Vitamins and Sleep

Sleep Affects Neurological Problems:

In 2005 one of my patients who suffered terrible daily headaches found out that she had sleep apnea. She put on a CPAP mask and voila! her headaches went away! I thought, “Wow I have a lot of headache patients, what if helping their sleep would make their headaches better? “I started to send all of my headache patients for sleep studies. They all had abnormal sleep! Usually they didn’t stop breathing, they just didn’t have a normal amount of deep sleep. Eventually I did sleep studies on all the rest of my patients. They had a variety of neurologic disorders; epilepsy, vertigo , Parkinson’s disease, memory loss,  burning in the feet. The majority of them had abnormal sleep too, sometimes without even realizing that their sleep was abnormal.

In the beginning all I had for treatment were sleeping pills and sleep apnea masks. They both worked to some extent,  but they wore off over time. It seemed like the disease in the background (the reason why the brain wasn’t sleeping properly) wasn’t really being  fixed. Then I accidentally discovered that all of the patients who had abnormal sleep had vitamin D deficiency. And it turned out that vitamin D was not their only deficiency. Nearly everyone with abnormal sleep had a combination of both vitamin D and B vitamin deficiencies. This section will tell you which vitamins you need and why. Also see the FAQ section.

Vitamin D affects intestinal bacteria and the production of B vitamins:

Vitamin D deficiency leads to a change in the intestinal bacterial populations that make and supply us daily with 8 B vitamins. The B vitamins never came from the food, they have always been supplied in the daily doses we need by the bacteria in our intestine. But the “healthy” bacteria need our vitamin D to thrive, so when we don’t have enough to pass down to the good bacteria they die off and are replaced by  the “unhealthy” bacteria who don’t make B vitamins. So vitamin D deficiency usually exists along side of additional B vitamin deficiencies. This means that the sleep does not just magically go back to normal with just vitamin D. For your sleep to normalize and your health to improve the intestinal bacteria must return to normal as well, read further to see how we’ll do that.

Vitamin D is not a vitamin:

We’ve been taught that Vitamin D is the “bone vitamin”, but it is really a sun hormone. It is not in the food. It is a chemical that we make on our skin from sun exposure. Only the UVB wavelength of light makes vitamin D. It is a hormone like thyroid, estrogen or testosterone. Using the proper word “hormone” reminds us that it affects multiple parts of the body and that it is not “extra”. It is essential to every cell in the body and it was never meant to be in the food. It is supplemented in milk but as a cup of milk has only 100 IU (international units) of vitamin D you would have to drink 100 cups of milk a day to keep from being D deficient.

D hormone is made on the skin and absorbed:

D hormone is unique among our hormones because we make it on our skin from a specific wavelength of light. Where there are seasons every living thing must cope with 6 months of good weather and available food, and six months of terrible cold and no food. As we move away from the equator there is no UVB wavelength in the winter light, so during the winter we still need D every day but we have to use what we made and stored during the summer.

To survive the winter we must either migrate or hibernate:

Animals far from the equator where there are long, cold winters without food must either migrate toward the sun at the equator or hibernate. Any animal that cannot spend the winter in Florida must devise a way to eat more and get strong in summer, and eat less and sleep more in the winter. Mammals, reptiles, birds, fish and insects use this same chemical, D3 (cholecalciferol), to adjust their metabolism and their sleep to the seasons and make it through the winter.

The vitamin D blood level is important:

Our vitamin D blood level fluctuates with the seasons; it goes higher in the summer and lower in the winter. Most people can make 20,000 IU of vitamin D on their skin daily during the summer but only with large amounts of skin exposed, in a bathing suit for instance, after 2-3 hours in the sun at the pool. Darker skinned people have their own sunscreen, melanin, it blocks the formation of vitamin D so they must be in the sun longer than a lighter skinned person to make the same amount of D. Too much vitamin D in the body is as harmful as too little, a vitamin D blood level over 80 ng/ml affects the sleep as much as a level under 60 ng/ml. Because humans do not have fur to protect from making and absorbing too much D we developed our own sunscreen, produced in the skin, as a way to block the formation of D. During the summer we use 10,000 IU per day and put away 10,000 as storage for the coming winter.

