A.S. is a 36 year-old female who presented with insomnia and stress. She reported having a constantly elevated level of stress since starting her job seven years ago as a service dog trainer. Stress levels became overwhelming as a result of personal/relationship issues . A.S. felt stuck in a loop of more stress & less sleep. As her stress increased, so did her insomnia, which in turn fueled the stress .
A.S. reduced her caffeine intake and tried to eat less refined sugar and carbs in her diet. She brought a list of supplements that she had at home, but admitted that she didn’t take them consistently. These included: vitamin D3, probiotic, multivitamin, Ashwagandha, magnesium, and melatonin at doses of 5mg or 10mg for it to be effective.
I started her on Resolaxin by Vita Aid, which has a combination of chamomile, lemon balm, wild jujube, passionflower, L-Theanine, magnesium citrate, and vitamin B6 per capsule. Though I recommended that she can take up to 3 capsules of it daily (Example – 2 capsules before bed and 1 capsule in the daytime to help with stress), A.S. found that 1 capsule of it daily before bed was more effective as she didn’t feel as good with the higher dosage.
A.S. was able to get general bloodwork from her medical doctor to make sure her complete blood count, ferritin, thyroid, vitamin B12, sugar, kidney and liver enzymes were within normal ranges.
I also recommended that she see a counsellor and to continue to take her current supplements consistently in the following way:
- 1 capsule of Ashwaghanda in the daytime (which had 300mg of organic KSM-66 Ashwagandha Extract per capsule)
- 2000mg of total omega 3 EPA+DHA
- 200mg of magnesium bisglycinate
- ½ tablet of 5mg melatonin (as needed before bed to help with falling asleep)
- 2000IU of Vitamin D3
- 20 billion cfu Probiotics
I switched her Multivitamin to the Thorne Stress B complex – 1 capsule daily with food in the daytime.
After 3 weeks, she reported that her sleep was better. Previously, she was waking up multiple times at night and could not go back to sleep. Since treatment started, she would only wake up once and was able to fall back asleep more easily. She discovered that she still needed to take 10mg of melatonin on occasion to fall asleep. This time, I had her add in 1 capsule of Sereniten Plus at night before bed, and to continue with the rest of the supplements as we discussed. Sereniten Plus has a combination of Lactium, L-theanine and Vitamin D3.
The main ingredient Lactium in the Sereniten Plus is a bioactive milk decapeptide isolated from casein that has been shown to help support the hypothalamic-pituitary-adrenal
(HPA) pathway and promote a healthier cortisol response by the adrenal glands when under stress. It does so by re-establishing receptor sensitivity feedback within the HPA-axis by enhancing hypothalamus sensitivity to cortisol.
After 1 month, I followed up with AS and unfortunately her stress levels had increased during the Easter weekend when she went home to visit her parents. One of her coworkers who had attended a staff meeting later tested positive for COVID-19. This caused AS to worry that she might have indirectly transferred the virus to her parents. She wasn’t able to relax until her parents confirmed that they were healthy during and after the holiday visit.. As a result, A.S.’s sleep became inconsistent again.
Her energy was another concern; A.S. felt extremely tired all the time.
This time, I increased her Ashwagandha dosage to 1 capsule twice a day for the next 2 weeks, and she continued on the rest of her other supplements.
Ashwagandha (Withania somnifera) is an adaptogenic herb that has been shown to improve stress and reduce anxiety in healthy adults. A study by Salve J. et al (2019), showed a greater effect in reducing cortisol level and improving sleep quality in those taking a higher dosage of 600mg daily of Ashwagandha in comparison to only 250mg daily. The effects also appear to be cumulative in that a greater effect was seen over 8 weeks.
Interestingly, after 2 weeks AS reported that she had been sleeping better and had more energy as a result of taking the Ashwagandha twice a day (600mg total daily dosage). A couple months later, AS continues to do well and we are looking to start decreasing her supplements as her stress and sleep remains better. She reports rarely needing to take the melatonin to help her to fall asleep.
It would have been interesting to see a 24-hour 4-point cortisol curve before and after the course of her treatments to see if the lab values would have reflected the improvements she experienced with the supplementation. As she responded well to the increased dosage of the Ashwagandha, it is likely that her cortisol level was higher in the earlier stages of adrenal dysfunction.
This case reminded me how the body may need some time before things can get back into balance and to manage patients’ expectations – persistence is key. Consistency while gradually increasing the dosage when necessary is also important to have greater results.
References
Salve J, Pate S, Debnath K, Langade D. Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study. Cureus. 2019 Dec 25;11(12):e6466. doi: 10.7759/cureus.6466. PMID: 32021735; PMCID: PMC6979308.