Functional Medicine

How Magnesium influences sleep quality

Sleeping Beauty
We cover :
– mechanisms of sleep
– biochemistry of magnesium in sleep physiology
– analysis of magnesium levels in the body
– supplementation protocols
You don’t have to pull on grass to make it grow.
The body is fascinating. Sleeping takes NO effort on our part, but our organism does an incredible job of reorganising our physiology during sleep.
Anti-Oxidation. When we experience darkness our body releases Melatonin. It is the strongest anti-oxidant of the human body. It neutralizes free radicals that accumulated during waking times and thereby reduces the risk of illness and reduces aging processes.
Defragmentation. At some points during sleep something really freaky happens. Our brain completely shuts down the connection to our muscular system for up to 6 periods of around 20-30 minutes each. Our muscle are completely paralysed. No muscle tension at all. Only our eyes move very fast from left to right. This stage of sleep is called the Rapid Eye Movement (REM) Stage of sleep. This is when we dream. Dreams are a series of simulations run by our consciousness to test some of our trusted propositions against “reality”. It would be terrible if we still had connection to our muscular system at that time. That would be a very heavy case of sleep walking. These simulations are important to keep us sane. There is strong association between loss of REM sleep and mental illness. REM sleep sorts out our conscious. Like cleaning a room. Every morning you wake up to a clean room if the REM Stage did its job right.
Tissue Regeneration. During sleep Human Growth Hormone and Testosterone get secreted in high amounts. These are very expensive and powerful hormones if you were to buy them on the black market. Pro athletes buy this stuff on the black market to recover faster from tissue damage caused by hard training or injury. You get them for free if you sleep right. And the hormones are very sensitive to sleep deprivation. It has been shown that only 5 nights of reduced sleep can drop a males testosterone levels by the same amount as if he were aged 10 years older. 
Memory Formation. Ever felt like taking a nap after some hours of studying? Better trust that instinct because memory formation is highly improved after sleeping. Mathematical information is better retained after sleeping and the same thing happens with motor learning. You will be better at a motor task after you slept a night.
The reality is that most peoples sleep is shit. About 60% of all athletes I have ever worked with have sub-optimal sleep. They will do anything to sleep better. But whatever they do, they will still wake up at night or just feel run over when they wake in the morning, even after they slept through.
Waking up at night, Not being able to fall asleep, or feeling run over in the morning are all signs of bad sleep quality. 
Reasons for bad sleep quality range from environmental factors, emotional distress, toxicity, hormonal imbalances, radiation, to nutritional factors.
For this article let us focus on one of the micronutrients that is often out of balance when somebody experiences bad sleep quality. 
So lets get to it.


There are several reasons for magnesium deficiency :
3) Alcohol consumptions depletes magnesium stores in the body
4) Sympathetic Activation (Stressful work, Training) depletes magnesium stores in the body
Aside from possible major sleep disturbances magnesium deficient people also may show reduced speed&power, sugar cravings and reduced energy. 

Magnesium improves sleep quality via four intertwined pathways.

