Insomnia, a pervasive sleep disorder affecting at least one in four people in Singapore [1], often leads sufferers to seek alternative treatments beyond conventional medicine. Traditional Chinese Medicine (TCM), with its holistic approach and centuries-old practices, offers a unique and comprehensive method for addressing insomnia. This article delves into the principles of TCM and how it can help promote restful sleep.
By definition, insomnia is classified under “不寐” in TCM. It describes a disorder in which one is unable to obtain proper rest– in terms of quantity and quality of sleep– due to the lack of nourishment to the Heart (心) organ or restlessness in the Heart Spirit (心神).
Clinically, it can present as:
Difficulty falling asleep
Lack of deep sleep
Waking in the middle of the night, with/without difficulty falling asleep afterwards
Nightlong sleeplessness
“不寐” is equivalent to “primary insomnia” in conventional medicine. “Secondary insomnia” caused by other medical causes, mental disorders or sleep disorders does not fall in the scope of this article. Common conditions that may cause secondary insomnia are: pain conditions, obstructive sleep apnea, medication-related causes, anxiety or mood disorders, menopause, Parkinson’s disease and dementia. These conditions need to be treated in tandem in order to achieve better sleep.
Insomnia, if left unmanaged, can affect performance at work/school, reduce judgement and memory capacity, as well as cause irritability and mood changes. Studies have shown that sleep deprivation increases the risk of depression [2] and people with chronic insomnia are five times more likely to develop depression [3]. The lack of sleep has also been found as a contributing factor to a range of health issues such as obesity, diabetes, hypertension and cancer [4].
Lack of balance causes insomnia
Normal proper sleep relies on a harmonious state between Yin and Yang where Yin is in balance and Yang is contained (阴平阳秘). This causes the organs to be in balance as well. In such a balanced state, Wei-defensive yang (卫阳) can enter Yin and causing sleep to happen. Insomnia arises when Yin and Yang are no longer in balance, organs are in disharmony, and Wei-defensive yang (卫阳) is unable to successfully enter Yin. Any imbalance can directly or indirectly affect the Heart Spirit (心神) and cause insomnia.
In the world of TCM, the Heart is seen as a vital organ that plays a central role not only in the circulatory system but also in the overall health and well-being of the body, mind, and spirit. TCM views the Heart differently from its anatomical and physiological functions in Western medicine; it is seen as the seat of consciousness, emotions, and spirit. Thus, supporting restful sleep.
Imbalance in emotions: The imbalance in emotions can lead to disharmony in the organs’ functions. For example, when one is excessively angry or depressive, it injures the Liver and causes Qi stagnation. The Qi stagnation can transform to heat and affect the Heart Spirit. Overly joyous without constraint can cause excitement and disturb the Heart Spirit. Overly anxious or excessive worrying can injure both the Heart and Spleen, leading to restlessness in the Heart Spirit as well.
Improper diet: Excessive eating can cause food to stagnate in the digestive system, injuring the Spleen and Stomach. This may lead to the formation of phlegm-heat (痰热) which disrupts proper Stomach Qi flow, giving rise to insomnia. Clinically, it is common that someone with gastrointestinal issues experience poor sleep due to the intricate relationship between the digestive system and the Heart (gut-brain axis).
Imbalance between work and rest: Overworking or having a sedentary lifestyle injures the Spleen Qi, resulting in poor digestive capability in generating Qi and Blood. Often, this leads to lack of nourishment to the Heart, giving rise to sleep problems.
Pre-existing chronic condition or major illness: Having pre-existing chronic conditions or major illness can predispose one to have deficiencies in the body, which can lead to poor nourishment of the Heart organ.
TCM Techniques for Insomnia
A person’s medical history and symptoms will be assessed by a licensed TCM Physician. In combination with tongue and pulse diagnosis, the pattern of disharmony associated with insomnia can be diagnosed.
