Insomnia

Emily Kane ND

INDEX

INSOMNIA

For starters, here is a handy list which could be called the "Ten Commandments for Sleepers:"
1) Go to bed and get up at the same time every day.
2) Make sure your sleep environment is as comfortable as possible.
3) Keep your bedroom as dark and as quiet as possible.
4) Avoid caffeine -- in coffee, tea and soft drinks -- in the evening.
5) Don't drink alcohol or smoke before going to bed.
6) Get some exercise every day -- but not in the late evening.
7) Don't nap in the daytime.
8) Develop a sleep ritual -- a nightly routine that eases you down from the day's activity.
9) Use your bedroom for sleeping instead of working, worrying or watching television.
10) If you can't sleep, get out of bed and do something relaxing, like reading, deep breathing or yoga.

A recent onset of insomnia is usually related to a current problem such as health concerns, marital troubles, dilemmas at work, etc., and as such usually last less than three weeks. If no such mental/emotional reason can be uncovered, then physical causes should be investigated. It is important to "rule-out" obvious causes of insomnia such as anemia, hypertension (high blood pressure) or prescription drugs. Insomnia that does not respond to simple measures is often due to an emotional upset, especially depression.

The results of prolonged insomnia can be very discomforting: chronic fatigue; anxiety about sleeping; lack of concentration, etc. The conventional treatment is sedative hypnotics if over-the-counter (OTC) drugs fail to help.

Can I use Physical Medicine to treat insomnia?
If there is any panacea (cure-all) in medicine it must be a clean diet and regular aerobic exercise that makes you happy. Treating insomnia is no different. Regular aerobic exercise that you enjoy is crucial to getting a good night's sleep, every night, without fail. Find an exercise buddy in your neighborhood and make a pact to exercise together 3 or 4 times weekly, doing something you both enjoy like briskly walking for an hour, playing tennis, joining a water aerobics class, whatever. Just do it!

You can also make a habit of taking a NEUTRAL temperature bath before bed. This is about body temperature. Both cool and hot baths are too stimulating to both nervous and vascular systems to be of use in insomnia before bed. Some people find it helpful to use a cupful of 3% hydrogen peroxide in the neutral bath water. You can also give yourself a deep foot massage, especially concentrating on the soles of the feet, while in the bath, or just before turning out the light.

What about Botanical Medicine to help with sleep?
Herbal medicine has a long tradition of being able to induce peaceful sleep. A word of caution, however. Many of the botanicals listed below affect the central nervous system, and must be taken with the supervision of a qualified herbalist or naturopathic physician. Please consult with one of these health care professionals to determine the correct dose and form of the potential toxic herbs.
· Anenome pulsatilla (Wind, or Pasque, flower -- can be toxic)
· Avena sativa (Oat straw). Yes, this is the familiar kitchen item frequently eaten as oatmeal. In fact, oats are one of the most universally used medicinal foods to soothe the nerves. You may want to eat your oats in the evening instead of breakfast, but not too close to bedtime, to ensure a restful sleep. No food should be taken closer than 2 hours to bedtime to make sure your digestive workings don't keep you awake. Oats may be used as a soothing bath: put a handful in an old sock and let the bath water run through the sock so the bath water becomes slightly slimy. Bathe in this gentle brew to allow the mildly sedative qualities to seep in through your skin. You could also take oats in a tincture form, using frequent doses at short intervals beginning after dinner.
· Matricaria recucita (German chamomile, or any chamomile species) for sleep disturbed by anxiety or irritability. This herb is especially good for children. Take note: if you are using the chamomile in a tea (infusion) form, don't let it steep more than 3-5 minutes. A strong chamomile tea can actually be mildly stimulating.
· Gelsemium sempervirens (Yellow Jasmine, can be toxic)
· Humulus lupulus: (Hops, a popular flavoring for beer) can allay irritation or anxiety, thus promoting sleep. This doesn't necessarily endorse beer drinking! A better approach would be to rest your head at night on a pillow filled with dried hops leaves.
· Hyoscyamus niger (Henbane, may be toxic) works well for insomnia due to irritability, unrest, fright, or terror. This herb has the power to subdue excitement and induce sleep, especially in sleeplessness due to pain. Great for both the aged and infants.
· Lavendula officinalis (Lavender flowers) works primarily through the sense of smell. It is extremely soothing to simply sniff a small opened bottle of the volatile oil made from these redolent blossoms. Many health food stores will carry some brand of Lavender oil. Keep it next to your bed or add a few drops to the bath water before retiring.
· Leonurus cardiaca (Motherwort) is particularly useful for lack of sleep due to heart problems, including a "broken heart." This herb is known traditionally to "gladden the heart."
· Melissa officinalis: (Lemon Balm). This tasty plant can soothe a nervous heart or a nervous stomach and therefore aid in insomnia which presents as difficulty falling asleep.
· Nepeta cataria (Catnip). It works for humans too!
· Passiflora incarnata: (Passion flower) is a relaxing nervine, indicated for sleep disturbed from mental worries or anxiety, and for geriatric cases where the insomnia is due to fear.
· Piscidia erythrina (Jamaican dogwood, can be toxic in somewhat high doses). This plant was originally used to mildly "stun" fish in a pond to make them easier to catch. It is great as a gentle pain reliever and for general nervousness.
· Scutellaria lateriflora: (Skullcap) is another sweet tasting herb to help alleviate nightmares or restless sleep. Combines well with Passiflora incarnata.
· Valeriana spp. (Valerian) has an active ingredient from which the medication Valium was first derived. It can both relax and stimulate the central nervous system. Don't use this botanical for more than 3 weeks at a time. It combines well with Hops.