The dose of vitamin D taken as supplement is different for each person:

Though most people can make a maximum of 20,000IU/day there are some that make and use much less. About 1/50 people only make and need 2,000 IU/day. Every single person must have vitamin D blood levels done several times during the first year of supplementation to see what dose they need to maintain their vitamin D blood level at 60-80 ng/ml, (where best sleep occurs). It is the D blood level, not the dose of the pill we take, that determines good health and normal sleep.

Low D goofs up sleep:

Most of the neurological problems my patients have are not directly related to vitamin D deficiency, they are related to the fact that vitamin D is tightly linked to sleep. Vitamin D levels lower than 40 ng/ml, (now considered “normal “ since the widespread use of air-conditioning), cause sleep disorders; insomnia, sleep apnea, REM related apnea, unexplained awakenings to light sleep, inappropriate body movements during sleep. All of these disorders keep us from healing our bodies during sleep. When the sleep improves the headaches, seizures, tremor, body pain, walking difficulties, depression, memory loss, etc. all get better. (See the Sleep section for more detail about why.)

D hormone affects our weight and appetite through changes in the intestinal bacteria:

In the summer as we have more sun exposure our D blood level climbs to 80 ng/ ml, we eat more calories, but store less. The high D message is “it’s summer it’s time to build our strength”. We turn more of our calories to building stronger bodies, we sleep less. In the winter the low D message is; “sleep longer, put on fat to survive the winter”. Lower vitamin D changes the bacteria in our intestine. The new “winter” bacteria affect our appetite, making us hungry for high fat, high calorie foods, insuring our survival. Unfortunately, if the D level stays low all year long we keep gaining weight. (see Economist article – The human microbiome: Me, myself, us.) When we attempt to lose weight the body is still listening to the winter message and is still putting half the calories into fat. Then as we exercise we use the proteins of our muscles as an energy source and get weaker instead of losing weight.

D deficiency affects the GI tract in many ways:

There are D receptors in our salivary glands, our teeth (we get more cavities if our D is low), our esophageal sphincter, and the stomach cells that make stomach acid. When the stomach sphincter is weak the acid moves up into the esophagus, where it doesn’t belong, causing “acid reflux”. The D we make on our skin goes to the liver, then into bile, keeping the bile acids dissolved, preventing the formation of gall stones. So gallbladder disease is probably related to low vitamin D. Because there are D receptors in the islet cells of the pancreas which make insulin, not enough D may also contribute to the formation of diabetes. Low D results in a change in the intestinal bacteria, so irritable bowel symptoms of bloating, constipation and diarrhea begin. Also, when the normal “healthy”, bacteria leave there is no bacterial source of B5. B5 is needed to make cortisol so our ability to heal and to fight infection are no longer normal. The white blood cells become lazy or too aggressive and we start to develop a “pro-inflammatory state” that can turn into an autoimmune disorder or increase our risk of heart attack and stroke.

Poor sleep causes hypertension, heart disease and stroke:

The sleep disorders experts report that every American with high blood pressure has a sleep disorder in the background. Therefore the real killer in America is not the long term effects of hypertension, but the long term effects of abnormal, non-restorative sleep. Vitamin D appears to affect our sleep cycles through D receptors in the lowest part of the brain called the “brainstem”, where we control the timing and paralysis of sleep. Sleep occurs every night to allow us to heal and make repairs. It is during sleep that we make the chemicals that keep our blood pressure normal during the following day. While we sleep our arteries repair and stay smooth so they don’t have the cholesterol build up that closes off the vessels leading to heart attack and stroke. The pacemaker cells in the heart heal normally so we don’t get atrial fibrillation that can lead to strokes. Several of the B vitamins play a role in atherosclerotic heart disease and stroke. B5 is necessary to make acetylcholine which is used to slow the heart rate. This means that people with D/B deficiencies often have a higher resting heart rate. They are frequently told that their heart racing is a “panic attack”, even though there is no reason for them to be “panicked”.

Poor sleep causes memory problems and depression:

While we sleep we make permanent memories. During sleep we also make the serotonin that we use during the day to stay happy and curious, so low D hormone can cause depression and memory problems.

