According to Health Direct, 30% of Australians experience insomnia at some point in their lives, although only 5% require professional treatment. Insomnia can last for a short time, or months, even years. Women and elderly people are more likely to suffer from it.

In the clinic, we often see and hear about poor sleeping habits these days. The challenges of life and existence are not always easy to manage. Frequently, problems with sleeping arise in conjunction with another issue.

Professor Matthew Walker, a Neuroscientist with a special interest in the science of sleep, says: “Two-thirds of adults throughout all developed nations fail to obtain the recommended eight hours of nightly sleep”.  Eight hours of sleep is recommended for adults by both the World Health Organisation (WHO) and the National Sleep Foundation.

An article in Psychology Today debates whether sleep deprivation is considered torture or not, and further states: “The first signs of sleep deprivation are unpleasant feelings of fatigue, irritability, and difficulties concentrating.  Then come problems with reading and speaking, poor judgment, lower body temperature, and a considerable increase in appetite.  If the deprivation continues, the worsening effects include disorientation, visual misperceptions, apathy, severe lethargy, and social withdrawal.” Individuals will die if sleep continues to be deprived.

In Chinese medicine, the importance of sleep is often underrated, primarily due to the balance of Yin and Yang. Yin is the inactive, quiet part. The phase where we internalise and consciousness withdraws into the ‘centre of the blood’, the most Yin part of our body. Our sensory organs are shut to avoid stimulation, and the blood replenishes.

The foundation of sleep

Our biology is based on our entire health and well-being, including sleep. And yes, based on eight hours of sleep per night, we will spend 30% of our existence sleeping. But if we don’t, we may experience impaired health. Thousands of studies have established the importance of sleep for any organism on this planet that lives past several days. It’s essential to our existence (and survival), no matter how foolish it seems.

Nature helps us establish a good rhythm, known as the circadian cycle. It responds to the changes of light in our environment. It is essential to recognise that we all form our rhythm, and therefore, some people prefer to rise early, while others stay up late. The cycle also controls our preferred times for eating, the fluctuation of body temperature, moods and emotions, the amount of urine we produce, our metabolic rate, and the release of hormones.  Once we have discovered and established our cycle, it’s best to honour it.

The structure of sleep

NREM (Non-Rapid Eye Movement) sleep

It encompasses all stages of sleep, except for REM (Rapid Eye Movement). These stages of sleep vary in depth, ranging from stage 1 (the lightest) to stage 4 (the deepest). Stages 3 and 4 are considered deep sleep, and it is during this stage that most physical restoration occurs. At this stage, growth hormone is produced, and cellular repair begins in NREM.

REM (Rapid Eye Movement) sleep

It’s the deepest of all the stages of sleep. It usually takes up about 25 per cent of our sleep time. REM comes in short bursts at first and lasts for only a few minutes, but then it gradually stretches into longer time segments. REM is great for building memory, as during this phase, the brain moves information from short-term to long-term memory.

As the body seems to be in a paralysed stage and doesn’t move, the eyes move quickly from side to side. They remain closed whilst doing so. Dreaming is a heavy process that accompanies the REM phase of our sleep. As we age, our sleep architecture changes, and we spend less time in deep sleep, tending to wake more easily after the REM (Rapid Eye Movement) phase.

What’s detrimental to good sleep

According to Professor Matthew Walker, five key factors have powerfully changed the quality of our sleep:

Constant electric and LED lights

At dusk, when natural light fades, the part of our brain that is in charge of our internal clock (the suprachiasmatic nucleus) floods our system with melatonin that signals our body that darkness is near and it’s time to prepare for bed and sleep.

With constant lights around us (especially when living in the city), this natural process is inhibited, and the body’s preparation for sleep is delayed or impaired. The invention of LED (Light Emitting Diodes) made the situation worse, as the light receptors in our eyes that communicate with the brain are sensitive to the short-wavelength light that LEDs emit, and thus the release of melatonin is suppressed more strongly.

We might not look at LED-powered light sources all night, but we might stare at LED-powered screens: smartphones, tablets, laptops, TVs. Those devices emanate a blue light that has harmful effects on our bodies when preparing for sleep.

Regulated temperatures

Body temperature has to drop by about one degree Celsius to be conducive to sleep. Our body temperature is regulated by the hypothalamus. Those cells in that particular endocrine gland live close to the suprachiasmatic nucleus, the part of the brain that regulates the release of melatonin.

