Pain is the primary impetus for most patients coming into our clinic. Although acupuncture is usually very effective at treating pain, it becomes limited when sleep is hindered. Often there is a correlation between insomnia and pain patterns. Our bodies perform some of their best repair mechanisms while we sleep, and if we cannot find a comfortable position for sleep due to pain, it is easy to see their intertwined relationship. In looking at insomnia patterns according to Chinese Medicine, there are a few basic delineations.

To begin, it’s important to determine if one is experiencing primary insomnia or secondary insomnia. Secondary insomnia is defined as sleep disturbances caused by another factor: too much light, too much caffeine, sleep apnea, an irritating rash (to present a few examples). Resolve the causative factor, and insomnia is no longer an issue. Primary insomnia, on the other hand, is not caused by an outside influence. There is an internal imbalance that must be addressed in order for sleep to be restored.

Chinese Medicine recognizes four main patterns in deficient type insomnia and three main patterns in excess type insomnia. There are up to thirty patterns involved in insomnia cases altogether, but these seven are the most common. All are treated differently and adapted to the individual. The following is a short break down of main insomnia patterns and the primary herbal formulas used in those patterns. It’s important to remember that more than one pattern is often involved.

Deficiency Patterns

Heart & Gall Bladder Qi Deficiency

Characterized mostly by light sleep with excessive dreams, Heart & Gall Bladder Qi Deficiency can cause one to awake with a start in the middle of the night, with fear and/or palpitations. During waking hours, one may feel timid, can be easily startled and possibly experience shortness of breath and/or fatigue. The tongue is usually pale and the pulse is thready and wiry.  An Shen Ding Shi Wan.

Heart & Liver Yin Deficiency

Palpitations and waking easily are inherent in this pattern. A general sense of restlessness can pervade both waking and sleeping life. Feeling warm, especially at night, dry mouth and/or scratchy throat, vivid dreaming and headaches can be common. The tongue is red with little or no coat and sometimes contains many small cracks. The pulse is often thin and rapid. Tian Wan Bu Xin Dan or Suan Zao Ren Tang.

Heart & Spleen Blood Deficiency

This pattern will present with light sleeping and being easily wakened. There can be palpitations and excessive dreaming (often busy or stressful in nature). During waking life, the person with this pattern will often experience dizziness, fatigue, pallor, poor appetite and forgetfulness. The tongue is pale with a thin coat and the pulse is gentle and thready. Gui Pi Tang or Suan Zao Ren Tang.

Heart & Kidney Not Communicating

Insomnia with a feeling of irritability or anxiety. Palpitations, dizziness, tinnitus and forgetfulness all can show up with this pattern. A frequently achy low back, night sweating, hot palms and dry mouth may also be present with this pattern. Tian Wan Bu Xin Dan or Gui Zhi Jia Long Gu Mu Li Tang.

Excess Patterns

Liver Qi Stagnation turning into Fire

Difficulty falling asleep with unpleasant dreams or nightmares characterizes this pattern of insomnia. Frequent feelings of agitation, having a short fuse or red eyes can show up here. In waking life, one can experience a bitter taste in the mouth, constipation and dark urine. The tongue is red with a yellowish coat and the pulse is rapid and wiry like a guitar string. Long Dan Xie Gan Tang.

Phlegm-Heat Disturbance

Difficulty falling sleep, restless sleep and irritability are all pronounced. Concurrently, there is usually a sense of constriction or tightness in the chest and profuse sputum or mucus. Sometimes there can be an aversion to food, decrease in appetite, nausea/vomiting, acid reflux or a bitter taste in the mouth. The tongue is usually swollen, red with a thick yellow coat, while the pulse is often rapid and slippery. Huang Lian Wen Dan Tang.

Food Stagnation

Restless sleep and feeling as though one never gets into deep levels of sleep combined with discomfort in the upper abdomen characterize this pattern. One may also experience poor appetite, disinterest in food, sour taste in mouth, foul-smelling belching and irregular bowel movements. The tongue is usually thick with a greasy coat and the pulse is often slippery. Bao He Wan.

Recognizing patterns is interesting for some patients that want to become more involved in their treatment. At the heart of it, Chinese Medicine is a preventative medicine: it is called The People’s Medicine in China because there are so many things we can do in our daily lives to enhance the resolving of our patterns. With each of these main insomnia patterns, there are exercises and foods which will help resolve the pattern along with acupuncture and herbal therapy. Establishing quality sleep by working with your acupuncturist is attainable. Talk to your acupuncturist about your sleeping habits, any changes in sleep, or let them know when sleep is good. The correlation between sleep and pain resolution is a direct one.

Julie Baron is an East Asian Medicine Practitioner at the Thompson Family Acupuncture Clinic in Walla Walla, WA. Julie seeks to empower individuals and communities.  As a movement and mindfulness educator, she has a penchant for functional anatomy. As an EAMP, she has also has a passion for herbal medicine.