Jennifer Moffitt, L.Ac., Dip. OM
Last time, we explored the concept of food as medicine, and the role that diet, micronutrients
and supplements play in maintaining or improving your health. In this section we are going to
discuss the importance that sleep plays in the healing process, and how to best make the most
out of your sleep time.
While everyone understands the importance of a good night’s sleep, many people in our culture
are chronically sleep deprived, and don’t realize that they either 1) don’t get enough sleep or 2)
don’t benefit from the sleep they receive.
The Good
First before we cover anything else, let’s define what constitutes a good night’s sleep. Generally
speaking, most people need 7-10 hours of sleep (surprise, surprise). The sleep should be
deep, continuous and uninterrupted. Upon waking, you should feel rested and refreshed.
Generally, it is considered normal to get up at night one time to urinate, but you should be able to
fall back to sleep easily and quickly.
The Bad
Frequent sleep patterns I observe in patients that are not healthy, and that are problematic:
You find it hard to fall asleep or stay asleep (It should not take 2 hours!)
You wake frequently during the night, or don’t achieve a deep sleep
You wake early in the morning (>4 AM and can’t go back to sleep)
You need to urinate more than once per night (I have patients who thought it was
normal to get up 2-4 per night).
You don’t feel rested in the morning
You have frequent active dreams or nightmares
You suffer leg cramps or pain that make it difficult to sleep
The Western Medical Perspective
Now from the perspective of western medicine, insomnia is defined as the following:
difficulty falling asleep
waking up frequently during the night with difficulty returning to sleep
waking up too early in the morning
un-refreshing sleep
Do you fit any of these categories? Surprisingly, the number of hours you sleep is not a
determining factor in diagnosing insomnia. Rather, it is the quality and regularity of sleep that is
most important. In allopathic medicine, it is generally accepted that people over 55 generally
have shallower sleep that is more fragmented, with frequent waking and decreased daytime
alertness.
Many patients with chronic pain or illness are surprised to discover that what they consider a
“normal” sleep cycle may be very poor indeed. In my clinic, almost without exception I find that
patients with pain, inflammatory conditions and chronic fatigue have poor sleep patterns, and
that their subjective experience of pain is almost double that of someone who sleeps well. Like
it or not, in order to achieve the best health possible, some time and attention must be given to
improving your sleeping habits.
Sleep deprivation can make you fat…
In our discussions of qi and vital energy, it makes sense that if you don’t sleep, then you don’t
get enough rest to recharge your batteries. But it is much more complex than that - chronic
sleep deprivation interferes with the chemical messengers (called hormones) that the body uses
to communicate on a cellular level. Now most of us think of hormones as those pesky critters
that cause problems in personal relationships, alá Mars-Venus, or what changes during
menopause, pregnancy, etc. But there are literally dozens of hormones used by the body to
communicate between systems - we understand a mere fraction of how they interact with each
other. But to disrupt the endocrine system means that even if you give the body the best
nutrition and supplements in the world, it may not recognize the fuel that you give it or be able to
use it appropriately. The body’s failure to recognize its own fuel may explain some of the
overeating patterns seen in our society today.
Researchers at the University of Chicago found that they were able to induce a pre-diabetic
state in their healthy male subjects (ages 18 – 27) merely by limiting their sleep to 4 hours per
night for one week. They found that the metabolic and endocrine changes from significant sleep
debt mimic the aging process, and suggest that chronic sleep loss may not only hasten the
onset but also the severity of age-related ailments such as diabetes, hypertension, obesity and
memory loss. 1,2,3 These metabolic changes were particularly strong when tested in the
morning, with glucose tolerance tests that were consistent with the diagnostic criteria for
impaired glucose tolerance, an indication of early-stage diabetes. Furthermore, patients with
chronic sleep deprivation had higher circulating levels of interleukin-6 (IL-6) with implications for
inflammatory disease such as rheumatoid arthritis. 4
The good news, however, is that all study patients returned to baseline levels after spending
more than 12 hours in bed, with added benefits noted when they consistently spent more than 8
hours in bed per night. The studies suggest that our health may be improved by getting more
than 8 hours of sleep on a regular basis. 1,2
Turn off the computer…
When working with a new patient, before I consider herbs or other measures, I find it helpful to
consider behavior when it comes to bedtime and sleep. How do you typically spend the evening
hours? Believe it or not, our activities in the evening have a profound impact on our ability to
have restorative sleep, and minor activity changes can yield dramatic results with little other
intervention.
It is important to establish an evening sleep ritual. Parents of young children already know this –
my friends with young children jealously guard regularity and bedtime like mother tigers. This
does not change as we age - the body likes and needs regularity, and you can actually help re-
train the body to sleep by following the same patterns every night before bed.
