Insomnia: Patterns & Treatment Strategies
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Before the pandemic, approximately a third of Americans struggled with some form of chronic insomnia. In the era of Covid, that number is even higher. Economic stress, survival fears and disrupted routines have conspired to create a second pandemic: one of sleeplessness. If you're suffering, you're not alone.
This post covers general sleep tips before delving into four main patterns of insomnia, and how to approach treating them from a Traditional East Asian Medicine and Western Herbal perspective.
General Tips & Sleep Hygiene
Caffeine - Few realize that the half-life of caffeine in the body varies widely from person to person, depending on individual genetics. For those on the sensitive side, caffeine can last upwards of 24 hours before being broken down completely. In other words, your body may never get to experience its normal, non-stimulated baseline--and your morning cup of coffee may affect sleep quality all night. Bottom line: if you're struggling with sleep, don't assume that limiting caffeinated drinks to morning hours is sufficient.
Alcohol - A nightcap may help some people fall asleep, but it doesn't make for good sleep quality. Best to limit alcoholic drinks to one serving and have it before or with dinner, not afterward.
Screen Time - Blue-spectrum light tilts the nervous system balance towards activity and away from rest-and-digest. This is true no matter the content, but more intense stimulation (like from violent shows or the news cycle) adds an extra layer of frazzle. Best plan is to ease off the screen (phones, I'm looking at you) by 8.30 or 9pm. You can also download an app like Flux that shifts the spectrum of your screen towards red after sunset.
Evening Routine - Creating a relaxing, restful routine for yourself sends the signal that it's time to wind down. Low light, soft music, a bath, natural incense (available at Sattva Apothecary), stretching, rubbing your feet, meditation and prayer are just a few possible ingredients.
Insomnia Patterns and Treatment Strategies
1. Burn-out or depletion insomnia
This is probably the most common kind of insonia. Stress, overwork, overstimulation, and too much screen time take a toll on the system. Imagine a light bulb that’s burned so hot for so long that it has scorched the lampshade, burning right through it such that the shade no longer protects from the glare. In East Asian medicine terms, yin and blood are depleted--specifically Lung and Pericardium yin and Heart blood.
If you’re suffering from this kind of depletion insomnia, you may be hooked into dependence on caffeine or other stimulants. This can become a vicious cycle, since what’s needed is rest but you’re preventing yourself from doing just that.
Targeted herbal therapy can break the cycle by replenishing yin and blood. The classical formula Suanzaoren Tang, Spiny Ziziphus Seed decoction, is a good starting point. I custom tailor this five-herb recipe to meet the needs of individual patients, who are always more complicated than the textbook example. Many also benefit from Milky Oatseed, an excellent Western herb for this situation.
Elderly patients tend towards this type of insomnia, along with the next type.
2. Arrhythmic insomnia
In this type, you may fall asleep fine and sleep well for a few hours, but you wake in the early hours feeling not at all rested and have trouble getting back to sleep. This kind of insomnia pertains to the Lung, in East Asian Medicine terms. The Lung is called the "delicate organ” and is susceptible to being impacted by many external factors, from air pollution to heat or cold.
If you’re waking between about 3 and 5am, your Lung most likely needs some attention, whether that be to clear heat, dispel phlegm, or some other treatment principle. A note here, the Lung is especially susceptible to heat, and hot-natured alcohol steams up and affects the Lung adversely. Something to note if you’re waking around 4am after drinking what you thought was a fine amount of merlot.
If you do find yourself wide awake in the early hours, try getting up, sitting quietly in the dark and doing some gentle yoga, deep breathing or meditative practice. Get your lungs working. This will help reset the body’s master rhythm and will usually allow you to get back to sleep before the sun comes up. It beats lying there tossing and turning.
Herbal strategies depend on the specific pattern, but frequently Lung yin enriching herbs such as Schisandra and Lily Bulb are called for.
3. Digestive insomnia
You wake in the night with your stomach gurgling, pounding, tight or otherwise complaining. Was it something you ate?
Digestive problems are an often unappreciated cause of sleep trouble, a fact recognized 2,000 years ago in the Yellow Emperor's Inner Classic. Think of the digestion like a wheel that’s turning in the center of your body. When the wheel gets stuck, nothing can descend. Often we see ‘hot above, cold below” type patterns here: all the energy is in the head and chest. The mind is active, going around in circles, while the feet may be cold.
Treatment will depend on what exact pattern is presenting, but often a classical formula called Banxia Xie Xin Tang (Pinellia Decoction to Drain the Heart) taken during the day will resolve this kind of issue, especially if there is a stuffy, stuck feeling around the epigastrium and the tongue has a red tip.
Whenever digestive distress accompanies sleep issues (or anxiety), working with the Earth element and harmonizing the Spleen and Stomach are the place to start.
4. Wound Up Insomnia
This kind is easy to differentiate: you’re too wound up to fall asleep in the first place.
The main tissue states here are heat and tension. There can be an underlying element of deficiency, like in type #1, but there’s also a need to clear heat and relax tension.
Cooling nervine remedies are helpful here, including Blue Vervain and Skullcap. And Peach Leaf tincture, a valuable remedy I learned about from Matthew Wood, is very specific here. It turns the master volume knob down right at the cellular level and bring you from red back to yellow and into green, so you can go under.
These four types aren’t mutually exclusive—you can have more than one pattern at the same time. There are other possible patterns as well outside of these four, such as Nervous Bladder Insomnia, and Vital Fire Exhaustion Insomnia as seen in serious pathological states.
Due to the complexity of the human body, seeking individualized treatment from a well-versed practitioner is always a good idea.