Hypnosis can be particularly useful in the treatment of insomnia, especially for very anxious adolescents who are often able to keep their anxiety at bay during the day by distracting themselves with daily tasks, but whose anxiety begins to surface as evening draws on, specifically focusing on fears that they may not get off to sleep and concerns that they will not get enough sleep. Other approaches to insomnia would involve addressing the underlying medical or psychological prob-lems. Exploratory techniques may need to be employed to discover any underlying reasons for the insomnia, such as childhood incidents, nightmares or phobias. As with younger children, suggestions which emphasise warmth, safety and security whilst lying in bed, along with general suggestions evoking a calm and peaceful state are helpful. The removal of any anxiety about not sleeping, with positive suggestions about going off to sleep, staying asleep and awaking refreshed in the morning is central to this approach.
Herbal remedies
Herbal preparations which are traditionally used to induce sleep include nervous restoratives such as St John's wort, vervain (Verbena officinalis), rosemary (Rosmarinus officinalis),wild lettuce(Lactuca virosa),skullcap(Scutellaria lateri-folia) and lavender (Lavandula officinalis)(Mills 1994). The overall approach of a medical herbalist would be to use calming and relaxing agents rather than heavy sedatives. St John's wort, mentioned in relation to depression, has a calming effect but can also act as a restorative tonic for the nervous system. For relaxation, gen-tle calming agents such as chamomile should be tried first, whilst lime flowers (Tilia cordata) or lemon balm (Melissa officinalis) have a traditional use in the treatment of anxiety states and tension, although no scientific evidence is available to support this. However, lime flowers should not be used in people with cardiac problems. Herbs with a stronger sedative effect include hops(Humulus lupulus), skullcap(Scutellaria laterifolia), valerian(Valeriana officinalis),or passion flower (Passiflora incarnata).Barnes et al (2002) offer evidence for the antispasmodic and sedative effects of hops but caution that this herb should not be taken by anyone suffering from depression as the sedative effect may exacerbate the symptoms of depression. In addition, alcohol and orthodox sedative therapy will enhance the therapeutic action. In spite of the traditional use of skullcap as a relaxant and anti-convulsant, there are no documented scientific data to support these claims.
Animal research into the action of passion flower indicates evidence of central nervous system depression and anticonvulsive properties. There were no reported side effects to passion flower, but excessive doses may give rise to heavy sedation and may potentiate MAO! therapy (Barnes et aI2002).
164 11-18 years
Valerian is an ancient medicinal herb (the name derives from va/ere which means 'to be in health') used in Galen's time for epilepsy (Bremness 1995), and is particularly good as an additive in very stressful circumstances. It is for this reason that it was issued to the civilian population during World War II to help them sleep through the blitz. Research using a double blind repeated measures random order design supported the hypothesis that extract of valerian would shorten sleep latency times in people having problems getting off to sleep, as well as shortening the time taken in settling down to sleep. According to the authors, the design was chosen to mimic the 'occasional' sedative consumption typical of poor sleepers;
secondly, it is more complex than the straightforward crossover design and reduces the risk that volunteers might detect the different treatments by other means than sensing their effects on sleep; and thirdly, the design allowed the researchers to detect any carry-over effects as they occurred. Although the valerian did not increase the total sleep time, it did produce more stable sleep during the first quarter of the night and, overall, did not diminish or disrupt the normal levels of movement during the night. In addition, subjects reported improved sleep with no side effects such as nightmares or feeling 'hung over' the next morning. Sleep latency times were reduced by an average of 7 minutes. The researchers concluded that valerian was as effective as small doses of benzodiazepines and barbiturates (Leathwood&Chauffard 1985). They also noted that valerian improved the qual-ity of sleep.
Good results were also obtained using valerian with subjects who had all suf-fered sleep difficulties and fatigue. Half of them regularly or periodically took conventional sedatives. The subjects were randomised into two groups with regard to which tablet should be taken the first night. Twenty-one out of twenty-seven subjects rated the valerian better than the control and again reported that they slept very well, with no side effects and with the disappearance of the night-mares and disturbed sleep that they had reported as occurring with conventional medication (Lindahl & Lindwall1989).
Research on the use of St John's wort on sleep patterns noted that it produced an increase in deep sleep during the total sleep period; however, sleep latency, sleep maintenance and total sleep time were not affected (Schultz&Jobert 1994).
