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Sleep and Traditional Chinese Medicine

From a TCM point of view, the sleep cycle is a dynamic interaction between Yin and Yang, coupled with an underlying spirit (Shen, as it is called in TCM terms) factor.

Sleeping is a critical component for maintaining balance of Yin and Yang within the body.  From a broader scale, the daily (and even seasonal) cycles in nature are an expression of the waxing and waning of Yin and Yang in the universe.  Because TCM theory sees a strong relationship between individual and universal Yin and Yang, the human body is programmed to live in harmony with the rhythm of nature.  Sleep itself, therefore, is a critical component for maintaining the balance of Yin and Yang within the body. 

As it is stated in one of the classical TCM texts (the Lingshu, or Spiritual Pivot), “when Yang Qi is at its limit and Yin Qi is abundant, one's eyes are closed.  When Yin Qi is at its limit and Yang Qi is abundant, one is awake.”  Likewise, we naturally go to bed at the Yin predominate time (night) while wake up at the Yang predominate time (day).  The Yin or Yang in this sense can also refer to the fluctuating levels of each in the body.  At night, the body enters a more “Yin” state, and during the daytime, it is in a “Yang” state.

If there is an imbalance in Yin and Yang in the body, sleep is often affected.  People who are unable to fall or stay asleep at night tend to have deficiencies in either Yin or Blood (defined a nutritive substance within the body that tends to have Yin-like qualities).  When we use acupuncture and Chinese herbal medicine to treat sleep issues, we often use points and herbs that build Yin and Blood so that the transition into and maintenance of sleep becomes easier and more consistent.

On the other hand, if a person feels sleepy all day long and cannot seem to feel rested after getting even 10 or 11 hours of sleep (plus naps), he or she most likely has a deficiency in either Yang or Qi (Qi is considered to be similar in nature to Yang energy in TCM theory).  Similarly, when we treat patients with such symptoms, we use acupuncture points and herbs that supplement Yang energy and Qi. 

In addition to Yin-Yang balance, the sleep cycle also involves the concept of spirit, or Shen.  In TCM, Shen generally refers to the state of consciousness and mental functions that keep the mind sharp and alert.  It is the highest authority of the physical body that orders it to rest or work.  In coordination with the natural rhythm, Shen retreats to the internal organs (TCM organs) at night for recharging, and comes out during daytime to exert its duties.  

Sometimes, when the Shen is too active or excited, sleeping problems can occur.  Causes for its overactivity include emotional conflict, stress, anxiety, overthinking, use of stimulant substances, or even vivid, scary, or violent dreaming.  In this case, when we treat patients for Shen-related sleep disturbances, we use acupuncture points and herbs that “calm the Shen” and help the body to become more relaxed.

In addition to acupuncture and herbs, we also like to recommend lifestyle suggestions for those suffering from sleep issues.  The following are tips that may be helpful those with problematic sleep (in this case, we focus on inability to sleep):
  • Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime. While alcohol is well known to speed the onset of sleep, it disrupts sleep as the body metabolizes the alcohol, causing arousal.
  • Exercise can promote good sleep.  Vigorous exercise should be taken in the morning or late afternoon.  A relaxing exercise, like yoga, can be done before bed to help initiate a restful night's sleep.
  • Food can be disruptive right before sleep; stay away from large meals close to bedtime.  When you eat a lot right before bed, you naturally rev up your body’s metabolism, making it hard to fall asleep.
  • Ensure adequate exposure to natural light during the day.  Light exposure helps maintain a healthy sleep-wake cycle.
  • Establish a regular relaxing bedtime routine.  Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don't dwell on, or bring your problems to bed.
  • Associate your bed with sleep. It's not a good idea to use your bed to watch TV, work on your computer, or text message – keep the electronics out of the bedroom as much as possible.
  • Make sure that the sleep environment is pleasant and relaxing. The bed should be comfortable, the room should not be too hot or cold, or too bright.

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