Insomnia is an extremely oppressive condition to live with, attacking both our physical and mental well-being. Unfortunately, many people continue to suffer unnecessarily. Their concerns may be dismissed by people who have not personally suffered from insomnia, and who usually fail to fully appreciate just how life-affecting it can be. Some may dismiss the seriousness of insomnia by suggesting that the person cannot sleep because they are not really tired, or do not need to sleep as much. Others simplistically suggest that reading a book before bedtime will enable better sleep. Of course, such advice provides no help.
Insomniacs who seek treatment may be prescribed sedatives, but such drugs can be highly addictive. In addition, patients commonly experience side effects such as dizziness, lassitude and drowsiness throughout their day. Not surprisingly, many people with insomnia choose not to take sedatives regularly or, if possible, avoid them altogether.
Eastern medicine, in contrast, has been used very successfully to treat insomnia, and without any unwanted side effects. The approach is to improve the self-healing ability of the patient. The treatment is as effective as Eastern medicine treatments for other mental health issues, such as anxiety and depression, although the treatment period is typically longer.
More and more patients are visiting our clinic seeking relief from insomnia. Given this trend of growing interest and need, we will be writing over the next few weeks about different aspects of this condition. Today, we will start by sharing the Eeastern medicine approach to diagnosing insomnia, and then describe the three main types of this condition.
When diagnosing insomnia, it is important to first determine whether any physical issues are contributing to sleep issues. If a patient cannot sleep due to physiological pain, then the pain should be addressed as a first step. This is, perhaps, an obvious approach when the patient is experiencing physical pain. But it gets more complicated when the physiological pain is more like dysfunction than clearly experienced pain. Take, for example, the more complicated case of indigestion-related insomnia. Many patients who complain of insomnia have weak digestive systems due, for instance, to over-eating or starvation habits. The point is that we must first identify and treat any physiological causes of insomnia, and only afterwards focus on persisting insomnia.
Once we eliminate physiological pain as a contributing factor, and determine that the issue is solely a sleeping issue, we then categorize the type of insomnia the patient is experiencing from among three broad categories.
- Difficulty falling asleep. No matter how tired the person is, they lay in bed for hours before finally falling asleep. Often, they cannot stop overthinking things.
- Waking up throughout the night. The person can fall asleep, but frequently wakes up throughout the night. The person will wake up every couple of hours aware of a lot of dreams, and does not feel rested in the morning.
- Inability to fall back to sleep once awakened. The person will wake up around 3 to 4 am, and simply space out until they have to get up for work. Many patients with this type of issue dream of staying asleep until daybreak.
The second and third types are both easier to treat and, for the patient, easier to bear. The patient at least has some sense of having been asleep, if not soundly or uninterruptedly.
The first type is by far the most challenging to bear and to treat. We will focus on this type of insomnia for the rest of this post.
Difficulty falling asleep can be caused by either our sympathetic nervous system (SNS) or our parasympathetic nervous system (PNS). Together, these nervous systems form our body’s autonomic (involuntary or unconscious) nervous system, which registers our reactions to stress. When we endure great stress, our SNS goes into overdrive and awakens our mind. The role of the PNS is to counter this hyperactivity, but when it fails to do so, the heightened state of awareness makes it difficult to fall asleep. So, difficulty falling asleep can be caused by either a hyperactive SNS, or a sub-performing PNS. A hyperactive SNS can be caused when we are very angry, resulting in SNS initiated insomnia. Worry and overthinking affects our PNS, resulting in PNS initiated insomnia. Eastern medicine seeks to restore balance, so that both the patient’s para- and sympathetic nervous systems are operating in a healthy way, allowing patients to fall asleep.
The inability to fall asleep may also be caused by psychological disorders such as anxiety, which manifests itself in the upper body. Anxiety causes heart disease like symptoms, such as chest tightness and palpitations, and puts our bodies in a nervous state. This prevents us from falling asleep.
In the weeks to come, we will discuss in more detail each of the three types of insomnia and methods of treatment.