Synopsis
- Sleep from a Chinese Medicine perspective offers a more nuanced understanding of the causes of insomnia.
- All matters of consciousness involve the Heart, therefore insomnia is first and foremost a Heart issue.
- If the Heart qi is agitated at first there will be difficulty falling asleep due to excessive thoughts, which corresponds in the Western perspective to an overactive sympathetic nervous system.
- With more severe Heart qi agitation there can be no sleep at all, such as in manic states. This is related to a state of excess dopamine in the brain.
Many, many people have trouble sleeping. Some amount of difficulty sleeping has become so widespread people are starting to think it’s normal, especially as we get older. It might be normal, but it’s not healthy. Getting good quality sleep is one of the most important ways to stay healthy and vital. Chinese Medicine has some interesting things to say about the different types of insomnia. Let’s take a look at how sleep works from a Chinese Medicine perspective. Then we can make some correlations with the biomedical understanding of sleep and physiology.
Consciousness in Chinese Medicine is associated with the Heart, and any disturbance in sleep necessarily involves this most important organ system. According to Dr. Leon Hammer, in a series of lessons on clinical insights (hosted on his website comfoundation.org), sleep is characterized by a number of important aspects.
- First, the Liver stores, rejuvenates, and replenishes the Blood at night by removing Blood from the general circulation. This removal of Blood is what causes the Heart to lose consciousness, as falling asleep requires that the Blood leave the Heart.
- For the Blood to go into the Liver the Heart must relinquish its grasp on consciousness. Thus, if the person is too mentally active and is full of thoughts or emotions, sleep will not be possible as the Heart is refusing to release the Blood to the Liver.
- Similarly, if the Stomach is working and the Blood is being held by the Stomach there will also be difficulty falling asleep. This happens in many people if they eat too much late at night.
- During waking hours the Blood is consumed. It is very difficult to replenish the Blood while the Heart and Mind are active.
- When Blood diminishes due to lack of sleep the person tends towards anxiety or worry. This further depletes the Blood.
Patterns of Insomnia
Mild Heart Qi Agitation – Sympathetic Dominance
In the most mild form this pattern shows up as being unable to fall asleep quickly, but once asleep the person stays asleep for the rest of the night. The person typically lies in bed feeling worried or anxious, and often has lots of thoughts that prevent them from falling asleep. A person could take 30 minutes to fall asleep, or it could be several hours. Over time this disturbance in the Heart will effect the other organ systems as qi and blood are consumed without adequate rejuvenation.
From a biomedical perspective this is a situation of sympathetic dominance: excessive activity of the sympathetic nervous system (SNS) and overproduction of epinephrine (adrenalin), norepinephrine (noradrenalin), and dopamine. This is our fight or flight system and these neurotransmitters amp up the system, preventing sleep. Other symptoms of sympathetic dominance include cold hands and feet from constricted blood vessels, racing thoughts, anxiety, and easy sweating, especially armpits, hands, and feet.
Treatment revolves around calming the Heart and SNS. Very often there is shock or trauma lodged in the Heart that must be cleared. The SNS is activated because of the perception of danger. The Heart and corresponding pattern of arousal in the SNS need to be calmed down.
Severe Heart Qi Agitation – Excess Dopamine
In more severe cases of Heart qi agitation a person could be unable to fall asleep all night, and lie there awake with racing thoughts. The thoughts are often about grand plans and projects, usually of an unrealistic nature. This is one characteristic of a manic episode. This excess Fire in the Heart depletes the Liver and Kidney which will inevitably cause a crash in the future. As Fire nourishes Earth this excess Heart Fire can cause the earth organs to become hot and dry, leading to digestive symptoms like abdominal pain or constipation. This is coupled with the inability of the Stomach to bring the Fire of the Heart downwards, leading to the flaring of consciousness that is characteristic of mania. This is nature of bipolar disorders. Once the person has exhausted their resources they fall into fatigue and depression. When they’ve recovered, the agitation in the Heart begins again.
The biomedical perspective here revolves around excessive levels of dopamine. Psychologically increased levels of dopamine can cause euphoria, agitation, insomnia, aggression, increased risk taking and impulsive behavior, all the way up to hallucinations and psychosis. Dopamine also has functions in the GI tract, and excessive dopamine can result in nausea, vomiting, or constipation. This correlates with the Chinese Medicine picture above.
Treatment for this more severe form of SNS activation and Heart Fire involves engaging the ability of the Stomach to descend the qi. Biomedically this means activating the parasympathetic nervous system (PNS) GABA to counteract the excessive sympathetic arousal. If the GI is involved then treatment must engage the vagus nerve and the PNS in the gut; this is the function of the Stomach with regards to the digestive system. If the GI is not involved then an approach that engages the central nervous system by activating GABA is more appropriate; this is the function of the Stomach in sensory perception and consciousness.
In part 2 we will examine some patterns stemming from deficiency.