Make a rule with yourself to turn off the computer or stop studying/book work by 9 PM or so.
Many times, folks who work on the computer or in the office until it’s time for bed are surprised
when they cannot fall asleep. From the perspective of Traditional Chinese Medicine, analytical
work causes the qi to rise to the head, which can lead to the mental-hamster-wheel that so many
of us experience in the evening. If this seems unrealistic, remember that the time sacrificed
working in the evening is often made up for by greater productivity and better health during the
day. Whatever benefits you may have derived from working or studying late are soon wasted
after a night tossing and turning.
Other supportive practices include:
Take a hot bath or shower, and give yourself a nightly massage on the feet with pure therapeutic
grade lavender oil to help to calm the mind and move the qi out of the head. (I stress pure
lavender oil here because perfumed soaps and lotions do not have the same medicinal
properties that pure plant extracts do. Therapeutic grade oils can usually be found at Henry’s,
Whole Foods, or your local health food store. Young Living Essential Oils makes a very pure
Lavender oil which you can purchase online. Young children and folks with sensitive skin should
dilute pure lavender oil with olive oil before rubbing onto their feet.)
Avoid any caffeine, soda, green tea or chocolate after 5 pm.
Go to bed on an empty stomach!! This one is HUGE: the body’s digestive processes slow
down at night, and a heavy meal such as roast beef, gravy, french fries and cheesecake can
keep your stomach busy digesting for over 8 hours. You won't sleep as soundly during this
process, and some of my patients don’t sleep at all. A low-fat meal such as fish and veggies can
be digested in a few hours, and you can facilitate this by the use of a digestive enzyme. For
folks with heartburn, hiatal hernia, or Gastroesophageal Reflux Disease (GERD), this is even
more important. If scheduling is a problem, then you might choose to make lunch your biggest
meal, and eat more simply in the evenings to avoid the “boa-constrictor-like” lump that will sit in
your tummy and interfere with sleeping.
For my patients with nocturia (frequent urination at night) it is often helpful to avoid beverages
after 7 PM. until we strengthen the bladder and kidneys.
Gentle, slow moving hatha yoga or qi gong can help relax the body and calm restless mental
chatter. Be careful to maintain slow ground postures which do not induce sweat or strain. The
focus should be to clear the mind and relax the body rather than a work out or strengthening.
Go to bed a little earlier to take advantage of the Yin energy available before midnight.
Remember that we described yin as cooling, night, inert, and in TCM theory, sleep is described
as falling into “the envelope of yin,” which is at its peak before midnight. The most beneficial
sleep is, in fact, that which is achieved before midnight, with every hour before worth 2 of the
hours afterwards. Whether that is literally the case remains to be seen, but it is generally harder
for the body to slip into that “cool mantle of yin” after 12 AM.
If you take all these steps and still do not have restful sleep, accept the fact that you may need to
get some outside help to restore the body’s sleep cycle. For patients with chronic disease and
pain, this is even more important. Acupuncture and oriental medicine can be extremely helpful
for treating many types of insomnia, and you may want to start there.
Remember that chronic insomnia disrupts many areas of the body’s chemistry, so it will take
time and patience to see results, sometimes several months. Don’t stop treatment before the
miracle happens… most of my regular senior patients now sleep better than I do.
This allows me to segue neatly into our next section called…Bodywork.
References
1. Plat, L., Leproult, R., L'Hermite-Baleriaux, M., Fery, F., Mockel, J., Polonsky, K.S., & Van Cauter, E. (1999). Metabolic
effects of short-term elevations of plasma cortisol are more pronounced in the evening than in the morning. Journal of
Clinical Endocrinology and Metabolism, 84, 3082-3092, ( http://www.endocrinology.uchicago.edu/facultypages/fac_cauter.
html)
2. Spiegel, K., Leproult, R., & Van Cauter, E. (1999). Impact of sleep debt on metabolic and endocrine function. Lancet,
354, 1435-1439
3. Van Cauter, E., Leproult, R., & Plat, L. (2000). Age-related changes in slow wave sleep and REM sleep and relationship
with growth hormone and cortisol levels in healthy men. Journal of the American Medical Association, 284, 861-868.
4. Redwine, Laur, Richard L. Hauger, J. Christian Gillin and Michael Irwin. Effects of Sleep and Sleep Deprivation on
Interleukin-6, Growth Hormone, Cortisol, and Melatonin Levels in Humans The Journal of Clinical Endocrinology &
Metabolism Vol. 85, No. 10 3597-3603 (http://www.jcem.endojournals.org/cgi/content/full/85/10/3597)
5. Pathophysiology of the Endocrine Sysytem (http://www.arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/
