines for its members with regard to melatonin in order to demonstrate that industry is making an effort to ensure the safety of its customers and be transparent with them. Despite some negative (and misleading) press, melatonin’s supremacy within the category is difficult to challenge. It is and will remain a staple in the sleep category. That said, there is an opportunity for other ingredients to step in to be an alternative to this well-known ingredient.

The Vicious Cycle

While melatonin is a sleep aid taken prior to bed to promote sleep, emerging ingredients are taking a different approach to supporting sleep, by addressing the underlying problems impacting sleep, such as stress. While not everyone has the same levels of sleep disruption in response to stress, it is well known and accepted that stress impacts sleep quality. High levels of sleep reactivity (ie. the degree to which stress disrupts sleep) can even be predictive of a high risk of developing insomnia or even depression and anxiety.²

“When we experience stress, our bodies release a cascade of stress hormones, particularly cortisol and adrenaline. These hormones are part of the body’s ‘fight or flight’ response, which increases alertness and prepares us to deal with perceived threats. However, elevated levels of these hormones can interfere with our ability to fall and stay asleep,” explains Maria Ángeles Gutiérrez, marketing director of Suannutra (Elche, Spain). “Cortisol, for example, follows a diurnal rhythm and should decrease at night to allow for restful sleep. High levels of cortisol due to stress can disrupt this natural pattern, leading to difficulty falling asleep or frequent waking during the night.”

The impact of poor sleep can be compounding, having a negative impact on our overall quality of life. “A lack of rest or poor sleep quality…leads to a change in our emotional state and poor management of physical and mental stress, which creates a vicious cycle,” says Laura López, PhD, head of product, research, development and innovation for Nektium (Las Palmas, Spain).

Ingredients such as Monteloeder’s (a subsidiary of Suannutra) lemon verbena extract (RelaxPLX),and Nektium’s Vanizem, which is derived from the West African spice Aframomum melegueta, are both marketed as stress-relieving ingredients that also positively impact sleep. In a recently published study, 71 healthy adults complaining of sleep disturbance were randomly assigned to receive either Monteloeder’s RelaxPLX or placebo for 90 days. Results showed that subjects taking the extract experienced significantly greater improvements in sleep quality based on the visual analogue scale as well as improvements in overall score, sleep latency, and sleep efficiency based on the Pittsburgh Sleep Quality Index. Researchers also observed that plasma nocturnal melatonin levels increased significantly in those taking the lemon verbena extract.³

“By addressing the physiological effects of stress through these mechanisms, RelaxPLX helps to create an internal environment that is more conducive to restful sleep,” says Gutiérrez. “It’s not just about masking the symptoms of stress, it’s about supporting the body’s natural ability to manage stress and improve sleep quality holistically.”

In a different study on Nektium’s Vanizem (not yet published at the time of this writing), 30 male and female volunteers between the ages of 50 and 60 experiencing day-to-day stress and anxious feelings were given either placebo or three doses of Vanizem, (50 mg, 100 mg, and 150 mg). Results showed that a dose of at least 100 mg significantly reduced scores on the Hamilton Anxiety Scale, and by the end of the study, scores were below the threshold for anxiety. At 150 mg per day, the Profiles of Mood States found that there were self-reported reductions in stress (19%), fatigue (23%), depression (34%), and vigor (8%) after three days of supplementation. The Leeds Sleep Evaluation Questionnaire showed that Vanizem quickly helped with sleep after an initial 100 mg dose, and after three days, sleep was reported to be 30% better compared to placebo.

According to Netkium, the extract targets the endocannabinoid system by inhibiting the fatty acid amide hydrolase (FAAH) within the endocannabinoid system to maintain levels of anandamide which is known as the “bliss molecule.” López explains that FAAH becomes elevated during stressful situations, therefore the extract restores balance to the endocannabinoid system.

