Treating Insomnia with Chinese Medicine

I often begin blog entries by defining a disease or condition. With
insomnia, however this is almost not necessary as almost every one has
experienced sleeplessness at one time or another. What make insomnia an issue that people will seek an acupuncturist for is chronicity. The fact that it happens frequently, or even every night.

For some clients, insomnia is their sole concern and what drives them to seek us out. Others experience problems sleeping due to other problems, such as menopausal hot flashes (article to come), pain, digestive issues or anxiety (article to be written). In essence, then insomnia is perceived to arise as a result of some sort of physical discomfort, mental stress or anxiety or - far too frequently -without any sort of trigger - the person simply can’t sleep or finds themselves awakening with no clear trigger.

Chinese medicine is extremely effective in managing insomnia from most causes and can restore normal sleep in the vast majority of cases.

Chinese Medical Approach to Insomnia

As with most health issues, an acupuncturist will approach insomnia by evaluating the whole individual. Questions, which may not appear to have immediate bearings on sleep, will help us to determine which pattern of insomnia the individual is living with. By pattern, Chinese medicine is describing a complex of energetic and functional relationships between body systems which, when taken together, create the symptom or disease the individual possesses. Looking up insomnia in a textbook of Chinese medicine one would see described many patterns, each with a different method for treatment. Proper pattern differentiation will lead to effective results. A well trained and experienced acupuncturist will be able to deduce the appropriate protocol based on how the patient presents to us.

If a pattern is treated successfully the patient will gradually find themselves sleeping longer, deeper and more restfully. An added advantage of such a strategy is that once the problem has been successfully resolved and the course of treatment completed, it is rare for an individual to need further treatment for that particular issue.

Research on Insomnia:

• The Chinese Medical Journal studied one particular technique which might be used by an acupuncturist, electro-acupuncture, and its effect upon sleep quality. The study found that this technique was very effective in the majority of patients and also cited an increase in daytime functioning among this cohort. While most acupuncturists would not use this technique as a first resort - simply because other methods are so useful - it would be considered with unusual or recalcitrant cases.

• The Journal of Alternative and Complementary Medicine published a meta-analysis of 43 studies of acupuncture in the treatment of insomnia. A meta-analysis is a statistical means of analyzing multiple research reports and looking a what the cumulative thrust of them is. This meta analysis showed a dramatic trend toward alleviating insomnia in the large majority of studies.
• A Chinese medical journal, Zhongguo Zhen Jiu citing a university teaching hospital's research, looked at the effect of treating one particular pattern of insomnia. It looked at both outcomes (sleeping through the night) as well as changes in blood flow to the brain. The study found that not only did people suffering from this particular type of insomnia improve with acupuncture, but that there was a corresponding increase in blood flow to the parts of the brain which regulate sleep.

• The medical journal, Sleep Medicine Review performed an meta-analysis of 30 studies on acupuncture and insomnia and cautiously concluded that while there was a substantial positive response to acupuncture treatment of sleep disorders (93% of the participants in these studies manifested positive results) more study would be beneficial.

• The psychiatric monthly, The Journal of Neuropsychiatry and Clinical Neurosciences performed a study on anxiety and insomnia. It concluded that not only was sleeplessness dramatically improved by acupuncture treatment, but that several neurochemical markers which are correlated to a good nights sleep were positively altered by this therapy.

• A study of 55 patients with ADHD and insomnia by Wanzhu Hou, Guangpi Xu, James C. Butler and Hanjie Wang, demonstrated 'exceptional' results with these patients.

• A  page with a survey of current Chinese medical research on insomnia can be found here. Though couched in the jargon of Chinese medicine, it can give one a sense of what type of research is being done in Asia in an attempt to merge Chinese medicine with modern research techniques.

• A Japanese study on acupuncture on an animal model, readable here, concluded that,

acupuncture benefits sleep. A controlled trial conducted on pigs measured sleep outcomes when the subjects received acupuncture at acupoints GV20 and Dafengmen (an acupoint anatomically similar to human GV20, Baihui). Results were measured using an actigraph (Octagonal Basic Motionlogger) and by measuring catecholamine counts in the urine after the application of acupuncture. Pigs receiving acupuncture at Dafengmen for 20 minutes at a depth of 10-20mm showed significant values on the actigraph and urine analysis showed significant changes in the catecholamine count. 

Pregnancy and Acupuncture

While a large part of my practice involves the treatment of infertiliy, once the client has conceived she may opt to continue therapy. There are many reasons that clients who have used Chinese medicine to conceive will continue to work with us through the beginning of their pregnancy, to seek treatment toward the end of term, or use us to help them throughout the entire gestation. In the beginning of the pregnancy, usually through the first trimester, acupuncture can be very useful to minimize the chances of miscarriage due to uterine insufficiency. For women who have had previous miscarriages or who worry that they may carry a risk of such an occurrence may opt for this careful approach by using Chinese medicine. Additionally, acupuncture may be used to minimize or eliminate uncomfortable effects of pregnancy such as morning sickness, digestive problems, lowered energy and musculoskeletal pain - for which it can be extraordinarily effective.

Some women, by virtue of their age, risk factors or general health may opt to work with an acupuncturist throughout the entire pregnancy to ensure that her body remains as strong as possible and to minimize risk to the baby. The added bonus of this type of ongoing work is that labor and delivery is often quite a bit easier as a result.

Finally, many women will use an acupuncturist's services in the last month of pregnancy in order to help with a breach presentation of the baby, induce labor if the child is past term and the mother wants to avoid using chemical means of inducement or Caesarian section; or simply to ease the delivery.

All of these strategies can be very useful for a pregnant woman. Below I've included a few western medical studies demonstrate that the scientific community is beginning to recognize these benefits:

Research:

From the journal, Pain and Symptom Management, and summarized in Acupuncture Today, comes a study which demonstrates dramatic reduction in morning sickness in women receiving acupuncture versus placebo. 

The Journal of Complementary Medicine, 2009 published a study in which it was showed that women who used acupuncture during their pregnancy and labor had much lower rates of Caesarian section and a subjectively higher rate of comfort during the actual labor process.

From the US Pharmacists journal comes a compendium of many other studies demonstrating the utillity of acupuncture for morning sickness.

From the  Scandinavian journal, Acta Obstetricia et Gynecologica Scandinavica comes a study evaluating the treatment of pelvic and low back pain with acupuncture, during preganancy. Not only did the study conclude that acupuncture was very effective at treating this type of pregnancy related pain, but it also found that it obtained a superior result to using physical therapy as the sole treatment for this type of discomfort.

Using acupuncture to treat pregancy and/or post-partum related depression often yields powerful results. And we see this quite often in our clinic. In The Journal of Affective Disorders, there is a study which demonstrates this positive effect.

In the Journal Obstetric and Gynecologic Investigation, a rat model is used to investigate the potential chemical basis for acupuncture's effect in preventing one type of miscarriage.

From an Austrian Obstetrics journal, Wien Klin Wochenschr, comes a study on the effectiveness of using acupuncture to induce labor and ripen the cervix.

A small study in the journal, Acupuncture Medicine, demonstrates the effectiveness of using acupuncture to treat the insomnia which can be connected to pregnancy in many women.

From Science comes this French study on the successful management of  pelvic pain in pregnant women.