by Erin Kumpf
Mmmm…there is nothing like waking up after a good night’s sleep, right? That refreshed, ready-to-conquer-the-world feeling that propels us into the day with gusto. Well, that is a dwindling luxury that most of us cannot afford due to normal life circumstances: a demanding job, a late-night feeding for your newborn, or a task list a mile long that proves there are just not enough hours in the day. For others, however, the hours of blissful slumber are available, but their body just can’t access them for whatever reason. Yes, the dreaded word…INSOMNIA. And, it is much more common than you think.
Take this statistic, for instance: 40 million people in the United States suffer from chronic sleep disorders, and another 30 million are troubled by transient or occasional sleep problems. [i]
That’s 40 million out of the 320 million people in the US, roughly 12%. 12% of the population is not sleeping adequately. That is pretty significant considering what sleep is, what physiologically occurs when we sleep and maybe more poignantly, what happens when we don’t sleep. Lets first dive a bit into sleep and look at some of the implications of sleep deprivation.
WHAT MAKES US SLEEP? From what we understand and according to the National Sleep Foundation, sleep is controlled by two internal influences: Sleep homeostasis and circadian rhythms. [ii] Homeostasis is defined as “any self-regulating process by which biological systems tend to maintain stability while adjusting to conditions that are optimal for survival.” It is essentially how our bodies maintain a steady state and regulates sleep intensity. One neurotransmitter influencing our homeostasis under study is adenosine which acts as a neuromodulator; it inhibits some of the neurotransmittors associated with our wakefulness such as norepinephrine, serotonin and acetylcholine and builds in our awakened state until a point when we can no longer stay awake. This buildup of adenosine occurs (as a by-product) as we use up our energy store of ATP during the day (ATP is the driving molecule for most of our cellular reactions.) During sleep adenosine decreases. (Side note: caffeine works by disrupting adenosine receptors.) Circadian rhythms on the other hand are cyclical changes (physical, mental and behavioral) driven by our biological clock that are in sync with the external environment, namely light.[iii] The circadian clock regulates the timing of sleep. Thus, it is through these two driving forces that our bodies naturally (or should naturally) fall into a pattern of wakefulness and slumber.
WHAT HAPPENS WHEN WE SLEEP? A misnomer is that we need “x” amount of hours of sleep a night to be healthy and of sound mind. However, sleep “architecture” shows its not just about number of hours, but the QUALITY of hours of sleep and the right mix of something called Rapid Eye Movement (REM) and Non Rapid Eye Movement (NREM). A regular sleep cycle is a mixture of NREM and REM sub-cycles lasting 90-110 minutes, repeating 4-6 times per night.
Non-REM or Non Rapid Eye Movement is a stage of sleep that is broken down into subsections, each of which is marked by certain physiological changes (which can be measured by something called an EEG or electroencephalogram.) Stage 1 and 2 include the initial transition between awake and falling asleep then light sleep where brain waves and muscle activity slow followed by the actual onset of sleep, where breathing and heart rate are regular, temperature drops. Stage 3 and 4 are considered the “slow wave sleep.” It is in these two stages where we are our deepest/most restorative sleep. Our blood pressure lowers, our breathing slows, muscles are relaxed and there is an increase in blood flow, there is an increase in certain hormones, including GROWTH HORMONE…which is vital for tissue growth and repair. It is also in this stage that children experience bedwetting, night terrors or sleepwalking.
REM or Rapid Eye Movement first occurs about 90 min after falling asleep and RECURS in a cyclical rhythm, about every 90, getting increasingly longer later in night. This is an active period of intense brain activity, where breathing becomes more rapid, irregular and shallow and the eyes move rapidly (this is also the stage where dreaming occurs.) This stage is characterized by mixed frequency brain waves, similar to those experienced when we are awake (theta, alpha and even beta waves, which are a more typical in active concentration and thinking.)
