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Jennifer Moffit is a Licensed Acupuncturist
with a Masters of Science in Traditional Oriental Medicine.
She received a Bachelor's of Science in Environmental
Toxicology at UC Davis, teaches Oriental Medicine to medical
students at UCSD, and practices in San Diego at the West
Coast Center for Integrative Medicine.
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While everyone understands the importance of a good night's sleep,
many people in our culture are chronically sleep deprived, and
don't realize that they either 1) don't get enough sleep or 2)
don't benefit from the sleep they receive.
The Good
First before we cover anything else, let's define what constitutes
a good night's sleep. Generally speaking, most people need 7-10
hours of sleep (surprise, surprise). The sleep should be deep,
continuous and uninterrupted. Upon waking, you should feel rested
and refreshed. Generally, it is considered normal to get up at
night one time to urinate, but you should be able to fall back
to sleep easily and quickly.
The Bad
Frequent sleep patterns I observe in patients that are not healthy,
and that are problematic:
- You find it hard to fall asleep or stay asleep (It should
not take 2 hours!)
- You wake frequently during the night, or don't achieve a deep
sleep
- You wake early in the morning (>4 AM and can't go back
to sleep)
- You need to urinate more than once per night (I have patients
who thought it was normal to get up 2-4 per night).
- You don't feel rested in the morning
- You have frequent active dreams or nightmares
- You suffer leg cramps or pain that make it difficult to sleep
The Western Medical Perspective
Now from the perspective of western medicine, insomnia is defined
as the following:
- Difficulty falling asleep
- Waking up frequently during the night with difficulty returning
to sleep
- Waking up too early in the morning
- Unrefreshing sleep
Do you fit any of these categories? Surprisingly, the number
of hours you sleep is not a determining factor in diagnosing insomnia.
Rather, it is the quality and regularity of sleep that is most
important. In allopathic medicine, it is generally accepted that
people over 55 generally have shallower sleep that is more fragmented,
with frequent waking and decreased daytime alertness.
Many patients with chronic pain or illness are surprised to discover
that what they consider a "normal" sleep cycle may be
very poor indeed. In my clinic, almost without exception I find
that patients with pain, inflammatory conditions and chronic fatigue
have poor sleep patterns, and that their subjective experience
of pain is almost double that of someone who sleeps well. Like
it or not, in order to achieve the best health possible, some
time and attention must be given to improving your sleeping habits.
Sleep deprivation can make you fat…
In our discussions of qi and vital
energy, it makes sense that if you don't sleep, then you don't
get enough rest to recharge your batteries. But it is much more
complex than that - chronic sleep deprivation interferes with
the chemical messengers (called hormones) that the body uses to
communicate on a cellular level. Now most of us think of hormones
as those pesky critters that cause problems in personal relationships,
a lá Mars-Venus, or what changes during menopause, pregnancy,
etc. But there are literally dozens of hormones used by the body
to communicate between systems - we understand a mere fraction
of how they interact with each other. But to disrupt the endocrine
system means that even if you give the body the best nutrition
and supplements in the world, it may not recognize the fuel that
you give it or be able to use it appropriately. The body's failure
to recognize its own fuel it may explain some of the overeating
patterns seen in our society today.
Researchers at the University of Chicago found that they were
able to induce a pre-diabetic state in their healthy male subjects
(ages 18 - 27) merely by limiting their sleep to 4 hours per night
for one week. They found that the metabolic and endocrine changes
from significant sleep debt mimic the aging process, and suggest
that chronic sleep loss may not only hasten the onset but also
the severity of age-related ailments such as diabetes, hypertension,
obesity and memory loss. (1,2,3) These metabolic changes were
particularly strong when tested in the morning, with glucose tolerance
tests that were consistent with the diagnostic criteria for impaired
glucose tolerance, an indication of early-stage diabetes. Furthermore,
patients with chronic sleep deprivation had higher circulating
levels of interleukin-6 (IL-6) with implications for inflammatory
disease such as rheumatoid arthritis. (4)
The good news, however, is that all study patients returned to
baseline levels after spending more than 12 hours in bed, with
added benefits noted when they consistently spent more than 8
hours in bed per night. The studies suggest that our health may
be improved by getting more than 8 hours of sleep on a regular
basis.
Turn off the computer…
When working with a new patient, before I consider herbs or other
measures, I find it helpful to consider behavior when it comes
to bedtime and sleep. How do you typically spend the evening hours?
Believe it or not, our activities in the evening have a profound
impact on our ability to have restorative sleep, and minor activity
changes can yield dramatic results with little other intervention.
It is important to establish an evening sleep ritual. Parents
of young children already know this - my friends with young children
jealously guard regularity and bedtime like mother tigers. This
does not change as we age - the body likes and needs regularity,
and you can actually help re-train the body to sleep by following
the same patterns every night before bed.