A lovely mixture for a herbal night pillow is Oregano, Thyme, Lavender flowers, Valerian root and Hops leaves. If there is an herbalist near you can ask them to make this up for you, or ask your doctor for a referral to an herbal supply company. A mugwort leaf pillow is said to make for happy dreams.

Another great way to take sleep-inducing plants is in the form of a cup of tea before bed. An excellent sedative tea contains a mixture of Valerian root, Lemon Balm leaves, Hops leaves in equal part. Use 1-2 tsp. to 1 cup boiling water. Infuse at least 15 minutes and drink 1 cup before retiring. Use regularly over a period of time.
Another sedative tea formula contains:
Angelica root, 20 g.
Rosemary leaf, 10 g.
Lemon balm leaf, 30 g.
Lavender flower, 10 g.
Hops leaves, 20 g.
Yarrow flowers, 10 g.
1-2 tsp. to 1 cup boiling water. Infuse. Drink 1-2 cups before going to bed. Use regularly over a period of time.

Can my diet effect getting a good night's sleep?

It certainly can. There is one amino acid (from protein breakdown) that is a potent biochemical inducer of serotonin, the major sleep neurohormone. This amino acid is Tryptophan. Tryptophan is high in turkey meat, eggs, fish, dairy products, bananas, pineapples, whole wheat toast and walnuts. If you decide to supplement with Tryptophan: make sure to also take the cofactors which will facilitate the conversion to serotonin. These are Vitamins B3, B6, and C.
Other therapeutic food suggestions include:
· increase foods high in Vitamin C (all tart fruits, dark leafy greens and red peppers) and Vitamin B-complex such as Brewer's yeast.
· Traditional Chinese Medicine food recommendations for deeper sleep include chicken, duck, oysters, celery, sesame seeds, and walnuts.

If you are inclined to make fresh juices, the following combinations are said to help induce deeper sleep:
· lettuce and celery
· carrot and spinach
· carrot and celery

Naturally, there are food to avoid because they are stimulants. This is especially true in the afternoon and evening. These foods are:
· meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar.

Sometimes food alone is not enough to get out of your restless sleep cycle. The following supplements have been shown to be effective in treating insomnia, but please consult with a qualified healthcare professional before experimenting.
· myo-inositol (a high quality fat, usually derived from soy bean) 500 mg daily
· niacinamide (buffered Vitamin B3) 1000 mg at bedtime (if you can fall asleep readily but cannot return to sleep after waking)
· L-Tryptophan 1-4 g 30-45 minutes before bedtime with carbohydrates, no protein
· Calcium 500 mg before bedtime
· Avoid B-complex after 5 PM, especially B6 which is known to cause prolific dreaming
· Vitamin B12 injected intra-muscularly (IM) 2 cc weekly until your deep sleep is restored. This can be administered at home, but get your doctor to show you or your spouse the correct injection technique.

