Stress and insomnia go hand in hand… and so does a pandemic that disrupts the economy and life as we know it. While insomnia was an ongoing issue for some, now it seems ubiquitous. Why exactly is this happening? Stress.Worrying about illness, the future, job security, or the state of the world, causes overthinking patterns that disrupt relaxation. Change in routine is also to blame. Nowadays, both bedtimes and waking times may be much later, especially for those of us who are unemployed or working from home. Many people are less active and perhaps eating differently. Alcohol consumption in quarantine has skyrocketed apparently, and this also decreases sleep quality.
Humans and all living things require regular rest or dormant time. Some say that we can live without food longer than we can live without sleep! A typical adult needs 7-9 hours of sleep each night. Insufficient rest leads to daytime fatigue, mood swings, lower libido, and trouble concentrating. A lot happens during sleep as the brain cycles through nonREM and REM (Rapid Eye Movement)activity. In addition to mind and body restoration, the brain needs these phases for learning and memory. In slumber, many bodily processes are regulated:metabolism, hormones, tissue repair, blood sugar, blood pressure, memory transcription. Sleep deprivation may lead to hypertension, increased migraines,weakened immune system, weight gain, blood sugar elevation and more. Recent research shows that consistently getting less than 7 hours of sleep per night may contribute to the development of diabetes, cardiovascular disease, obesity and depression. When tired, the body craves sleep and this will affect cognitive function, job performance, and may lead to accidents while driving or operating machinery, and other dangerous situations. Interestingly, sleep deprivation is considered a public health problem in the US today.
Insomnia, defined as trouble falling or staying asleep, maybe acute or chronic (lasting at least three nights for at least 3 months). According to WebMD, insomnia can be divided into primary or secondary causes- primary insomnia has no known medical basis whereas secondary insomnia is caused by an underlying condition such as a mental health problem (anxiety or depression), disease(asthma, alcoholism, cancer, acid reflux), pain, sleep apnea or medications.
In Chinese medicine, there is no one-size-fits-all diagnosis for sleep disorders, as with most health issues. Every person is viewed as their own universe, emotions and all, and 10 different patients with insomnia may present with 10 unique underlying syndromes. Viewing the world through the yin and yang lens, we see that everything has two opposing sides needed for balance: night and day, inside and outside, cold and hot, moon and sun, form and function and so forth. Daytime is considered yang while nighttime is yin. Both are essential for life to exist and thrive. In daytime, yang energy is active and expansive, while nighttime is meant for rest and repair, for moving inward;this is when yin takes over. As day turns into night and bedtime approaches, the body must surrender to the yin phase of the day and sleep. If there is a disruption in the ability to do this, the person will not get the required rest;if this becomes a chronic pattern, all types of health issues might arise,including an exacerbation of pre-existing ones. The shen, or spirit, is thought to be housed in the heart in Chinese medicine, and it is highly involved in the mind’s ability or inability to quiet down for deep sleep.
Many factors can disrupt a restful mind and sound slumber. There may be a syndrome of excess in which the liver qi is congested (possibly caused by stress) and there is an upward flare of energy disturbing the shen and preventing the patient from falling asleep. If this congestion turns into fire, a further development of symptoms such as red eyes, headache, irritability and/or depression, bitter taste in mouth may be experienced. If the stomach is involved, shallow sleep and digestive symptoms are present (gastrointestinal symptoms, belching, dry mouth, for instance). A development of phlegm heat in the body (usually from a lousy diet) causes indigestion or reflux, dizziness, chest oppression, profuse sputum, restless sleep and so on. On the other hand, a deficiency in some aspect of the body may be the culprit, namely in yin and specifically affecting the heart, which may also involve the spleen, gall bladder or kidney, and may lead to symptoms like falling asleep and waking up, unable to return to sleep, waking in fear, dream disturbed sleep, absent mindedness/poor memory, blurry vision,loss of appetite, night sweats, palpitations, hot palms and soles of the feet, backache,dizziness, tinnitus, fatigue, dry mouth, shortness of breath, etc. Blood flow is yet another factor- if the blood is insufficient, or perhaps congealed or sluggish, this gives rise to even more complex symptoms.*
As you can see, details about the sleep patterns, the coinciding symptoms as well as the mental and emotional state of the patient must be considered (as well as pulse and tongue observations) in order to decipher the exact root cause of the insomnia. Many of the general symptoms overlap among the different syndromes, so the details of the patient’s experience and their presentation are what reveal the true diagnosis. Some of the most common syndromes for insomnia include deficiency of the heart and spleen, yin deficiency causing hyperactive fire, liver qi stagnation (transforming into fire), heart and kidney disharmony, and qi deficiency of the heart and gall bladder.
As with any ailment, acupuncture is designed to treat the whole patient at the source, not just their manifesting symptoms. Once the underlying cause of the insomnia is determined, specific points are applied to address it.There are points on the body that are generally helpful to treat sleep disturbances(around the ankles and back of neck). But if, for example, the cause is liver qi stagnation, points that quell fire and sooth the liver are employed as well.If the spleen and heart are deficient, points that tonify and nourish both the spleen and heart are needled. As with most conditions, acute insomnia is straightforward and fairly easy to address, while chronic cases are more complex and take longer to treat.
*symptoms and syndromes mentioned here serve as an abbreviated summary to illustrate the variety of experiences that accompany sleep disorders.