Insomnia

Insomnia is a common sleeping disorder where a person may have trouble falling asleep, staying asleep, or getting good quality sleep. It affects our mood, quality of life, social functioning, and is a risk factor to a variety of diseases such as high blood pressure, cardiovascular disease, depression, diabetes, and cancer.

In Chinese medicine, our body and mind are seen as an interactive whole. Insomnia is either due to unregulated yang (often hyperactive) or a yin deficiency (not enough yin to hold the yang). Insomnia is a result of yin and yang imbalance. At nighttime (the yin part of the day), there should be enough yin to enclose the yang. If there is not enough yin (or blood – a yin substance), the yin cannot hold the yang in place and the yang rises causing the inability to sleep.

In Chinese medicine, the Heart is seen as the house of the mind (Shen). Shen is the accumulation of Qi, Jing (our essence), and blood in the Heart. Shen can have different meanings, and it can be used in two different contexts. Shen can be used to describe our complex mental faculties that are said to reside in the Heart. This means that the state of our Heart (and blood) will affect our mental activities and emotional state. On the other hand, Shen is also used to describe the whole sphere of emotional, mental and spiritual aspects of a person. In this way, it relates to all other organs as well, especially the yin organs (Heart, Spleen, Lungs, Liver and Kidneys).

Emotions, consciousness, memory, thinking and sleep are all functions that are affected by the state of the Heart. When the Heart is strong and the blood abundant, we will have normal mental activity, a balanced emotional life, a clear consciousness, a good memory, keen thinking and good sleep. When the Heart is week and blood is deficient, one might experience depression, poor memory, dull thinking and insomnia.

The blood is seen as the root of the mind, and there is a mutual dependance between the Heart and the blood. The heart’s function of housing the mind depends on the nourishment from the blood, and conversely the Heart depends on the mind to govern blood. When the Heart blood is deficient, it cannot anchor the mind and one might have mental restlessness, depression, anxiety and/or insomnia.

By definition, insomnia is a Shen disorder. There are three basic mechanisms for insomnia: malnourishment of the Shen, evil heat, and/or an obstruction of movement of Qi in the Heart. When the Shen is malnourished, there is not enough Qi and blood in the Heart. Evil heat might come from an obstruction in the flow of Qi (either by dampness, phlegm, blood, or food stagnation), emotions, blood deficiency or a disruption in the Qi mechanism can engender Liver Qi stagnation which, over time, will generate heat. Evil Heart can affect the calmness of the Shen, unsettle the Heart and cause insomnia. This will often be seen on the tongue with a red tip or red dots on the tip of the tongue. Anxiety, frustration, frequent sighing can be accompanying symptoms as well. Obstruction of movement of Qi in the heart might be due to phlegm and/or blood stasis obstructing the smooth flow of Qi. People with chronic sleep disorders, may have multiple factors at play: malnourished Shen, Evil Heat, and obstruction in the movement of Qi.

Difficulty falling sleeping, waking up too early, light sleep and waking up in the middle of the night (and not being able to fall back asleep) are all types of insomnia. As a person gets older of if the sleep condition is chronic, it often takes longer to treat. Cutting back on food and alcohol before bedtime, not listening to the news or any stimulants before bed, giving yourself time to wind down, making the sleeping environment darker, balancing rest and activity, and daily exercise are all helpful tips to improve sleep. Traditional Chinese medicine, including acupuncture and Chinese herbal medicine, are a known and safe modality that regulates and maintains the balance within the body and it is often used to treat insomnia.

References

https://www.nhlbi.nih.gov/health/insomnia

https://my.clevelandclinic.org/health/diseases/12119-insomnia

Maciocia G. Principles and strategies of treatment. In: The Foundations of Chinese Medicine. London: Elsevier; 2005:1115–1132