How can Acupuncture and Traditional Chinese Medicine (TCM) help with insomnia?
Insomnia is not really a "disease" but a symptom of in imbalance in your physical, mental or emotional body. The TCM approach is to find your constitutional diagnosis, by looking at your tongue, feeling your pulses, asking lots of questions then determining where the vital force (Qi) has become stagnant. Insomnia can be due to a very large number of imbalances, one of the most common being "Disharmony between the Heart and the Kidneys." The Heart, in Chinese medicine, is not only a cardiovascular pump, but the "house" of the "Spirit." The Kidneys are the producers of Yin and Yang, as well as controlling the production of blood, hormones and brain tissue. Based on your TCM diagnosis, the acupuncturist or Oriental Medical doctor may wish to prescribe an herbal or patent medicine formulation to help you sleep better. The following incomplete list will give you an idea of what there is to chose from:

· Corydalis Yanhusus Analgesic Tablets (patent) for insomnia due to pain
· Ginseng and Longan C. (Gui Pi Tang) (available as patent)
· Bai Zi Yang Xin Wan (patent) for Heart Blood Deficiency with Spleen Qi Deficiency) for poor appetite and memory, pale face, anemia
· Miao Xiang San, a patent combination, for Heart Qi Deficiency with symptoms of forgetfulness, spontaneous sweating, anxiety, restlessness
· Ginseng and Zizyphus F. (Tian Wang Bu Xin Dan)
· An Mian Pian (patent): Heart Yin Xu (Deficiency) for exhaustion due to excessive mental work; tossing and turning; also for patients on tranquilizers or sleeping pills for so long that they no longer have an effect
· Coptis and Gelatin C. plus cinnamon bark (rou gui) (Huang Lian E Jiao Tang): Kidney and Heart Not Communicating: strong patient, so irritable they cannot even lie down in bed, dizziness, tinnitus
· Baked Licorice C. (Zhi Gan Cao Tang) minus linum (huo ma ren) plus zizyphus (suan zao ren) for Qi Deficiency with Blood Deficiency for slow, irregular or thin pulse, palpitations, shortness of breath, emaciation, dry mouth and throat, pale shiny tongue
· Licorice and Jujube C. (Gan Mai Da Zao Tang) for "Shen" (Spirit) Disturbance, which presents as absentmindedness, moodiness, crying spells, restless sleep
· Ci Zhu Wan (patent): Kidney and Heart not Communicating.
· Bupleurum and Peony F. (Jia Wei Xiao Yao San) for Liver Qi Stagnation with Yin Deficiency, particularly with menopausal or menstrual difficulties. "Yin" is the fluid, feminine, dark, deep form of our vital force while "Yang" is the solid, masculine, light, surface aspect.
· Xue Fu Zhu Yu Tang a classic formulation for Blood Stagnation which shows up as insomnia with depression, extreme anger, headache, poor memory, chest or abdominal pain, purple tongue (the classic sign of blood stagnation).
· Zizyphus C. (Suan Zao Ren Tang) for Liver Blood Deficiency with Liver Yang Rising: insomnia caused by deficiency and overwork, indecision, many dreams, dry mouth and throat, night sweats; also with chronic illness
· Gardenia and Soja C. (Zhi Zi Dou Chi Tang) a patent medicine for insomnia with tossing and turning in bed and very restless sleep thereafter, irritability, slightly rapid pulse and slightly yellow tongue coat.

Another important part of TCM is using ultra-fine needles to tap into, and stimulate to optimal circulation, the Qi, or vital force, which runs throughout the meridians. Based on your diagnosis, the acupuncturist will decide on several acupoints, which should help your sleep after 3 to 10 treatments. After the course of treatment, you may need an acupuncture "tune-up" from time to time. Below are given a brief list of the locations of some of the pertinent points.