Magnesium is a natural inhibitory modulator of N-methyl-D-aspartic acid (NMDA) receptors. NMDA receptors are excitatory receptors. That means they release dopamine when activated and thereby activity of the brain will increase. Think of the NMDA receptors as our brains “ON” switch. Activating NMDA receptors will wake us up. For example Ritalin and Adderall for ADHD treatment activate the NDMA channels. NMDA receptors are also activated by cholesterol from animal fats and from glutamate in foods like chips. This is not what we want when we want to sleep. So when sleeping we want the NMDA receptors to not be activated. Magnesium helps us accomplish that. Magnesium downregulates the excitatory threshold of NMDA receptors. That means the “ON” switch is now harder to push down. You know how you sometimes wake up from mini noises in your room? And sometimes you sleep like a baby when your bookshelf collapses? This has a lot to do with the excitatory threshold of your NMDA receptors at that time.
Alcohol inhibits NMDA as well. Thats why some athletes resort to alcohol to be better able to fall asleep. BUT acute alcohol consumption also reduces REM sleep, which reduces the sleeps ability to improve defragmentation and learning. And in chronic Alcohol consumption our body increases the amount of NMDA receptors over time to counter the effect of the alcohol. Eventually alcohol loses its sleep inducing effect and that is also why acute reduction of alcohol consumption leads to restlessness. Because then you have so many excitatory NMDA receptors without them being blocked. So better use magnesium than alcohol. 
Magnesium increases GABA receptor sensitivity.
In principle the biochemistry of alertness is governed by two chemical compounds in our brain. Glutamate is the principal excitatory neurotransmitter and wakes us up. Glutamate is the chemical key for the NMDA receptor. Like stated earlier NMDA is the “ON” switch in our brain. On the other hand we have GABA as the most important inhibitory neurotransmitter. GABA connects to the GABA receptor group, which is the most important inhibitory receptor group in our brain. GABA reduces alertness, which would allow us to sleep. Most heavy sleep medicines like Benzodiazepines (e.g. Valium) and Barbiturates (e.g. Thiopental) act directly on the GABA receptors. Magnesium reduces the excitatory threshold of GABA receptors. It makes it easier for GABA to trigger its receptors and thereby inhibiting overall brain activity. This makes us sleepy. So Magnesium reduces the effect of excitatory NMDA receptors, while at the same time increasing the effect of inhibitory GABA receptors.
Magnesium and Melatonin levels. 
The third pathway of how Magnesium improves our sleep is that it is involved in Melatonin synthesis via the Serotonin-N-acetyltransferase (AANAT) enzyme. This enzyme makes melatonin from serotonin in our pineal gland. The primary trigger for activity of AANAT is darkness. When our retina is exposed to complete darkness AANAT activity is increased 100-fold and makes a lot of melatonin. Some investigations found Magnesium to be involved in AANAT activity with reduced magnesium levels associated with reduced AANAT activity. 
Its important to note that especially the light wavelengths of 460 to 480 nanometers (blue light) are responsible for suppressing AANAT activity and thereby reducing melatonin levels. Our ancestors had only a fire after the sun went down. Fire emits a red/yellow light, which does not include blue light wavelengths. The same holds true for the old fashioned light bulbs. So melatonin was still being produced while sitting by a fire or a yellowish light bulb. Sleeping in was easier with that. Only the newer energy-saving bright light bulbs emit blue light. Same with televisions and computer screens. They emit a lot of blue light, which suppresses melatonin levels and makes it harder to fall asleep. It could be speculated that this higher confrontation with „blue“ light in recent times could have something to do with the mysterious calcification of the pineal gland. Maybe the calcium layer is the „oakley shade“ of the pineal gland. But lets stick to the evidence for now.
It is not quite clear yet how melatonin makes us sleepy. The current scientific hypothesis is that it decreases core body temperature, while at the same time acting on the GABA receptors and thereby reducing brain activity.
Magnesium and Serotonin levels.
The base compound our body uses to synthesise Serotonin is tryptophan. It is found mostly in white meats. My first impactful encounter with tryptophan was in the fall of 2008 when I went to visit my college roommates family in northern Wisconsin and we had the most brutal turkey coma. After eating a lot of thanksgiving turkey me and the whole family just feel asleep for several ours in the living room while the Minnesota Vikings played Thursday night football . Magnesium plays a key role in activating the TPH enzyme responsible for making serotonin out of tryptophan. 
Take-Away points so far :
– If you want to sleep avoid things that activate the NMDA receptors via glutamate (e.g. glutamate in food, cholesterol (high animal-fat foods)).
– Consider a craving for high-fat foods (cholesterol) or highly processed foods (glutamate) as your bodies attempt to stay awake via activation of NMDA receptors. So instead of indulging into chips or fries give your body what it really needs….Rest.
– Magnesium down regulates NMDA activity, and upregulates GABA activity. It doesn’t trigger directly. It just decreases/increases their respective sensitivity. 
– Alcohol and Benzodiazepines (e.g. Valium) have a similar but more powerful mechanism of action on the NMDA and GABA receptors as magnesium has. 
– Chronic use of Alcohol or Benzodiazepines leads to your body increasing the amount of NMDA receptors, and decreasing the amount GABA receptors. That is why you build a tolerance to both alcohol and benzodiazepines until you have to increase the dose to achieve the same effect. This also leads in part to restlessness associated with withdrawal.
– Darkness increases AANAT activity in the pineal gland and thereby increasing melatonin levels.
– Melatonin increases sleepiness by reducing core body temperature and acting on GABA receptors
– Therefore darkness is vital for proper sleep quality. Avoid blue-light emitting light sources like screens and bright light bulbs after sunset. The melatonin effect on core temperature also helps us understand why a room temperature of around 16-18°C seems optimal for sleep quality.
– Never eat too much turkey when you want to stay awake for the Thanksgiving football game
In summary lets look at the mechanism of magnesium via my skillful representation of its actions :
See how Magnesium doesn’t influence the levels of Tryptophan, Serotonin, Melatonin or GABA directly. It just modulates the affinity of the NMDA and GABA receptors and increases conversion from tryptophan to serotonin to melatonin.

