If you have trouble getting a good night's sleep, you're not alone. A survey conducted by the National Sleep Foundation found that literally millions of people sleep so poorly that they're tired during the day. Forty-three percent of them were so sleepy it interfered with their activities. Fatigue can have serious side effects. Sleepiness causes 100,000 auto accidents each year in our country alone.

What's worse, sleeping pills are often addictive and can have serious side effects. But there are other great ways that will safely help you get a good night's sleep.

This is important because a restful night's sleep affects your emotional and physical health. In fact, it's just as important for you to get enough good quality sleep as it is to eat healthy foods and exercise regularly. It's part of a lifestyle that promotes health and fights disease.

When you sleep, your body eliminates free radicals, your immune system strengthens itself, and your body and mind refresh themselves. As we get older, we tend to have more interrupted sleep. One reason is that we produce less melatonin, a hormone that controls our response to light and dark.

Melatonin supplements can help regulate your sleep cycles. From one to three mg of melatonin taken half an hour before bedtime is usually enough for a deep, restful sleep. For more information, read the articles on melatonin on my website: www.womenshealthletter.com.

But there's much more you can do to help you sleep than take melatonin. If you simply make a few minor lifestyle changes, you'll soon find the sleep you want and need. Some of these changes work by helping your body's ability to produce more melatonin naturally. Others relax you so you can get to sleep more easily.

Change your diet

What you eat — especially at night — affects how you sleep. You may think that a sugary snack before bedtime is a good idea because it makes you sleepy. Well, it isn't. Sugar initially raises your blood sugar and causes you to be alert. Then it drops and you get sleepy. Later in the night, when blood sugar levels drop still further, you may wake up and have difficulty getting back to sleep. Refined grains (white flour and white rice) and alcohol can have the same effect.

Instead, snack on a few whole grain crackers with a little cheese or an ounce or two of nuts. Protein helps keep your blood sugar level while you sleep. A little fruit-sweetened yogurt, or a single piece of fruit, is also acceptable for nighttime snacks.

An afternoon cup of coffee or tea, or even a piece of chocolate, can keep you awake at night if you're particularly sensitive to caffeine. Many people have an increased sensitivity with age. Avoid caffeine after noon. At most, drink a cup of green tea. Although green tea contains a little caffeine, many people find it doesn't interfere with their sleep.

Modify your environment

Prepare yourself for sleep an hour or two before you go to bed. Begin by turning down the lights. Darkness helps your body make melatonin. If you're watching TV, don't put on any bright lights in the room.

Of course, use good lighting for reading, but don't read stimulating books or watch intense TV shows before bedtime. They can keep you awake. Sleep in a room that's as dark as possible. Only use a night-light in your bathroom. If you turn on the overhead light, you'll stop all melatonin production for the rest of the night. If necessary, wear an eye mask to block out light.

Get exposure to plenty of bright light during the day. If you read a lot, use full spectrum fluorescent light bulbs found in all hardware stores. These are not like ordinary fluorescent bulbs. They mimic daylight and contribute to melatonin production.

Try an herbal sedative

If you don't want to take pharmaceutical drugs, but want a relaxant, you may want to try herbs. Valerian root, hops, skullcap, chamomile, linden flowers, and passionflower all have relaxing, sedative effects. You can find several of them in various herb tea blends and in capsules.

Valerian (Valeriana officinalis) is particularly effective for women who have irregular sleep patterns, or have difficulty falling asleep. From 300-600 mg of valerian can be as effective as pharmaceutical sedatives. Caution: Never take herbal sedatives with either over-the-counter or prescription drugs.

Write it down

If you don't want to forget tomorrow's chores, or if you're worried about something that nags at you, write it down on a small pad kept on your night stand. Use a pen with a tiny light, or write one or two words in the dark. You'll be able to decipher it later. Once you've written it down, you can let that thought go. Deal with it in the morning when you're more alert and refreshed. This tiny modification can make all the difference between getting to sleep or lying in bed with a racing mind.

