Insomnia is defined as difficulty initiating or maintaining sleep that impairs daytime functioning and activities. In this article we are specifically exploring trouble falling asleep, which is called sleep onset insomnia. One of the most common effects of insomnia is fatigue and decreased mental focus. Some resources report higher number of insomniacs, but more conservative statistics report 10 to 20% of the US population is suffering from insomnia, with 50% of it being chronic insomnia (Buysse, 2013).
Common treatments for insomnia
The traditional treatments for insomnia are medications and Cognitive Behavioral Therapy for Insomnia (CBT-I), however other integrative approaches show positive evidence in the treatment of insomnia, such as mind-body therapies, acupuncture, and dietary supplements (Zhou, Gardiner & Bertisch, 2017).
Dr. Rubin Naiman, the sleep specialist at the University of Arizona’s Center for Integrative Medicine, explores the concept of medicalization versus personalization and suggests looking at the patient who has the disease, instead of the disease that the patient has (Naiman, 2015). That is one of the basic principles by which Chinese medicine aims to help people heal. The main complaint, in this case insomnia, shows us what the patient struggles with. However, we look beyond the main complaint, to build the story of who this person has become, their sleep story and their overall mental, emotional and physical status.
Acupuncture and Chinese medicine current research for insomnia
A systematic review of acupuncture studies on insomnia reveals promising evidence (Shergis, Jackson, Zhang, Guo, Li & Xue, 2016). The positive effects were attributed to increase of gamma-Aminobutyric acid (GABA) in the cerebrospinal fluid and increased melatonin production. Overall, the quality of the sleep was improved. In addition, acupuncture was well tolerated by patients. However, even though both acupuncture versus sham and acupuncture versus medication have shown statistically significant effects, the studies were either smaller than ideal or there was no long term follow up. Larger studies are recommended to show the effectiveness of acupuncture in the treatment of insomnia.
My clinical practice shows even better results than the studies above. This is because we tend to treat the patient with acupuncture in combination with lifestyle changes, diet changes and additional support, such as herbal medicine.
Acupuncture is only one branch of Chinese Medicine, along with herbs, nutrition moxibustion, and Chinese massage (Tuina). This means that most acupuncturists will employ a combination of two or more of these therapies in the treatment of insomnia. In a systematic review done in 2012, 227 studies with 17,916 subjects were reviewed (Wing-Fai, Chung, Yan-Yee, Shi-Ping, Zhang & Vivian, 2012). This systematic review analyzed two branches of the Chinese medicine field, acupuncture and Chinese herbs. Just as with the acupuncture alone studies, we need larger and more vigorous studies. However, one of the important findings that were highlighted is that Chinese medicine is not aimed at sedating, but rather at solving the underlying diagnostic pattern that has lead to insomnia in the first place. None of these studies explore specifically sleep onset insomnia, but rather a combination of sleep onset insomnia and maintenance insomnia.
Chinese medical theory and sleep onset insomnia
The concept of diagnostic patterns was mentioned earlier in this paper. Diagnostic patterns are used in the Chinese medical theory to find the appropriate treatment with therapies such as acupuncture and herbs. These diagnostic patterns are certain combinations of symptoms, palpation, observation, tongue and pulse diagnosis. For example, insomnia in combination with gut issues will point towards certain patterns, while insomnia associated with hot flashes to others.
Most acupuncturists will look at these diagnostic patterns and treat their patients according to them. Some of the most common organs associated with sleep onset insomnia are the Heart, Kidneys, Lungs and Spleen (Montakab & Montakab-Pont, 2012). The Heart and Kidneys are more commonly affected sleep onset insomnia where the person is wide awake, the mind is clear and able to read if the person choose to, but there may be some anxiety associated and in some cases even palpitations. The other type of sleep onset insomnia commonly seen in the clinic is correlated with Lung and Spleen patterns and involves the person laying in bed trying to fall sleep, tossing and turning for an hour or two, or dozing off ever so slightly only to wake up again. Sometimes it can go on for the whole night and the person feels like they never slept at all. This pattern can tends to be associated with overthinking and it often shows up with various degrees of digestive issues.