Herbal Medicine
Herbal medicine is a common therapeutic method in the management of insomnia. The goal is to balance Yin and Yang, clear any excess patterns, and nourish deficiencies. Common herbs that help improve sleep are 酸枣仁 (Ziziphus jujuba, or sour jujube seed), 柏子仁 (Platycladus orientalis, or arborvitae seed), 合欢皮 (Albizia julibrissin, or mimosa tree bark), 远志 (Polygala tenuifolia, or Chinese senega), 茯神 (Poria cocos), 龙骨 (Fossilised bones), 牡蛎 (Ostrea gigas, or oyster shell), 丹参 (Salvia miltiorrhiza, or red sage root), 五味子 (Schisandra chinensis, or Schisandra berry), and 夜交藤 (Polygonum multiflorum, or Fleeceflower stem).*
These herbs are known to have properties that calm the spirit and mind, thereby promoting good sleep. They are also often used in combination with other herbs to create customised formulations tailored to an individual’s specific symptoms and underlying imbalances. Typically, we advise our patients to consume herbal medication for at least three months to see effect. Longer course of treatment may be necessary if the insomnia is longstanding or severe.
Acupuncture
Acupuncture is another common method in managing insomnia. Common acupoints used to help promote sleep are: 神门 (HT7), 照海 (KI6), 申脉 (BL62), 安眠穴 (EX-HN22), 三阴交 (SP6) and 印堂 (EX-HN3). There has been evidence that acupuncture brings about a positive effect in the treatment of insomnia [5]. The number of sessions required as well as the frequency of acupuncture is dependent on the severity of the insomnia symptoms. Generally, having an acupuncture session once or twice a week is a good frequency to get started on reaping the benefits of acupuncture for your sleep.
Lifestyle and Dietary Recommendations
Apart from acupuncture and/or herbal medication, the effectiveness of TCM management of insomnia is also influenced by the individual’s diet, lifestyle and emotional well-being. In the management of insomnia, try to incorporate exercise sessions regularly into your schedule.
Practise good sleep hygiene such as:
Establishing a regular sleep schedule
Limiting exposure to screens at least one to two hours before bed
Avoiding heavy meals at least two hours before bed
Limit caffeine and alcohol intake before sleep (although alcohol may make some individuals sleepy, it has been found to interfere with sleep quality)
Manage stress levels before sleep through relaxation techniques or journaling
Using your bed only for sleep and not for watching TV or working
Get natural light exposure during the day
Keep naps short during the day
TCM holds a holistic view towards the body and is a good option for sleep management. Depending on one’s medical history and condition, a licensed TCM Physician can recommend a suitable care plan involving TCM therapies to aid you in your sleep. Otherwise, sweet dreams!
*Do not self-medicate, always consult with a qualified TCM practitioner before starting any herbal treatments, as they can ensure the appropriate herbs and dosages for your condition.
References:
[1] Lee YY, Lau JH, Vaingankar JA, Sambasivam R, Shafie S, Chua BY, Chow WL, Abdin E, Subramaniam M. Sleep quality of Singapore residents: findings from the 2016 Singapore mental health study. Sleep Med X. 2022 Jan 28;4:100043. doi: 10.1016/j.sleepx.2022.100043. PMID: 35243325; PMCID: PMC8861160.
[2] American Academy of Sleep Medicine. (2014). Studies find new links between sleep duration and depression. Retrieved July 12, 2024, from https://aasm.org/studies-find-new-links-between-sleep-duration-and-depression/
[3] Neckelmann, D., Mykletun, A., & Dahl, A. A. (2007). Chronic insomnia as a risk factor for developing anxiety and depression. Sleep, 30(7), 873-880.
[4] Jackson, C. L., Redline, S., & Emmons, K. M. (2015). Sleep as a potential fundamental contributor to disparities in Cardiovascular Health. Annual Review of Public Health, 36(1), 417–440. https://doi.org/10.1146/annurev-publhealth-031914-122838
[5] Cao H, Pan X, Li H, Liu J. Acupuncture for treatment of insomnia: a systematic review of randomized controlled trials. J Altern Complement Med. 2009 Nov;15(11):1171-86. doi: 10.1089/acm.2009.0041. PMID: 19922248; PMCID: PMC3156618.
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