Acupuncture and Sleep

Acupuncture and Sleep
Email Newsletter:
Volume 6 Number 2

Dear Friends and Colleagues,

For New Yorkers, Labor Day marks the end of summer and the beginning of our back to school or work routines. We become very busy people: Fall here is a whirlwind season of starting projects (or picking up ones that languished during the dog days), reconnecting with friends, meeting social commitments, and starting back at the gym or other therapeutic practices. For parents it is a time of major transition as kids go off to school and need help with homework, as well as transportation to a myriad of after-school activities and play-dates. New York's fall cultural season offers enticing riches in the fields of music, dance, theater, etc., that can keep us out and busy almost nightly and all weekend. Some of us are also resuming our service commitments in community groups or religious affiliations. And for one and all there is food shopping, meal preparation, laundry, bill paying and house cleaning.

So how do we pack all this activity into our daily lives? For too many of us the price we pay for this level of stressful living is the loss of sleep. For better or for worse, New York is a 24-hour city and anything can be done at any time. Some of us just don't get to bed early enough and have to get up early the next day regardless. Others are so taxed physically, emotionally and spiritually that we have trouble falling asleep or staying asleep or both.

This newsletter will explore sleep issues from both the Western and TCM perspectives and discuss treatments modalities.

Topics: Sleep Deprivation
1. Scope of the Problem
2. Focus on Insomnia
3. Western Treatment
4. Chinese Medical Approach
5. Synthesis
6. Turning Point News

1. Scope of the Problem
In a study released in late 2004, the National Sleep Foundation, a nonprofit organization that lobbies Congress and state governments on public health and safety issues surrounding sleep disorders and sleep deprivation, concluded that 3 out of 4 adults have sleep problems. Most experts agree that adults need 7-9 hours of sleep nightly, but the study showed that the national average was only 6.9. Less sleep is correlated with poorer overall health, decreased work productivity, increased danger on our roadways and a less vibrant sex life. Furthermore the same study made the point that the quality of sleep is as important as the quantity. Only half the people polled thought they slept well at night.

Do you have a sleep problem?
Take this online survey to see: this link.

Most sleep problems are of psychosocial origin, but there are many exceptions: Sleep apnea, characterized by sleep with pauses for breath, can originate in the central nervous system (CNS). More often it is due to soft-tissue obstruction of the airway and is commonly seen in people with obesity. (There is also a mixed variety of sleep apnea with both CNS and airway obstruction.)

Some sleeping problems are associated with other medical conditions, such as, cardiac conditions, allergies and asthma, fibromyalgia and CFS, epilepsy and, of course, the sleep interruption that often accompanies hot flashes in menopause. Changes in sleep patterns are seen in advanced age, psychiatric patients and as a side effect of some medications. People with acute and chronic pain also have problems being able to sleep comfortably.

Finally there is the issue of sleep disturbance that results from jet travel or from nocturnal shift work.

This newsletter will not explore these areas but will focus instead on the sleep patterns that are labeled insomnia in Western medicine.

2. Focus on Insomnia
The patterns of sleep disturbance in insomnia are: trouble falling asleep, trouble staying asleep and awakening without feeling refreshed, and early morning wakefulness. Insomnia is a symptom, not a disease. In Western medicine it tends to be treated as an independent entity, whereas in Chinese medicine insomnia is seen as an expression of an underlying disharmony.

3. Western Treatment
Regardless of the type of insomnia, Western medical treatment tends to be the same in all cases. While there are many simple approaches to sleep problems, today's busy physicians often respond to patient complaints of insomnia with pharmaceuticals.

Sleep medications are generally sedative-hypnotics; most, but not all, are barbiturates and benzodiazepines. Together they account for a huge percentage of all prescribed medication. In 1999 about 100 million prescriptions were written for benzodiazepines, a family that includes Valium®, Xanax®, Ativan®, Halcion®, Dalmane® , Restoril®, Tranxene®, Klonopin® and Librium®.

All sedative-hypnotics are central nervous system depressants. They work by increasing the activity of GABA (Gamma Amino Butyric Acid), the principal neurotransmitter in the brain for CNS depression. Neurotransmitters are chemicals that enable the brain cells to communicate with each other.

Sedative-hypnotic medications mask the symptoms of insomnia but are not curative. When the medication is discontinued, the symptoms of the sleep problem resume. Worse still, since all sedative-hypnotics can be habit forming, they are dangerous to use over a prolonged period of time. Patients can even develop addictions to sleep medication. In these instances ever-greater amounts of medication are needed to get a therapeutic effect (i.e., tolerance has developed), and patients will suffer a withdrawal syndrome similar to that found in alcoholism if they abruptly discontinue the drug. Rebound effects from the discontinuation of sedative-hypnotics ironically include insomnia and irritability.

