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    Features

    Supplement Support: Delivering a Good Night’s Sleep

    Nighttime nutritional regimens are getting more diverse than ever.

    Supplement Support: Delivering a Good Night’s Sleep
    By Mike Montemarano, Associate Editor09.27.22
    Vital to mental health and physical wellbeing, sleep is fundamental to the way people feel and behave each day. With growing demand for supportive products, brands and formulators are diversifying their offerings through active ingredients, dosage formats, and delivery methods.

    The market for dietary supplements positioned for sleep represents about $737.9 million in revenue for the past 52 weeks ending on Aug. 7, growing 6.2%, according to SPINS data. Notably, sleep supplements are outselling and outpacing the $702.1 million market for ingestible over-the-counter (OTC) sleep aids, which grew 3.2% in the same timeframe.

    Melatonin has been the leader in the sleep support market, however, other ingredients such as L-theanine, magnesium, ashwagandha, lemon balm, chamomile, vitamin C and others are also performing well.

    For sleep supplements and OTC sleep aids combined, melatonin sales were up 8.6% to $687.5 million, L-theanine was up 19.3% to $6.5 million, valerian dropped -28.2% to $5.96 million, magnesium grew 37.2% to $3.47 million, lemon balm was up 21.7% to $1.61 million, and ashwagandha was up 42.6% to $995,000. 

    The Impact of Troubled Sleep

    Disordered sleep has been rising over the past decade. About 70 million Americans suffer from chronic sleep problems, according to the U.S. Centers for Disease Control and Prevention (CDC).

    Sleep troubles seem to skew toward younger people and women, according to the Casper-Gallup State of Sleep in America 2022 Report, which surveyed 3,035 adults. Participants discussed the quality of sleep they had the night before taking the survey, and the perceived impacts their sleep quality had on a number of factors.1

    According to the survey, sleep quality tends to improve with age; 38% of adults age 18-49 reported their sleep quality the night prior to taking the survey was fair or poor, compared to 30% of adults 50-64, and 24% of those age 65 and older.

    This correlates with demographic trends in stress. According to the survey, 64% of adults between 18 and 29, 57% of adults between 30 and 39, and 52% of adults between 40 and 49 said they experienced stress “a lot” of the prior day, compared to just 37% of adults between 50 and 64 and just 24% of those who are 65 and older.

    Sixty-one percent of adults under the age of 50 said that sleep had a major impact on their mood, followed by one’s day at work (57%), health in general (53%), and one’s ability to have fun (38%).

    While 61% of women said that sleep is a major priority compared to 48% of men, women were more likely than men to report trouble sleeping overall the prior night (59% vs. 49%). Women were also slightly more likely than men to report some trouble falling asleep (17% vs. 12%).

    Gallup’s survey also found that people who reported they typically get a poor night’s sleep had more than double the rate of absenteeism from the workplace compared to all others (2.29 unplanned missed work days compared to 0.91, respectively), resulting in an estimated $44.6 billion in lost productivity each year. These data were controlled for overall health, clinical depression and anxiety, significant daily stress, and COVID-19.

    Sleep deprivation is intertwined with obesity and related metabolic diseases, as sleep helps to regulate leptin and ghrelin, two hormones responsible for appetite control and satiety. A study published in March by Mayo Clinic researchers found that restricting the amount of time participants were able to sleep in a clinical setting (with free choice of food) was associated with a 9% increase in total abdominal fat area and an 11% increase in abdominal visceral fat, compared to control sleep, in which participants were allowed nine hours in bed to sleep.2 The sleep-deprived participants over the two-week study period consumed an average of 300 more calories per day than they did during the acclimation period.

    In June, the American Heart Association (AHA) updated its seven-item scoring tool, renaming Life’s Simple 7 to Life’s Essential 8, adding healthy sleep as essential for optimal cardiovascular health. The updated list, appearing in AHA’s journal Circulation, was changed due to research linking healthy sleeping patterns to improvements in measures of weight management, blood pressure, and risk of type 2 diabetes.3

    Life’s Essential 8 now includes healthy diet, participation in physical activity, avoidance of nicotine, healthy sleep, healthy weight, and healthy levels of blood lipids, blood glucose, and blood pressure.

    Sleep disturbance has also been shown to result in more serious complications than previously understood. A review of data collected by the National Institutes of Health (NIH) Adolescent Brain Cognitive Development (ABCD) study, for instance, found that among 12,000 volunteers between the ages of 9 and 10 years old, a group of 4,000 children who got nine or more hours of sleep per night had significantly fewer mental and behavioral challenges than those who got less sleep, including impulsivity, stress, depression, anxiety, aggressive behavior, and thinking problems.4

    The differences between the two groups persisted at a two-year follow-up. Further, children who had insufficient sleep had less gray matter or smaller volume in certain regions of the brain responsible for attention, memory, and inhibition control than those whose sleep habits were healthier, according to brain scans.

