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Insomnia

בעיות שינה

Sleep is essential for our existence and for maintaining the health of our body’s hormonal system, immune system, heart function, balanced blood pressure, memory, energy resources and mental state. It is common to think that the average person spends a third of their life sleeping. The amount of sleep required varies among different age groups, but overall decreases over time - at young age at least 10 hours of sleep are required, while over the age of 25 between 7-9 hours of sleep are required.

Sleep stages are divided into non–rapid eye movement (non-REM) and rapid eye movement (REM). During sleep, a person usually progresses through the 3 stages of non-REM sleep before entering REM sleep and this cycle is repeated 3-4 times each night.

Sleep is regulated by two biological mechanisms:

1. Homeostatic control, related to the body's ability to maintain critical functions such as sleep, blood pressure and body temperature in an optimal and stable levels. As a result, we feel more sleepy when we spend too much time awake and far more replenished and energetic when we wake up following a good, restful night sleep.

2. A biological clock (circadian rhythm), based on 24-hour cycles that responds to environmental stimuli such as light and darkness. In the evening, when darkness falls, melatonin (=sleep hormone) is released in the Pineal gland and aids in the body’s transition into sleep mode.

What is insomnia?

Insomnia, also known as sleeplessness, is a disorder where people have insufficient or poor sleep, which is typically followed by daytime sleepiness, low energy, irritability, and depressed mood.  Insomnia is manifested as either difficulty falling asleep, waking up in the middle of the night accompanied by difficulty falling back asleep, waking up early (before sunrise) or having superficial sleep that does not allow the body to rest. Insomnia can be acute (short-lived), chronic (over three months) or may appear and disappear periodically.

Women tend to suffer from insomnia twice as much as men and although it may appear at any age, incidence increases with age and may reach up to 50-60% at in the elderly. In fact, incidence in people ≥ 65 years is double.

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Insomnia is categorized broadly into primary and secondary insomnia. Primary insomnia is not directly associated with any health condition while secondary insomnia is directly related to a health condition such as menopause, heart failure, pain, depression, anxiety, stress, medication side effects, and consumption of coffee, alcohol and drugs.

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Insomnia has significant direct and indirect consequences on health and quality of life, including the following medical conditions (1):

  • Decreased memory and ability to concentrate, cognitive function, Alzheimer's disease and dementia

  • Metabolic syndrome including development of type 2 diabetes (due to decreased glucose tolerance), hypertension and obesity (as a result of increase in the hunger hormone ghrelin)

  • Damage to the hormonal system. Many hormones are secreted during sleep, including growth hormone (GH), cortisol and the sex hormones LH and FSH

  • Reduced immunity from common diseases such as cold and flu to more complicated and severe diseases such as cancer. In addition, a significant increase in pro-inflammatory cytokine levels seen in chronic inflammatory diseases such as arthritis and other autoimmune diseases.

  • Depression, anxiety and insomnia are closely related and insomnia has been found in studies to be a significant predictor of mood swings 

  • Cardiovascular: chronic insomnia may damage the vagus nerve, which affects physiological functions, such as pulse, blood pressure and blood supply to the heart muscle. Insomnia and sleep duration double the risk of coronary heart disease, heart failure and stroke.

How is insomnia treated in Western Medicine?

Currently, treatments for primary insomnia include benzodiazepine-type hypnotic drugs or other sedatives, which can relieve some of the symptoms but do not address the root of the problem. These medications usually improve sleep onset and overall sleep time, but do not improve sleep quality and cause daytime sleepiness which increases the risk of car accidents, falls and fractures.  As a result, health authorities restricted their use to severe and disabling insomnia, for a limited time and for intermittent use only, though in many cases this is not enforced.

In addition, these drugs act on the GABA receptor in the brain and this leads to a phenomenon called tolerance (= the brain "gets used" to the drug and in order to get an effect the dose needs to be increased from time to time), addiction, rehabilitation and nervous system toxicity.

Other treatment options include Melatonin supplementation, as well as cognitive behavioral therapy (CBT) which has been shown to be very effective but costly.

Insomnia in Chinese medicine

According to Chinese medicine, sleep is one of the key pillars of health and longevity, along with proper nutrition, breathing and movement. Chinese medicine views night time as Yin and day time as Yang. This means that Yang activities, such as working, eating, exercising should be done during the day, while Yin activities like resting, sleeping and cleansing should take place at night.

The amount and quality of sleep is depends on the “state of mind”, or Shen, which is anchored in the heart. When the heart is healthy, blood is abundant, the Shen is well anchored and sleep will be good. Chinese medicine, like Western medicine, distinguishes between difficulty falling asleep, the quality of sleep (with or without dreams and the nature of dreams) and waking time with each being attributed to a different organ system and treated differently with acupuncture and herbs.

How can you treat sleeplessness with Chinese Medicine?

The treatment of insomnia according to Chinese medicine begins with a comprehensive questioning designed to understand the root of the problem, especially due to the different stages of sleep affected and their association with different organs. After an accurate diagnosis including palpation of the pulse, observation of the tongue, diagnosis of the face and abdomen, an acupuncture treatment protocol will be tailored according to the nature of the sleep problem.

A review and meta-analysis study that included 42 clinical trials and 3,304 patients compared different acupuncture methods to Western drugs in the treatment of insomnia. Acupuncture was significantly more effective than drug treatment and without any side effects (2). Additional studies have shown that acupuncture is effective in treating depression-related insomnia (3), menopause-related insomnia (4) and cancer treatment-related insomnia (5).

In most cases, acupuncture treatment will be accompanied by herbal treatment, herbal infusions, and dietary and lifestyle modifications. It is important to make sure that the daily diet does not include foods that may interfere with sleep as they cause the body to “work extra time” while we try to fall asleep (for example, "warming" drinks such as cinnamon, fried foods etc). In addition, it is advisable to avoid prior to bedtime activities such as watching bright screens, violent movies, reading emails or doing sport activities, all of whom result in the release of stress hormones, impair the release of melatonin and make it difficult to fall asleep.

There’s no need to suffer from sleepless nights, and the earlier you treat it, the more likely you will rid of it!

Research Bibliography:

  1. Lin YF et al. J Integr Med. 2016 14(3):174-86. doi: 10.1016/S2095-4964(16)60248-0 

  2. Huachong Xu et al. Evidence Based Compl Alter Med. 2019. https://doi.org/10.1155/2019/8961748

  3. Dong B et al. Biomed Res Int. 2017. doi: 10.1155/2017/9614810

  4. Fu C et al. Sleep. 2017 40(11). doi: 10.1093/sleep/zsx153

  5. Garland SN et al. J Natl Cancer Inst. 2019. 111(12):1323-1331. doi: 10.1093/jnci/djz050

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