Being unable to sleep can be extremely frustrating. Once in a while it happens to most of people, and usually there is an obvious reason: Coffee after 6pm, reading something on a smart phone before switching off the bedside light, exercising too late in the evening etc. But if you’ve drunk your camomile tea, had a bath, done some yoga, read a few pages of a book and still can’t sleep, what is the cause? More importantly, what is the cure?
Insomnia: prevalence and consequences
The HSE defines insomnia as difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning. According to a recent Laya Healthcare survey reported by the Irish Times (9/4/18) some 80% of the Irish work force experienced a lack of sleep in the previous month with 18% saying that sleep deprivation was a significant problem for them.
The consequences of tiredness from lack of sleep are numerous: poor job performance, accidents, carelessness, poor social interactions and reduced self-care to name a few, and, of course, a feeling of a reduced quality of life overall. In the worst cases, poor mental health (anxiety, depression), and heart disease, can be an outcome of long term sleep deprivation.
Western Medical approaches to Insomnia
Medical treatment for insomnia may initially be to offer advice on good preparation for sleep habits (or ‘good sleep hygiene’, as it is sometimes called). This includes avoiding blue light from electronic screens for a couple of hours before bedtime; taking an appropriate amount of exercise each day; not drinking stimulants such as coffee and alcohol late at night; reading; taking a bath; and, practising yoga or meditation.
For more severe and disruptive insomnia, the patient may be referred to a sleep disorder clinic, offered sleeping pills (benzodiazepines or non-benzodiazepines), or given melatonin in the case of the over 50s. Benzodiazepines are only recommended in severe cases for short periods (less than 2 weeks) because of the risk of dependency.
Diagnosis and treatment with Chinese Medicine
Ancient texts indicate that Chinese Medicine has been addressing the problem of poor sleep for many centuries. This suggests that insomnia is not only a modern, western phenomena, although it may well be much worse in the 21st century, developed world.
Having ruled out diet and lifestyle factors as a cause, a practitioner of Chinese Medicine makes a diagnosis specific to each patient according to Chinese Medical Theory by asking particular questions about their insomnia and other aspects of their health, looking at their tongue, feeling their radial pulse, and using other techniques to inform their diagnosis.
In the clinic, stress, anxiety, depression and pain are the most common factors for insomnia. Also, women are more prone to insomnia, and as a general rule, our sleep becomes less deep and refreshing as we age.
Acupuncture is generally effective at improving sleep quality and duration, with patients reporting that they are better able to get to sleep, wake less frequently, and are better able to go back to sleep if they do wake.
Insomnia and Heart Disease
Besides the common reasons for insomnia outlined above, there can be another reason for insomnia: heart disease.
The first time I came across this was in a 51 year old, post-menopausal woman who presented with no significant symptoms besides being unable to get to sleep, restlessness, and feeling exhausted. The only item that stood out on her Intake Form was the fact that she had had two stents placed in her heart at the age of 49. Upon questioning, it became apparent there was a strong history of heart disease in the family. After the first treatment the patient reported having slept more soundly than she had slept in many years, and after three she felt there was no need for further treatment. Over the years since then I’ve seen similar presentations. The easier to spot cases of insomnia related to heart disease are those following a heart attack, but in one case the patient was relatively young, fit and healthy man who had not had heart problems himself, although again there was a history of heart disease in the family.
I use a technique called Channel Examination to help inform my diagnosis and in every case where cardiovascular disease is a factor I find a soft lump or hard nodule about half way up the inner aspect of the forearm, in the Pericardium channel. This channel is closely associated with the heart and is commonly used to treat heart/chest symptoms (palpitations, chest pain and tightness, breathlessness); mental-emotional symptoms (irritability, depression, anxiety); and, insomnia.
(Pathway of the Pericardium channel and its principal acupuncture points)
Modern science confirms ancient Chinese wisdom
What’s fascinating is how so much scientific research now seems to confirm what Chinese Medicine has always understood: namely that there is a link between the condition of our hearts and the functions of our brains in terms of sleep and mood. For instance, research published in 2017 confirms that insomnia – and often depression – can follow a heart attack (myocardial infarction), strongly suggesting that there is a link between the physical damage done to the heart tissue by the heart attack, and brain function. Other research has found that insomnia is a risk factor for heart attack, suggesting that the relationship is a two way street: the condition of the heart affects brain function, and the functioning of the brain affects the heart’s condition.
Treatment of insomnia linked to heart disease
Medical treatment for insomnia following a heart attack will depend on the severity of the insomnia and whether it is deemed to be impairing recovery. In the first instance, the advice will be to lose weight if need be, cut out smoking, excess alcohol and high fat foods, and get more exercise to improve the condition of the heart and promote better sleep. In the worst cases, anti-depressants may be prescribed if depression is deemed to be preventing the patient from making lifestyle adjustments.
Chinese medicine treats Insomnia linked to heart disease with needles placed in acupuncture points on the Pericardium channel (see above) that have the function of moving Blood in the chest and heart, supported by others on associated channels with similar functions. The extra advantage of acupuncture is that it is capable of treating the insomnia and any mental-emotional problems at the same time.
Considering your treatment options
As indicated above, if you suffer from insomnia the first thing to consider is whether your diet and lifestyle are contributors and take appropriate steps. Another option to consider is supplements such as Balance for Nerves and Melissa Dreams (available from health food shops). These may be helpful in cases where stress is a factor.
Although there is a lack of high quality research specifically concerning acupuncture for insomnia, clinical experience amongst practitioners of Chinese Medicine leads us to believe that acupuncture is very much a worthwhile treatment for insomnia of all kinds. Moreover, where insomnia is an aspect of anxiety or depression (which is relatively common) there are positive research findings concerning the use of acupuncture to treat such mood disorders. Lastly, given that sleeping pills can only be prescribed for short periods of time anyway, there is good reason to consider acupuncture as a first line of treatment, or alongside prescription drugs.