· Governing Vessel-20 is located right on the top of the head and is a great release point for excess heat, anger, frustration or nervousness that "rises" and builds up in the head. Needling this point can calm the nerves, relieve headaches and stabilize the willpower.
· an mian is an extra point which means "sweet sleep," located at the top of the neck just behind the ears. It functions to calm the Spirit (Shen) to enable restful sleep.
· yi ming (-): calms the Shen to enable restful sleep
· Bladder-38 is above the back of the knee and is known as the "Happy point" because it strengthens Deficiency conditions, tonifies the Heart function and releases unresolved emotions.
· Bladder-15 is located about an inch lateral to the spine on the back at the level of the heart and works to clear the Brain, calm the Heart and the Shen (Spirit), relieve palpitations, regulate the Xue (Blood) and Qi and relaxe the chest.
· Bladder-23 is also about an inch away from the spine, at about waist level. It the major point on the back regulating the Kidney function. Since insmonia, in TCM, is primarily due to imbalance between the Heart and Kidneys, both these organs must be properly treated to relieve your restless sleeping.
· yin tang is a famous extra point right between the eyebrows. It is famous for its calming effect on the entire system, probably because it stimulates the pituitary and pineal glands, thereby promoting relaxation.
· Heart-7 is located near the inner wrist and is specific for insomina due to fear or an internal organ problem.
· Spleen-2, located at the inner aspect of the base of the big toe is said to be the patient who "cannot lie still in bed."
· Stomach-45, on the top of the foot, between the second and third toes, pacifies the Shen (Spirit) and facilitates flow of Qi.
· Liver-3 is between the big and second toes on the front of the foot and also pacifies the Shen, relieves anger and mellows spirits of those who are frustrated and jealous.
· Kidney-6, near the inner ankles is yet another point to pacify the Shen and also stabilizes the Will, nourishes the Heart, balances excess or deficiency of any hormonal secretion, and sedates pain.

Can Homeopathy help me get a good night sleep regularly?
Yes it can, but like TCM the prescriptions are made based on your constitution, and not on the disease, or in the case of insomnia, the symptom alone. Therefore it is advisable to consult a skilled homeopath before using these remedies. Some of the more common ones used in insomnia, with their peculiar indications, are as follows:
· Aconitum napellusfor sleeplessness after midnight with anxiety and nervous fear; restlessness; skin hot and dry; increased thirst for cold water.
· Arsenicum album also for sleeplessness after midnight; nervous exhaustion; restlessness and prostration; due to nausea and gastric troubles; fear of death or of being left alone; thirst for small sips.
· Belladonna is the remedy for sleeplessness of nervous excitement; flushed face; starting on first falling to sleep; sleep interrupted by talking, startings, muscular jerkings and spasmodic motions; head hot and throbbing; worse from noise and light.
· Calcarea carbonica is for the workaholic insonmiac, troubled by phantoms; by frightful images which appear as soon as the eyes are shut.
· Chamomilla works well in children for insomnia due to irritability; for complaints of bowels and flatulence; sleeplessness due to pain; teething in children; the child wants to be carried.
· Cinchona is well known as a malaria remedy and is also useful for sleeplessness from exhausting diseases; the mind indulges in castle building; ther may be a pressure-type pain in the head; this insomniac will start with fright as they begin to fall asleep.
· Coffea, a remedy derived from coffee, treats sleeplessness due to exciting, agreeable causes; this person cannot switch off their mind; all the senses are more acute; the insomnia is especially pronounced during convalescence from acute diseases.
· Hyoscyamus is for sleeplessness from nervous excitement with bewildering ideas and images; the patient complains of tossing about the bed.
· Ignatia, made from the strychnine nut, treats sleeplessness from grief, fright or suppressed mental suffering; for women with sleepless "hysteria."
· Lachesis, from snake venon, is for excessive mental exertion which prohibits sleep; particularly at menopause when there are frequent hot flushes and a felling of heat at the top of the head.
· Nux vomica, an addiction remedy, is for poor sleep from a "crowd of ideas"; night-watching; when late-night reading or singing is followed by wakefulness; this patient awakes from anxiety and frightful dreams; insomnia comes after the use of drugs, strong coffee, and/or tobacco.
· Pulsatillais given to the insomniac who is wakeful until early morning, then falls sound asleep but wakes unrefreshed. The symptoms are worse at menstruation; this remedy if for mild, timid women who suffer from indigestion and feel better in a cool breeze.
· Rhus toxicodendron, made from the Poison Ivy plant, is for the patient who is extremely restless with general soreness; is worse getting wet, better from heat, and has "exercise dreams" of walking, running or climbing.
· Sulphur is a remedy for the "hot, rumpled philosopher" who's mind is cluttered with arithmatic figures; sleeps for short periods of time only, or wakes frequently, or sleeps all day and is sleepless at night.

