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Q: Sleep.
Can someone address the efficacy of warm milk as a sleep inducer? I've had significant trouble with Hepatitis B and liver cirrhosis during the last several months, including severe edema, thinning blood vessel walls, anemia. All of which, I'm sure, were complicated by the HIV.
I've gotten much better in the last few months. My doc has me on HAART (Combivir, Sustiva), Intron A (interferon) for the Hep B, epogin for the anemia, and lacix, aldactone, and lactulose for the edema and other liver problems.
I'm responding quite well - weight is back up close to 180, liver function tests report that I'm in normal ranges, both viral loads are "undetectable." However, I can't seem to sleep on a normal rhythm. My doc is hesitant about drugs that induce sleep (for good reason). I did some research on Valerian - two sources advised it, but one warned to avoid it if there are liver problems. Drinking to induce sleep is not good (though I still love my occassional martini).
Finally, last night I tried the old folk remedy of warm milk. There's no problem about consuming the protein in the milk - doc and nutritionist say that I can have protein again. But does warm milk actually work? Or did I just finally fall asleep and the milk had nothing to do with it?
Any advice would be greatly appreciated. I've finally returned to work, and don't have the luxury of being awake during the night, and sleeping when I'm ready to.
A: Chester Myers, PhD, MS responds:
Occasional use of Valerian might be okay, but until we know more, I'd try to avoid this. Your liver has enough work 'on its hands' for now. Also there could be interactions with some of the medications. Alcohol is strongly toxic to the liver, so be really careful on this one, what with the bucketload of medications!!
Although I'm not aware of studies in the area, there's a lot of anecdotal evidence, and good strong scientific rationale, that warm/hot milk does indeed provide some sleep inducement. There are apparently peptides (sections of the milk protein) released by the heating, and these appear to be responsible for the sleep effect. My guess is that these peptides are rich in the amino acid tryptophan (this may be a better way to get the tryptophan than from supplements). If, for whatever reasons, there are concerns with excess dietary fat, you could use low fat milk, or skim milk.
My experience on this one is that it may be helpful to have a glass of (cold) milk with the evening meal, followed by some hot milk just before bedtime. If you have any lactose problems, you may want to skip the milk with the meal.
If it's any encouragement, on nights when my mind is just too full of thoughts to get to sleep, I take a trek to the kitchen where I heat a cup of milk, put about 2 tablespoons of it in a bowl for one of my two cats (who loves to accompany me to the kitchen). I drink the rest myself. Sleep is rarely far behind!!
Diana Peabody, RD responds:
I believe it is the tryptophan in the milk that has a sedating effect. Taken with some starchy foods (eg toast or crackers) the tryptophan will have an even greater CNS (Central Nervous System) effect because the starch stimulates the release of insulin which promotes the transport of tryptophan into the brain.
