Sleep Better – TCM for InsomniaChristopher Michael Di Tecco R.Ac, R.TCMP June 1, 2007
Insomnia can be described as: difficulty or inability to fall asleep, waking throughout the night, restless sleep, waking in the early hours of morning with the inability to fall back asleep, and dream-disturbed sleep. Insomnia is considered chronic if it persists over a couple of months. Approximately one third of adults experience some sort of occasional or persistent sleep disturbance throughout their lives.
Good sleep is a sign of good health. If sleep is poor, this is a sign of imbalance in the body. Regularly disturbed sleep can affect not only your energy level and mood, but also your health because sleep helps strengthen the immune system. Sleep is as important to your health as diet and exercise. The effects of insomnia are both mental and physical. People suffering with chronic insomnia are more likely than others to develop depression or anxiety disorders. Lack of sleep affects mental faculties associated with problem solving and decision making. Long-term sleep deprivation may increase the severity of chronic diseases and increase the time it takes to recover from illnesses.
Traditional Chinese Medicine (TCM) considers insomnia a symptom and not a disease. TCM also breaks down insomnia into “true insomnia” and “transitory insomnia”. True insomnia is mainly caused by prolonged emotional upset and stress, improper diet, excessive sexual activity, and a weak constitution following an extended illness. Transitory insomnia is usually due to external or temporary changes such as outside noise, weather changes, coffee and other stimulants, eating too late at night, and a recent emotional upset.
Sleep disturbances due to pain, itching, asthma or other breathing disturbances are not considered true insomnia. These issues must be treated to allow a restful night’s sleep.
According to TCM theory, insomnia is associated with agitation of the shen (the spirit/mind). Shen is a form of qi. It is the “lightest”, least substantial, and least stable form of qi. Shen plays a role in the higher mental functions associated with the intellect and the spiritual aspects of consciousness. Shen is light and subtle, therefore it must be anchored by the yin aspect of qi (jing) and the blood or else it is possible it could “float away”. The shen must be calm at night and is housed by the heart during sleep. If this is disturbed it will result in disturbed sleep and insomnia.
The Heart and shen have a special interdependent relationship. The heart is the residence of the shen and during sleep the heart houses the shen. In Chinese medicine, sleep is seen as one’s yang energy moving inward to be enfolded by yin. Insomnia therefore, is a dysfunction in the interchange of yang entering yin.
Through TCM diagnosis the qualified practitioner will determine the TCM “pattern” of the patient based upon TCM theory. With a thorough diagnosis, the practitioner can determine the root cause of the insomnia and treat accordingly. These patterns can overlap to some extent and other associated symptoms may also be present. The individual patterns can be treated with acupuncture or herbal therapy and are often treated by a combination of both. A general overview of the most common TCM patterns associated with insomnia are outlined below.
LIVER QI STAGNATION LEADING TO HEAT OR FIRE
Frustration, anger, resentment, emotional turmoil and repressed emotions can all lead to the stagnation of qi. Qi stagnation will cause blood circulation to be affected and can result in a poor supply of blood to the heart – the heart will be undernourished and less able to house the shen.
Over time, stagnation of qi causes heat which agitates the heart and the shen. The heat does not allow the shen to settle.
Typical symptoms of insomnia due to qi stagnation and heat are: difficulty falling asleep, waking repeatedly around 2 am to 4 am, and insomnia that is aggravated by stress.
Other associated symptoms can be: depression, irritability, restlessness, moodiness, headaches, shoulder and neck tension, teeth grinding at night, and possible anxiety with heart palpitations.
TCM treatment aims to relax liver qi, clear heat, and calm the shen.
STOMACH DISHARMONY AND PHLEGM HEAT
Overindulgence in food and/or irregular eating habits (eating too late, eating while upset, eating too fast) cause stagnation of food. Dampness and phlegm are caused by a weak spleen or overconsumption of phlegm-producing foods (rich, greasy, sweet, spicy, and alcohol). Obstruction of the stomach by food (poor digestion) gives rise to phlegm heat which harasses the shen.
Symptoms include: insomnia with bloating, epigastric distension and fullness and possibly acid reflux, fitful sleep and profuse dreaming or waking in the early hours with difficulty falling back to sleep.
Individuals with this particular pattern may also experience dizziness, heaviness of the head, fullness/discomfort of the chest and stomach, belching and copious phlegm.
The TCM treatment is designed to relieve food stagnation, harmonize stomach, clear heat, transform phlegm and calm shen.