Core temperature can drop if we cool parts of the body’s surface, such as the hands, feet, and face. If you are feeling hot, give your extremities and face a cooling down with a cold compress, and your core temperature can drop by one degree, preparing your body for sleep.

Now living in air-conditioned homes, we have severed the natural relationship with our environment that signals the body the onset of night with cooler temperatures. This is one more reason why air conditioners seem appealing but are not supportive of our health, except in some circumstances.

Professor Matthew Walker recommends a bedroom temperature of 18.3 degrees Celsius, assuming that their standard bedding and clothing made from natural fibres is used as well. There are slight variations based on gender, age and unique physiology, but you will know what’s right for you.

Caffeine

Adenosine is the chemical that builds up in our brains when our body requires sleep. With every passing minute, the buildup grows, and the desire to sleep intensifies. There is one chemical that counteracts this process, and it’s called caffeine. Caffeine is the most used psychoactive stimulant in the world and the second highest commodity traded after oil.

Caffeine fights for the adenosine receptors. In this way, caffeine blocks the sleepiness signal, and that’s how we feel more awake and alert. In pharmacological terms, caffeine has a half-life (which means that it builds up in the body at a rate of half) of five to seven hours. For instance, if you have a cup of brewed coffee at 7.30 am, (which contains an average of 95mg of caffeine), six hours later, at 1.30 pm, there is still 44.5mg of caffeine in the system.

This amount halves again in the next five to seven hours, meaning that at 7:30 pm, an amount of 22.25 mg of caffeine is still in the system. Most people do not realise how long it takes the body to clear caffeine out of the system. This certainly explains why drinking coffee (or eating chocolate or ice cream that may contain caffeine) is not ideal if you struggle to sleep at night.

By the way, decaffeinated coffee still contains caffeine, about 15-30% of the amount found in regular coffee. 

Alcohol

In contrast to our expectation for alcohol to relax us, it sedates us, which doesn’t mean that our sleep improves. Alcohol is a powerful sedative and suppressor of the critical REM phase of sleep. Alcohol also fragments sleep, which you might not remember, because its effects have sedated you.

As a result, sleep is broken, and its restorative effects are lost. Over time, this will build up, and a lack of continuous sleep (during the night) will have a harmful impact. The body will go to the extent of erupting the REM phase into waking consciousness as hallucinations, delusions and disorientation. To illustrate the importance of the REM phase for our health and well-being.

Women are more susceptible to the effects of alcohol due to the delayed metabolism of alcohol in the system. Alcohol is retained in the body for longer because a larger content of fatty tissue inhibits its uptake.

Waking with alarm clocks

How do you feel about living in an industrialised world, where most of us start and finish work at the same time? Nine to Five? Being rattled out of our slumber and worse, repeatedly shocking the cardiovascular system with the snooze button, over and over again?

We are actively working against our unique circadian rhythm unless our rhythm reflects the nine-to-five cycle. A study showed that participants who are woken from sleep prematurely with an alarm clock experience a spike in blood pressure and an acceleration of their heart rate, triggered by the fight-or-flight response of the nervous system.

What’s great for better sleep

With all the information provided, it’s easy to work out which activities promote quality sleep and why:

• Use candlelight or turn off LED lights at night, particularly leading up to bedtime.
• Switch off screens such as smartphones, tablets and TVs and read a book to avoid the harmful effects of blue light on sleep.
• Turn off the air conditioner so your body can naturally adjust to environmental temperatures and pick up the cool breeze at dusk, signalling the end of the day and sleep ahead.
• Stop drinking alcohol if you want to catch a good night’s sleep, particularly if you are a woman.
• Don’t drink excessive amounts of coffee, particularly after midday, or make coffee an exception rather than a necessity.

When treating sleeplessness with Chinese medicine, we identify the pattern that causes insomnia. Secondly, we address the imbalance through acupuncture and Chinese herbal medicine, and discuss sleep hygiene.

Table 1 – Source: Classification of Insomnia Using the Traditional Chinese Medicine System: A Systematic Review

The following are the 10 most common Chinese medicine patterns for insomnia:

The pattern of insomnia is most likely connected to other signs and symptoms. The application of tongue and pulse diagnosis and well as looking at your circumstances, enables us to suggest a treatment strategy.

If you are considering acupuncture for improved sleep, here are some details about your local AHPRA-registered practitioner.

Book your appointment today or reach out with any questions that you might have.