Trouble Sleeping At Night? It Could Be Insomnia and Here’s How to Treat It

Do you have trouble sleeping or staying asleep? This problem is more common than you think. According to a report published in 2020, nine out of 10 Malaysians suffer from some level of sleeplessness or insomnia, and experience more than one type of sleeping problem.

Read on to learn about the causes of insomnia, its associated health risks and treatment options from the perspectives of both Western practice and Traditional Chinese Medicine (TCM). 

The Pea Under the Mattress

Insomnia is characterised by difficulty in initiating or maintaining sleep. It can also mean waking up too early in the morning well before the desired time. This is regardless of the adequate circumstances for sleep each night. This disorder is accompanied by substantial distress and impairments of daytime functioning.  

Having trouble sleeping can affect anyone, women and people above 65 years old are more susceptible to developing insomnia. However, there are other risk factors like: 

1. Psychosocial issues (stress at work, loss of a loved one) 
2. Genetics (apolipoprotein E4, period circadian regulator 3) 
3. Personality traits (excessive worrying, perfectionism)
4. Psychiatric comorbidities (depression, post-traumatic stress disorder)  
5. Excessive intake of substances (alcohol, caffeine, nicotine) 

TCM practitioners believe that having trouble sleeping through the night reflects a dysfunction or imbalance within the body. This is especially in the Heart, Liver, Spleen, Kidney or Gallbladder.

Among working adults in Malaysia, 55% reported sleeping less than the recommended seven hours per night for adults. Factors associated with insufficient sleep were old age, smoking and high psychological distress. 

Beyond Those Sleepless Hours 

Insufficient or poor-quality sleep can significantly impact daytime functioning. It can lead you to wake up feeling tired in the morning. You might also experience reduced workplace productivity, be more prone to errors and accidents, and have a poor quality of life.  

Research shows that even an hour deficit in optimum sleep duration regularly links to a 60–80% higher risk of depression, hopelessness, nervousness, and restlessness. Notably, you cannot compensate for the weekday sleep debt like sleeping in on weekends. 

In patients who experience chronic insomnia disorder (sleep disturbances for over three months during which night-time sleep is affected for more than three times a week), there is an increased risk of comorbidities such as cardiovascular diseases, hypertension, type 2 diabetes, gastroesophageal reflux disease, asthma, and thyroid disorders. 

Eu Yan Sang’s TCM Physician Kwek Le Yin, adds that in extreme cases, having trouble sleeping could develop into chronic fatigue syndrome, which is a debilitating lack of energy that renders simple tasks impossible. Women who are pregnant should also take special care as sleep deprivation could affect the development of the baby. 

When Counting Sheep Fails 

In Western medicine, cognitive behavioural therapy is the first-line treatment for insomnia. It typically comprises six sessions over six to eight weeks, covering topics such as sleep education, relaxation techniques, sleep restriction therapy and stimulus control therapy. However, the scarcity of therapists and high treatment costs make it less practical for many patients.  

Pharmacotherapy with melatonin — including drugs that exert hypnotic, sedative, anxiety-relieving, and muscle-relaxing effects — is approved for treating chronic insomnia.

You should only use these drugs in conjunction with education on sleep hygiene. That includes lifestyle modifications such as limiting daytime naps, avoiding late-night dinners, restricting electronic gadgets or smartphone use during bedtime, and restraining from smoking, consuming alcohol or caffeine in the evening.

In TCM, physicians also explore both physical and lifestyle factors before designing a treatment plan for each patient. Physician Kwek shares the combination of herbal medicine and acupuncture. When properly administered, they can bring relief in just a few days. 

Sour jujube seed is a common TCM herb that physicians use in insomnia treatments that nourishes the Liver and Heart, calms the mind and helps with the management of physical symptoms brought about by stress.

Gui pi wan — a pill that contains Codonopsis root, Astragalus root, liquorice root, Poria, Senega root, sour jujube seed, longan, Chinese angelica root, costus root, Atractylodes rhizome and red dates — is beneficial for nourishing the Spleen, Heart and blood, as well as calming the mind. Other herbs that can treat insomnia include spine date vinegar, blueberry, cranberry, Aronia, blackcurrant, West Indian cherry and walnut membrane. 

Acupuncture targeting the shen mai (申脉) and zhao hai (照海) points can regulate and promote the balance between yin and yang energy. They can also relax the body and mind, thereby promoting sleep.

However, it may not be suitable for those who are pregnant or are afraid of needles. Massaging the acupuncture points (tui na) or cupping are potential alternatives in such cases. 

Physician Kwek emphasised that “whether you have a sleep disorder, or your sleeplessness is symptomatic of other issues, seeking help can prevent it from developing into anything more serious”. If poor sleep has been troubling you recently, please consult your doctor or physician soon.