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Category Archives: Insomnia
Insomnia is a term covering a number of disturbances to our normal sleeping pattern. Some people may for example, have difficulty going off to sleep in the first place, while others wake during the night and may be unable to sleep soundly thereafter. Whatever the pattern, chronically disturbed sleep means waking unrefreshed, and makes it hard to function properly during the day. It also undermines our vitality and full enjoyment of life. Due to the propensity to seek out sugary snacks to combat the fatigue, insomnia is even associated with weight gain in some individuals.
Actress Julie Walters describes how she tried acupuncture after thirty years of badly disrupted sleep: “On that very night, I slept through without waking, and the next morning, I cried and cried, grieving for what I had missed.” Singer and actress Toyah Willcox, has had acupuncture over the past thirty years, and has talked in the media about her very positive experience of acupuncture for insomnia. Actress Julianne Moore said,“I had a period after my mother died where I couldn’t sleep….I was just a wreck. I had some really intense acupuncture treatments, and it reset my nervous system.”
If you have been taking medication to help you sleep, then that is usually no barrier to receiving acupuncture. You may have been prescribed small amounts of drugs like zopiclone or zimovane. GPs are reluctant to supply anything more than limited quantities because they are not intended for long term use, and tolerance can develop in three to fourteen days. Under such circumstances, acupuncture may effectively fill the gap left by a lack of further treatment options.
When you come to see me about insomnia, my first step is to ascertain exactly how your sleep is disturbed. You might identify with some of the patterns I commonly encounter:
– Do you find it difficult to go off to sleep at the very start of the night. Is a busy mind part of the problem? Your thoughts may be around worrying or stressful issues, or they may hop incessantly from one inconsequential topic to the next.
– Conversely, is your mind peaceful, and yet it is still hard to drop off to sleep in the first place?
– Or are you someone who can go to sleep fairly easily, but who then wakes in the early hours? If you wake at broadly the same time most nights, then the time can be of significance to me.
– Do you sleep for most of the night, but restlessly, perhaps due to disturbing dreams, feeling hot etc? Is chronic pain affecting your sleep? If so, we should look at that too.
Your answers to these questions provide useful pointers, and coupled with information about your general health and wellbeing, I can arrive at a Chinese medical diagnosis of the causes of your insomnia. Treatment would in most cases be weekly, for a fixed period. If your insomnia stems from stress or worry, then we can try to address that too.
It is also helpful to look at lifestyle and see whether there are any useful steps you can take for yourself. These depend on the type of insomnia you have, but may include a calming ritual before bedtime, and being choosy about any television or other stimulation in the evening. The ten o’clock news might not be the best choice if you wish to promote the harmony of spirit which is conducive to sound sleep!
Restricting the light intensity to which you are exposed in the last hour before going to bed, may also help. This may mean not sitting in front of your computer too late (which is mental stimulation as well of course), and using dimmer lighting in your living and bedroom. The screens of laptops, tablets and smartphones are particularly unhelpful to be looking at, because they emit a lot of light at the blue end of the spectrum. This is the most disruptive part of the spectrum for our sleep, because it delays the release of melatonin, the hormone associated with the onset of sleep.
Caffeine is a substance whose levels fall really quite slowly in the body. You may be someone who should have less overall, and who shouldn’t have any caffeinated drinks from lunchtime onwards.
Avoid alcohol in the evening. Although it may help you to fall asleep initially, it is likely to give you a more restless night overall.
Reserve your bedroom for sleep and try not to use it for exercise or as an office. That way, you benefit from a subtle psychological cue on entering, that this is a room associated with sleep. Try also to keep the bedroom temperature slightly lower than that in the rest of the house. A little drop in the body’s core temperature is physiologically important for us to fall asleep.
If you cannot sleep for things on your mind, try getting up and writing them down on a list, so that they are out of your head.
Finally, ensure you take enough exercise: see my item on coastal walking and sleep by scrolling down through the Longevity & Health section.
Acupuncture helps sleep and can reduce pain levels in military veterans, according to American researchers. Forty-five veterans aged 18 to 65 experiencing insomnia and chronic pain, were randomised to receive either ear acupuncture or usual care. The study was undertaken at the largest American hospital outside the US, a military facility in Germany, with specialist insomnia and pain departments.
Both groups showed improvements in sleep, but that in the acupuncture group was significantly greater. Acupuncture was also associated with significantly greater reductions in pain levels, compared with usual care. The study authors state that ‘Acupuncture reduced pain and insomnia, compared to usual care. With the heightened focus on the opioid crisis in the United States today, this easy-to-administer protocol can be a treatment modality for military beneficiaries who have chronic pain and insomnia.’
(Auricular Acupuncture for Chronic Pain and Insomnia: A Randomized Clinical Trial. Medical Acupuncture, 15 October 2018.)
A large randomised controlled trial on acupuncture for insomnia has concluded it is effective and safe. Researchers in Hong Kong allocated 224 subjects to receive either acupuncture alone, acupuncture plus ear acupressure, or a waiting list control. There was no significant difference between acupuncture and the combination treatment. However, both were significantly better than the waiting list at reducing insomnia, with a moderate to large effect size, and at reducing anxiety, depression and fatigue. Improvements were maintained at 13 weeks after treatment.
(Acupuncture with or without combined auricular acupuncture for insomnia: a randomised, waitlist-controlled trial. Acupuncture in Medicine, 11 December 2017.)
Clinicians undertaking a study in Porto Alegre, Brazil have found that acupuncture is effective for improving sleep quality and psychological distress in elderly patients with sleep problems. A total of 48 community-dwelling elderly patients were randomised to receive ten sessions of either true acupuncture or sham acupuncture. True acupuncture was found to be highly effective for improving subjective scores of sleep quality, depression and stress. The researchers noted that immune and neuropeptide markers commonly associated with stress and sleep impairment, were unaltered following treatment.
(Acupuncture for sleep quality, BDNF levels and immunosenescence: A randomized controlled study. Neuroscience Letters, 5 February 2015.)
Researchers at Pennsylvania State University in the US have compared the effects of reading in the hours before bedtime, either an electronic light-emitting device (LE-eBook) such as an iPad or iPhone, or a printed book. They found that people reading an LE-eBook took longer to fall asleep and had reduced evening sleepiness, reduced melatonin secretion, later timing of their circadian clock, and reduced next-morning alertness compared to when reading a printed book.
In the randomized, crossover study, twelve healthy young adults were admitted to Brigham and Women’s Hospital in Boston for fourteen days, in order for the researchers to control for other factors. Two situations were examined: 1) reading an LE-eBook in an otherwise very dim room for around four hours before bedtime for five consecutive evenings; 2) reading a printed book in the same very dim room for around four hours before bedtime for five consecutive evenings. Blood samples were taken to allow melatonin levels to be measured, and sleep characteristics such as time taken to fall asleep and sleep stages, were all recorded.
Compared with the print-book readers, the LE-eBook readers: averaged nearly ten minutes longer to fall asleep; had significantly less rapid eye movement (REM) sleep; rated themselves as less sleepy an hour before bedtime; and, felt more sleepy the morning after reading an LE-eBook the prior evening. Furthermore, it took them longer to fully “wake up” and attain the same level of alertness.
The researchers say these results indicate that reading an LE-eBook in the hours before bedtime probably has unintended biological consequences that may adversely impact on performance, health, and safety. The mechanism would appear to be the disruptive effect of light at the blue end of the spectrum which is emitted by these screens. There are also implications for children looking at screens for evening homework and social media interaction.
(Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proceedings of the National Academy of Sciences of the United States of America, on-line 22 December 2014.)