WHY IS SLEEP SO IMPORTANT? Research shows sleep is needed for survival; it facilitates bodily repairs (during sleep there is an increased production of proteins which are building blocks needed for cell growth and repair of damage.) Sleep affects our mood, and has memory and cognitive implications. One study highlighted that after one night of total sleep deprivation, subjects scored significantly lower on tests of judgment, simple reaction time, explicit recall, and inverse word reading. [iv] Our endocrine systems are also affected by sleep (hormones like the pituitary growth hormone is secreted during sleep, FSH and LH which are key to reproduction also increase, as well as the pineal hormone melatonin.) The immune system is also affected by sleep. One study “found a sleep-dependent rhythm of reporter T cell proliferation, with lower levels in sleep deprivation condition during the day after sleep deprivation. This finding would be consistent with the wildly held view that sleep deprivation increases susceptibility to infectious diseases.”[v] It is not difficult to see how inadequate sleep could result in serious health problems such as increased susceptibility to infectious diseases, high blood pressure, increased stress hormone production and diabetes/obesity (this last bit, due to the potential correlation between inadequate sleep and insufficient levels of the hormone leptin, which regulates carbohydrate metabolism. Low levels of leptin causes the body to crave carbohydrates.) In fact, studies such as the 1999 study at the University of Chicago found that inadequate sleep impacts sugar metabolism. In the study, healthy 11 years olds were restricted to only four hours of sleep for several nights, after which “their ability to process blood glucose declined, in some cases to a pre-diabetic state, prompting their bodies to produce more insulin.”[vi]
Other issues of sleep deprivation that may not, at first glance, appear to be a major issue are impaired cognitive ability and reduced concentration. However, is estimated that 100,000 crashes, 71,000 injuries, and 1500 deaths occur each year due to sleep deprivation. [vii] Sleep deprivation has also been a potential contributing factor to catastrophes such as the Exxon Valdez Oil Spill.[viii] The alarming thing is that despite the fact that 12% of Americans report having chronic sleep problems, more than 60 percent of adults have never been asked about the quality of their sleep by a physician, and fewer than 20 percent ever initiated a discussion about it.[ix] With such a pervasive problem, it is no wonder that it is estimated poor sleep costs US Businesses roughly $150 billion due to absenteeism and lost productivity.[x]
HOW IS INSOMNIA TREATED? Conventional treatment for insomnia include the following pharmaceuticals: antihistamines, which block the action of histamine in the brain, causing sedation, short-acting sedative-hypnotics such as Ambien, benzodiazepines (tranquilizers that slow down the central nervous system, causing drowsiness), and antidepressants….All of which have various side effects including dependence, drowsiness, and dangerous activities such as sleep-driving (defined as driving while not fully awake after ingestion of a sedative-hypnotic product, with no memory of the event.) Nevertheless, in 2002, it was estimated that in the United States, 27 million prescriptions were filled for hypnotics, worth about $1.2 billion [xi]
Other, non-medical treatment therapies include relaxation training (breathing exercises, meditation techniques), stimulus control (including limiting amount of activity in the bedroom), cognitive behavioral therapy (CBT) and, not surprisingly, ACUPUNCTURE.
WHY CAN’T SOME PEOPLE SLEEP? There are various causes implicated in insomnia which include but not limited to our worries, physical factors (pain, urination urges, noise like partner’s snoring), stress, environmental factors such as room temperature, light levels, bedding and extraneous noise.
In Traditional Chinese Medicine, sleeping maintains a balance of yin and yang. As everything Chinese Medicine, there is a balance, a waxing and waning of sleep is akin to the waxing and waning of seasons…both of which are an expression of the waxing and waning of yin and yang. We naturally go to bed a the predominantly yin portion of the day (yin is associated with qualities such as cold, rest, tranquility, darkness, passivity and receptivity) and wake up as yang starts to dominate (yang is associated with qualities such as warmth, activity, lightness, stimulation, arousal.) From the LING SHU “ When yang qi is at its limit and yin qi is abundant, one’s eyes are closed. When yin qi is a its limit and yang qi is abundant, one is awake.”
At night, the SHEN (or, our spirit as it is oft translated) which we say is rooted in our blood, “hides” or recedes deep into our body, into the organs at night. Insomnia is therefore a function of dis-regulation in the yin and yang of the body which causes a restless spirit and is typically a function of relative blood or yin deficiency. There is literally not enough anchoring substance to hold the spirit down and in. As such, our spirit or yang floats up to the surface of our consciousness and we are awake. Nourishing the blood and/or yin are examples of how we address certain manifestations of insomnia. However, treatment is dictated by what the individual presents with, which can vary. For instance, there are various forms of insomnia:
*difficultly falling asleep initially, but then staying asleep
*no difficulty falling asleep initially but inability to stay asleep
*both difficultly falling and staying asleep
*and falling asleep and staying asleep, but waking very early
These are all various forms of insomnia and form what we call “patterns” and these “patterns” are treated in different ways with different acupuncture points and herbal formulas. Acupuncture and herbal medicine work to regulate the yin and yang of the body so that the spirit/consciousness is able to retreat inward and feel nourished and “housed” and anchored by an appropriate balance of yin, yang, blood, qi, and fluids. When we are in balance, sleep is more readily available and at appropriate times.