    Moving Beyond Melatonin

    Melatonin, a hormone found in the pineal gland which is associated with regulation of the circadian rhythm, is certainly not being edged out of the spotlight anytime soon. In fact, according to a review of National Health and Nutrition Examination Survey (NHANES) data, Americans in 2018 used substantially more melatonin than they did two decades earlier, with 2.1% of Americans now self-reported melatonin users compared to 0.4% in the 1999-2000 NHANES.5

    However, some consumers cite feelings of grogginess the next day as a barrier to using melatonin, and would prefer melatonin-free supplements. Contemporary studies are emerging to support its use specifically with circadian rhythm disorders such as jet lag, while its potential role in treating insomnia is less conclusive, according to recent data.

    Not to lose out on the melatonin-averse consumer, formulators are developing more diverse melatonin-free options, bringing amino acids, botanicals, and more to the forefront.

    With several products launched this year, Gaia Herbs’ sleep portfolio includes gummies, capsules, teas, and tonics. Its Adrenal Health Nightly Restore capsules contain ashwagandha, magnolia bark, cordyceps, and lemon balm; SleepThru capsules contain ashwagandha, passionflower, and jujube date; and Sound Sleep capsules contain California poppy, skullcap, and passionflower.

    Gaia’s Sleep & Relax is a blend of passionflower, lemon balm, and chamomile available in tea and capsule delivery formats; Sleep Gummies contain ashwagandha, passionflower, reishi mushroom, and jujube date; and the company’s collection of tinctures includes Valerian Root, in standard and organic varieties, and Valerian Poppy Supreme.

    Instead of products with melatonin as a sole active ingredient, formulas that combine melatonin with other sleep-associated ingredients are popular among other legacy brands. The common idea across many of these product launches is to combine melatonin with occasion-based ingredient selections; often, these ingredients are stress-related, pertaining to physical stress, mental stress, and even stress on the immune system.

    Natrol, for instance, launched several new products in its Sleep+ line this year, each of which combines melatonin with other active ingredients, including: Sleep + Calm Capsules, which contain melatonin, ashwagandha, L-theanine, and lemon balm; Sleep + Immune Health Capsules, which contain melatonin, elderberry, zinc, and vitamins C and D; and Sleep + Recovery Capsules, which contain melatonin, turmeric, and a blend of antioxidants designed to support a healthy inflammatory response in recovery from daily activity, including mild and moderate exercise.

    Olly also launched a new line of sleep products this year in the form of dissolvable tablets. These are available in four varieties: Sleep, a combination of 3 mg of melatonin and lemon balm; Extra Strength Sleep, a combination of 5 mg of melatonin and lemon balm; Relaxing Sleep, a combination of melatonin and L-theanine; and Immunity Sleep, a combination of melatonin and vitamin C.

    NatureMade Wellblends, which debuted this year, is a portfolio of products tailored to one of three categories that, to many, have defined the nutraceuticals market over the past three years: sleep, stress, and immunity.

    Notably, the Sleep portion of this product line contains products that address specific sleeping complaints like sleeping longer or falling back asleep in the middle of the night, with unique delivery and dosage technologies for each. Fall Asleep Faster supplements are formulated with 10 mg of melatonin, vitamin B6, and L-theanine, the latter of which is included due to its rapid bioactive effect. On the other hand, Sleep Longer capsules contain a tri-layer design that slows down the release of melatonin alongside L-theanine and GABA, in order to ensure continuous absorption of the bioactive ingredients throughout the night. Back to Sleep tablets deliver a dose of melatonin, GABA, and L-theanine through dissolvable tablets in order to ensure that the dose is as fast-acting as possible.