It is unfortunate that today's busy physicians so frequently respond to patient complaints of insomnia with pharmaceuticals. Some of this alacrity to prescribe is in response to patient demand for a quick fix, and some is fueled by an aggressive campaign on the part of the drug companies to market their products. The current Lunesta^TM ad campaign is a case in point. Lunesta^TM is a non-narcotic, non-benzodiazepine sedative-hypnotic that, like all of that class of drugs, works by increasing GABA. Even their literature notes that while the drug is short-acting, it is nevertheless a "Schedule IV controlled substance" and that "sedative hypnotics have produced withdrawal signs and symptoms following abrupt discontinuation."

There is clearly a place for the use of sedatives for acute sleep disorders. Some patients, for example, suffering from the loss of a loved one, may benefit from short-term treatment of this kind, but it is not an ideal solution for a person with chronic sleep deprivation issues.

A note about over-the-counter sleep aids: While they are non-addicting, these preparations are primarily antihistamines that cause drowsiness (such as, Nytol, Sleep-Eez and Sominex) or a consist of a combination of an antihistamine and a pain reliever (Anacin P.M., Excedrin P.M., and Tylenol P.M). Side effects can include dizziness, blurred vision, and dry mouth. There are some restrictions on taking these preparations for people with angina, heart arrhythmias, glaucoma, prostate and urinary problems.

4. Chinese Medical Approach
In contrast to the Western medical approach in which all types of insomnia receive the same treatment, Traditional Chinese Medical (TCM) requires that the underlying pattern of disharmony be defined in each case of insomnia and treated accordingly. Most classical texts describe 4-6 underlying patterns that result in sleep problems. Each is defined by a landscape of symptoms. The TCM practitioner explores the patient's complete medical history so that these associated symptoms of the patterns can be discerned, and then uses pulse and tongue diagnosis to confirm the clinical impression.

The vast majority of sleep problems seen at Turning Point Acupuncture are emotionally based. In TCM each of the internal organ systems is correlated with an emotion: The lung organ system is associated with grief and sadness, the liver with anger and frustration, the kidney with fear, the spleen with worry and the heart with joy. An excess of any of these emotions can adversely effect the organ system and conversely, if the organ system is affected, the associated emotional state may be elicited. Since all the organ systems are connected internally by a series of pathways (called meridians), any disturbance in one system will, over time, effect the others.

Note: In TCM the organ system is not the same as the anatomical organ we think of in Western medicine. Therefore the liver in TCM refers to a series of functions that includes the internal organ, but does not refer to that organ directly.

The non-physical realm is critical to the understanding of TCM. Remember that Chinese medicine developed out of the spiritual belief system Taoism. As such the role of the spirit or "Shen" is central: Optimal health demands that the Shen be strong and steady. In fact, the definition of insomnia in TCM could be that the Shen is disturbed - due to either insufficient tranquility (deficient yin energy) or excess stimulation (yang energy). Manifestations of Shen disturbance include palpitations, dizziness and most commonly insomnia.

In TCM insomnia most often originates as a disharmony of the liver or heart, the two organ systems directly related to different aspects of the Shen. If these organ systems are not in harmony the spirit will wander.

Here are some examples of organ system disturbances resulting in insomnia:

Violent emotions, especially anger, depress the liver organ system. Depressed liver Qi may be transformed into fire, which interferes with the normal functions of the heart - the organ where the Shen is housed. The problem here is trouble falling asleep.

Excessive anxiety suppressing joy, may directly impair the heart and cause the Shen to be restless, resulting in interrupted sleep.

Kidney problems are also associated with insomnia. In fact, poor communication between the heart and kidney organ systems is a frequent cause of insomnia, particularly in the aging. As we age the kidney yin naturally becomes deficient but to varying degrees in each individual, depending on genetics and life experience. Other causes of kidney yin deficiency include living through traumatic, fearful experiences or depletion through drug abuse, multiple childbirths, etc. When the kidney yin is deficient, the heart is not supported and the Shen can not rest. The result is interrupted sleep.

Excessive worry, compounded by eating bad food can hurt the spleen organ system. In this case the insomnia occurs due to inadequate supply of nutrients and blood to the heart. Imagine the college student, surviving on junk food, cramming for an exam. Heart - spleen deficiency manifests as trouble staying asleep.

