Insomnia and Disturbed Sleep

Insomnia & Sleep Disorders

Sleep is often one of the first things our patients tell us has changed, even when insomnia was not what brought them in. They may notice that they are falling asleep more easily, sleeping more deeply, or waking less often — sometimes before the condition they originally came to address has begun to change.

Sleep problems themselves, however, are not all the same. There is an important difference between being unable to fall asleep, waking at two or three in the morning and lying awake, waking repeatedly throughout the night, being awakened by night sweats, dreaming so vividly that sleep never feels restful, and sleeping for eight hours only to wake exhausted.

Chinese medicine pays close attention to these distinctions. The timing and character of the disturbance, what wakes you, whether you can return to sleep, how you feel in the morning, and the other symptoms occurring alongside the insomnia all contribute to the diagnostic picture. Two people who both say, “I can’t sleep,” may therefore receive quite different treatments.

What we treat

• Difficulty falling asleep, particularly when the mind remains active despite being tired
• Waking during the night and being unable to return to sleep
• Frequent or restless waking throughout the night
• Early-morning waking
• Unrefreshing sleep despite adequate time in bed
• Night sweats that interrupt sleep, particularly during perimenopause and menopause
• Sleep disturbance during pregnancy, when medication options may be more limited
• Sleep disrupted by pain
• Sleep disrupted by anxiety, worry, or persistent mental activity
• Vivid or exhausting dreams
• Sleep disturbance following a period of acute or prolonged stress
• Jet lag and shift-work disruption
• Sleep disturbance during a physician-supervised reduction in sleep medication

How we approach it

Chinese medicine has a beautiful way of thinking about sleep. The Heart is associated with fire and can be imagined as the sun, while the Kidneys are associated with water — the deep, salty ocean. Good sleep depends in part on the relationship between the two, and on the body’s ability to move naturally between the activity of day and the stillness of night.

At night, the sun disappears below the horizon. Activity settles inward, and the cooler, quieter qualities of water and darkness predominate. Toward morning, that movement begins to reverse: yang begins to rise, the body’s systems become more active, and we gradually emerge into wakefulness.

When that transition happens too early, a person may wake at four or five in the morning not groggy, but suddenly and completely awake — as though morning has arrived several hours before it should have. Someone else may have the opposite problem: the activity of the day never fully settles at night, and the mind remains bright and active long after the body has gone to bed.

These are different kinds of insomnia in Chinese medicine. The time you wake, whether you are hot or cold, restless or calm, whether your mind is racing, whether you dream heavily, and whether you wake refreshed all help us understand where the normal rhythm of sleep and waking has become disrupted. Treatment is chosen from that larger pattern rather than from the diagnosis of insomnia alone.

We also look beyond the night itself. Pain, anxiety, digestive problems, hormonal changes, medications, stress, and other health conditions can all affect sleep. Sometimes insomnia is the primary complaint; sometimes it is one part of a larger pattern. Treatment is shaped accordingly.

What treatment involves

We generally begin with weekly acupuncture, but there is no standard set of points we use for insomnia. Treatment is based on the pattern we find. We take into account the particular nature of your sleep disturbance, along with your other symptoms, pulse, and what we observe during treatment.

Sometimes the picture is one of considerable stress and physiological arousal — a restless mind, a guarded breathing pattern, or persistent tension through the diaphragm and rib cage. In that case, much of the treatment may be directed toward helping the body settle. In another patient, hormonal changes, pain, digestive symptoms, or a very different Chinese medicine pattern may be what needs our attention.

This is also why treatment can change as sleep changes. Someone who initially lies awake for two hours may begin falling asleep easily but continue waking at four in the morning. That is progress, but it also gives us new information. We adjust the treatment to the pattern that is present rather than continuing to repeat the same points simply because they were used at the beginning.

Sleep is often one of the first things patients report changing. Sometimes that happens within the first few treatments; longer-standing insomnia generally takes more time. We follow what is actually changing: how long it takes to fall asleep, how often you wake, whether you can return to sleep, and how restored you feel the following day.

