Somewhere near the beginning of the film Fight Club Edward Norton’s character observes that “when you have insomnia you’re never really asleep and you’re never really awake.” I still think it’s one of the best observations about insomnia I’ve come across; not being able to sleep wouldn’t be a problem if it didn’t make being awake so hard! Perhaps my most direct experience of how insomnia feels is as the father of a child who wouldn’t sleep, waking multiple times a night for at least the first two years of his life. Strictly speaking that’s not insomnia, more sleep deprivation, but it gave me some insight into just how hard living without proper sleep is. In this post I want to have a quick look at how Chinese Medicine might understand sleep and what that says about insomnia, its causes and possible cures.
I think any medicine, Eastern or Western, conventional or complementary would agree on the restorative and healing power of sleep. A quick Google search turns up plenty of scientific papers on the detrimental impact poor sleep can have on immune response, wound healing and recovery times. Chinese medicine sees sleep as one of the prime ways the body’s Qi is restored and replenished, so that poor sleep should have these effects and leave a person lacking in energy, with poor mental functioning etc. is of no surprise. The fact that sleep plays such an important role in replenishing the body’s Qi explains the strong correlation between poor sleep and obesity. Food is the other major way the body’s Qi is replenished and if we’re short on sleep we’ll lean more heavily on food. For these reasons the Yang Shen (Nourishing Life) tradition has much to say on how to cultivate good sleep.
In Daoist thought the night, and so also sleep, are seen as being Yin and so much of the advice provided by the Yang Shen tradition is about cultivating a Yin state within the body and mind. In the first instance the mind should be prepared for sleep with a period of quiet before going to bed. Also, in the hours before sleep, one should avoid becoming over stimulated either mentally or emotionally (no binging on box-sets). Other advice concerned avoiding eating in the hours before sleep, the position that should be adopted for sleeping (on one’s side with knees drawn up) and soaking the feet in warm water before sleeping. This latter is to draw energy (Yang) down to the lowest (more Yin) part of the body and away from the head where it would disturb rest.
In fact in traditional Chinese thought proper sleep involves the Yang being contained by the Yin. More concretely our most Yang aspect, our Spirit, should be rooted in our most Yin aspect, our Blood, and so settle calmly in the Heart. These last two are somewhat metaphorical in this context, but this model, together with the Chinese Body Clock (see illustration), which suggests which organs are most active at what times, provide a framework within which many causes of insomnia can be understood and so treated. If we exclude things such as pain and breathing problems then what causes insomnia is some sort of agitation, either mental or emotional, and I want to briefly look at a few of the most common here.
For some people it’s getting off to sleep that seems hardest. The go to bed feeling tired but when they get into bed they find they can’t settle their mind. Looking at the Chinese Clock the Heart is considered to be energetically at its peak between 11am and midday and so is weakest between 11pm and midnight, the very time that many people are trying to get off to sleep. In Chinese medicine the Heart is understood as the psychological and emotional centre for the body and in order to sleep the more Yang aspects of ourselves’ (our mental and emotional faculties) need to settle quietly within this centre. If they are unable to do so sleep becomes elusive. So any disharmony within the body that exacerbates the energetic weakness of the Heart may well produce this sort of difficulty in getting off to sleep. Common disharmonies that create this sort of sleep disturbance are Heart Yin or Heart Blood deficiency, two very similar conditions with much overlap and which may well result from a more general Blood deficiency. The exact meaning of these diagnoses isn’t that relevant for the purpose of this post but such differentiations allow treatment to be specific to the patient’s experience.
For others getting off to sleep might not be an issue but they then find themselves waking in the early hours of the morning, sometime between 1am and 3am. This is Liver time and in Daoist thought the Liver has particular characteristics that make this type of insomnia something I see quite often. In 5 Element terms the Liver is associated with the Wood element and it’s Qi is forceful, direct and rises. If you think about how when you get angry, that anger rises in your body you’ll get the idea. Interestingly the emotion associated with the Liver in Chinese thought is usually translated as anger but this emotion might also be understood as frustration. Often people who wake at this time find themselves frustrated/angry at their inability to get back off to sleep and this frustration only adds fuel to the fire and it may be several hours, way past the peak Liver time, before they get back to sleep.
Another thing people with this sort of insomnia may do when awake in the night is plan. They find themselves mentally wrestling with some problem the solution of which suddenly seems almost within their grasp. It’s almost as if they believe that it’s this problem that’s woken them or is stopping them getting back to sleep. But from the perspective of Chinese medicine this really isn’t the case. The ‘Spirit’ associated with the Liver is the Hun, this is the aspect of us that can project into the future and so plan. Like the person frustrated by their inability to return to sleep those who compulsively plan are adding fuel to the Liver’s fire. A better response is to spend 20 minutes or so engaged in some mindfulness practice in order to calm the Hun and lead the body back toward a more Yin state.
The other common sleep problem people may experience is waking after 3am. The Bladder is at its weakest between 3am and 5am and so this is often a time when people wake to go to the toilet, but most of us go back to sleep without difficulty. The Kidney energy is also weak at this time, its low point coming between 5am and 7am and for this reason in Chinese medicine insomnia that leads to wakefulness after 3am is often associated with aging. This is because our Kidneys carry our Jing, which is often translated as essence but doesn’t have any clear equivalent in Western thought. One might think of it as our genetic inheritance, life force or potential and it, along with our Kidney energy, declines as we age. Those with this sort of insomnia may well find they wake somewhat hot and/or sweaty in the early hours and are then unable to return to deep sleep, instead they doze, drifting in and out of sleep. They may find their waking is accompanied with feelings of anxiousness that add to the sense of not sleeping. They may actually be sleeping for more of this time than they think (we’re aware of our waking but not of our sleeping) but the sleep is shallow and not refreshing. They may also find that after 7am they are able to return to a deeper sleep. This sort of insomnia may often affect menopausal women and is associated with Kidney Yin deficiency.
This is by no means an exhaustive explanation of the possible causes of insomnia as understood by Chinese medicine. But I hope gives a brief insight into how a practitioner of Chinese Medicine may investigate the roots of a patient’s insomnia in order to provide effective, individually tailored treatment. For me this careful differentiation of symptoms in order to create a highly individualised diagnosis and treatment is one of the great strengths of Chinese medicine.
Bruce Bell is a 5 Element Acupuncturist working from clinics in Midsomer Norton, Bath and Keynsham.