Insomnia and TCM

Insomnia… sleepless nights… nightmares… difficulty falling asleep… difficulty staying asleep… waking up much too often in the night… tossing and turning… sleep disorders… etc.. etc… I treat this a lot. By now most of you must know what my favorite sleep aid/trick is (use a long word like thalassotherapy and each letter find five words in your mind maybe on the same theme) but beyond the obvious sheep counting insomnia is a serious disorder and in order to stay healthy we need good quality sleep (along with quality exercise, nutrition and mindfulness). In my practice, every insomnia pattern is as different as every patient is different. Acupuncture and herbal medicine usually yield long lasting results. Book a visit now if you suffer from insomnia. TCM can help.

What is Insomnia?

Insomnia is a sleep disorder causing difficulty falling asleep or inability to sleep throughout the night leading to insufficient sleep. Symptoms of insomnia include sleepiness during the day, fatigue, low energy, diminished mental alertness, and issues with concentration. Insomnia can be acute, lasting 1 night to a few weeks, or chronic, lasting 3 nights a week for 3 months or more. There are two main types of insomnia, primary and secondary. Primary insomnia is classified as sleep problems that are not linked to another health condition. Causes of primary insomnia include noise, temperature, or changes in sleep schedule such as jet lag. Secondary insomnia is usually more chronic and is due to a health condition. 

Insomnia in TCM

Biomedicine tends to not differentiate the various etiologies of insomnia and TCM practitioners and their patients have the advantage of further investigation and scrutiny regarding the nature and causes of insomnia which in turn allows us to target treatment with more subtlety (as opposed to using strong chemical sedatives which definitely sometimes can have a role to play, but probably not for long term healing). In Traditional Chinese Medicine (TCM), imbalances of the inner organs can cause deficiencies which can lead to insomnia (please note that the following is for information and patient education only and is NOT a diagnosis or a self-diagnosis tool. Always consult with a board certified health practitioner!). There are also helpful links at the end of this email.

Liver Yin Deficiency

The Liver metabolizes and clears important hormones that regulate the sleep-wake cycle. This includes both melatonin and cortisol. In patients with hepatic insufficiency, melatonin clearance is slow and the levels of melatonin is high during the daytime. This causes the modification of melatonin secretion patterns with delayed peak of secretion and sleep onset. Patients may experience bouts of daytime fatigue or drowsiness followed by night-time alertness when the liver finally breaks down the melatonin circulating in the blood.

Liver Functions

The circadian rhythm of cortisol secretion has a waveform pattern with the nadir for cortisol occurring at about midnight. Low cortisol levels are necessary for falling asleep. Cortisol begins its rapid rise after the first morning awakening and continues for about 60 minutes. This is called the awakening response. Cortisol in the blood is supposed to be cleared by the liver during the day so that its levels are low by nighttime. Elevated cortisol levels at night can cause difficulty falling asleep.

Stress, diet, and obesity can upset the liver leading to a liver deficiency. Poor liver function from a liver deficiency due to stress and anxiety can compromise the cortisol clearance and lead to an increase in cortisol levels in the body. Chronic stress or anxiety can continually overwhelm the liver leading to excess cortisol staying in the bloodstream for longer, making it difficult to fall asleep, causing chronic insomnia.

Role of Stress

Stress can also deplete the liver’s storage of glycogen. Eventually, the liver becomes fatigued from producing abnormal amounts of glycogen which leads to high blood sugar levels, upsetting the sleep pattern. Diet can also affect the liver since it is the organ that breaks down fats. If the liver is deficient, it can’t break down fats properly which can lead to digestion issues such as diarrhea or constipation, both of which can affect your sleep pattern. Unfortunately, sleep deprivation can also impact digestion, so a vicious cycle can occur.

Liver Yin Deficiency

On top of the insomnia symptoms, a Liver Yin deficiency also includes symptoms of irritability, timidity, and frequent fearful awakening. A common symptom among liver cirrhosis patients includes difficulty falling asleep. Recent findings indicate that delayed sleep onset and circadian variations may also have to do with the core body temperature. Heat loss through vasodilation is essential for sleep onset. Cirrhotic patients are unable to decrease their distal temperatures at the end of the day leading to impaired sleep. Although serious health conditions such as fatty liver disease and cirrhosis are linked to sleep disturbances, minor upsets can also bring about a noticeable change in sleep patterns.

Heart Heat and Kidney Deficiency

HT KD Disharmony

The Heart and Kidneys are aligned in TCM. The Heart is a fire organ while the kidneys represent water. Harmony between the Heart and Kidney comes from this dynamic relationship of descending and ascending movement of Yin and Yang in the Heart and Kidney. The Heart Yang Qi descends to strengthen the Kidneys while the Kidney ascends to help the Heart Yin fluid, to prevent Heart Heat. If the heart-kidney balance is disturbed, it can cause a condition called Xin Shen Bu Jiao in TCM, which means the heart and kidney are disconnected. This can lead to arrhythmia with symptoms including dream-disturbed sleep, night sweats, and insomnia.

KD Yang Xu 

Kidney disorders due to Kidney Yang deficiency lead to a variety of sleep-related conditions. The most common problem caused by poor Kidney function is trouble staying asleep. Patients usually experience difficulty falling back to sleep after waking up during the night. Kidney dysfunction strongly affects physiological functions that can cause disturbances in normal homeostasis, therefore, affecting sleep. Ineffective glomerular filtration leads to an inability to maintain homeostasis with respect to various metabolic products such as bio-elements and proteins.

Heart Heat or Heat Fire

This can cause restricted blood circulation to the extremities including the brain affecting sleep and causing insomnia. Initiation of sleep also requires that the HPA axis activity must be at its lowest. Heart Heat can also trigger liver yang rising and cause heart-mind restlessness syndrome which leads to HPA axis hyperactivity and insomnia.

Other Insomnia Etiologies

The initiation of sleep occurs when HPA axis activity is lowest, and sleep deprivation is associated with HPA activation. Chemical imbalances in the brain can also cause insomnia. A recent study was performed on individuals with chronic insomnia that described the brains of individuals with chronic insomnia have lower levels of GABA, an inhibitory transmitter in the brain. If levels of GABA are low, then individuals have a hard time “shutting off” their brains at night time.

An overactive mind is a key feature of psycho-physiological insomnia. Patients can also show symptoms of restless leg syndrome and numbness in certain parts of the body. The HPA axis will also be disturbed by blue light from devices such as phones or tablets – put them away long before bedtime, the world is falling apart whether you read about it in bed or not! (I favor the Kindle to read bedtime stories)

We could go on and on about insomnia and sleep disorders and I leave that to individualized treatment since it’s my job! Sweet dreams everyone! Read also the Anxiety article.

Sources + References

• Very Well Health – What is Insomnia
• Very Well Health – Insomnia Causes and Risk Factors
• Bruyneel, Marie, and Thomas Sersté. “Sleep disturbances in patients with liver cirrhosis: prevalence, impact, and management challenges.” Nature and science of sleep vol. 10 369-375. 2 Nov. 2018.
• Mancini, E., Beglinger, C., Drewe, J., Zanchi, D., Lang, U. E., Borgwardt, S. (2017). Green tea effects on cognition, mood and human brain function: A systematic review. Phytomedicine, 34, 26–37. 
• Wei Labs Training Materials – Insomnia and TCM