Low D affects all the blood cells:

The B vitamins are needed on a daily basis for the proper production of the red and white blood cells. Anemia is linked to D/B deficiencies. All of the autoimmune diseases: multiple sclerosis, lupus, rheumatoid arthritis, psoriasis, ulcerative colitis, are related to low vitamin D in combination with secondary B vitamin deficiencies. B5, pantothenic acid is the raw material used to make cortisol. Cortisol is the daily hormonal message that tells all of the white blood cells how to behave. Cortisol is used to treat the autoimmune disorders, to tell the white blood cells to stop attacking our own body. Patients who have autoimmune disorders have had combined D/B deficiencies for many years and always have an accompanying sleep disorder. Only normal sleep for many months will bring back the normal immune system. Our own white blood cells travel through our bodies at night seeking out and killing cancer cells. Thus, increases in breast, colon and prostate cancer are also believed to be related to low D. Women with breast cancer who are told they “can’t take hormones”, (meaning estrogen), should still take D hormone. The right D level (in addition to normal sleep and correction of the intestinal bacteria) helps the body’s own immune system fight cancer.

D hormone, bones and calcium:

Even though most of us have been told we need extra calcium, D deficiency is what causes osteoporosis, not calcium deficiency. D helps the GI tract absorb calcium and keeps the calcium from leaking into the urine. So low D may also cause kidney stones, either before or after the D supplementation is started. Osteoporosis is a vitamin D deficiency state, if the vitamin D level is kept 60-80 ng/ml for several years calcium is properly absorbed from the diet and calcium supplementation and the medicines used to treat osteoporosis are not needed.

Low D causes balance difficulties and pain:

D deficiency can also cause leg pain, burning in the feet, and difficulty with balance through the secondary B vitamin deficiencies. Both vitamin D and B5 affect our ability to get paralyzed correctly during rapid eye movement (REM) sleep. B5 deficiency can cause stiffening of muscles that are supposed to get paralyzed while we’re dreaming. This contraction of the muscles while we’re sleeping can cause body pain on awakening; fibromyalgia, arthritis, chronic low back pain, knee pain, hip pain. Every moving part of the body must get perfectly paralyzed to repair at night. If paralysis does not occur correctly during sleep the body doesn’t heal and morning pain results. B5 deficiency can also cause burning in the hands and feet that is usually called “neuropathy” and blamed on diabetes, even when the sugar measurements are normal.

Low D causes infertility, polycystic ovary syndrome and endometriosis:

There are vitamin D receptors in the ovaries, the testicles and the fallopian tubes to help match our reproduction to the amount of food available. As the D level climbs in the fall to 80 ng/ml we sleep better and therefore make more estrogen and testosterone that make us want to mate. Because our human babies develop over 9 months, the baby that is conceived in September is born in June. This guarantees that at birth the baby is in the sun making her own D hormone because there is very little D in the breast milk ( unless mom is supplementing). Low vitamin D levels suppress ovulation so that our babies will be born only when mom has food (food comes from the sun so does the D). “Polycystic ovary” describes an ovary with many eggs that are all trying to mature at once. Because ovulation is inhibited by the low D, the ovaries are stuck at the stage of many eggs trying to mature and cysts develop leading to abdominal pain, (often accompanied by weight gain and acne which are related to the accompanying pantothenic acid deficiency and the “wrong “ intestinal bacteria).
Endometriosis results from endometrial tissue going backward up the fallopian tube into the abdomen instead of out the cervix, (the opening in the uterus), during menstruation. Because the fallopian tube is open into the abdomen the only thing that keeps the endometrial tissue heading out the cervix are wave-like movements in the fallopian tubes pushing toward the uterus. There are vitamin D receptors in the fallopian tubes that influence the propulsive movements, promoting or preventing fertilization if the D level is low. Also, once the endometrial cells have arrived in the abdomen, where they don’t belong, the white blood cells are supposed to find and kill them. Because the low D also affects the function of the white blood cells the proper elimination of the endometrial tissue doesn’t occur and fixed implants of endometrial tissue appear in the abdomen, causing abdominal pain during menstruation.