Move your clock

Many of us have a clock we can read in the dark near our bed. Move it out of sight. If you are having trouble falling asleep, or if you wake up, it won't help to know the time. All this does is create more worrying and keep you awake.

Another reason to move your clock is that its electromagnetic fields, found in all electric appliances, can interrupt your sleep. Many years ago, I had a patient who was very sick with a number of serious health problems. She had insomnia, and lack of sleep further lowered her immune system. I questioned her thoroughly and discovered she slept under an electric blanket. The blanket interfered with her body's electromagnetic field and kept her awake. Don't sleep under an electric blanket, and keep your clock at least three feet from your bed.

Tip: If you like to jump into a warm bed, use the electric blanket to warm the sheets. And then remove the blanket when you go to bed.

Stay warm

Keep your bedroom cool and your body warm. Your body temperature drops at night, and this can keep you from falling asleep. Take a hot shower or warm bath before bed to raise your temperature.

Have cold feet? They can wake you up. The solution: wear socks or knitted booties to bed. If your feet get too warm, like mine often do, booties are easy to slip off without waking up.

Listen to music

A study in a nursing journal found that playing soothing music for 45 minutes at bedtime improves sleep patterns. All of the study's participants, aged 60-83, slept longer, woke up less frequently, and were more awake during the day after three weeks of listening to music at night.

Music had a cumulative effect. The longer they played it, the more improvements they noticed. Buy a little tape recorder that automatically shuts off at the end of a tape. Listen to music each night at bedtime, and watch your sleep improve.

Take the right minerals

Many people take calcium at bedtime to help them sleep. The body loses calcium at night, so this may sound like a good idea. But calcium contributes to anxiety and causes muscles to contract, contributing to restless leg syndrome and leg cramps.

Magnesium, on the other hand, relieves anxiety and relaxes muscles. In fact, magnesium often reverses restless leg syndrome and cramping legs and feet.

Instead of calcium, try taking 100-200 mg of magnesium citrate, glycinate, or amino acid chelate at night. If it causes loose stools, get your magnesium in an evening snack like nuts, seeds, or whole grains.

Try these easy solutions for a great night's sleep. And next month, I'll show you some homeopathic treatments for sleep disorders. I've seen these help even the most stubborn cases of insomnia.

Lai, H.L. and M. Good. "Music improves sleep quality in older adults," J Adv Nurs, February 2005.

The Lancet, vol 354, October 23, 1999.

Trivieri, L, Jr. and J.W. Anderson. Alternative Medicine: The definitive guide, second edition, Celestial Arts, 2002.

Beyond Insomnia: Your Favorite Sleep Hormone Is Now Used in Cancer Therapy

You probably know it as a supplement that can help you sleep or overcome jet lag. Certainly, this hormone has been used safely in small doses for dozens of years for these purposes. As numerous people — and I — can attest to, from 0.5 to 3 mg of melatonin taken half an hour before bedtime can turn a restless night into a restful one. And it can save you a day or more of fatigue if it's used before and after long plane rides.

But melatonin does much more, especially in higher quantities. It's being used to protect against cancer, and to enhance the effectiveness of cancer treatments.

This hormone regulates the patterns of wakefulness and sleepiness that coincide with light and darkness known as circadian rhythm. Melatonin levels should be highest at night and lowest during the day. But light shuts down your body's production, so if you're in a well-lighted room late at night you may not be able to make enough melatonin to sleep well.

The melatonin/cancer connection

Exposure to light at night not only affects your ability to sleep during the day, it also increases your risk for cancer. Studies show that women who work late night shifts have an increased risk for getting breast cancer. And if you work late at night for just three nights a month over a period of 15 years, your risk for colon cancer escalates.

For a long time, we couldn't explain this phenomenon. Recently, however, a group of circadian-clock control genes were discovered that regulate the growth of normal cells and cancer cells. When these genes mutate, they cause a spontaneous outbreak of cancer. Why do they cause specific cancers? We don't know yet.

