Insomnia, Serotonin and Massage

Insomnia means trouble either falling asleep or staying asleep. The prevalence of insomnia is staggering, with more than 30 percent of American adults suffering from occasional bouts of insomnia and 10 percent of Americans experiencing chronic insomnia. While insomnia may be a symptom on its own, it also can be connected to a long list of healthcare problems.

Chronic insomnia is poor sleep every night or most nights for more than six months. This endless cycle can cause extreme fatigue, problems with concentration and can adversely affect a person’s mood and well-being. Recurring insomnia should be evaluated by a healthcare professional or a sleep disorder specialist.

Methods of treating insomnia cover a wide span of lifestyle adjustments, psychological services, Western medical treatments and complementary/alternative medical choices. Under that last category, complementary/alternative medical choices, be certain to include massage therapy as a viable option to help the sleep deprived. While it may not be the first appointment that an insomniac thinks to make, looking at the neurochemistry of sleep, and the effect massage has on that neurochemistry, may provide a solid link between massage and insomnia treatment.

The neurochemistry of sleep is very complex. While there are many aspects of the brain and its chemicals that contribute to sleep, we will look at the serotonin component of sleep.

Serotonin is an extremely important neurotransmitter that is essential to our survival. Serotonin plays a role in mood, behavior, body temperature, physical coordination, appetite and sleep. Derived from the amino acid tryptophan, serotonin can also be converted by the brain into melatonin.

The involvement of serotonin in sleep has been repeatedly proven. However, the mechanism of that involvement remains unclear. A number of studies revolve around a specific area of the brain that mediates deep sleep. This area of the brain is called the raphe nuclei. The raphe nuclei contain nerve cells that use serotonin to communicate with each other. In laboratory experiments using cats as subjects, destruction of the cats’ raphe nuclei resulted in their inability to sleep. Another experiment consisted of blocking serotonin synthesis with a drug (p-chlorophenylalanine). Administration of this drug produced insomnia, an effect which was reversed by the subsequent administration of serotonin.(1) These studies all demonstrate the necessity of serotonin for healthy sleep.

Serotonin is a precursor to the body’s rendering of melatonin. Melatonin is a hormone released by the brain’s pineal gland to quiet and reset the part of the brain (the suprachiasmatic nucleus) that directs circadian cycles to prepare for sleep. According to Charles Czeisler, professor and chair of the Division of Sleep Medicine at Brigham and Women’s Hospital, Boston, MA, circadian cycles are internal periodic rhythms that profoundly affect sleep and wakefulness.(2)

The chemistry of sleep is relevant to massage therapists because massage can directly influence the body’s production of serotonin. A study on back pain, conducted in January 2000 by the Touch Research Institute in conjunction with the University of Miami School of Medicine and Iris Burman of Miami’s Educating Hands School of Massage demonstrated that in addition to a decrease in long-term pain, subjects receiving massage experienced improved sleep and an increase in serotonin levels.(3)

This massage study employed twice-weekly, 30 minute massages for five weeks. Starting in the prone position, the following techniques were used:

Kneading and pressing the back muscles
Stroking both sides of the spine and hips
Gliding strokes to the legs
Kneading and pressing the thighs

In the supine position, participants received:

Gliding strokes to the neck and abdomen
Kneading of the rectus and oblique muscles that help bend the trunk of the body forward
Stroking of the legs
Kneading of the anterior thighs
Flexing of the thighs and knees
Gentle pulling on both legs

In addition to other assessments, a sleep scale to measure quality of sleep and urine samples to measure levels of serotonin were used. The results of this study were originally published in the International Journal of Neuroscience in 2001.

Massage is an intelligent, healthy and substance free choice to help the scores of people that have insomnia. Because serotonin plays a role in sleep in multiple areas of the brain, it is logical to seek ways to increase serotonin levels for people that are sleep deprived. In addition, serotonin is needed for our bodies to produce melatonin. As melatonin influences the sleep stage of our circadian rhythm, a natural way of boosting serotonin is a positive sleep inducing option. This connection calls for further research showing the direct affects massage therapy has on serotonin and sleep. In the meantime, the existing evidence is certainly enough to condone regular massages for sleepless clients.