Insomnia

Insomnia generally refers to the inability to have regular, quality sleep that results in waking feeling rested and refreshed. It can involve difficulty in initially falling asleep (known as sleep-onset insomnia), difficulty staying asleep, and early waking (both of which are considered sleep-maintenance insomnia). It can also cause excessive daytime sleepiness (EDS) the following day, which can lead to lowered productivity, and be hazardous if one has to operate heavy machinery.

Insomnia can be classified as acute if lasting from a few days to a few weeks, chronic, if lasting more than one month, or intermittent if coming in periodic episodes.

In Western, or biomedical medicine, insomnia is further classified into different types according to its characteristics and causes.

ADJUSTMENT INSOMNIA

Adjustment insomnia is acute in nature and caused by stressful life events. This type of insomnia resolves when the stressors that are its cause are resolved. Adjusting to a job or relationship loss are examples. If this type of insomnia is persistent and is resulting in excessive daytime sleepiness and fatigue treatment is warranted.

PSYCHOPHYSIOLOGIC INSOMNIA

When the factors causing acute insomnia have resolved and the insomnia persists it has become what is known as psychophysiologic insomnia. In this instance, the person experiences anxiety about having ongoing sleepless nights followed by fatigue the next day. This anxiety becomes a major contributing factor in causing the insomnia, and they may spend hours ‘tossing and turning’ focused on their inability to sleep and its consequences.

PHYSICAL SLEEP DISORDERS

Physical Sleep Disorders are a type of insomnia with a physical issue at the root of why the individual is unable to sleep at night. The most common causes are pain and discomfort that persist through the night and disrupt sleep. Various causes from arthritis to physical injuries are at play here. When the pain is treated, sleep is regained.

MENTAL SLEEP DISORDERS

There is a strong correlation between what are termed mental disorders and difficulty sleeping. Mood disorders, and specifically major depression and bipolar disorder very often involve insomnia.

Western medical treatment of insomnia typically involves a combination of cognitive-behavorial therapy and hypnotics, as well as the development of good sleep hygiene maintenance, education, and possibly relaxation practice. In cases of physical sleep disorders, analgesics are usually prescribed for symptom relief, and antidepressants and sedatives are used in instances determined to have a mental component.

Insomnia is known in Chinese medicine as 失眠 (shī mián) or “to lose sleep.”

As with every illness in Chinese medicine, treatment involves analyzing the symptoms experienced by the patient into a syndrome pattern according to which the treatment proceeds. In the case of insomnia, there are 5 syndrome patterns, each articulating a unique type of insomnia, and calling for a different prescription of acupuncture points and herbs, as well as lifestyle and dietary advice.

SPLEEN QI & HEART BLOOD DEFICIENCY

This syndrome pattern develops from a deficiency of Spleen Qi. In TCM, the function of the Spleen is to transform what we intake as food and drink into qi and blood. The function of blood highlighted in this syndrome pattern is its function of “housing the mind.” While the blood of the vessels is circulated and serves the function of carrying oxygen and nourishment throughout the body, Heart blood is the material basis for the spirit, consciousness, thinking, and memory. Insufficient Heart blood, resulting from a deficient Spleen leads to a spirit that is “insufficiently housed,” with symptoms of restlessness, frequent dreaming, palpitations, issues with memory, and possibly dizziness or vertigo. The deficiency of Spleen Qi manifests in additional symptoms such as fatigue and loss of appetite.

In this pattern the tongue is pale with a thin coat, and the pulse is weak or thready.

Acupuncture and herbal prescriptions act to strengthen the Spleen’s function to produce more blood, nourish the blood itself, and calm the mind to promote sleep.

This pattern is typically caused by cases of anxiety and strain or excessive work, which damage the Spleen Qi, as well as the Heart. It is also seen in chronic illness, or postpartum.

DISHARMONY BETWEEN THE HEART AND KIDNEY

In Chinese medicine the Kidney and Heart have the relationship of fire and water. Specifically, the Kidney yin (water) serves the function of controlling the Heart (fire) by keeping it from flaring into hyperactivity. If the yin is insufficient, the fire can become hyperactive, and the mind is then restless and unable to be calm enough to sleep.
This pattern sees the combination of symptoms of Kidney yin deficiency: possible night sweats or hot sleeping, dizziness or tinnitus, and aching or weakness of the low back and legs, with symptoms of Heart fire: insomnia with irritability.

The tongue is red and the pulse is thready and rapid.
Acupuncture and herbal prescriptions act to nourish the yin, drain the fire and calm the mind, thus harmonizing the Kidney and Heart.

This pattern is typically caused by a congenital deficiency or prolonged illness leading to a deficiency of Kidney yin, or a significant emotional upset, which can cause Heart fire directly, which the Kidney yin is unable to control.
This pattern can also be seen in menopause, when the Kidney yin declines significantly in a short period of time.

LIVER FIRE

In Chinese medical theory, the Liver ensures the free flow of qi, blood, and emotions, and is susceptible to stagnation in conditions of stress. Liver qi stagnation over time leads to heat, which can cause Liver fire, which flares upward to disturb the mind.

Insomnia owing to Liver fire is characterized by irritability, dream-disturbance, fear or fright, headache, distending pain in the costal region, and a bitter taste in the mouth, possibly with an increased level of thirst.
The tongue is red, and may have a yellow coat, and the pulse is wiry and rapid.

Acupuncture and herbal prescriptions act to clear heat, drain Liver fire, and calm the mind.
This pattern is typically caused by unresolved emotional stresses over time.

STOMACH QI DISHARMONY (STOMACH DYSFUNCTION)

This syndrome pattern involves difficulty sleeping accompanied by digestive issues. As there is dysfunction in the transformation and transportation of food and drink (the function of the Spleen/Stomach in Chinese medicine) food accumulation develops, resulting in the experience of a feeling of distension and possibly suffocation in the epigastric region, which is the cause of insomnia. Difficulty in defecation is also often experienced.
In Chinese medicine, accumulation of food is known to lead to dampness and can also turn to heat, which can disturb the mind and further complicate sleep.

In this pattern the pulse is rolling or slippery, and the tongue coating is visibly sticky.

Acupuncture and herbal prescriptions act to reduce the accumulation, regulate Stomach qi, and calm the mind, as well as to clear any heat that may have developed.

This pattern can be caused by any form of excessive or irregular eating, especially at night.