Circadian rhythm organization

Cancer cells multiply at certain times of the day, so it stands to reason that cancer therapies should be timed with cancer cell growth. Yet, cancer treatments are given at times that are most convenient for doctors and patients — not at times when a hormone, nutrient, or medication would work the best. This just doesn't make sense.

We have some studies that support giving cancer treatments according to circadian rhythms. One study showed that there was less toxicity and a better response from drug therapy in patients with colon cancer who were given their medication at night. Combine traditional treatments with melatonin, and the benefits increase dramatically. Let's take a look at some good studies on this subject.

A group of patients with advanced cancer were given 10 mg of melatonin at night for at least two months along with their other medications. They lost less weight and their disease progressed more slowly than those on the same therapy who didn't take melatonin.

Melatonin added to prescribed medications was also associated with survival for more than a year in people with brain cancer, melanoma, lung cancer, and untreatable glioblastoma. The combination worked better than the medications alone.

But that's not all

Melatonin is an aromatase inhibitor. Aromatase means that it reduces the ability of male hormones (adrogens), such as testosterone, to turn into estrogens. This means that melatonin has anti-estrogenic effects. When you combine it with tamoxifen, it actually enhances tamoxifen's effects. Melatonin also boosts the effectiveness of interferon on kidney cancers.

I'm particularly impressed with how this hormone protects healthy cells from toxins, such as chemotherapy, radiation, and other drugs. Perhaps this activity explains why it has proven to be so useful in people with untreatable cancers.

In several studies, there was less muscle wasting, less weakness, and a longer survival when patients were given 20 mg of melatonin at night along with either chemotherapy or supportive care.

What does this mean for you?

I'm not suggesting that you start taking high doses of melatonin even though there a number of supplement companies that sell it in 20 mg tablets. Melatonin is a hormone, and while I think that up to 3 mg a day is safe to take, I think that higher amounts should be monitored by your doctor, especially since there are interactions between melatonin and some pharmaceutical drugs. You don't want the melatonin to increase the activity of other drugs without your doctor's knowledge.

You might, however, show him or her this article and suggest they read some of the studies I've cited. Melatonin could be an appropriate nutrient to take for women who have hormone-related breast cancers, for people with inoperable cancers, and to protect you if you're at a particularly high risk. This is a subject that's worth exploring.

Cos, S., et al. e-pub ahead of print, Int J Cancer, 2005 August 3.

Lissoni, P., "Is there a role for melatonin in supportive care?" Support Care Cancer, 2002 March; 10(2).

Mahmoud, F., et al. "The therapeutic application of melatonin in supportive care and palliative medicine," Am J Hosp Palliat Care, 2005 July-August; 22(4).

Staying Healthy During the Holidays ... And Beyond

This is a difficult time of year for the many people who want to stick to their eating plans and are faced with temptation. Healthy dietary programs get tested with holiday gifts of cookies, candies, and cakes. Gatherings with family and friends tend to be centered around comfort foods high in fats and sugars. The problem is, these foods not only put us at risk for winter colds and flu, some of them also contribute to chronic diseases, such as cataracts, heart disease, diabetes — and weight gain.

You may think that fats are the primary culprit. Actually, the biggest problem foods we face during holidays and other special occasions are simple carbohydrates — sugar, corn syrup, honey, white flour, white rice, and sugar-filled beverages (from colas to fruit juices). Because many holiday desserts are also laced with fats, reducing carbs can lower your fat intake as well.

In the past, I've talked about the glycemic index — a way to measure how fast foods turn into sugar. High-glycemic foods (carbohydrates that turn into sugar quickly) have been implicated in numerous chronic illnesses, including diabetes and heart disease. The more fiber your carbohydrates contain, the slower the carbs turn to sugar and the safer they are. This is why unrefined grains are better for you than white flour, white rice, and highly processed cereals. And why fruit is a better choice than fruit juice.

