The restorative role of sleep in health and vitality is one of the most important concepts for clinicians to consider when examining and treating patients. This critical aspect of health must also be introduced and explained in detail to patients, with clinicians not simply prescribing herbs and administering acupuncture, but also teaching patients about the role sleep hygiene plays in health and healing.
Resolving Sleep Issues: Not Always a Simple Solution
Sleep issues are not always a simple solution. The complex characteristics of sleep disorders are one of the reasons why the specialized therapies of traditional Chinese medicine and acupuncture have so much to offer patients suffering from disturbed sleep.
It is not uncommon for patients to show up at my clinic presenting with sleep disorders and express in frustration that they have "tried melatonin and valerian; nothing works." These are the two most common supplements I encounter with patients and in almost all cases, their pattern presentations are much more nuanced and complex than a simple sedative or over-the-counter supplement can address. The formulas of Chinese medicine can truly shine in such scenarios.
One important point should be mentioned when discussing sleep disorders in the clinical setting. Clinicians should always inquire as to the quality of the patient's sleep, regardless of the presenting complaint. Deep, restorative sleep is a key factor in lowering systemic inflammation and allowing the entire body to recover from almost every type of malady. If a patient suffers from poor-quality sleep, any other issue they suffer from can be exacerbated. Patients often consider it to be normal to have poor sleep as well.
Sleep disorders are generally categorized as excess or deficient in presentation. In this article, I focus primarily on the deficient category. Two key TCM formulas are: Suan Zao Ren Tang and Tian Wang Bu Xin Dan. Both target much deeper aspects of the patient's sleep syndrome than melatonin or valerian can address.
Suan Zao Ren Tang
This important formula calms shen, nourishes heart and liver blood / yin, clears deficiency heat, and invigorates blood. Key signs for this formula are a thin / wiry and rapid pulse; and a tongue which could be normal / red / geographic and perhaps dry with slight cracks. This formula is extremely gentle, can be used for a long period of time, and does not overly sedate the patient. As a result, I use this formula for patients who present with the aforementioned pulse and tongue indications and claim that melatonin or valerian "makes them too groggy."
I often have patients take this patent medicine one hour before bed with a cup of strong chamomile tea, and then a second dose right at bedtime. In many cases, the dose on this gentle formula can be increased to two doses one hour before bed and a third dose right before bed.
This gentle formula can be taken long term and is particularly important for patients who claim chronic issues with sleep; patients who suffer from poor concentration or mental fatigue; and patients who also experience daytime anxiety. In these types of cases I will often have the patient take a dose during the day as well as the evening doses. Daytime dosing of this formula rarely causes drowsiness.
Tian Wang Bu Xin Dan
This exquisitely crafted formula calms shen, cools blood heat, nourishes heart blood / yin / qi, and clears heat. Pulse signs are usually thin and rapid, while the tongue is usually red with a red tip, dry with potential cracks, and may be geographic as well.
Although this is a complex, finely crafted formula, it does tend to act slowly. However, the actions are deep and long lasting; definitely not just a simple Band-Aid approach. I use this formula extensively in the clinic and find it incredibly effective for patients who have used stimulant medications for attention issues and for patients who have suffered from long-term grief or stress. It's very important to explain to the patient that this formula is slow acting, but over time will bring deep changes over and above simply improving sleep quality.
This formula can address sleep issues, but can also target chronic anxiety, poor focus and concentration, and even fatigue due to chronic worry / stress. With patients who fit this formula, I always educate them on sleep hygiene and breathing exercises to lower sympathetic stress responses, and encourage them to incorporate some type of meditation into their daily schedules. I have the patient do this formula in the morning, during the day, and before bed as well. This formula is also an excellent fit for menopause-related sleep disorders and sleep disturbances with nightmares.
Don't Forget Sleep History
When dealing with sleep issues in the clinical setting, start by uncovering the patient's sleep history. It is common for clinicians to look at an overall medical history or dietary history, without asking about the quality of sleep over a patient's life. Asking about sleep history can reveal important behaviors or personality traits that can provide clues to direct the appropriate acupuncture and/or Chinese medicine protocols; or reveal the need for education on stress-reduction techniques and sleep hygiene. Always remember to ask questions about the quality of the patient's sleep, as it will often reveal the answers to many long-standing issues. All we have to do is ask and then listen.
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