Women bearing babies are the ones who are most affected:

The reason why thyroid disease, gallbladder disease, B12 and iron deficiency, obesity and sleep disorders (and therefore severe headaches) often occur in young, healthy women is because they’re the ones having the babies. Each baby sucks up mom’s vitamin D. Unfortunately each prenatal vitamin has only 400 IU of vitamin D, which is not nearly enough to provide for mom and the developing baby. Each baby uses up mom’s D and if she’s not out in the sun enough after delivery her D deficit is never corrected between pregnancies. Each resulting child is more D deficient and each baby sleeps worse than the last. Mom also sleeps badly, being more D deficient herself with each baby. The chronic sleep disorder over several years can result in postpartum depression. All women who have had babies are likely to be D deficient. Pregnant women need a D level done several times during pregnancy. The level should be maintained at 60-80 ng/ml during the pregnancy to assure that the baby is carried to term. Women of reproductive age with low D need to correct their D level and their colonic bacteria with an accompanying three months of B50 before they get pregnant to be sure that their baby receives all the D it needs during development and is inoculated with the right bacteria on delivery. Large doses of B vitamins such as B50 are not indicated during pregnancy but a prenatal vitamin with small doses of all eight B vitamins (100% min daily recommended dose) should be taken during pregnancy. Most women need at least the same dose of D during the pregnancy that they needed before getting pregnant and should only add more D if their blood level falls.

Vitamin D and aging:

Even under perfect circumstances, with perfect sun exposure, we don’t live forever. Humans live about 90-100 years. Every decade our vitamin D production (per hour of sun exposure) goes down. At age 70-75 the vitamin D production on our skin goes so low that four complaints become common in the elderly; “my bowels don’t work”, “I’ve got rheumatism” (I wake up stiff and in pain), “I don’t sleep well”, and “my nose runs all the time.” When the sleep starts to fail we begin to get hypertension, diabetes, high cholesterol, heart disease, stroke or cancer and die 5-10 years later. Therefore our D level and our ability to sleep normally are linked to our life span.

There are problems with making a hormone from the same sunlight that can damage the skin:

The rate of production of vitamin D is dependent on the skin color, the age and the location on the planet. Lighter skinned humans began to appear in far northern and southern latitudes because they survived better. Their lighter skin color did not block the D production so they were stronger and could reproduce in lower sun environments. However, those bright white or freckled people have a disadvantage when they move to a high sun environment, they don’t have the natural melanin sunscreen and their skin burns. When humans were adapted to their latitude with the “proper” coloration, and their internal D level was normal, some of the pre-D that they made on the skin from UVB light stayed on the skin and was converted to the active chemical D 1,25 OH. D 1,25OH has been shown to go into the nuclei of skin cells to repair the DNA damage caused by the UVB exposure helping to prevent skin cancer. This means that there was already a natural biologic process that protected us from skin cancer caused by sun exposure.

How much D should I take?

As most of us don’t receive D from the sun daily, our supplementary vitamin D requirements are much higher than the FDA recommended 800 IU per day, and are probably closer to 5,000-10,000 IU per day. But about 2% of the population needs much lower doses of 1000IU -2000IU /day so each person must have vitamin D blood levels done frequently in the first year to measure the blood level. When your doctor measures your D blood level it should be the D 25 OH, not the D 1,25 OH level that is ordered. To sleep normally the vitamin D25OH blood level should be 60-80 ng/ml. A vitamin D level of 30 ng/ml  is the “I don’t have rickets” level. Most of us want a  D blood level that allows us to thrive!

Why FDA recommendations are so low:

Cholecalciferol is a hormone not a vitamin. It makes no sense to put hormones into food. We would never dream of putting estrogen or testosterone or thyroid hormone into the milk. Because it was incorrectly called a “vitamin” the FDA has been put in the very difficult position of making “recommendations” for hundreds of thousands of people who have different D levels from year to year depending on their lifestyle, where they live and their skin color. The FDA knows that high vitamin D levels can cause medical problems and death so the FDA has appropriately recommended a dose of vitamin D that is unlikely to hurt anyone. This does not mean that 800 IU is what you need. Each person must find out what dose they need to stay at 60-80ng/ml by measuring their blood level. Medicare and most insurance companies will pay for four vitamin D levels per year if a billing code of E55.9 (vitamin D deficiency) is on the lab slip.

What is the right D hormone dose?