HEART BLOOD & SPLEEN DEFICIENCY
Overwork, physical/mental exhaustion, worry, irregular diet with too much cold, raw food all damage the spleen. The spleen engenders blood which nourishes the heart. If the spleen is weak it can lead to blood deficiency. This condition can also be caused by difficult pregnancy or difficult labour or a prolonged illness which weakens the body and depletes the energy and blood. This type of insomnia is characterized by difficulty falling asleep (esp. turning off the mind) and dream-disturbed sleep. A person with heart blood and spleen deficiency will also exhibit signs of listlessness, loss of appetite, and lustreless complexion.
The TCM treatment will strengthen and nourish heart and spleen to promote the production of blood and calm the shen.
YIN DEFICIENCY WITH HEAT
Kidney yin can be depleted by overwork, overindulgence in sex, inadequate rest, and aging. Heart Fire can burn unchecked if not balanced by the Kidney. With too much fire, the yin will literally be burned down over time. The blood and yin are deficient; therefore the shen is not adequately anchored – causing insomnia.
Insomnia of this type is usually chronic and characterized by waking throughout the night with feelings of heat and possible night sweats. Associated symptoms can be: irritability, dizziness, vertigo, dry mouth, and warm hands and feet.
TCM treatment focuses on nourishing the heart, liver and kidney yin, clearing heat and calming the shen.
HEART & GALLBLADDER QI DEFICIENCY
This is usually caused by excessive shock or even shock within the womb. Individuals with this pattern are often very timid and suffer from anxiety and worry and are easily frightened. Individuals are unable to deal with changes in routine and have difficulty coping in new situations.
This type of insomnia is characterized by frequent waking, often “waking with a start”, usually caused by recurrent bad dreams. These individuals are generally prone to fright.
Treatment will aim to strengthen the qi to alleviate fearfulness, and calm the shen and mind.
Insomnia usually responds quite well to TCM treatment. If the individual being treated is currently taking sleep medications, it can take weeks or months to wean off them.
Recent studies performed by researchers at the Centre for Addiction and Mental Health in Toronto have shown that individuals with difficulty sleeping, who received a course of acupuncture treatments, experienced reduced anxiety while sleep times increased by an average of 1.4 hours – showing a significant increase in melatonin production. The researchers concluded that acupuncture had value as therapeutic intervention for individuals with insomnia and anxiety and could be an alternative to pharmaceutical therapy.
Adjunctive therapy is very important in the treatment of insomnia. Relaxation practice and/or meditation is often critical in order to calm the mind. The effects of these practices are cumulative and the longer one works on relaxing the mind the easier it will be to fall into a relaxed state when attempting to get to sleep.
Lifestyle changes are usually necessary. If insomnia is caused by excessive stress related to work, family or emotional problems, these issues must be addressed. Relaxation practice coupled with the relaxation effects of acupuncture treatment will help in dealing with the effects of stress and prolonged emotional turmoil. Eating late at night should be avoided and if other dietary factors are contributing to insomnia, dietary changes can be recommended.
Good practices before bedtime are key in the treatment of insomnia:
– Maintain bedtime and wake time on a constant schedule.
– Avoid “trying too hard” when having difficulty sleeping. The harder you try, the more awake you’ll become. It is recommended one read or do a quiet, relaxing activity until you become drowsy, then go to bed.
– Exercise and stay active during the day. Get at least 20 to 30 minutes of vigorous exercise daily, preferably at least five to six hours before bedtime. Exercising too close to bedtime is too stimulating.
– Avoidance of stimulation before bed is also important (caffeine, drugs, and even excessive visual stimulation of TV). Caffeine after lunchtime, as well as using nicotine, can keep you from falling asleep at night. Alcohol, while it may initially make you feel sleepy, can cause restless sleep and frequent waking throughout the night. In TCM theory, alcohol and coffee are very heating. The heat agitates the heart and liver, negatively affecting the quality of sleep.
– Learn to relax. A warm bath or soft, calming music may help prepare you for sleep. A massage also may help relax you. Tai Chi, Qigong, Yoga and meditation are very helpful to calm the mind and body.
– If hunger keeps you awake try a light snack (a small portion of easily digestible food). Avoid heavy meals right before bed.
Don’t let the effects of insomnia impact your life. Seek effective treatment with TCM now. The sooner you commence treatment the sooner you will be enjoying a restful night’s sleep.