43. Acupuncture and Insomnia

Jul 28, 2012   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 4 (7), July  , 2012, © Copyright

 

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Fax: (203)637-2693

 

Insomnia

Alice E, a forty-five-year-old woman, came to me complaining of insomnia. She had the same difficulty falling asleep, especially after experiencing stress, that she’d had at college on the nights before exams. She would lie in her bed, staring at the ceiling, and not fall asleep. If she was lucky enough to doze off, she would wake up frequently, even at the slightest noise. She had experienced this problem for about ten years, but recently the problem had escalated, owing to her marital situation. Her husband, the CEO of a large company, had quit his job because he would not fly from New York to Houston each Monday, then return to New York each weekend. He had managed this schedule for two years, but it had become too burdensome to him, hence his decision to quit. Though he sent out many résumés each week, his job search had produced no results, and the family’s financial situation had become difficult over the six months her husband had been unemployed. For the last two or three months, she could only sleep an hour or two each night, owing to stress, and this caused her difficulty during the day, as she found it hard to concentrate on any issue. This sleep deprivation impaired her memory, her social interactions, and her motor coordination, which caused problems with her driving. It was at this point she consulted me.

 

Types and Causes of Insomnia

Insomnia is a symptom, not a disease. It is defined as difficulty in initiating, or maintaining, sleep—or both. It is due to an inadequate quality or quantity of sleep. Most adults have experienced insomnia or sleeplessness at one time or another in their lives.

Insomnia can be classified based on the duration of the problem:

  • Transient insomnia. These symptoms last less than one week.
  • Short-term insomnia. Symptoms last between one and three weeks.
  • Chronic insomnia. Symptoms last longer than three weeks.

Most Common Reasons for Insomnia

  • Stress. Many people experience stress from the environment, including that caused by life, work, family, and the like. This keeps them thinking about the stress and trying to deal with it, which makes falling asleep extremely difficult.
  • Anxiety. Everyday activity and anxiety, or severe anxiety disorder may keep the mind too alert to fall asleep.
  • Depression. This is a very pronounced reason to keep people alert and make sleep difficult.
  • Long-term use of sleep medication. Drugs such as Ambian or Wellbutrian cause psychological dependence on them.
  • Pain. Many conditions, including arthritis, fibromyalgia, neuropathy, trigeminal neuralgia, plus assorted injuries, will cause pain, making it hard to fall asleep and stay asleep.
  • Aging. When people age, they do not need as much sleep as they did when young. The reasons for this include changing life patterns, family changes, and other worries, all of which can cause insomnia.

 

Treatments in Western Medicine

From the perspective of Western medicine, there are two major types of treatments.

Non-Medicinal Treatments and Behavioral Therapy

  • Sleep hygiene. This is a component of behavioral therapy, with several simple steps that can be taken to improve the quality and quantity of sleep, such as timing of sleep, food intake, sleeping environment etc. Sleep hygiene combines advice about aspects of sleep control, how to avoid sleep deprivation, and how to respond to unwanted sleep interruptions if they occur.
  • Increased exercise. Exercising a minimum of 45 minutes a day, 6 days a week, will greatly improve the quality of sleep.
  • Relaxation therapy. Massage, meditation, muscle relaxation, or a hot bath or shower can assist in falling, and staying, asleep. No one should ever try to force themselves to sleep, but should retire in a relaxed mood.
  • It is best to keep a regular sleeping and waking schedule and not drink caffeine, or any beverage, before sleeping. Nor is it good to smoke. Do not go to bed hungry, and make sure the sleeping chamber is adjusted for light, temperature, and noise to make sleeping easier.
  • Stimulus control: It’s important to go to bed as soon as you feel sleepy, and not watch television, read, eat, or worry in bed. It is not advisable to take long naps during the day. (Oversleeping does not improve insomnia.)

Medication

  • Benzodiazepines. There are many different types, including temazepam, lorazepam, triazolam, and clonazepam. All of these benzodiazepines are very effective in improving the quality and quantity of sleep.
  • Nonbenzodiazepine medicine, which includes Lunesta, Sonata, and Ambien.
  • Melatonin. This is a hormone secreted by the pineal gland. It is produced during the night and helps body relaxation. (Attention needed here, however, because regular use causes the body to permanently lose its ability to produce the hormone.)
  • Rozeren. This will stimulate the melatonin receptor to improve sleep quality and quantity.
  • Some antidepressants, such as Elavil, Endep, or Desyrel, have also been used for a long time to aid in depression as well as sleep.
  • Antihistamines. Benadryl, for example, and other antihistamines can be used to induce drowsiness. The drawback to this is that, during the day, they can make it dangerous for a patient to drive or operate machinery.

 

Treatments in Traditional Chinese Medicine

Chinese medicine indicates five types of insomnia.

Excessive Fire in the Heart and Liver

The main symptom is irritability, difficulty falling asleep, sleeping intermittently, waking up easily, sometimes experiencing dizziness, dry mouth, bitter taste in the mouth, and dry tongue body, with yellowish coating on the tongue and a rapid pulse. The method of treatment is to decrease the excessive fire of the liver and heart. The acupuncture points are Xing Jian, Feng Chi, Sheng Men, and An Mian.