Aside from the conventional treatments and non-conventional treatments aforementioned, here are some things you can do to help improve quality of sleep:
- Getting to bed by 11
- Avoid eating within 2-3 hours before bed (allowing digestion to complete before hitting the sac)
- Avoid drinking alcohol (which can disrupt blood sugar levels and be the cause of some sleep irregularities)
- Avoid eye stimulation right before bed: turn off the TV, put down the iPhone..in fact, keep it outside the bedroom, and shut off the iPad. Light is stimulation and our bodies react to light. Even the little light emitted from our phones.
- Establish a bedtime routine (using essential oils like lavender, yoga poses such as legs up the wall, drinking a cup of soothing tea such as chamomile, or taking a warm bath. By picking one or more and establishing a consistent routine can set the tone for peaceful, relaxation.)
- Using an eye mask or heavy curtains to block out light
- Keep room slightly cooler (its common knowledge that our bodies drop in temperature during the night. Sleeping in a room that is too warm can disrupt your body’s natural temperature regulation and cause restlessness)
- Avoid caffeine before bed
Erin Kumpf L.Ac, MSTOM is a nationally board certified and state licensed Acupuncturist and Herbalist. She graduated from the Pacific College of Oriental Medicine with a Masters of Science in Traditional Chinese Medicine. She incorporates various facets of this ancient medicine including acupuncture, herbs, tui na, gua sha and moxa. While working as a general practitioner, she also has clinical training as an acupuncturist at the Lutheran Medical Center, working in the Labor and Delivery Ward as well as experience working at the drug addiction treatment center at St. Joseph’s Hospital in Yonkers. She is also a Pediatric Acupuncturist, working with all ages from newborns to teenagers. She approaches and respects each patient as a unique individual with unique ailments and strives to help them to wellness with personalized strategies.
[i] National Institute of Neurological Disorders and Stroke (NINDS). Brain Basics: Understanding Sleep. Available at: http://www.ninds.nih.gov/disorders/brain_basics/ understanding_sleep.htm.Accessed April 28, 2016.
[ii] Sleep-Wake Cycle: Its Physiology And Impact On Health. 1st ed. 2006. Web. 29 Apr. 2016. Available at: https://sleepfoundation.org/sites/default/files/SleepWakeCycle.pdf
[iii]Circadian Rhythms Fact Sheet. National Institute of General Medical Sciences. Nov. 2012. Available at: https://www.nigms.nih.gov/Education/Pages/Factsheet_CircadianRhythms.aspx
[iv] Sleep-Wake Cycle: Its Physiology And Impact On Health. NSF. Backgrounder:Why Sleep Matters, op.cit.
[v] Bollinger, T., Bollinger, A., Skrum, L., Dimitrov, S., Lange, T., Solbach, W. Sleep-dependent activity of T cells and regulatory T cells. NCBI. 2009 Feb; 155(2): 231–238. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675254/
[vi] Spiegel K, Leproult R,Van Cauter E, Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1425-9.
[vii] Knipling R, Wang J. Revised estimates of the U.S. drowsy driver crash problem size based on general estimates system case reviews. “Drowsy Driving and Automobile Crashes: Report and Recommendations.: National Highway Traffic Safety Administration.
[viii] NationalTransportation Safety Board.Grounding of the U.S.Tankship EXXON VALDEZ on Bligh Reef, Prince William Sound near Valdez, AK March 24, 1989. Washington, DC. National Transportation Safety Board; 1990. NTIS Report Number PB90-916405.
[ix] National Sleep Foundation. Survey: Sleep in America. Washington, DC. National Sleep Foundation; 2000.
[x] Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. 4, Functional and Economic Impact of Sleep Loss and Sleep-Related Disorders. http://www.ncbi.nlm.nih.gov/books/NBK19958/
[xi] Colten, Altevogt, “Sleep Disorders and Sleep Deprivation..”