It’s worth noting that some research does indicate that melatonin may too alleviate stress⁴, but supplementation with melatonin may cause drowsiness, making it impractical to consumer during the day when the bulk of our stress occurs.⁵ 

“Consumers are increasingly receptive to calming nerves to aid sleep rather than relying on sedative products,” says Gutiérrez. “This shift is driven by a growing preference for natural and holistic health solutions, greater awareness of the side effects of sedatives, and more research supporting the effectiveness of stress reduction techniques. Consumers are also finding it easier to integrate calming methods into their daily routines, contributing to a balanced lifestyle and better sleep.”

Another underlying condition that impacts sleep in pain. The relationship between pain and sleep is bidirectional, in that pain will disrupt sleep, and in turn, deficient sleep will will lower pain threshold and increase spontaneous pain.⁶ PLT Health Solutions, for example, recently launched a synergistic blend of proprietary Boswellia serrata and ginger extracts, called Serezin, that is marketed to support restorative sleep and offer pain relief. The company announced the results of a yet-to-be-published study that showed supplementation significantly improved pain and sleep in 60 healthy men and women between the ages of 50 and 70 dealing with aches and pains that disturb their sleep. More specifically, 300 mg per day of the extract for four weeks improved restorative sleep by 64% compared to placebo. Additionally, participants taking the extract experienced improvements in pain scores within seven days. This also resulted in improvements in mood as well.⁷

When it comes to pain, consumers are also looking for more natural options as an alternative to the over-the-counter drugs (OTC) they might typically take for acute pain relief. While useful, long-term use of OTC drugs is not healthy.

Ingredients like the aforementioned extracts offer a comprehensive approach, allowing consumers to support their overall health to improve their quality of life, and in turn make their nights more restful. There’s still a place for more acute sleep support, but when stress and pain plague people’s lives and impact sleep, those factors are worth confronting.

References

1. Krawiec, S. Annual pediatric melatonin ingestion up 530% between 2012 and 2021, says CDC report. Nutritional Outlook. June 7, 2022 https://www.nutritionaloutlook.com/view/annual-pediatric-melatonin-ingestion-up-530-between-2012-and-2021-says-cdc-report (accessed 2024-05-29).
2. Kalmbach, D.A.; Anderson, J.R.; Drake, C.L. The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res. 2018, 27 (6), e12710. DOI: 10.1111/jsr.12710
3. Pérez-Piñero, S.;Muñoz-Carrillo, J.C.; Echepare-Taberna, J.; Muñoz-Cámara, M.; Herrera-Fernández, C.; García-Guillén, A.I.; Ávila-Gandía, V.; Navarro, P.;Caturla, N.; Jones, J.; López-Román, F.J. Dietary Supplementation with an Extract of Aloysia citrodora (Lemon verbena) Improves Sleep Quality in Healthy Subjects: A Randomized Double-Blind Controlled Study. Nutrients. 2024, 16 (10), 1523. DOI: 10.3390/nu16101523
4. Repova, K.; Baka, T.; Krajcirovicova, K.; Stanko, P.; Aziriova, S.; Reiter, R.J.; Simko, F.Melatonin as a Potential Approach to Anxiety Treatment. Int J Mol Sci. 2022, 23 (24), 16187. DOI: 10.3390/ijms232416187
5. Melatonin. Mayo Clinic. August 10, 2023. https://www.mayoclinic.org/drugs-supplements-melatonin/art-20363071 (accessed 2024-05-29).
6. Haack, M.; Simpson, N.; Sethna, N.; Kaur, S.; Mullington, J.Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology. 2020, 45 (1), 205-216. DOI:10.1038/s41386-019-0439-z
7. Krawiec, S. PLT Health Solutions launches new ingredient marketed for pain relief and sleep support. Nutritional Outlook. February 26, 2024. https://www.nutritionaloutlook.com/view/plt-health-solutions-launches-new-ingredient-marketed-for-pain-relief-and-sleep-support (accessed 2024-05-29).