Practical recommendations may be part of treatment as well, but we try to make them relevant to the person in front of us. For a mind that becomes particularly active at bedtime, we may teach simple strategies such as cognitive shuffling — a technique for interrupting repetitive thought by moving the mind through unrelated, neutral images or ideas. Someone whose sleep is being interrupted by menopausal night sweats needs something different from someone who is being awakened by pain, and our recommendations reflect that.

Chinese herbs are available when they seem useful, but they are not a required part of treatment. Many patients prefer to begin with acupuncture alone, and we are perfectly comfortable doing that. If sleep remains difficult, or the particular pattern suggests that herbal medicine might add something useful, we can discuss it.

Herbal treatment does not always have to mean taking a complex formula. Sometimes we recommend much simpler traditional remedies — for example, a tea made with goji berries and black sesame seeds, a combination we use for its gently calming qualities. What we recommend, if anything, depends on the person and the nature of the sleep disturbance.

When poor sleep may be something else

Not every sleep problem is insomnia.

If you sleep for seven or eight hours and routinely wake exhausted, we want to know why. If you snore heavily, stop breathing during sleep, wake choking or gasping, have morning headaches, or experience significant daytime sleepiness despite adequate time in bed, talk with your physician about whether a sleep study is appropriate. Obstructive sleep apnea is common and requires proper diagnosis and treatment.

Restless legs syndrome, circadian rhythm disorders, medication effects, and other medical conditions can also interfere with sleep and may require evaluation beyond our office. We are glad to work alongside your physician or sleep specialist once the problem has been identified.

For chronic insomnia, cognitive behavioral therapy for insomnia (CBT-I) is an established first-line treatment and can be used alongside acupuncture. If we think a formal sleep evaluation, CBT-I, or another form of medical care would be useful, we will tell you.

Working with sleep medication

You do not need to stop sleep medication in order to receive acupuncture. In fact, we do not want you changing prescription medication simply because you have begun treatment with us.

Tell us what you take and at what dose, along with your other medications and supplements. Some sleep medications can produce significant rebound insomnia or other withdrawal symptoms when reduced or stopped, and any decision to change a prescription medication should be made with the clinician prescribing it.

If Chinese herbs are being considered, a complete medication and supplement list is particularly important because herbs can interact with prescription and over-the-counter medications.

Common questions

How quickly will I notice a change?

Sleep is often one of the first things our patients report improving, and some notice a difference within the first few treatments. Longer-standing sleep problems may take more time. We look for changes not only in the number of hours you sleep, but in how easily you fall asleep, how often you wake, whether you can return to sleep, and how you feel the next day.

What if I’ve had insomnia for years?

We treat many people whose sleep problems are longstanding. A pattern that has been present for years may take more time to change than a recent bout of insomnia, but its duration does not mean there is nothing to work with. We look closely at the particular pattern of your sleep and at the factors that may be perpetuating it, and reassess according to how you respond.

Can I have treatment if I take sleep medication?

Yes. Acupuncture can be used while you continue your prescribed medication. Decisions about reducing or stopping it should be made with the clinician who prescribed it.

Can I take herbs for sleep?

Sometimes. Chinese herbs may be appropriate depending on the pattern of your sleep disturbance, your health history, and the medications and supplements you take. We review those before prescribing herbs.

I wake at the same time every night. Does that matter?

Yes. The timing of waking is one part of the pattern we consider in Chinese medicine, along with what you experience when you wake and what else is happening with your health. It does not mean that waking at a particular hour automatically identifies a problem with a particular organ.

I sleep eight hours and wake exhausted. Is that insomnia?

Not necessarily. Adequate time asleep without feeling restored can occur for a number of reasons and deserves further investigation, particularly when accompanied by snoring, breathing disturbances, significant daytime sleepiness, or persistent fatigue. A sleep study or other medical evaluation may be appropriate. You may also want to read our Chronic Fatigue & ME/CFS page.

Will I need to keep coming?

Not necessarily. Once sleep has become more stable, some patients finish treatment and return only if the problem recurs. Others choose occasional treatment because they find it useful. We reassess rather than assuming that everyone needs ongoing maintenance.