What about Subtle Energy techniques to help me sleep?
Check the Introduction to Modalities essay to learn more about some of the Subtle Energy techniques in more detail. Flower essences are similar to homeopathic remedies in preparation, but work primarily on a mental/emotional level. Some of the flower essences used most frequently for insomnia are:
· agrimony
· rock water
· beech
· oak
· olive
· pine
· sweet chestnut
· cherry plum
· water violet
· impatiens
· willow
· centaury
· elm
· heather
· honeysuckle
· chamomile
· chaparrel
· white chestnut
· red chestnut
· mimulus
· dill
· lavender
· Saint John's wort

Others have found relief from the use of color therapy, either by wearing clothing of certain colors, or using plastic gels over light sources at home or work. Here are some ideas for applying this simple, deeply effective technique:
· violet acts as a tranquilizer when directed towards the face
· purple raises the threshold of pain and is soporific when applied on the face, throat and chest if your pulse fast or throbbing
· blue on the forehead and temples for 5 minutes before bed
· orange on abdomen
· green or magenta
· indigo, blue, green and orange

Yet another method is the use of precious or semi-precious gems to subtly balance the disharmony which may be causing your sleeplessness. Try the following, either by wearing jewelry made with these elements, or placing them in significant places in your home or bedroom:
·Pearl
· Moonstone
· Ruby, Coral, Topaz, Cat's Eye combination )

Should I consider Guided Imagery or Meditation for my insomnia?
Sleep is the time to rest the body, mind and spirit. During sleep the autonomic ("automatic") portion of the nervous system kicks in, our brain waves slow way down, we are temporarily relieved from the struggle against gravity, and the vital organs, including the brain, perform detailed and minute repairs throughout the night. Psychological techniques may well be the KEY to restoring your restorative night's sleep, without which life can quickly become miserable. Consider the following ideas, and if any of them rings true for you, pursue the thought further.
· Inability to forget the day may be due to guilt.
· Fear of death, since sleep can be equated to death.
· Depression can be a major cause of insomnia.
· Habit-bound insomnia.
· Fear. Not trusting the process of life. Guilt.
· Insomniacs are afraid of the night, of passivity. Transitoriness and death are important issues for them. They are lacking in native trust and the capacity for self surrender, and are usually identified with their active pole, the 'doer'.
Now consider the following ideas for modifying your behavior before and around bedtime:
· Bed should be used for sleeping, and not for other activities such as reading, watching TV, or eating. The bed should be behaviorally associated with sleeping.
· Meditation, breath concentration, mantra recitation, counting sheep; all these methods are monotonously boring to the left side of the brain and allow it to let go of its dominance.

A very important technique for aiding sleep is called progressive relaxation. This is where, when lying comfortably in mind, you systematically focus on, and consciously relax, each part of your body starting with your toes, moving up through the ankles, calves, knees, etc all the way up the the head. Don't forget to visualize the inner organs relaxing when you're at the belly. And don't forget the eyes, ears and brain. Feel the tissues softening, becoming warm and heavy, and compliant to the idea of deep relaxation. You should be feeling somewhat sleepy just reading this!

Other folks may get more sustained benefit from creating soothing "pictures" in their minds, such as the classic sheep-counting exercise, or imagining yourself drifting down a stream. And you can also talk to yourself, looking gently in the mirror, or writing up a mini-pep talk and posting it in the bedroom. An example from Louise Hay, the affirmation "queen" is:
· I lovingly release the day and slip into a peaceful sleep, knowing tomorrow will take care of itself.
Another psychological technique that may help insomnia is hypnotherapy. This is a light trance state, self-induced or facilitated by a therapist, which allows you to back-track in your history to the time before you had problems sleeping. When a series of memories is recalled through this method, you can get to the forgotten traumatic source of a personality problem that had previously been in your unconscious mind. This gives your body to physiologically recreate the hormone-encoded source of a problem that can now be accessed and reframed therapeutically.

Restful sleep implies the ability to bring the day consciously to a close, so as to give yourself over totally to the night. Sleeplessness could be taken as a cue for asking the following questions:
· Am I able to let go?
· Am I having sufficient regard for the night-side of my soul?
· How dependent am I on power, control, intellect, and observation?
· How afraid am I of death? What terms have I come to with this?
· How developed are my facilities for self-surrender?
· What is the symptom preventing me from doing? What is the symptom making me do?

As with all "diseases" or symptoms of imbalance, much can be learned about yourself by a little thoughtful exploration. There are no accidents, only a resistance to understanding.