Synopsis
- Insomnia can be caused by stagnation of various substances, such as qi, blood, food, or phlegm.
- Qi stagnation in the Heart leads to intense dreams and waking with a rush of adrenalin. This can correspond to trauma or PTSD.
- Blood stagnation, a more localized obstruction, causes waking after 3-5 hours of sleep where the person cannot fall back asleep. There can be coronary artery disease in this situation.
- If there is stagnation of food in the digestive system there can be waking only an hour after falling asleep. The parasympathetic nervous system can be under-activated.
- Insomnia that presents with other mental health issues is considered to be phlegm, or mucus, that is obscuring the Heart and effecting consciousness. The phlegm often comes from the digestive system, and there is a link between digestive function and mental health issues.
In part 1 we looked at sleep issues involving agitation of the Heart. In part 2 we examined patterns of insomnia relating to deficiencies. Insomnia can also be due to stagnation, whether of qi, blood, or fluids.
Heart Qi Stagnation – PTSD and Trauma
With Heart qi stagnation the qi is either locked out or locked in. In both situations the Heart suffers the lack of free movement. The person can experience vivid or disturbing dreams and often wakes up in a panic with a rush of adrenalin. Other symptoms may include a feeling of congestion or constriction in the chest, shallow breathing, anxiety, panic, and difficulty sleeping on the left side.
The physical situation is that of impeded circulation in the chest. This could manifest as reduced lymph flow, reduced blood flow, tightness and constriction in the diaphragm, and a general feeling of tightness in the chest. This tightness is mediated by the nervous system, thus the correlation with PTSD and trauma. The tightening of the chest is instinctual in a traumatic situation due to the need to protect the heart and other internal organs. If the energy generated in the nervous system to meet the perceived threat is not discharged appropriately it will continue to create tension. This shock affects the Heart, and thus the sleep.
Opening the chest and restoring proper circulation is the only way to resolve this situation. Though PTSD and trauma is usually thought of as a nervous system issue addressing the more physical side is often very effective. Because releasing the qi and associated pattern in the nervous system can cause emotions to come out it is important that treatment happen in a safe space.
Heart Blood Stagnation – Coronary Artery Disease
With this pattern the person sleeps for 3-5 hours, wakes up, and is unable to go back to sleep. When more serious there can be sharp or stabbing pain in the chest. There might be memory issues that present with losing words (“it’s on the tip of my tongue”). Blood stagnation often develops from excess heat in the Blood over time, as Blood contains heat that is unable to be discharged via sweat, urine, or stool. This heat can come from suppressed emotion, prolonged Heart qi agitation, rich diet, or exposure to toxic chemicals.
Blood stagnation from a Western perspective can be understood as a reduction of blood flow to particular tissues or organs, stagnant blood in veins (like varicose veins), and blood clots (thrombosis). There is a correlation between insomnia and the risk of cardiovascular disease and heart attacks, though the mechanism behind this isn’t clear. Sharp chest pain can be caused by reduced blood flow to the heart; when chest pain is heart-related it is called angina. Reduced blood flow to the brain is also related to poor sleep.
Treating Blood stagnation involves identifying the underlying causes and moving the Blood. Depending on where the heat or toxicity is coming from different treatment methods can be used. A particularly useful acupuncture protocol focuses on the luo – or connecting – channels. These channels are created by the body in order to store and hold pathology via the Blood, and can be seen under the skin. Cooling and moving the Blood with herbs, addressing the constitution with homeopathic remedies, and working on any emotional suppression are all elements of a successful treatment.
Food Stagnation – Poor Digestive Function
When food stagnates in the digestive tract sleep is interrupted as Blood is kept in general circulation by the Stomach. Often the person falls asleep and wakes only an hour later, though they may be able to fall asleep again and sleep through the night. Additional symptoms can include abdominal fullness, indigestion, reflux or heartburn, nausea, belching, bad breath, and other digestive disturbances. Overproduction of mucus, or phlegm, often results from stagnation in the digestion. This can create chronic sinus congestion, phlegm in the throat, and other signs of excessive mucus. Feeling excessively full when going to sleep can cause these issues.
Weakness of the digestive system is often due to a lowered parasympathetic response. This decreases stomach acid and digestive enzymes as well as slowing down peristalsis, the contractions of the stomach and intestines that moves food downwards. This leads to a feeling of fullness, and decreased stomach acid can cause heartburn since the sphincter between the esophagus and the stomach tightens in response to acid in the stomach. The slowed transit time and potential acid reflux can cause excessive mucus secretion to deal with the inflammation that results. Inflammation leads to increased cortisol and adrenalin; this could be a link between digestion and sleep. The physical discomfort can also cause insomnia. Because the parasympathetic nervous system is impaired, and peristalsis is slowed, the mucus that is produced can’t be cleared away fast enough. This leads to the sinus and throat congestion mentioned above.
Treatment is focused on strengthening the digestion, as well as eating the proper amounts at the proper time. For people who have Blood deficiency eating right before bed can be helpful, but for those prone to food stagnation or excessive phlegm it is better to eat a small meal earlier in the evening and go to bed with an empty stomach. As the activity of the parasympathetic nervous system can be decreased due to stress or anxiety learning how to relax before eating or sleeping is very important.
Phlegm Misting the Orifices – Mental Health Issues
For any of the patterns mentioned so far there can be the additional complicating factor of phlegm in the Heart. Symptoms pointing to this factor are increasingly severe insomnia, mental confusion, vivid or disturbing dreams, and other mental-health problems. The phlegm often comes from an inability by the Stomach to digest things properly (food, emotions, life experiences, etc), and this phlegm moves up to obscure the Heart.
There are links in the biomedical literature between digestive function and cognitive issues. Recent evidence has correlated the use of proton-pump inhibitors (commonly prescribed for reflux) to the development of dementia. There is also preliminary evidence that the neurotransmitter GABA is reduced in the brains of those with Alzheimer’s; GABA is a neurotransmitter related to Stomach function in Chinese Medicine. GABA receptors exist throughout the digestive tract and seem to play a role in intestinal motility, which may be one way to explain the link between digestive function and cognitive decline. Hopefully further research will make these mechanisms more clear.
Treatment for phlegm obscuring the Heart involves stimulating the digestive functions of the Stomach in such a way as to disperse this phlegm. Though the cognitive issues can make treatment more difficult the mental clarity that results is always worth it.
Conclusion
As you can see insomnia can have many different causes and must be treated according to what is going on for each individual person. Because sleep is so important any disturbance in sleep can create a lot of problems, in both the short-term as well as the long-term. If you are relatively healthy, but not sleeping well, find out why; then you will stay healthy. If you have some health issues, and also are not sleeping well, make sure to get yourself sleeping well; then you will become healthy much quicker and easier.