For most people the daily supplemental D dose will be 1-5000 IU per day in summer, 5-7,000 IU per day in winter, but if your level is 30 or below and it’s winter, I recommend that you take 10-15,000 IU for 4 weeks to get your level back above 50 more rapidly. Then check your level again in no more than 4 weeks to be sure it is above 60. Over 1-2 years measure your D levels every 6 to 12 weeks and make sure that you are taking enough to provide a D blood level between 60-80 ng/ml all year long. Don’t take extra D when you’re using a tanning bed or out in the sun in the summer, you’ve just made your daily supply on your skin. Never take doses over 1000 IU/day without checking your levels regularly.

How the prescription D2 can hurt you:

We doctors have been, incorrectly, taught that it’s safe to give vitamin D2, (ergocalciferol) as a once a week pill of 50,000 IU. D2, Ergocalciferol is not the same as D3 Cholecalciferol, and may be dangerous for some, in fact the majority of my patients felt that it made their sleep and headaches worse. Make sure what you buy is D3. This important mistake resulted from using the rat as the experimental model to look for the “vitamin” that prevented the bone disease of rickets in the 1930’s. Rats are nocturnal animals. In order to spend their lives in the dark, they had to have a vitamin D receptor that allowed them to use a different chemical, D2, made by fungus that grows on grain. D2 is similar but not identical to what you and I, and all other animals, make on our skin. D2 does come in the food, (which is why the “vitamin” word was originally applied). The rat’s ability to use this chemical allowed it to be nocturnal, active at night and able to run about our houses eating our food at night. This is why humans don’t like rats and therefore find experimentation on them less objectionable than on other animals. Once D2 was discovered it did, in fact, help rickets in children. The original “anti rickets” chemicals; D1 and D2, were found together first on grain, then several years later, D3 was discovered on the skin of pigs, made only by UVB light exposure. Because D3 acted similarly to D2 at bone receptors and the scientists were focusing on the bone promoting actions of D they did not study the actions of D2 at the other vitamin D receptors. D2 appears to act differently than D3 in the brain, it usually does not improve the sleep, and may make it worse.

Vitamin B12 deficiency:

Vitamin B12 deficiency is a common secondary deficiency that also affects sleep. It appears that vitamin D deficiency also causes B12 deficiency. There are Vitamin D receptors in the stomach cells that make “intrinsic factor”, the chemical that binds to B12 and allows us to absorb it from the food. When the D is so low that the intrinsic factor production becomes low also we are not able to absorb B12 from our food and become B12 deficient. Even though B12 is also made by the colonic bacteria the absorption of B12 in humans is in the small intestine so the B12 in the colon is not our primary source. Only about a quarter of my D deficient patients have an accompanying B12 deficiency. But all D deficient patients have accompanying changes in the intestinal bacteria that must be corrected for normal sleep to occur. Ask your doctor to check your B12 level when you check the D the first time. The B12 level for normal sleep is above 500, (the lab result will say over 225 is normal but you want it to be 500 or more for normal sleep). If the B12 blood level is < 500 it should be supplemented separately as a daily pill of 1000 mcg/day to help the sleep normalize. It should be taken daily for several years in addition to the other B complex pills such as B50 and B100. Monthly B12 shots are not as effective as daily pills. 

Why is pain so common in vitamin D deficiency?

If you have fibromyalgia, muscle pain, arthritis, or burning in the hands or feet you also have pantothenic acid (B5) deficiency. Every person who starts vitamin D supplementation (without correcting the intestinal bacteria by taking B50 or B100 for three months in combination) eventually becomes B5 deficient and starts to wake with pain in the morning. In order to bring back the “right” intestinal bacteria B-50, (a B complex that has 50 mg or 50 mcg of each of the 8 B vitamins) should be taken for 3 months in combination with a vitamin D dose high enough for the blood level to be > 40ng/ml. If it takes a couple of months for your D blood level to get up to 40 ng/ml you must start counting the three month time span once your D is 40 or above. Supplying the vitamin D and all 8 B vitamins together encourages the “right” bacteria to grow back. Most patients who have little or no pain at the start of D supplementation do well with B50. Patients who already have fibromyalgia or significant arthritis should start with B50 but after about a week, if you still awaken with significant pain try increasing to B50 morning and evening. The right dose is the dose that allows you to wake in the morning pain free. Arthritic pain takes weeks to improve as the joint injuries are slowly healed every night, so watch for when your joint pain begins during the day it should slowly move to later and later in the day. Once the intestinal bacteria are back making B vitamins, (after three months) you must stop the B50 supplement. You now have the healthy bacteria making your vitamins and if you’re still taking the pill it’s double the dose, and pain will return. Both vitamin D and B5 affect our ability to get perfectly paralyzed in deep sleep and can cause body pain if the dose is not right. Every time you feel old and stiff on awakening check the D level first, if the D is 60-80 ng/ml then then B5 dose is either too high or too low, (or you just fell out of a tree and you shouldn’t have been up there with that chain saw anyway). Some people get nausea from multivitamins or B complex if this happens to you you may have to wait 2-3 weeks of D by itself until you can tolerate a multivitamin. You can also try a child’s chewable multivitamin with lower doses of all 8 B’s and slowly increase by one every couple of weeks until you are tolerating the equivalent of B50, then switch over to B50 plus the multivitamin.

