In Oriental Medicine, insomnia is seen as part of a larger topic of sleep disturbances which include difficulty falling asleep, restless sleep with frequent waking through the night, waking too early in the morning while still fatigued, and complete sleeplessness. Symptoms such as headache, dizziness, poor memory, panic attacks, vivid or disturbing dreams, and depression may accompany insomnia. These all relate in some degree to disturbances of the Heart spirit (shen). In addition, in planning a treatment for insomnia, a patient’s constitution, personality and habitual behavior must be considered.

Traditional Chinese Medicine describes several kinds of spirit; these denote the emotional and mental sides of bodily function. The kind of spirit associated with mental processes is related to the Heart and called the shen. Thus, the mind is thought to be rooted in the Heart, particularly in the Heart blood. When one falls asleep, the shen, or mind, descends interiorly to the Heart. If the Heart is well nourished and comfortable, the shen feels well-anchored and safe, and a person sleeps well. Deficiencies or agitation in the Heart (particularly heat or fire) produce an uncomfortable shen and poor sleep. The ethereal soul (hun) functions in a similar manner, but is related to the Liver. If the ethereal soul is uncomfortable, it wanders at night, producing restless sleep with vivid, tiring dreams. In both cases, an adequate supply of nourishing fluid to the organ is very important.

Inadequate supply of these fluids is usually referred to as blood deficiency. However, this does not refer to blood in the western sense in which deficiency is anemia, rather it speaks to a broader category of cool, nourishing fluids, or Yin fluids. Sleep is a Yin activity. It is restful, quiet, dark, intuitive, creative and interior. Its opposite is the Yang activity of daytime, where logical, rational thought, action, movement and stress predominate. For many people, the value and focus placed upon action and logical thought preclude relaxation and the release of the spirit to sleep. This produces an imbalance of Yin and Yang, and a need to nourish Yin, to find an inner peace that can persist through daytime activities. Acupuncture and herbal medicines can be very helpful in restoring this balance and dealing with immediate symptoms. Meditation and gentle exercise such as Qi Gong and Tai Chi can provide long-term help in maintaining a balanced life.

When the heart and liver are well nourished and Yin and Yang balanced, the body is able to adapt well to stressful situations and to the changes of schedule that seem to be an unavoidable part of modern society. One of the goals of Oriental medicine is to strengthen the basic health so that temporary stresses do not cause significant symptoms. However, for those experiencing insomnia or with a history of insomnia, certain activities should be avoided. These include eating late at night or eating excessively, excess caffeine, smoking more than a pack a day, and daytime naps. Moderate daily exercise is important. For some, small quantities of alcohol may be useful, such as a glass of wine in the evening. However, excessive use of alcohol disrupts the sleep cycle, a problem that may persist for months after cessation of drinking.

Another factor that must be considered in treating insomnia is illness. Any illness that produces pain, respiratory difficulties, frequent urination, or itching may cause insomnia. In these cases, it is more important to treat the root illness; the insomnia will resolve of itself. In children, fear and disturbing dreams are a frequent cause of sleep problems; these may be related to Kidney/Liver issues. Excess studying is seen as wearying to the spirit and to the spleen, which causes poor digestion and poor nutritional absorption; it may produce phlegm, deficient blood, and, eventually, repeating or circular thoughts and worrying at night. Western medicine notes that sleep becomes lighter with age and is more easily disrupted and that this is why insomnia is a common problem in the elderly. In Chinese medicine it is seen as a decline in Yin fluids and essence, which may be treated with acupuncture and herbs such as American Ginseng. Insomnia may also be caused by residual heat from an unresolved cold or flu. In this case, the cold or flu, called in Chinese medicine terms a wind heat invasion, rather than being fully cleared from the body, hides inwardly, lodging in the diaphragm where it can flare to the heart, disturbing sleep.

Different types of sleep problems suggest differing diagnoses:

  • Difficulty falling asleep – blood deficiency

  • Waking frequently at night – yin deficiency

  • Waking early – Heart and Gall Bladder deficiency, panic attacks may occur

  • Vivid dreams – Liver unable to hold the ethereal soul

  • Snoring – phlegm in stomach channel

Acupuncture treatment for insomnia is often immediately helpful. Points along the heart channel are frequently used to calm and soothe the mind, with other channel points to address the specific diagnosis. Many herbal formulas are available as well. These focus on supporting the energy and calming the mind; unlike Western medications, they do not produce a drowsy or hung-over sedative effect.

Western medications for insomnia are effective but may be habituating, and produce many side effects as well as sleep of poor quality; in addition they do not treat the root of the problem. In addition to constitutional treatments to help improve health and resolve the root condition causing sleep difficulty, acupuncture – through detox treatments – can be very effective in helping those who wish to stop using Western sleep medications.

Related issues: hypersomnia (sleeping too much) and parasomnia (unusual behavior during sleep)