Again, these sedative herbs should not be taken alongside conventional sedatives.
Homeopathy
Building on the homeopathic remedies for insomnia discussed in previous chap-ters, remedies which are particularly relevant to adolescents who have problems with sleeping might include Coffea cruda, particularly for those who have an overactive mind, with general feelings of agitation, possibly as a result of study for exams or anticipation of an interview. For those who have been overworking, are unable to switch off and are feeling irritable, angry and very stressed, Nux. vomica is recommended. These two remedies are very similar and it may be necessary to try both before the correct remedy is found. Both are useful if the young person is having difficulties in sleeping whilst in the midst of a series of exams and finds it difficult to switch from thinking about one exam (and the statutory post-mortem on the paper) to thinking about the next. Of the remedies mentioned, readers may recognise Coffea, which has been used medicinally throughout the Middle East as a remedy to address problems that resemble the ingestion of too much coffee; just
Problems related to sleep 165 as too much coffee can stimulate symptoms of over excitement, so homeopathic doses of Coffea have the opposite effect.
Bach flower remedies
Two of the Bach flower remedies are of particular value since they address the sort of problems common to those who cannot get off to sleep. White Chestnut is help-ful specifically for the times when the mind is help-full of problems, ideas, thoughts and recurrent anxieties or mental arguments, and Red Chestnut is helpful for those who worry incessantly about other people and those who strongly identify with the sufferings of others. Both these remedies were first potentised in 1935.
Ayurvedic medicine
Suggested yoga positions for help in dealing with insomnia include the cobra, corpse and backward bend (Lad 1984). The erratic lifestyle of the adolescent mil-itates against the routine of Ayurvedic medicine, but for insomnia, which is usually caused by excess vata, the interventions outlined under depression should be used.
Aromatherapy
In addition to the research discussed in earlier chapters on the efficacy of lavender essential oil, research has also been conducted using essential oils of passiflora (Passiflora incanarta) and lime blossoms (Tilia cordata). Mobility in mice was reduced by 55% by the inhalation of lime blossoms, whilst there was no reduction in mobility for passiflora. However, when caffeine overactivity was induced, motility was reduced by inhalation of both lime blossoms and passion flower (Buchbauer et aI1992).
Research into the activity of essential oil of neroli(Citrus aurantium)(Jager er al 1992) demonstrated the sedative effects of the oil and the effect was noted to be greatest during the first 30 minutes of exposure to the vapours. This was con-firmed by an interesting study which was conducted on the effect of oils on sleep latency, using EEG and psychological scoring. The aim of the study was to test the effect of oils on sleep latency under stress conditions. The oils used included spike lavender, sweet fennel, bitter orange (neroli), linden, valerian and mar-joram (the botanical sources were not stated). The odour of bitter orange short-ened the time it took to go to sleep significantly compared with no odours, suggesting that the odour of bitter orange affected the cortex and inhibited the excitement of the central nervous system, thus encouraging sedation. The sub-jects reported that they found it easy to sleep even under conditions of mental stress (Miyake et aI1991).
A further review of the data by Buchbauer et al (1993), investigating the trad-itional uses of essential oils, confirmed the sedative properties of sandalwood, neroli and lavender essential oils and showed that lavender oil exhibited a super-ior sedative effect, but found that the traditional use of rose oil as a sedative was not confirmed (the botanical sources were not stated). The fact that lavender provedtobe sedative, even after hyperactivity was induced by caffeine, might be
166 11-18years
useful to adolescents who have difficulty in getting off to sleep after drinking too much coffee or too many caffeine drinks.
Anthroposophical medicine
InAnthroposophical medicine, Steiner advocated meditation exercises to facili-tate connection with the spirit world, as well as Anthroposophical remedies such as Coffea tosta or Belladonna. Attention would also be addressed to living patterns, such as times of eating. Anthroposophical medicine recognises a number of causes for insomnia, e.g. psychological shock, for which silver is the remedy of choice, or insomnia as a result of nervous restlessness, which is treated with Avena Sativa comp, a mixture of valerian, passion flower, hops, oats and a high homeopathic potency of Coffea, or Malvae cornp. tea, which contains mallow, lavender flowers and valerian root.
TCM
The use of isocones, which were referred to in Section 2, could be of value for adolescents since they may help to adjust the erratic sleep patterns that occur when adolescents are out of synchronisation with circadian rhythm.
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