Many of my patients complain about not sleeping well. Especially as we move into middle age, a truly restorative night’s sleep can become more of a treat than an expectation. People may find they have a harder time falling asleep, or may spend some time awake in the night. They can become distressed that they have insomnia, and this worry makes their sleep troubles worse.
In Chinese medicine, sleep troubles can come from different factors, primarily involving the Chinese Liver, Kidney, and Heart organs. Dysfunction in those organs, or a deficiency of qi or blood, can lead to poor sleep. In evaluating sleep patients, we have to distinguish the factors that contribute the most, and treat them.
We have to be clear on what good sleep is. Many of us have the idea that falling right to sleep, and sleeping for eight unbroken hours is the standard for good sleep. That is a myth, and it creates anxiety about insomnia in people who don’t sleep that way. Historically, we see what’s referred to as “the second sleep.” It was very common in premodern times for people to go to sleep, wake for awhile in the night, and then go back to bed to finish sleeping. In the Catholic monastic tradition, there is even a service held at 2 a.m., Matins. I remember reading about a study where the scientists took modern people and put them in an environment without supplemental light, so people were dependent upon the sun. After several weeks, they had adopted a two sleep pattern.
According to an article I read, I regret I do not have a link, historically the second sleep was for quiet activity. People would do some reading, pray or meditate, write letters, or enjoy their partners without the interference of children. Yet many of my patients worry that the appearance of a two sleep pattern indicates sleep dysfunction. They feel dysfunctional because right when they fall back asleep, it seems the alarm goes off, and they have to get up and prepare for the day, under-rested and groggy.
This is the crux of the matter: the problem isn’t the second sleep, it’s the schedule. Premodern people, largely in charge of their own labors, were free to enjoy the second sleep. Modern people, wedged into somebody else’s schedule, have to be at work at a time chosen by someone else. They are not free to sleep late enough to complete the second sleep. The brain’s regeneration is interrupted, and the sleep is not restful. The problem is with the clock, not with the people.
In addition to those who worry about normal sleep, there are the people who just don’t go to bed. These are people from teens through middle age who don’t think they need to sleep, and think they are fine if they get 4 or 5 hours of sleep per night. They are not fine. You are not fine. This is not enough sleep. I know the TV show is compelling, I know you are hip deep in that project, I know you think the world will fall apart if you don’t get that done, but you are sacrificing your health. No, you can’t “make it up” by sleeping til noon on the weekends. It doesn’t work, and the unpredictability of the sleep schedule makes it hard for your body to establish a sleep rhythm.
A new paper in the journal Sleep Health outlines common sleep myths, how they are harmful, and some truths about sleep. I largely agree with this article. I take minor exception to their position on naps. (I am in favor of naps when a person’s work schedule does not allow them to meet their sleep needs overnight.) You can find the article HERE.
I do not deny there are genuine sleep problems. Disharmonies in the Chinese Liver, Heart, and Kidney certainly create sleep disturbances. Some people get their cortisol schedules backwards and feel groggy all day, but wide awake at night. These are real problems that deserve treatment. Chinese medicine has a lot to offer in terms of sleep treatment. But before you decide you have insomnia, reflect on whether you actually have a sleep problem or just a mismatch between your clock schedule and your natural sleep pattern.