When you replace refined grains and potatoes with whole grains, vegetables, and fruits, and reduce sugary drinks and juices, you reduce your risk for heart disease, help regulate blood sugar, and better control your weight.

When to eat carbs ... and what kind

I've found a way you can literally have your cake and eat it too! Start the day with fewer carbs of any kind, and save any simple carbohydrates for later in the day. Once you eat a few cookies, muffin, or a piece of fudge, your cravings will be off and running. Even highly processed cereals or toast can affect your blood sugar and cause sugar or carb cravings.

Instead, lower your consumption of carbohydrates in the morning. Reach for protein. If you're used to having toast, muffins, cereal, or a bowl of fruit for your first meal, you may find these tips for lowering your carbs helpful:

Breakfast

Don't skip this meal. You'll just crave sugars and starches later on if you do. You don't have to eat a complete meal, but something higher in protein than carbs will help keep you away from holiday temptations.

If you usually start the day with a glass of orange juice, eat an orange instead. The pulp makes this and other fruits a complex carbohydrate that turns into sugar slowly. But all fruit juices are simple carbs that can trigger an insulin response and lower your blood sugar. One orange contains the equivalent of three teaspoons of sugar. A glass of OJ equals the juice from three to six oranges. Do the math and choose fruit over juice.

Eggs: They're high in cholesterol, but also high in lecithin, which lowers cholesterol. As you saw in last month's article on fibrinogen, cholesterol isn't the best indicator of risk for heart disease (read the July 2005 issue on my website for further clarification). Make an omelete with leftover vegetables and a touch of herbs for added flavor. Or have two eggs with a single slice of whole grain toast instead of two pieces of white bread.

Soy yogurt and fruit: If you're a morning fruit eater, have a cup of berries and some walnuts or almonds in two-thirds cup of soy yogurt. (Remember last month's article on The China Study? It's on my website: www.womenshealthletter.com. Dairy is one of the most harmful proteins you can eat.) Add a few drops of vanilla extract and a dash of Stevia powder (a sweetener found in health food stores that is natural and won't affect blood sugar levels) for a sweeter taste.

Smoothies and protein drinks are usually high in sugar from fruit juices and heavily sweetened protein powder. If you don't like eating breakfast, but would have a breakfast drink, find an unsweetened protein powder, add a cup of frozen berries (which will contain about one teaspoon of sugar, while a banana has 4.9!), some soy or rice milk, and Stevia. I've added one-quarter of a pound of tofu to my smoothies in the past for additional protein. By the time the drink is blended, the tofu only thickens the drink. The taste remains the same.

Mori-Nu is a company that makes a 12.3 oz packaged organic tofu that can be kept unrefrigerated for years. I always have a few boxes in my cupboard. They're just the right size for two to three servings. Mori-Nu also makes a Tofu Scrambler Mix that contains all the herbs and dried vegetables you need for a tasty high-protein scrambled-egg substitute. Combine the two to make a quick low-carb breakfast meal without eggs. Both can be found in health food stores and in some supermarkets. I also like their Eggless Salad Mix for faux egg salad sandwiches (on dark bread or rye crackers, of course).

Look in the refrigerators and freezers of health food and grocery stores. You'll find soy-based sausages, chickenless nuggets, and veggie burgers. Any of these will work for a low-carb breakfast without giving you excessive animal fats.

Chiu, J., et al. "Carbohydrate intake and glycemic index in relation to the odds of earl cortical and nuclear lens opacities," Am J Clin Nutr, vol 81, 2005.

Matthias, B., et al. "Dietary approaches to prevent the metabolic syndrome: quality versus quantity of carbohydrates," Diabetes Care, vol 27, 2004.

Nutrition Detective

Some studies in the past have shown that the isoflavones in soymilk can protect your bones, while others found they didn't. Now we may know why. It could depend on whether or not you're using natural progesterone.

