In response to a question asked by the legendary Huangdi of why people are not able to rest, his minister doctor, Qibo, replied:
“藏有所傷，及精有所之寄則安，故人不能懸其病也。” (黃帝內經, 素問: 病能論)
When the internal organ systems are injured and the essence is not able to rest within its designated places, then one lies down but cannot rest. This is to say when there is an internal imbalance, and the body is using essential resources in order to rectify such an imbalance, a person is not able to sleep.
If you have ever experienced insomnia, especially over a long period of time, you know how awful it can be and how detrimental it is to a person’s well being. Not being able to sleep isn’t just that, it is also the feeling of not being normal, not being able to rest while everyone else is resting, not feeling energetic during the day, feeling fatigued and exhausted but not able to rest, again and again and again. Night after night there is the haunting feeling that you cannot rest even when you are completely exhausted. If you have been there, I am here to say, I feel for you. Patients that I have helped with cases of insomnia have been incredibly grateful to even have a few hours of sleep. A heart wrenching experience to know that someone is losing all hope in their life because they haven’t been able to sleep for several days, weeks or months. Some people have to go to the extreme of taking prescribed drugs, ones that totally inhibit the body, and force some sort of sleep, but the drugs unfortunately do not help a person return back to their normal sleep cycle, nor actually rest. This isn’t my way of trash talking pharmaceutical drugs for insomnia, however I am naysaying the “modern” approach to the treatment of insomnia. Treating insomnia is not as easy as taking a pharmaceutical drug that inhibits the body. It is a disorder that is much more complicated, and if only drugs are given without understanding why each patient is experiencing such an awful imbalance, than the insomnia will continue, and the patient will go without proper treatment.
With that being said, sometimes taking pharmaceutical drugs to get a decent night’s sleep is required meanwhile a practitioner and patient collectively help change whatever it is that is instigating the insomnia in the first place.
According to Chinese medicine, insomnia is not an isolated disorder, and there is always something else going on that is creating the imbalance in the first place. This is to say that insomnia is a consequence of something much bigger going on in a person’s life. This is not just the case with insomnia, in fact all disorders tend to be manifestations of greater imbalances. Insomnia can be a result of deficiency or a result of excess, it can be a result of heat, it can be a result of sadness and grief, it can be a result of shock and trauma, it can be a result of poor digestion, it can be chronic or acute, and most of all it can be health compromising.
The typical question a Chinese medicine practitioner asks when a patient is seeking treatment for insomnia is if the patient has difficulty falling asleep or staying asleep or if the patient wakes at a certain hour. Most cases of insomnia fall into these 3 categories, however between these three, there are very different causes. To not go too deeply into Chinese medicine theory (after all, my intention is not to teach someone Chinese medicine theory), I will do my best to explain why the 3 different types of insomnia form as well some possible changes a person could make in order to help resolve certain types of insomnia.
Difficulties with sleep could be simply caused by food retention, not fully digesting dinner before going to bed, eating too much and so on. This subtype could be easily resolved by eating earlier and eating a lighter dinner. However if you already eat early (3 hours before going to bed) and light enough and still your digestion feels stuck, taking some steps to improving your digestion with the guidance of a Chinese medicine practitioner could be helpful and necessary.
Another subtype could be related to a deficiency of blood, either directly or indirectly. A direct case of blood deficiency is that of anemia caused by excessive blood loss, the body is not producing enough due to lack of nutrients, and so on. An indirect blood deficiency is a deficiency according to Chinese medicine, but not according to allopathic medicine. For example, a patient may be experiencing dizziness, blurred vision and insomnia, however according to a blood test, they are not suffering from anemia. Yet, according to Chinese medicine, their body is not distributing blood well enough so the body feels fully nourished. Blood, in terms of Chinese medicine, is much more than blood in terms of allopathic medicine. So a deficiency of blood in Chinese medicine does not always equal anemia in allopathic medicine.
Another subtype could be related to an excessive amount of frustration, anger or stress during the day. Such excess causes the rising up of yang and this rising up leads to an imbalance that creates excessive activity in the upper part of the body. This excess then leads to the inability to rest the mind and rest the heart and as a result the inability to fall asleep and stay asleep.
A similar subtype to the one mentioned above is also due to the uneven distribution of yin and yang, yang rising up when it should be settling down, but instead of it being due to an excess cause, it is due to a deficiency cause. This is especially the case when someone either has difficulties staying asleep, waking several times during the night and early morning, or someone who wakes early in the morning at a specific hour and has difficulty falling asleep again. Such a deficiency is related to yin, and therefore yang is flowing up without control. If you are wondering what leads to yin deficiency, well many things, but on a basic level, anytime too much fluid is leaving the body over a long period of time, this leads to yin deficiency. Sweating too much, especially during seasons when sweating should be avoided (ie winter season), living in severe heat, too much alcohol consumption, excessively partying, eating too many spicy foods, too much ejaculation, heavy periods, grand multiparity, not able to properly hydrate or not hydrating enough, not getting enough rest (rest is considered a yin state, so not enough rest leads to yin deficiency), not relaxing enough, overworking, overthinking, focused too much, worrying often, not properly digesting meals, not eating enough, eating quickly or while doing other activities, excessive physical, mental, emotional and social growth (examples: hormones found in food, harsh abusive environments and peer pressure), excessive grief and crying, traumas and living too fast are all examples of what can lead to yin deficiency.
It can be difficult for a person to determine for themselves what is the cause of their insomnia, especially if the cause is a complex mix of excess and deficiency. However you can at the very least take steps to changing your life habits in order to avoid further imbalances related to your inability to get a good night’s rest.
Finding even just 2 minutes to rest after an hour of work, closing your eyes, not thinking about anything, just breathing gently and slowly, can be very helpful. Avoiding the above mentioned excessive actions and behaviors, one step at a time is a path we should all try to follow. Changing your emotional feedback loop, not becoming stressed during stressful situations, reminding yourself constantly that life is not about control, that it is about response, and choosing how you respond to a situation can mean maintaining a healthy level of yin and yang. Practicing rest and calm breathing while driving to work, sitting in traffic, waiting in line, eating, listening to someone who is angry or frustrated can make a grand difference in the balance of your body. Sure there are moments of imbalance, but in general, being able to maintain a balanced life with rest and relaxation can mean no more insomnia.