Make a rule with yourself to turn off the computer or stop studying/book
work by 9 PM or so. Many times, folks who work on the computer
or in the office until it's time for bed are surprised when they
cannot fall asleep. From the perspective of Traditional Chinese
Medicine, analytical work causes the qi to rise to the head, which
can lead to the mental-hamster-wheel that so many of us experience
in the evening. If this seems unrealistic, remember that the time
sacrificed working in the evening is often made up for by greater
productivity and better health during the day. Whatever benefits
you may have derived from working or studying late are soon wasted
after a night tossing and turning.
Other supportive practices include:
- Take a hot bath or shower, and give yourself a nightly massage
on the feet with pure therapeutic grade lavender oil to help
to calm the mind and move the qi out of the head. (I stress
pure lavender oil here because perfumed soaps and lotions do
not have the same medicinal properties that pure plant extracts
do. Therapeutic grade oils can usually be found at Henry's,
Whole Foods, or your local health food store. Young Living Essential
Oils makes a very pure Lavender oil which you can purchase online.
Young children and folks with sensitive skin should dilute pure
lavender oil with olive oil before rubbing onto their feet.)
- Avoid any caffeine, soda, green tea or chocolate after 5 pm.
- Go to bed on an empty stomach!! This one is HUGE: the body's
digestive processes slow down at night, and a heavy meal such
as roast beef, gravy, french fries and cheesecake can keep your
stomach busy digesting for over 8 hours. You won't sleep as
soundly during this process, and some of my patients don't sleep
at all. A low-fat meal such as fish and veggies can be digested
in a few hours, and you can facilitate this by the use of a
digestive enzyme. For folks with heartburn, hiatal hernia, or
Gastroesophageal Reflux Disease (GERD), this is even more important.
If scheduling is a problem, then you might choose to make lunch
your biggest meal, and eat more simply in the evenings to avoid
the "boa-constrictor-like" lump that will sit in your
tummy and interfere with sleeping.
- For my patients with nocturia (frequent urination at night)
it is often helpful to avoid beverages after 7 PM until we strengthen
the bladder and kidneys.
- Gentle, slow moving hatha yoga or qi gong can help relax the
body and calm restless mental chatter. Be careful to maintain
slow ground postures which do not induce sweat or strain. The
focus should be to clear the mind and relax the body rather
than a work out or strengthening.
- Go to be a little earlier to take advantage of the Yin energy
available before midnight.
Remember that we described yin as cooling, night, inert, and
in TCM theory, sleep is described as falling into "the envelope
of yin," which is at its peak before midnight. The most beneficial
sleep is, in fact, that which is achieved before midnight, with
every hour before worth 2 of the hours afterwards. Whether that
is literally the case remains to be seen, but it is generally
harder for the body to slip into that "cool mantle of yin"
after 12 AM.
If you take all these steps and still do not have restful sleep,
accept the fact that you may need to get some outside help to
restore the body's sleep cycle. For patients with chronic disease
and pain, this is even more important.
Acupuncture and oriental medicine can be extremely helpful for
treating many types of insomnia, and you may want to start there.
Remember that chronic insomnia disrupts many areas of the body's
chemistry, so it will take time and patience to see results, sometimes
several months. Don't stop treatment before the miracle happens…
most of my regular senior patients now sleep better than I do.
This allows me to segue neatly into our next section called…Bodywork.
References
1. Plat, L., Leproult, R., L'Hermite-Baleriaux, M., Fery, F.,
Mockel, J., Polonsky, K.S., & Van Cauter, E. (1999). Metabolic
effects of short-term elevations of plasma cortisol are more pronounced
in the evening than in the morning. Journal of Clinical Endocrinology
and Metabolism, 84, 3082-3092, http://endocrinology.uchicago.edu/facultypages/fac_cauter.html
2. Spiegel, K., Leproult, R., & Van Cauter, E. (1999). Impact
of sleep debt on metabolic and endocrine function. Lancet, 354,
1435-1439
3. Van Cauter, E., Leproult, R., & Plat, L. (2000). Age-related
changes in slow wave sleep and REM sleep and relationship with
growth hormone and cortisol levels in healthy men. Journal of
the American Medical Association, 284, 861-868.
4. Redwine, Laur, Richard L. Hauger, J. Christian Gillin and Michael
Irwin. Effects of Sleep and Sleep Deprivation on Interleukin-6,
Growth Hormone, Cortisol, and Melatonin Levels in Humans The Journal
of Clinical Endocrinology & Metabolism Vol. 85, No. 10 3597-3603
(http://jcem.endojournals.org/cgi/content/full/85/10/3597)
5. Pathophysiology of the Endocrine System (http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/)
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