And why do some people awaken at the same time every night? In TCM the body's life force energy (Qi) flows through the different meridians at a specific time of day and spends 2 hours in each one. Thus if a person complains that he/she awakens at the same hour each night, insight is gained into the nature of the disharmony. For example, the liver time is from 1:00 - 3:00 am (peak at 3 am) and the lung time is from 3:00 - 5:00 am.

Acupuncture and Chinese herbs are excellent treatment options to correct these underlying disharmonies. Your Turning Point practitioner can determine which disharmony is present and treat accordingly. Additionally at Turning Point we have nutritional supplements and homeopathic remedies that also address underlying causes of sleep disturbance.

5. Synthesis
More attention is being paid these days to measures that individuals suffering from a sleep problem can take on their own behalf. These recommendations, referred to as sleep hygiene, acknowledge our inherent circadian rhythm (our 24 day-night clock) and attempt to stabilize our daily habits to be consistent with that rhythm. Here are some of the recommendations that bridge Western and Eastern medical approaches:

Personal habits:
Go to bed and wake up at the same time each day: Set a regular sleep rhythm and maintain it, even on weekends. About napping: If you must nap, try to limit it to 20-30 minutes before 3 pm.
Avoid alcohol 4-6 hours before bedtime. (Alcohol is initially sedating but causes CNS excitation later.)
Avoid caffeine 4-6 hours before bedtime.
Limit nicotine exposure.
Avoid highly spiced, heavy or sugary foods.
Limit liquids after 8pm to avoid getting up to urinate.
Exercise regularly, but not near bedtime. (Eastern exercise practices like yoga, Tai QI and QI Gong are especially beneficial to establishing balanced energy flow in the body.)

Preparing for sleep:
You can't suddenly stop watching TV, or working on the computer, or talking on the phone and just go to sleep. It is important to develop a sleep ritual, i.e., to make a transition from regular activity to the world of dreams. Slow down, unwind, let go.

Spend 15-20 minutes in a relaxing activity (e.g., listen to music, relaxation tape or CD. Meditate.)
Eat a light snack before bedtime.
Drink a calming herbal tea such as chamomile or peppermint, unless urinating at night is an issue.
Do not take your worries to bed - write them down and set aside a designated time to deal with them.
Take a bath 60-90 minutes prior to sleep. As the body cools down you get sleepy.

Get in your comfortable sleeping position -if you do not fall asleep in 15-30 minutes, get up and in a dimly lit room read something boring. Do not watch TV or use the computer (too stimulation to the yang energy).

The sleep environment:
Use comfortable bedding
Sleep in a well-ventilated room that is neither too hot nor too cold. (A cooler room is better.)
Block out all distracting noise.
Eliminate as much light as possible.
Use your bed only for sleep and sex.

Pets sleeping in the bed with you may interfere with a full night's sleep. Consider keeping them on the floor.

6. Turning Point Acupuncture News The office is open six days a week, Monday - Saturday.
Our Saturday hours are changing. We will now be seeing patients from 10 am - 2 pm with rotating staff coverage so you get a chance to see your favorite practitioner in the relaxed atmosphere that the Saturday hours engender. Dorene Hyman, Amanda Silver, Deborah Turek and I will be staffing these sessions. Reiki continues to be available Saturday mornings with Reiki Master Lourdes Guzman.

To review our customary hours and staffing click here:
http://www.nycacupuncture.com/patientinfo.html

Some reminders:

- Please remember to allow a full hour for your regular visits. This will allow you to get the total benefit of your Turning Point treatment.

- Shane Hoffman is pursuing a doctoral degree at the Oregon College of Oriental Medicine. He will be away one long weekend each month and on the dates that Shane is away, his Thursday afternoon hours will be covered by me, and his Tuesday hours by Amanda Silver. The next such dates are:

Thursday, September 08 (2:30 - 6:30 pm) covered by Naomi Rabinowitz Tuesday, September 13 (10:00 am - 7:30 pm) covered by Amanda Silver. Thursday, October 06 (2:30 - 6:30 pm) covered by Naomi Rabinowitz Tuesday, October 11 (10:00 am - 7:30 pm) covered by Amanda Silver.

Have you moved or plan to change your email address?
Please let us know your new home or email address or other contact information.

Yours in peace,
Naomi Rabinowitz, MD
September 08, 2005
Turning Point Acupuncture
New York City, NY 10023
212 489-5038

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