- Insomnia is often due to a state of deficiency.
- There can be qi deficiency, where the person wakes frequently without agitation or restlessness, and is able to fall back asleep easily. This corresponds with issues around electrolyte regulation by the kidneys and adrenals.
- The next is yin deficiency, with frequent waking along with restlessness, corresponding with sex hormone imbalance and more frank adrenal fatigue.
- Yang deficiency, where the person must sleep in an upright position, presents biomedically as heart failure.
- Blood deficiency is where the person wakes after 3-5 hours of sleep but is able to fall back asleep after 30-60 minutes. This corresponds to problems with liver glycogen storage.
Heart and Kidney Qi Deficiency – Generalized Fatigue
With this pattern the person may be able to fall asleep relatively easily but finds themselves waking every hour or two throughout the night. They can often fall back asleep quickly, and there is no agitation, restlessness, or racing thoughts. Other symptoms of Heart qi deficiency can include fatigue, easily tired or out of breath with exertion, and palpitations, especially when anxious, stressed, or tired. Because the Kidney is the foundation of the Heart there is often Kidney qi deficiency as well. There can be dull back pain, weakness of the knees, and frequent urination (as if the water goes right through without being absorbed). The person might need to get up several times a night to go to the bathroom. This state typically comes from working physically beyond one’s capacity, as well as experiencing chronic stress that taxes the body’s reserves.
The relationship between the heart and kidney from a biomedical perspective can be partially explained through the role of electrolytes (minerals that carry charge, such as sodium, potassium, calcium, and magnesium). The kidneys and adrenals help regulate electrolyte levels in the blood; the kidneys reabsorb minerals from the urine, and many of the hormones produced by the adrenals effect electrolyte and fluid balance. Since the heart requires balanced electrolyte levels, if the kidneys are not regulating well there can be heart problems. With regards to sleep low levels of magnesium can cause insomnia, as well as Heart qi deficiency symptoms like palpitations. An imbalance in magnesium levels can indicate a more general issue with electrolyte levels in the body. Adrenal hormones like adrenalin, cortisol, and aldosterone all effect the mineral and fluid balance in the body, and excess stress hormones over time can cause mineral imbalances by increasing urination.
A requirement of treatment is rest. Because this state is often caused by working too much, or too hard, it will be difficult to recover without adequate rest. Stress management is also crucial to reduce the strain on the Heart and Kidney. In addition tonifying the qi with nourishing food and appropriate herbs will help speed recovery.
Heart and Kidney Yin Deficiency – Adrenal Exhaustion
This sleep pattern is marked by light, restless sleep, where the person wakes frequently and tosses and turns all night. There is often an element of Liver qi stagnation as well. Other symptoms can include night sweats, anxiety, irritability, hot flashes, depression, fatigue, palpitations, and various autoimmune diseases. Depletion of the body’s yin is most often the result of mental overwork, typically over the course of years or even decades. However, any use of energy beyond one’s capacity will result eventually in yin deficiency.
Yin deficiency in this context relates to a deficiency and imbalance of the sex hormones: testosterone, estrogen, and progesterone. Often all three hormones will be low, as by this point there has been chronic stress and overwork to the point of adrenal exhaustion. Both progesterone and estrogen help promote sleep, thus the success of hormone replacement therapy for insomnia in post-menopausal women. Testosterone, though it does not help a person sleep, is produced while sleeping, and can become low if the person is suffering insomnia. This mirrors the Chinese medicine understanding; testosterone is related to Kidney yang, and yang is replenished with rest and sleep. If yin is deficient (represented by progesterone and estrogen) then it is difficult to sleep, and yang will become deficient as well.
Treatment must be focused on restoring both yin and yang together. Foods and herbs that build yin tend to be dense, heavy, moistening, and cold; without simultaneously building yang with warming methods the yin will get stuck, creating a cold, heavy, damp body condition. Taking time off and resting is critical at this stage, as is learning how to relax and let go of work or projects. Managing stress with mind-body techniques, like meditation, yoga, or qi gong will be very helpful. Finally, making sure the digestion is good will facilitate recovery.
Heart and Kidney Yang Deficiency – Heart Failure
The end result of continued overwork and depletion of qi in the body, people with yang deficiency insomnia find they need to sleep sitting up. They have shortness of breath and can have spontaneous cold sweats. The Heart Fire can no longer warm the Kidney Water, leading to edema, fluid retention, and feelings of fear and dread. There can be frequent clear urination, or urinary retention. Feeling cold, palpitations, anxiety, extreme fatigue, and intolerance of exercise may all be present.
The extreme of Heart and Kidney yang deficiency corresponds to a Western diagnosis of heart failure. The circulation slows down and fluid accumulates in the extremities. Due to the inability to excrete excess fluids when a person lies down their lungs will fill up, causing pulmonary edema. Because blood is needed for all metabolic activity everything in the body slows down. There may be chest pain, palpitations, shortness of breath, fatigue, muscle pain, abdominal fluid accumulation, and other symptoms.
Treatment involves warming and strengthening the Heart and Kidney, along with draining out excess fluids that have built up. An integrative approach would engage the remaining vitality of the body, utilizing herbal formulas, homeopathic remedies, acupuncture and moxibustion, along with diet, lifestyle, and gentle exercise.
Heart and Liver Blood Deficiency – Low Glycogen Stores and Low Blood Sugar
When the Heart Blood is deficient the person will sleep for 3-5 hours and then wake up. After 1/2-1 hour of being awake they will be able to fall back asleep. Heart Blood deficiency is often the result of Heart qi agitation over a long period of time. There can be other symptoms of Blood deficiency, such as light-headedness, dizziness, memory issues, fatigue, dry skin and mucus membranes, and constipation. The Spleen and Kidney can also be deficient, as these are the two organs most involved in creating Blood.
Biomedically this pattern relates to low blood sugar caused by inadequate storage of liver glycogen. The liver stores glucose in the form of glycogen and releases it slowly in order to regulate blood sugar. If the liver isn’t storing glycogen well after a few hours of sleep the glycogen will be depleted. In order to get more sugar into the blood the adrenals will release adrenalin and cortisol, necessary to get the liver to produce glucose from other sources. This wakes you up, and keeps you up for a little while until the levels of adrenalin and cortisol drop enough to go back to sleep. Insulin resistance can play a role in the reduced ability to store glycogen; so can low thyroid hormone.
Treatment revolves around treating the appropriate deficiencies. To build the Blood nourishing foods and herbs can be used; making sure the Spleen is providing nourishing qi to the Heart is very important; and addressing any Kidney deficiencies is also necessary, as the Kidney helps create the Blood through its influence over the marrow. Eating a small amount before bed is also a good way to help regulate blood sugar.
In part 3 I’ll examine insomnia caused by patterns of stagnation.