insomnia - acupuncture physical medicine

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INSOMNIA

OVERVIEW

WESTERN MEDICINE DEFINITION

Insomnia includes having trouble falling or staying asleep. It's one of the most common

medical complaints. With insomnia, you usually awaken feeling unrefreshed, which takes a toll

on your ability to function during the day. Insomnia can sap not only your energy level and

mood, but also your health, work performance and quality of life.

How much sleep is enough varies from person to person. Most adults need seven to eight

hours a night. More than one-third of adults have insomnia at some time, while 10 to 15 percentreport long-term (chronic) insomnia. (Staff, 2009)

APM DEFINITION

Insomnia and agitated sleep patterns in people suffering from this first pattern of fatigue and

dysfunction are often due to a habitual increase in the persons level and amount of stressful

activity. They may be taking a lot of stress home with them after work. When business projects

find their way into the persons private life, there is no longer any separation between business

and leisure time. Returning home at night should be a return to a safe place, a place of peace

and rest and pleasure. Bringing work home creates a conflict between wanting some time to

oneself and what one should still be doing. It is impossible to go to sleep totally calmly in such

a situation, and unresolved work that has invaded the home space can easily invade ones

sleep. (Seem, 2000, p. 107)

SOURCES

Maciocia, G. (1994). The Practice of Chinese Medicine. In G. Maciocia, Insomnia (pp. 281-

303). Edinburgh: Churchill Livingstone.

Seem, D. M. (2000).Acupuncture Physic al Medicine. Boulder: Blue Poppy Press.

Staff, M. C. (2009, January 8). Insomnia. Retrieved December 1, 2009, from Mayo Clinic:

http://www.mayoclinic.com/health/insomnia/DS00187

CATEGORIES OF DISHARMONY

Dx: Tai Yang Zone Excess with Kidney and Heart Protection Meridian Dysfunction

The First Pattern of Fatigue: Spinal Irritation

The first pattern entails the dorsal, ortai yangacupuncture zone, and involves the tai

yang/shao yin circuit from an acupuncture perspective. My experience in these cases is that, in

addition to reactivity in the musculature of the tai yangor dorsal zone, there is a disruption of

the Chinese organ functions of the kidneys and adrenals in the lower heater and heart and heart

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protector n t e upper eater. e ney an eart unct ons const tute t e s ao y n unct ons

which are paired with tai yangor small intestine and bladder functions in acupuncture and

constitute a complete circuit. (Seem, 2000, p. 86)

CLINICAL MANIFESTATION

Usually people with such sleep disturbances have tremendous tension in the lower back, in the

quadratus lumborum and paraspinal muscles there, similar to what is seen in cases of adrenal

exhaustion, because they are running on empty. They are also usually very tight in the uppertrapezius, a noted stress muscle. Both of these areas need to be released with surface

myofascial techniques. (Seem, 2000, p. 107)

TREATMENT PRINCIPLE

Tx: Disperse Tai Yang Zone Excess and Regulate Kidney and Heart Protector Meridians

TREATMENT STRATEGY & PLAN

In addition to the wei, surface energetic release of the quadratus lumborum, lumbar paraspinal

muscles and upper trapezius, I treat the core level with SI 3 and BL 62 for du maiand yang

qiao mai, coupled with their yin counterpart Lu 7 forren maiand Ki 6 foryin qiao mai. I do SI 3

on one side, say the right hand, and BL 62 on the left foot in this example. Then I add Lu 7 on

the left hand and Ki 6 on the right foot, creating a crossing pattern. This is a ren mai/du mai

infinity treatment connecting front to back and upper to lower, thereby calming the nervous

system. This is the same as making water (the kidney root) communicate with fire (the heart

and shen, or spirit), in a five phase acupuncture approach. I also had Ht 7 to calm the spirit.

(Seem, 2000, p. 108)

Also, although Dr. Seem does not note it in this particular s ection of Acupuncture Physic al

Medicine, by using Kid 6 and BL 62 the treatment strategy is also regulating the Yin and Yang

Qiao extraordinary meridians which will harmonize the flow of energy to eyes and promote

sleep. (Maciocia, 1994)

Example of a full treatment protocol (Seem, 2000, pp. 108, 133):

Jing Level Points

Local:

B BL 10, BL 40: Divergent Channel Meeting Points

Distal:

R - SI 3: Du Mai Opening Point

L - BL 62: Yang Qiao Mai Opening Point

L - Lu 7: Ren Mai Opening Point

R - Kid 6: Yin Qiao Mai Opening Point

Ying Level Points

Local:

B - BL 23, BL 14: Harmonize Kidney and Heart Protector

Distal:

B - Kid 3, BL 58: Source/Luo for affected Meridians


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Wei Level Points

Distal:

BL 59: Releases the Occiput and the Back of the Neck

BL 58 1/2: Releases Quadratus Lumborum, Gluteals, and Piriformis

Local:

Van Nghi or Trigger Point Release Needling as indicated for the following muscles groups:

Quadratus Lumborum

Paraspinals of the Lumbar

Upper Trapezius Muscles

PATIENT EDUCATION / RECOMMENDATIONS

In addition to not allowing work to totally invade the home space, I recommend to patients that

they do no intellectual activity for the last hour before bed, and instead do something relaxing,

such as a hot bubble or Epsom Salts bath, drink a cup of calming tea such as Celestial

Seasonings Sleep Time Tea, or listen to calming music, to slow themselves down. I also

suggest eating no later than 7pm to allow the body to digest and drinking only a minimum, if

any, alcohol so as not to develop counterflow heat that often agitates sleep. (Seem, 2000, p.

108)

PROGNOSIS

Dr. Seem does not specify a prognosis. In most of his treatments regarding trigger points which

exist as a result of a holding pattern, though, there is often the recommendation for patients to

be treated three times at a weekly interval before taking a month off to re-assess if the body

has retained the retraining of the muscles which should result from the treatment. Often, the

more chronic the condition, however, the longer it will take for the disharmony to resolve.
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