Stress and insomnia go hand in hand… and so does a pandemicthat disrupts the economy and life as we know it. While insomnia was an ongoingissue 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, causesoverthinking patterns that disrupt relaxation. Change in routine is also toblame. Nowadays, both bedtimes and waking times may be much later, especiallyfor those of us who are unemployed or working from home. Many people are less activeand perhaps eating differently. Alcohol consumption in quarantine hasskyrocketed apparently, and this also decreases sleep quality.
Humans and all living things require regular rest or dormanttime. Some say that we can live without food longer than we can live withoutsleep! A typical adult needs 7-9 hours of sleep each night. Insufficient rest leadsto daytime fatigue, mood swings, lower libido, and trouble concentrating. A lothappens during sleep as the brain cycles through nonREM and REM (Rapid Eye Movement)activity. In addition to mind and body restoration, the brain needs thesephases for learning and memory. In slumber, many bodily processes are regulated:metabolism, hormones, tissue repair, blood sugar, blood pressure, memorytranscription. Sleep deprivation may lead to hypertension, increased migraines,weakened immune system, weight gain, blood sugar elevation and more. Recentresearch shows that consistently getting less than 7 hours of sleep per night maycontribute to the development of diabetes, cardiovascular disease, obesity anddepression. When tired, the body craves sleep and this will affect cognitivefunction, job performance, and may lead to accidents while driving or operatingmachinery, and other dangerous situations. Interestingly, sleep deprivation isconsidered 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). Accordingto WebMD, insomnia can be divided into primary or secondary causes- primaryinsomnia has no known medical basis whereas secondary insomnia is caused by anunderlying 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 diagnosisfor sleep disorders, as with most health issues. Every person is viewed astheir own universe, emotions and all, and 10 different patients with insomniamay present with 10 unique underlying syndromes. Viewing the world through the yinand yang lens, we see that everything has two opposing sides needed forbalance: night and day, inside and outside, cold and hot, moon and sun, formand function and so forth. Daytime is considered yang while nighttime is yin. Bothare essential for life to exist and thrive. In daytime, yang energy is activeand 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, thebody must surrender to the yin phase of the day and sleep. If there is adisruption 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 thoughtto be housed in the heart in Chinese medicine, and it is highly involved in themind’s ability or inability to quiet down for deep sleep.
Many factors can disrupt a restful mind and sound slumber. Theremay be a syndrome of excess in which the liver qi is congested (possibly causedby stress) and there is an upward flare of energy disturbing the shen and preventingthe patient from falling asleep. If this congestion turns into fire, a further developmentof symptoms such as red eyes, headache, irritability and/or depression, bittertaste in mouth may be experienced. If the stomach is involved, shallow sleepand digestive symptoms are present (gastrointestinal symptoms, belching, drymouth, for instance). A development of phlegm heat in the body (usually from alousy diet) causes indigestion or reflux, dizziness, chest oppression, profusesputum, restless sleep and so on. On the other hand, a deficiency in someaspect of the body may be the culprit, namely in yin and specifically affectingthe heart, which may also involve the spleen, gall bladder or kidney, and maylead to symptoms like falling asleep and waking up, unable to return to sleep, wakingin 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 isyet another factor- if the blood is insufficient, or perhaps congealed orsluggish, this gives rise to even more complex symptoms.*
As you can see, details about the sleep patterns, the coincidingsymptoms as well as the mental and emotional state of the patient must beconsidered (as well as pulse and tongue observations) in order to decipher theexact root cause of the insomnia. Many of the general symptoms overlap amongthe different syndromes, so the details of the patient’s experience and theirpresentation are what reveal the true diagnosis. Some of the most common syndromesfor insomnia include deficiency of the heart and spleen, yin deficiency causinghyperactive fire, liver qi stagnation (transforming into fire), heart andkidney disharmony, and qi deficiency of the heart and gall bladder.
As with any ailment, acupuncture is designed to treat the wholepatient at the source, not just their manifesting symptoms. Once the underlyingcause 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 liverqi 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 thespleen and heart are needled. As with most conditions, acute insomnia is straightforwardand fairly easy to address, while chronic cases are more complex and takelonger to treat.
*symptoms and syndromes mentioned here serve as an abbreviatedsummary to illustrate the variety of experiences that accompany sleep disorders.