Fourteen-year old Derek came to me with trouble sleeping. He was a healthy, active young man, who had trouble getting to sleep at night, and many nights was awake for hours. He tried sleeping on the floor to “get comfortable”, and rearranging his bedcovers in a variety of ways, none of which helped him sleep. Derek had trouble getting up in the morning because he was starting his day exhausted from the lack of adequate sleep.
The incidence of insomnia is far-reaching. It can be an annoyance for most people at one time or another. For many, however, it’s a chronic problem that leaves its sufferers exhausted, irritable, and unable to handle the physical and emotional stresses of everyday life.
Sleeplessness comes in many forms. For people with mild insomnia, dropping off to sleep may be a problem. Many sufferers are able to fall asleep, but wake during the night and spend the early morning hours wide-awake. In the extreme, people who are plagued by severe insomnia may be sleepless all night long.
In for practitioners of acupuncture and Traditional Chinese Medicine, insomnia is considered to be a disharmony between Yin and Yang, in which the Yang of daytime is unable to enter, or change into, the Yin of the evening and nighttime hours.
The principles of Yin and Yang can best be understood through the Chinese characters for each. The character for Yang was originally a pictograph representing the sunny side of the hill. It contains the radicals for mound, the sun above the horizon, and rays of light shining down from the sun. In contrast, the character for Yin contains the radicals for mound and the presence of clouds, indicating the shady side of the hill.
These characters tell us a lot about the nature of Yin and Yang. The sunny side of the hill, Yang, is warmer and brighter than the shady side, Yin, which is cooler, darker and moister. Yang represents fire, is active, and moves upward and outward. Yin represents water, is calm, and moves down and inward. Most important to this discussion of sleep, however, is that Yang represents the bright and active daytime hours, and Yin represents the quieter, darker nighttime hours.
During the day, Yang energy is strong, keeping us awake and alert and giving us the energy to conduct the activities necessary for each day. As the day moves into evening, the Yang energy begins to decline and turn inward, allowing us to relax and slow down. To be able to sleep, the Yang energy of the day must completely enter into the Yin aspect of the evening and nighttime hours. Therefore, normal sleep requires that the Yin and Yang energy of the body be in balance. Insomnia occurs when this balance is lost.
The Heart also plays an important role in our ability to sleep. In Chinese medicine, the Heart houses the spirit, which includes all thought processes, memory, emotions and the ability to sleep. During the night, the spirit also moves into the Yin, and people become calmer, quieter, and fall asleep. When the spirit is unable to move into the Yin, or when the spirit moves into Yin but is unable to quietly stay there all night, insomnia occurs.
For insomnia to occur, the spirit must be disturbed in some way. There are a variety of imbalances that may cause a disruption of the spirit, including heat, deficiency, or stagnation. The causes of these imbalances are often related to lifestyle, which means that there are changes that we can make on our own to sleep better. Common causes of insomnia in Traditional Chinese Medicine include emotions, diet, overwork, and a weak constitution.
Heat in the body is a common factor in insomnia. Heat is by nature Yang energy, which is active. Too much heat, or excess Yang, disturbs the Heart and spirit, making it difficult for Yang to transform into Yin at the end of the day, causing restlessness and irritability.
There are a number of patterns, or conditions, in Traditional Chinese Medicine that can cause heat. Excess heat from an external factor, such as a fever or the flu is one form. However, an occasional fever or an attack of the flu is short-lived, and not sufficient to cause chronic insomnia. Only when heat resides in the body long-term, will it ultimately disturb the Heart and spirit enough to interfere with sleep.
Heat may arise out of a deficiency of Yin energy. Remember, Yin is cool, moist and nourishing. When Yin is in short supply in the body, Yang becomes exuberant, causing heat and restlessness, disturbing the spirit and disrupting sleep. A classic example of this pattern is during menopause, when deficient heat in the form of hot flashes and night sweats accompany sleeplessness.
There are other substances in the body that can become deficient enough to cause insomnia. Qi (pronounced chee), described as life energy, or the transformative energy in all things, can become depleted. Blood is another substance that when deficient can cause insomnia. In Chinese medicine, Blood is considered the substance that nourishes the body and maintains muscle mass and fat. When Qi and/or Blood become depleted, the spirit is undernourished and unable to easily move into Yin and stay there during the entire night. Typically, a person suffering from insomnia due to deficiency may fall asleep easily, but wake during the night or have vivid, disturbing dreams.
Stagnation, especially of Qi, can also be responsible for insomnia. This type of insomnia is commonly associated with emotions. Qi normally moves smoothly throughout the body. However, strong emotions, especially anger, anxiety or depression, can impair the flow of Qi and cause it to stagnate. This stagnation over time turns into heat, disturbing the Heart and spirit, and causing insomnia. Frequently, people who can’t sleep because their “mind is running” all night are suffering from Qi stagnation.
The treatment of insomnia using Traditional Chinese Medicine might involve acupuncture, herbs, Tui Na (Chinese bodywork), and possibly diet therapy. If you suffer from insomnia, however, there are some changes you can make that may help you get a good night’s sleep.
-During the evening hours, try to move from Yang to Yin activities. For example, save exercise, studying, or physical work for earlier in the day. During the evening, quieter activities, such as reading and relaxing will help you move into Yin energy more easily.
-Wait a few hours after a large meal before you try to sleep. Eating too much food before bedtime can stagnate and interfere with your sleep.
-If you have trouble sleeping, avoid foods and drinks that contain caffeine for several hours before bedtime. Very spicy or heavy, greasy foods, if eaten regularly, may also cause insomnia.
-If emotions are causing sleeplessness, try visualizing yourself in a favorite, calming place, or systematically relax the muscles in each part of your body.
Keeping these principles in mind in working with Derek, I learned that he was instant messaging with his friends until he went to bed at about 11:00. Also, he had some issues that were causing him anxiety. I treated Derek twice with acupuncture and herbs and advised him to begin winding down for bed an hour or two earlier. This meant turning off the computer and reading before turning out his lights. After two treatments, Derek reported that he was able to get to sleep, and stay asleep all night.