Surprisingly, when nearly 100 women were given either soymilk with isoflavones, transdermal progesterone (a patch), both soymilk and progesterone, or soymilk without isoflavones, two of the groups had the highest amount of bone loss: the control group and the group that used both soymilk and progesterone.

On its own, transdermal progesterone can protect your bones. But when it's combined with the isoflavones in soy, it can have the opposite effect! And many postmenopausal women now include soy in their diets.

There's been a lot of misunderstanding about progesterone. Just because it's natural doesn't mean it's necessarily safe. Dr. John Lee, an MD who lived a few miles away from me, and with whom I had a number of personal interactions, claimed that transdermal progesterone increased bone density and that it had no negative side effects.

However, no studies have confirmed that it increased bone density. In addition, I have seen and heard of numerous women who did have side effects from using natural progesterone. Only use this and other hormones under the direction of a knowledgeable medical doctor who monitors you closely.

Personally, I haven't found anything progesterone can do that non-hormonal supplements and diet can't accomplish. So I'm personally opting for soy over progesterone. Food first is my motto.

Lydeking-Olsen, E., et al. "Soymilk or progesterone for prevention of bone loss: a 2 year randomized, placebo-controlled trial," Eur J Nutr, August 2004.

Ask Dr. Nan

Q: I have recently seen ads or products that claim to be "natural and safe" for enhancing the size of breasts. Are they safe? Some are in health food stores. — K.D., via e-mail

A: Without more information on the names of the products and their ingredients, I can't really comment much about them. However, I'm wary. If they stimulate estrogen production, for instance, as some say they do, they can increase your risk for cancer.

Never take any supplements containing natural hormones, or supplements that affect hormone levels, without first talking with your doctor, having your hormone levels tested, and being monitored. They can be dangerous.

My suggestion is for you to contact the companies involved and ask them for copies of all scientific studies done with their formula that show its safety and efficacy. If you can't understand these studies, send them to me and I'll evaluate them for you. Don't be surprised if there are no studies on these formulas. Without human studies, I would suggest that you save your money and appreciate your body more the way it is.

Q: I'm presently taking supplements, however, I don't know if they're good quality. I'm 51 years old, and I'm trying to take the necessary supplements needed for my age. Can you help me? — J.K., Peru, NY

A: If you're postmenopausal, your supplement should be iron-free. You get some iron in your diet, and too much of this mineral is associated with a higher risk for various cancers.

In my opinion, you should be taking equal amounts of calcium and magnesium. For most women, I suggest 500 mg of a well-absorbed form of these minerals, such as citrate, ascorbate, or amino acid chelate. You'll want your multi to include 400-500 IU of vitamin E, a powerful antioxidant, and two to three mg of boron to help build strong bones. Vitamin E should be d-alpha, not dl-alpha tocopherol. Dl means it's synthetic.

Because insulin resistance is a growing problem as we age, I suggest you get at least 200 mcg of chromium, either as chromium picolinate or ChromeMate — well-absorbed forms of this mineral. Selenium has been found to lower the risk for cancer; you'll want 200 mcg for this protection.

In addition, you want all the B vitamins, vitamin C with bioflavonoids, good amounts of folic acid (800 mcg or more), and vitamin A with carotenoids. And, of course, trace minerals, such as manganese and vanadium (for insulin resistance).

You can find all of these in some supplements in health food stores and on the Internet. You can also find them in Vitality Plus (800-728-2288), a multivitamin I helped formulate for Women's Preferred brand. I often suggest beginning with Vitality Plus because it includes an essential fatty acids formula. This eliminates the need to buy products.

After you're taking a good quality multi and fatty acid supplement, the need for additional nutrients depends on your body's individual needs, the level of supplemental care you want, and what you can afford. With a supplement like Vitality Plus, you can add on any other of our supplements without ever getting too much of any one. With other brands, you may need to read labels carefully to make sure you're not taking too much vitamin E or A. All WP supplements are designed to compliment one another without taking too much of any nutrient.