Table 7.1

Points Meridian Number Conditions Helped
1 Xing Jian Liver 2See Figure 7.1 Insomnia, abdominal distension, headaches, dizziness and vertigo, congestion, swelling and eye pain, deviation of the mouth, hernia, painful urination, retention of urine, irregular menstruation, epilepsy, convulsions
2 Feng Chi GB 20See Figure 7.3
3 Sheng Men Heart 7See Figure 7.4
4 An Mian Ex HN13See Figure 7.2 Insomnia, vertigo, headaches, palpitations, mental disorders

Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

 

Figure 7.1

 

 

Figure 7.2

 

Fig 7.3

 

 

Fig 7.4

 

 

These points can calm the mind and improve sleep. Xing Jian belongs to the liver meridian which, when treated, can decrease the fire of the heart and liver. Feng Chi is located in the gallbladder meridian, and together with Sheng Men, a point of the heart meridian, they will decrease the fire of the liver and heart, and help to calm the brain. An Mian is also a very important point for alleviating insomnia.

Overeating

Many people experience a restless night after overeating; they feel bloated and gaseous, and have constipation or diarrhea, with white coating on the tongue. The treatment is to strengthen the spleen and stomach to calm the mind and induce sleep. The acupuncture points are Pi Shu, Zu San Li, Sheng Men, and An Mian. Pi Shu and Zu San Li are the best points for the stomach bloating, constipation, and diarrhea. Digestion will be much improved by stimulating Pi Shu and Zu San Li. As mentioned, Sheng Men and An Mian will greatly facilitate sleep.

Table 7.2

Points Meridian Number Conditions Helped
1 Pi Shu UB 20See Figure 7.8
2 Zu San Li Stomach 36
3 Sheng Men Heart 7See Figure 7.4 See Table 20.2
4 An Mian Ex HN13See Figure 7.2 Insomnia, Vertigo

Please refer to the accompanying Figures (illustrations) for the

locations of the points. And please note that these illustrations are

for information only and may not show all the exact locations of

the acupuncture points.

 

Fig 7.5

 

Depression and Sadness with Deficiency of Lung Energy

The main symptoms are depression, low energy, slowed conversation with low tone, accompanied by congested lungs, difficulty sleeping, and always waking up during the night. Sometimes there is a shortness of breath and a thin white coating on the tongue, with a deeply weak pulse. The points should be Fei Shu, Lie Que, Sheng Men, and An Mian. The acupuncture points will help the energy of spleen, stomach, and lung to improve their function.

Table 7.3

Points Meridian Number Conditions Helped
1 Fei Shu UB 13See Figure 7.7
2 Lie Que Lung 7See Figure 7.6
3 Sheng Men Heart 7Fig 7.4 See Table 20.2
4 An Mian Ex HN13See figure 7.2 Insomnia, vertigo, headaches, palpitations, mental disorders

Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

 

Fig 7.6

 

 

 

Fig 7.7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disharmony of the Heart and Kidney

The main symptoms are anxiety, chest pain, difficulty maintaining asleep and easily waking up, heart palpitations, and stress, as well as weakness of the low back and legs, night sweats, and hot flashes, with red coating of the tongue and rapid and weak pulse. The points are Sheng Shu, Tai Xi, Sheng Men, and An Main.

Table 7.4

Points Meridian Number Conditions Helped
1 Sheng Shu UB 23

See Figure 14.1See Table 14.42Tai XiKidney 3

See Figure 16.6See Table 16.23Sheng MenHeart 7

See Figure 20.2See Table 20.24An MianEx HN13

See Figure 23.2Insomnia, vertigo, headaches, palpitations, mental disorders

Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

 

Deficiency of Qi (Energy) and Blood

The main symptoms of this type of insomnia are dizziness, drowsiness, forgetfulness, poor sleep, tinnitus, and weakness, as well as cold in all the extremities, a pale face and tongue, poor digestion, and a weak pulse. The method of treatment is to calm the mind, and tonify the blood and qi, thus improving sleep. The points are Pi Shu, Sheng Shu, San Yin Jiao, Sheng Men, and An Mian.

Table 7.5

Points Meridian Number Conditions Helped
1 Pi Shu UB 20

See Figure 7.8 2Sheng ShuUB 23

See Figure 7.8 3San Yin JiaoSpleen 6

See Figure 7.9 3Sheng MenHeart 7

See Figure 20.2 4An MianEx HN13

See Figure 23.2Insomnia, vertigo, headaches, palpitations, mental disorders

Please refer to the accompanying Figures (illustrations) for the locations

of the points. And please note that these illustrations are for information

only and may not show all the exact locations of the acupuncture points.

Fig 7.8

 

 

Fig 7.9

 

 

 

 

Alice’s Treatment

Since stress caused her poor sleep, Alice belongs to type three. I selected the acupuncture points UB 13 Fei Shu, Lu 7 Lie Que, Heart 7 Sheng Men, and Ex HN13 An Mian, and she reported that, after the first treatment, she slept three to four hours. After the second week, her sleeping increased to five or six hours a night and she was starting to feel much better. After a month, her sleep pattern became normal, and she could sleep through the night. Her husband’s news that he found a job locally and would no longer have to commute to New York also alleviated her stress, which further helped her establish a normal pattern of sleep. After her course of treatment, Alice thanked me for how much I had helped her achieve relief from her insomnia.

 

Tips for Personal Use at Home

  • Take a hot shower and then press An Mian points (see Figure 23.2) for 15 minutes on each side before you go to bed. Acupressure the points with your thumb or knuckle, pressing with comfortable pressure on the points.
  • Do not force yourself go to bed if you do not have desire to sleep.
  • Do physical exercise at least 45 minutes per day, 6 days per week. The exercise will help you a lot.

 

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