What to do in months 6-24 of RightSleep:

A Vitamin D blood level that stays in the range of 60-80 ng/ml for months to years on end encourages the brain to spend more time in deep sleep to make long-deferred repairs. In order to make those repairs you need all 8 B vitamins. The B vitamins are the building blocks of repair. Never take B vitamins (except for B12) individually. The B vitamins have always come together in a specific relationship to one another and are very biologically intertwined. If you take one B you should take all of them. In months 4-24 of D supplementation each person needs a specific amount of B5 based on how many repairs they’ve put off for how long. The intestinal bacteria appear to make the exact amount of B’s needed by a normal human who never fell apart, but they cannot respond to a request to make more B’s for the extra repairs that you need. For your “bone on bone” joints, or your autoimmune disease to repair (to get back to being a normal human again) you will need slightly more B’s for a finite period of time. When your brain has the right amount of B5 it will get correctly paralyzed during REM sleep and you will wake pain free. My patients have usually been able to tell a difference in 5 mg changes of B5 at this stage. Each person needs their own individual dose depending on how much extra REM repair they need. Both above and below that “sweet spot” there is pain on awakening. I ask my patients to go up by 5 mg of B5, every couple of days usually using a multivitamin with 5-10 mg of B5 per pill, until they awaken pain free in the morning. People who have been sicker longer and have more deferred repairs, appear to need much larger doses, 75-90 mg of B5, someone who has only been sick since the last pregnancy two years ago may only need 15 mg. Each person needs to find their dose. As the repairs get finished and you return to being a normal human you will need to lower the dose by 5 mg increments of B5. When all the repairs are finished you will no longer need vitamins in pill form (except for vitamin D). You will be back to using only the amount of B’s that your intestinal bacteria make and you’ll be sleeping normally again (as long as you keep the D in range), and even a low dose multivitamin might be more than your brain wants. Patients with sleep apnea on CPAP will take much longer to complete this process and will  need to stay on their mask until they are documented to have no apnea on their sleep study.

 Warnings about the B vitamins:

The brain only wants extra B’s if it is staying in deep sleep longer than normal so after the first three months of B50 stop large dose B’s and stay on just a multivitamin with small doses of B’s. Your multivitamin should have all 8 B’s and approximately 100% minimum daily recommended dose of each one. The routine generic multivitamins at large pharmacies usually have these doses. Cheaper is better, the expensive health food multivitamins often have very large doses of B vitamins which can hurt you if you don’t need them.

The first three months take D plus B50 and a mvi. After three months stop the B50 and continue the mvi. There is frequently a several month “honeymoon period” where everything runs well on just a mvi with 10 mg of B5. Then, if the sleep continues to be excellent the body pain may start to reappear. I believe this means that the brain has decided that it’s doing well enough to start making long-deferred repairs and it’s asking for more B’s to stay paralyzed longer. At this point you will need to add back smaller B doses in 5 mg increments of B5 until the morning pain is gone. Also, both B5 and vitamin D can make people act out their dreams if the level is not right. Thus kicking or chewing or talking during sleep are all signs that the body is not getting paralyzed correctly, either the vitamin D blood level or the B5 dose is too high or too low. Pantothenic acid (B5) blood levels do not reflect the pantothenic acid body stores and are therefore not reliable to determine what amount the brain wants. The body pain on awakening is more reliable, which is why I am not recommending that you test your B blood levels except for B12. sgominak 06182017