Insomnia and Sleeplessness

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Insomnia is characterized as the acute or chronic inability to initiate or maintain adequate nighttime sleep.  There are many reasons that insomnia may occur and a careful history of the severity, duration and consistency of the reported sleepless nights are important to ascertain. Generally insomnia is classified according to disruption and duration of the complaint such as difficulty falling asleep, frequent or sustained awakenings during the night, early morning awakenings, or persistent sleepiness despite adequate sleep.

Some biomedical differential diagnoses of insomnia include:

  • Acute causes due to: emotional stress, physical discomfort, jet lag
  • Alcohol use
  • Circadian rhythm disorder
  • CNS disease:  e.g.: brain tumor, complex partial seizures, neurosyphilis
  • Depression
  • Mania or bipolar disorder
  • Menopause
  • Medications:  e.g.: corticosteroids, benzodiazepine withdrawal, selective serotonin reuptake inhibitors
  • Medical illnesses: e.g.: chronic obstructive pulmonary disease, hyperthyroidism, hepatic encephalopathy, gastro esophageal reflux disease
  • Nocturia:  e.g.: use of diuretics, benign prostatic hyperplasia, urinary incontinence, congestive heart failure
  • Poor sleep hygiene:  e.g.: too many daytime naps, watching TV in bed
  • Restless leg syndrome
  • Stimulants:  e.g.: caffeine, nicotine

Traditional Chinese Medicine (TCM) views insomnia similarly and the potential etiologies listed above can cause classic zang-fu or meridian theory disruptions. Common TCM differential diagnoses for insomnia often include:

Waking up easily during the night:  Heart yin deficiency.

  • Waking at a specific time of the night or early morning awakening:  Liver, lung, or kidney meridian disorders, different time wake up reflected with different organs.
  • Dream-disturbed sleep:  Heart or shen imbalance, spleen deficiency, liver blood deficiency
  • Difficulty falling asleep:  Stomach, liver, gallbladder replete patterns.


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