March 2019 ExtraCare Newsletter

March 2019 ExtraCare Newsletter


After noting last year that insomnia is such a big problem with my patients, this year I have vowed to help you all get a better night’s sleep. This month is the first in a series of newsletters in which I will discuss sleep, its importance in your health and ways in which you can improve it.

I also want to give a huge shout out to my amazing staff for taking time out of their busy Saturday morning last weekend to join me in supporting the Scleroderma Foundation Walk for a Cure at Chase Palm

Kavinace


Many patients have been asking me recently what I think of the supplement Kavinace.  If you search kavinace on the internet it sounds like the best thing since sliced bread. Kavinace reduces stress, anxiety, fatigue and helps you sleep!!….  Could this be true?

According to the product information kavinace contains three main ingredients, Phenibut, Taurine and vitamin B6. The manufacturers claim that phenibut can increase GABA activity in the brain, thereby inhibiting excitatory transmitters and causing a calming effect. They also claim that taurine protects the brain from free radical damage and also increases GABA activity. Adding B 6, according to the manufacturer will assist in GABA synthetization and treat depression, asthma and PMS.

So are these claims true? And is it safe?

You all should know that the supplement industry, a multi-billion dollar industry in our country, is not directly regulated by the FDA.  The FDA is not authorized to review dietary supplements for safety and efficacy before they are marketed. They can only stop the sale of a supplement if they can prove the product is dangerous.

The NIH formed the The National Center for Complementary and Integrative Health (NCCIH) in 1998. This agency spends hundreds of millions of dollars a year studying complementary and alternative medicine treatments to prove safety and efficacy. As you can imagine, it takes a long time to study just one treatment and with hundreds of manufacturers with new products coming out daily they are truly fighting a losing battle.

One place that I go to research a supplement or alternative treatment is to the Therapeutic Research Center Natural Medicines Database. This non biased source pools the literature on all supplements and their specific ingredients for studies and case reports of efficacy and safety.

Kavinace is rated 2 out of 10 by the TRC database.

There is not a lot of literature on Kavinace’s main ingredient, Phenibut, and as a result they were unable to rate this ingredient for efficacy. For safety,  Phenibut was rated possibly unsafe, meaning this product has some clinical evidence showing safety concerns or significant adverse outcomes; however, the evidence is limited by quantity, quality, or contradictory findings. People should be advised NOT to take products with a “Possibly Unsafe” rating.

When looking at the other two ingredients of kavinace, taurine and B6, there was insufficient evidence to rate efficacy on sleep or depression and significant drug interactions, particularly with anti-hypertensive medications, anti-arrhythmic medications, seizure medications and mood stabilizing drugs. In addition there have been published case reports of psychosis, excess sedation, nausea and withdrawal effects from the active ingredients in Kavinace.  

As a physician who has taken an oath to “do no harm”, I cannot recommend that you take this product.

Insomnia


One thing that I realized after having my patients complete the PHQ-9 questionnaire during their annual physicals last year is that many of you have trouble sleeping. In fact, the statistics are staggering.  Over 60 million Americans suffer from insomnia, 30% of American adults have symptoms of insomnia and 10% of Americans suffer from chronic insomnia.

Insomnia is defined as having a hard time falling asleep or staying asleep. Insomnia is considered a disorder only when it causes a significant amount of distress or anxiety, or when it results in daytime impairment.

A high rate of insomnia is seen in middle-aged and older adults. Although your individual sleep needs do not change as you age, physical problems can make it more difficult to sleep well.  Women are more likely than men to develop insomnia (blame menopause). People who have a medical or psychiatric illness, including depression, are at risk for insomnia and people who use certain medications (such as steroids) may experience insomnia as a side-effect.

Below is a list of sleep hygiene techniques that everyone with insomnia should follow:
Go to bed at the same time each night and get up at the same time each morning, including on the weekends
Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature
Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom
Avoid large meals, caffeine, and alcohol before bedtime
Get some exercise. Being physically active during the day can help you fall asleep more easily at night.
Limit daytime naps to less than 30 minutes
The American Society of Sleep Medicine has recently published a consensus statement which provides guidelines for physicians on the treatment of insomnia.

They do NOT recommend using over the counter sleep medications containing antihistamines (Unisom, Benadryl, Tylenol pm) because these medications often cause drowsiness the next day. In addition they do NOT recommend using over the counter herbal or nutritional substances such as valerian root or melatonin due to lack of efficacy and safety data (I have written a separate article on Kavinace which is also NOT recommended).

They suggest that any medication regimen be supplemented with cognitive behavioral therapy to avoid the need for long term use. The recommendation is to start with short-intermediate acting benzodiazepines such as zolpidem or temazepam, especially with patients who have difficulty falling asleep.  Sedating antidepressants such as trazodone, amitriptyline, doxepin or mirtazapine are useful especially in patients who have trouble staying asleep.  In certain circumstances other sedating agents including anti-epilepsy medications (gabapentin, tiagabine) and atypical antipsychotics (quetiapine and olanzapine) can be useful in treating insomnia.

Insomnia is a huge problem in our country. In total, the U.S. loses over 1.2 million working days a year due to sleep deprivation among its working population. Productivity losses at work occur through a combination of absenteeism, employees not being at work, and presentism, where employees are at work but working at a sub-optimal level. In addition insomnia increases the incidence of workplace accidents and is a major contributing factor to death from motor vehicle accidents.

While it’s reassuring to know that you are not alone, it is also distressing to realize that this difficult problem has no easy solution.

If you are having trouble with sleep please let me know. Together we can work on a plan to improve your sleep and ultimately your health.

Good night……
September 6, 2019 Uncategorized
Jeneva Escalera
About Jeneva Escalera