Okay how do we know if magnesium is what my body needs?

Analysis of magnesium levels
Magnesium diagnosis is very elusive as 99% of all of bodies magnesium is found intracellularly. Blood serum levels are very stable, while intracellular levels and tissue levels fluctuate a lot. Serum diagnosis is easy, but inconclusive. You will have stable and normal serum magnesium levels if you are not on the edge of death. Intracellular (red blood cells, oral epithelial cells) and tissue (brain tissue) analysis would be more conclusive as it varies more but its close to impossible to measure it accurately. There are some promising approaches to look at intracellular magnesium from epithelial cells of the mouth, but these are not broadly available yet.
At the same time magnesium is very cheap and cannot be overdosed. That is why I recommend to just take it and see if it improves sleep. Sounds unscientific but if you really think all aspects through this is the most scientific and evidence-based approach.
Supplement protocol
It can take up to three months of (heavy) magnesium supplementation to improve sleep in highly deficient people. With some of the athletes I work with we attack the issue on several fronts:
1) We use oral magnesium supplementation via Magnesium-Threonate. This is the form of magnesium which is most readily absorbed by the brain. We have been using the “Neuromag” product by Designs for Health for that purpose. We use between 2-4g of Magnesium-Threonate per day, which equals to around 150 to 300mg of elementary magnesium per day. Magnesium-Glycinate is another very good form of magnesium for musculoskeletal symptoms of magnesium deficiency, but is not well absorbed across the blood-brain barrier, that is why I prefer Magnesium-Threonate for sleep disturbances.
2) Several times per week we use Epsom Salt baths. Epsom salt is Magnesium-Sulfate. This stuff is very cheap and you can buy it in big buckets of 10kg. Just pour around a kilo of it into the bathtub and take a 45 minute bath. Magnesium in this form is very well absorbed through the skin.
3) We spike massage oil with magnesium. We discuss with the physios the possibility of mixing magnesium into the massage oils to further improve magnesium exposure. Sometimes we are able to mix the massage oil with magnesium powder, and sometimes we just have the physios finish off every massage with magnesium oil. As most athletes get massages 4-5 times per week that is great way of increasing magnesium. BUUUT beware of ITCHING! A lot of magnesium oils have the tendency to itch A LOT. I haven’t quite figured out what makes it itch and what the hallmarks are of an oil that doesn’t. 
4) Another obvious way is to increase magnesium via natural foods. Dark leafy greens are usually very high in magnesium. As are nuts and seeds and avocado. Also dark bitter chocolate is good for the sweet tooth. Sodas and milk reduce magnesium absorption for their high content of phosphoric acid. These are not recommended.
As a side note it is important to know that adequate Magnesium levels are necessary for your body to hold on to Vitamin D and convert it into its active form. Chronically low Vitamin D levels can be a sign of Magnesium deficiency.  Just supplementing Vitamin D without adequate magnesium levels can be a problem, as it doesn’t get stored and will not be activated sufficiently. High Vitamin D supplementation can thereby further drain your bodies stores of magnesium, too. That is because the little magnesium you have already is being used to convert all the D into its active form simply speaking. So instead of just popping Vitamin D pills, it is important to consider filling up your Magnesium stores first. Then you need less Vitamin D pills to achieve the same active levels of D.
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Gerrit Keferstein, MD

Gerrit Keferstein is a Medical Doctor specialised in Performance & Functional Medicine. He is most known for his work on the optimisation of recovery and adaptation in elite athletes.

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