Our healthcare system – a druggy place to be
Most patients I see for insomnia have already tried a sedative and are looking for a healthier solution: drug-free, side-effect free and hangover-free. There is little awareness about the benefits of acupuncture for insomnia, in my view.
Most of us look to our GPs for guidance about the best treatments. Fact is, GPs (with some exceptions) very rarely refer for acupuncture. This isn’t news. The drugs available for insomnia are big business, there is no acupuncture on the medical card and traditional medicine is too ‘on the fringe’for most doctors. GPs ultimately practice pharmaceutical medicine rather than healthcare, where ‘do-no-harm’ is still the first principle. The research behind acupuncture for sleeplessness is impressive (see below), even on meta-analyses, but this is largely ignored by GPs, in favour of medicines.
The better GPs are more informed about wellbeing and want the best for their patients, they don’t rush to prescribe. They don’t risk further the health of the patient if there is a better place to start. The side-effects of drug therapy for insomnia are as bad a the problem itself. Common side-effects include daytime drowsiness, stomach pain, shaking and mental slowness or memory loss. I meet people who have been on medication for years and still suffer both insomnia and extreme withdrawal symptoms if they try to taper off their medication.
Sleeping on empty
Sleep is produced by a healthy body, not out of exhaustion but out of good function. If you view sleep as the last thing you do at the end of the day when you have nothing left in you, then it’s time to change your mindset. Essential homeostatic processes are reserved for sleep, because they operate under a lower heart rate, lower body temperature or lower rate of agitation in the muscles. This is not a coincidence, it’s the way we are programmed. Your body is busy at night, mostly with hormonal and immune activity, and it still requires some fuel in the tank.
As most sufferers of insomnia will tell you, being exhausted does not ensure you a good night’s sleep. Exhaustion causes our body to rely on our reserves, our adrenals, for the inertia to carry on. This releases cortisol, a stress hormone, which disrupts many other hormonal processes. The end result is poor health and a diminished capacity for the body to heal itself by sleeping well. So it follows the key to resolving insomnia is to correct imbalance by day rather than inducing sleep with medication at night.
Chinese Medicine and sleep: A different view
We put a lot of emphasis on sleep hygiene these days. Turn off your phone, avoid the blue screens, don’t eat late. Of course we need to do these things too but we’re missing the bigger picture. If you are already developing sleeping problems, you have to find out where the imbalance is in your health.
Absence of sleep at any stage of the process, from the initial attempt to drop off to the finishing mark in the morning, represents an imbalance in our health. Chinese Medicine, from which acupuncture is derived, views the characteristics of our sleeping patterns, conceptually, as reflective of different aspects of our health. (TCM practitioners will appreciate the simplified concepts to follow)
Difficulty getting to sleep is seen as a problem of ‘excess accumulation of heat’. Heat in Chinese Medicine produces a subjective sensation of heat, inflammation, constipation or dryness of the skin and fever. Heat rises in the body, as in nature, and agitates the mind, producing restlessness. This is counterproductive agitation and hence a delay to shutting down. An important note about heat, it is often produced by emotional excess and irregular lifestyle factors, essentially we are talking stress.
Waking during the night and waking early is often viewed as a deficiency syndrome, where there are insufficient reserves to maintain or hold sleep, often related to weak blood. Patients may have poor circulation, headaches, muscle cramps and poor appetite to accompany their insomnia. By comparison with the above this is a problem of ‘cold’ in the body (contracting, drawing down) but which normally progresses to a ‘heat’ syndrome (expanding and rising) over time and will lead to difficulty falling asleep.
Both syndromes represent the internal struggle for the body to reach balance. Yin Yang theory, which is the philosophical underpinning of all Chinese Medicine, is exactly that struggle between heat and cold in the body, excess and deficiency, off mode and on mode.
Lifestyle: Regularity, Reduction, Balance
Where to start the process of change? Firstly, regularity is all important and probably the most difficult change to get to grips with. Keeping regular mealtimes, bed times and working hours are essential to getting better. By doing this you are teaching your body that you are taking control, you don’t need an adrenaline infusion because you skipped lunch and are working late to cover someone else. Over days and weeks your cycles will adapt to your routine and your energy will start to pick up. Learn to say no to people when it means it breaks your routine, at least until you recover your sleep.
Sometimes we over complicate insomnia because it is such a distressing disorder. But it is exactly that, a disorder that needs reordering, not throwing lots of new ingredients into the mix. Sleep music, scented candles and expensive sheets make us feel relaxed and help us sleep but the question is, why are we feeling tense? Get to the root of the emotion and deal with it as best you can directly. Reduction is breaking away from the habits and paraphernalia of insomnia (focussing on coping) and putting the emphasis back on our health (focussing on the problem). Reduce the problem back to the root cause.
Balance means something different to every person and only you know where you lost it. How well do you know yourself and your body? Some work too much, others spend all day on the couch. Some eat late, some have no appetite. Can you pick an aspect of your life you are unhappy with and put a simple measure in place to combat it – and stick to it? It’s the sticking to it part that’s hard. This is really where acupuncture works to support recovery.
Acupuncture saves the day – and night!
The following research summary, as published by the British Acupuncture Council on their website, uncovers the mechanisms at work when we have acupuncture, which is seen to stimulate nerves in the muscles, triggering chemical responses and:
increasing nocturnal endogenous melatonin secretion (Spence et al 2004).
stimulating opioid (especially b-endorphin) production and µ-opioid receptor activity (Cheng et al 2009).
increasing nitric oxide synthase activity and nitric oxide content, helping to promote normal function of brain tissues, which could help to regulate sleep (Gao et al 2007).
increasing cerebral blood flow (Yan 2010)
reducing sympathetic nervous system activity, hence increasing relaxation (Lee 2009a)
regulating levels of neurotransmitters (or their modulators) such as serotonin, noradrenaline, dopamine, GABA and neuropeptide Y; hence altering the brains’s mood chemistry to help to increase relaxation and reduce tension (Lee 2009b; Samuels 2008; Zhou 2008).
Acupuncture can be safely combined with conventional medical treatments for insomnia, such as benzodiazepines, helping to reduce their side effects and enhance their beneficial effects (Cao et al 2009).
See the full details of each study here
Acupuncture points have been developed over thousands of years of clinical observation. Though science can now tell us what is happening in our brains when we have acupuncture, the end results are consistent with what Chinese Medicine has taught since the classics.
Acupuncture is intensely relaxing, due to the release of endorphin (our mood enhancing and pain killing chemical) from having the tiny needles inserted. It is completely unique as a treatment, as it has no side-effects that endanger our health and it is minimally invasive, yet it stands up to randomised controlled trials, the gold standard in medical trials.
Acupuncture for severe or long term insomnia should be used intensively in the early stages of treatment, at least twice a week in my opinion. Once sleep recovery has started, sessions can be reduced slowly. Many attend for acupuncture after sleep has normalised for maintenance or to combat stress.