    Focusing on the Fundamentals

    Notably, eating patterns such as the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, are often predictors of good sleep quality. One cohort study published in Nutrients in 2020 found that among 432 women, those whose self-reported diets adhered most closely to the Mediterranean diet had higher Pittsburgh Sleep Quality Index Scores, higher self-reported sleep efficiency, and fewer sleep disturbances.6

    A 2020 review of NHANES data for nearly 4,000 adults revealed that those who most closely followed the DASH diet were significantly less likely to have sleep-related daytime dysfunction. Additionally, data suggested that the potassium component of DASH had the strongest influence in women, while fiber had the strongest positive influence on a net of sleep symptoms among younger subjects.7

    Looking at essential micronutrients, another study published in 2019 found that among 26,211 subjects there was a significant association between shorter sleep duration and: lower usual intakes of calcium, magnesium, and vitamins D and K in all adults over the age of 19; lower usual intakes of calcium, magnesium, and vitamins A, C, D, E, and K in women over 51; and inadequate intakes of vitamin D in males over 51. Notably, the research took into account both food and supplemental nutrition.8

    Magnesium is also emerging as a therapeutic to improve sleep. Among the 300 cellular processes this mineral is involved with, it plays a stimulating role in the production of GABA, the primary inhibitory neurotransmitter for the central nervous system.

    In a review published in Current Developments in Nutrition, 5,115 young adults between the ages of 18 and 30 took part in a longitudinal study called the Coronary Artery Risk Development in Young Adults (CARDIA) study.9 The intake of magnesium was evaluated based on dietary history, and sleep measures were collected at baseline, at 15 year follow-up, and at 20 year follow-up. The highest quartile of the participants in terms of magnesium intake had significantly higher sleep quality than the lowest quartile, and were also significantly less likely to have short sleep.

    When it comes to research on omega-3 fatty acids, the potential role they have in supporting sleep quality is beginning to get attention. While several animal studies have linked inadequate DHA intake to disturbed melatonin rhythm and sleep disturbances, few human studies have been conducted.

    An observational study published this year in Sleep Health found that, based on NHANES data from 1,314 subjects, adults who had very short sleep duration had significantly lower EPA and DHA levels, and lower total omega-3 fatty acid blood concentrations compared to those with normal self-reported sleep levels.10

    In a randomized, placebo-controlled study published in the Journal of Sleep Research this year, taking a 600 mg supplement of the omega-3 DHA from an algal source was associated with significant improvements in sleep duration in a group of 362 children between the ages of 7 and 9 years old.

    Children who took a course of daily omega-3 supplements got, on average, 58 more minutes of sleep and seven fewer waking episodes per night compared to children taking a corn or soybean placebo. Results was substantiated further by correlations between higher blood levels of omega-3 fatty acid taken by a finger stick test. Notably, 40% of the children who participated in the study had “clinical-level sleep problems,” according to the authors.

    References

    1. Gallup (2022) The State of Sleep in America 2022 Report. Gallup.com.
    2. Covassin, N. et al. (2022). Effects of Experimental Sleep Restriction on Energy Intake, Energy Expenditure, and Visceral Obesity. Journal of the American College of Cardiology. 79(13)1254-1265. https://doi.org/10.1016/j.jacc.2022.01.038
    3. Lloyd-Jones, D. et al. (2022). Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory from the American Heart Association. Circulation. 146(5)e18-e43. https://doi.org/10.1161/CIR.0000000000001078
    4. Yang, F. et al. (2022). Effects of sleep duration on neurocognitive development in early adolescents in the USA: a propensity score matched, longitudinal, observational study. The Lancet. Epub ahead of print. doi: 10.1016/S2352-4642(22)00188-2
    5. Li, J. et al. (2022). Trends in Use of Melatonin Supplements Among U.S. Adults, 1999-2018. JAMA. 327(5)483-485. doi: 10.1001/jama.2021.23652
    6. Zuraikat, F. et al. (2020). A Mediterranean Dietary Pattern Predicts Better Sleep Quality in U.S. Women from the American Heart Association Go Red for Women Strategically Focused Research Network. Nutrients. 12(9): 2830. doi: 10.3390/nu12092830
    7. Liang, H. et al. (2020). Dietary Approaches to Stop Hypertension (DASH) Score and Its Association with Sleep Quality in a National Survey of Middle-Aged and Older Men and Women. Nutrients. 12(5):1510. doi: 10.3390/nu12051510
    8. Ikonte, C. et al. (2019). Micronutrient Inadequacy in Short Sleep: Analysis of the NHANES 2005-2016. Nutrients. 11(10)2335. doi: 10.3390/nu11102335
    9. Zhang, Y. et al. (2021). Association of Magnesium Intake with Sleep Duration and Sleep Quality: Findings From the CARDIA Study. Current Developments in Nutrition. https://doi.org/10.1093/cdn/nzab053_102
    10. Murphy, R. et al. (2022). Association of omega-3 levels and sleep in U.S. adults, National Health and Nutrition Examination Survey, 2011-2012. (8)3: 294-297. https://doi.org/10.1016/j.sleh.2021.12.003
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