Treatment plans for sleep onset insomnia
The treatments protocols are based on the various organ patterns. The Heart and Kidneys have numerous patterns. Some of them may be related to one single organ, such as Heart Blood Deficiency, where the person’s main symptoms are insomnia, palpitations, anxiety.
The Heart alone has multiple other patterns from the Chinese medical perspective. However, some of the patterns are combined with other organs. The pattern Heart-Kidney non-interaction is one of the most common ones found in the clinic which could be associated with some of the following symptoms: sleep onset insomnia, anxiety, low back pain, and menopausal symptoms (Dong, Wang, Zhao, & Chen, 2017).
When the sleep onset insomnia is associated with the Spleen, such as in the common pattern called Spleen Qi Deficiency, the person will experience insomnia, overthinking, and various digestive symptoms such as low appetite, bloating, loose stools, or food sensitivities. The concept of digesting in Chinese medicine involved the digestion of food but also the “digestion” of thoughts. People often ruminate and can’t achieve deep sleep.
The acupuncture treatment protocol is different for each particular pattern. Points tend to be located below the knees and elbows, with additional points on the abdomen and around the neck. The typical amount of acupuncture points used bilateral are four to six, for a total of eight to 12 needles. One or two points maybe be used in any of the patterns such as the point called An Mian which is translated from Chinese as Peaceful Sleep. Most patients start feeling a difference between third and fifth weekly treatment with more significant results around sessions 10 to 12. However, some of the cases require longer treatments, such as in perimenopausal women where hormonal changes take longer to shift.
For the Spleen Qi Deficiency pattern, diet changes customized to each individual can help heal both the digestive issues and the insomnia. For example, many people try to eat healthy by eating more salads, but for individuals with this particular pattern, steamed and lightly cooked foods will be more healing and nutritious. The diet changes in combination with acupuncture can be sufficient to solve the sleep onset insomnia. However, the patients with the Heart-Kidney non-interaction pattern oftentimes benefit from the taking herbs in additional to acupuncture. The herbs are usually given in capsule form with a bottle lasting three weeks, at which point it is assessed if continuing with the same herbs is advised or a different formula, until all symptoms resolve.
The second part of this article explores other approaches and resources for sleep onset insomnia. Lastly, it gives a timeline for how and when you should see results with acupuncture and Chinese Medicine. Read “Healing Treatments for Sleep Onset Insomnia”.
Resources:
Buysse D. J. (2013). Insomnia. JAMA, 309(7), 706-16.
Dong, J., Wang, T., F., Zhao, L., H. Chen, X., R. (2017). Pattern of disharmony between the heart and kidney: Theoretical basis, identification and treatment. Journal of Traditional Chinese Medical Sciences. Volume 4, Issue 4. Pages 317-321.
Montakab, H., & Montakab-Pont, S. (2012). Acupuncture for insomnia: Sleep and dreams in Chinese medicine. Stuttgart: Thieme.
Naiman, R. (2015). Integrative medicine approaches to insomnia. Los Angeles: Anthem Media Group. Retrieved from https://search-proquest- com.pacificcollege.idm.oclc.org/docview/1704412197?accountid=142078
Shergis, J. L., Ni, X., Jackson, M. L., Zhang, A. L., Guo, X., Li, Y., Xue, C. C. (2016). A systematic review of acupuncture for sleep quality in people with insomnia. Complementary Therapies in Medicine, 26, 11-20. doi:http:// dx.doi.org.pacificcollege.idm.oclc.org/10.1016/j.ctim.2016.02.007
Wing-Fai Yeung, Chung, K., Poon, M. M., Fiona Yan-Yee Ho, Shi-Ping, Z., Zhang-Jin, Z., Vivian, W. T. (2012). Prescription of chinese herbal medicine and selection of acupoints in pattern-based traditional chinese medicine treatment for insomnia: A systematic review. Evidence – Based Complementary and Alternative Medicine, 2012 doi:http://dx.doi.org.pacificcollege.idm.oclc.org/10.1155/2012/902578
Zhou, E.S., Gardiner, P., Bertisch, S. M. (2017). Integrative Medicine for Insomnia. Medical Clinics of North America. Volume 101, Issue 5, September 2017, Pages 865-879. https://doi.org/10.1016/j.mcna.2017.04.005
