montakabh ps2016 thursdayam presentation · 2016. 10. 14. · consequences of insomnia. •decline...

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Insomniaand the

Modern Worldby

Hamid Montakab M.D.

Sleep Physiology

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© Dr. H. Montakab© Dr. H. Montakab

What is Sleep; Why do we sleep

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• A necessary condition of rest for the body and the mind?

• We Sleep 1/3 of our lives; sleep time diminishes with age to about6-7 hours in an adult; 25% of overall sleep time is “REM” sleep

• Two stages are the most important for the organism:=> Deep sleep “N3”: assists physical repair=> REM sleep helps CNS repair: metabolite accumulation/ GABA

• Two Rhythms:=> Circadian: synchronized internally (25 h.) & externally (24 h.)=> Ultradian: 12 hours; ( reduced vigilance at midday)

• Sleep cycles: last from 90 to 110 minutes on average, and eachstage may have a distinct physiological function. (affect of pills &life style)


Optimum Sleep Time

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SCN (Supra Chiasmatic Nucleus) & the Circadian cycle

• Darkness stimulates the SCN which stimulates the production of Melatonin by the Pineal gland

• Bright light (blue light) inhibits Melatonin secretion

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Pineal gland

Insomnia

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Epidemiology of Insomnia• 30-40% of the adult population

• 15-25% in children (higher after puberty)

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Consequences of Insomnia• Decline of Cognitive performances; increased risk of

accidents (driving)

• Mortality risk increased by 30%

• Cardio-vascular risk increased by two times

• Increased risk of obesity, diabetes Type 2

• Reduced recovery from illness, wound healing

• Reduced anabolism (immune, CNS, musculoskeletal)

• Reduced memory

• Depression

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Energetics of Sleep in Chinese Medicine

© Dr. H. Montakab© Dr. H. Montakab 10

Sleep in Chinese Medicine- Daytime and activity are Yang, night time and sleep are Yin.- Health is a state of balance between activity/ Yang & sleep/ Yin- Normally sleep time is adapted to activity- Balance depends on two parameters: time & space (depth/

intensity)

- These parameters are controlled by the 8 Extraordinary Vessels- In a healthy state, the 8 Extra help adapt to external variations

Depth (how well we sleep)

Duration (how long we sleep)

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© Dr. H. Montakab

Wei Qi, concentrates in the Jing Jin-sinew channels during theday, it is maintaining muscle tone and mobility, it internalizes atnight allowing for the muscles to relax, which is the first stage ofsleep.

© Dr. H. Montakab

Movement of Wei Qi

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According to Ling Shu: Wei Qi circulates on the surface,predominantly in the sinew channels, 25 times during the day,penetrates at the ankle in the evening, circulates in the Zangfu 25cycles during the night, following the Ke cycle, and emerges at thecorner of the eye, most probably at Jingming BL-1, allowing forthe eyes to open.

Wei Qi also regulates body temperature which also presents arhythmic alternation, of about 25 hours. There seems to be aninteraction between sleep and body temperature rhythms. Fallingasleep and deep sleep occur during the lowest temperature dip,whereas waking occurs during the ascending phase of the curve.


Mental Relaxation

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• The Mind relates to Shen神• During sleep, Shen retires in to the blood, this explains the reduced

response to outer stimuli.• During the waking stage, the Liver manages the Wei Qi on the

surface (the muscular activity with the Jing jin-sinew channels)

• During sleep, Liver mobilizes Wei Qi (& Blood) inwards, resulting inthe relaxation of muscle tone and reduced sensory functions (eyes,nose & ears)

• The movement of Hun inwards, helps move Qi away from the mind andhelps relax the Shen.

• Periodically the Hun is released and will wander, producing dreams(rapid eye movement); dreams are necessary for health

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Shen, Hun & Blood

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• Blood stores both Shen and the Hun • => Importance of blood in the physiology of sleep• Blood vacuity affects Shen & Hun = difficulty falling

asleep - Calm insomnia: Fan-vexation, with mental restlessness (HE-blood) - Restlessness: Zao-agitation, with muscular restlessness (LR-blood)

• There will also be easy and frequent waking and dreamdisturbed sleep


Zang organs & the Emotions

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• Emotions are retained in the Zang and produce IPF

• The Hun, through dreams, helps release these PF• All emotions will affect the HE:

- anger produces HE-Fire

- joy & sadness affect HE-Qi

- worry affects HE-Blood- fear & fright disturb HE-KI communication

• All emotions therefore will affect Shen & disturb sleep

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“Hun” and Dreams

• Three categories of common dreams:– To clear External pathogenic factors

– To clear Internal pathogenic factors (retained PF or emotions)

– Premonitory: Hun having the “memory of the future”; also allowing for processing of life mandates.

• Nightmares: pathology of “Fire” (HE, LR, ST)• Lucid Dreaming

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Life styleand

Insomnia

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Most common Etiologies• Yin-Xu => causing Heart-Heat, Liver-Heat

• Blood-Xu => causing Heart Blood-Xu (Fan=agitation)

=> Liver Blood-Xu (Zao=restlessness)

• Wei Qi movements disturbed (Phlegm)

=> somatic symptoms

• Dream disturbed sleep/ nightmares: due to retained Heat in the Zang; un-resolved life issues

• Secondary insomnia: nycturia, pruritus, cramps, indigestion (counterflow Stomach Qi), other...

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Modern Life-style & the state of Yin

• Stress and over taxation of Yin (life-style), chronic use of sleeping aids

• Jing-Xu: from inherited weak Jing; Jing loss; or from

foods poor in Jing; drugs and medicines

• Light*** and sound pollution**

• Wrong diet: excessive Yang foods at night (red meat); Damp and Phlegm-producing foods (dairy); tardy intake of coffee (after midday)

• Excessive stimulation (sugar, caffein, tobacco, tonics)

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Modern Life-style and the Liver

• Liver-Qi stasis: stress, frustration; sedentary

work, lack of exercise and open air activity

• Liver-Heat/Fire: meat, saturated fats, alcohol,

drugs, medicines and pollutions (Liver as a filter)

• Liver Blood-Xu/vacuity from foods that are poor in

Jing; wrong diets (cold and Yin foods damaging the

digestif Fire)

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Modern Life-style and the Heart

• Heart-Heat: stress, emotions, excessive desires

• Heart Blood-Xu/vacuity from foods that are poor in

Jing; Liver-Blood-Xu

• Lifestyle: excessive taxing of the eyes

• Heart & Kidney communication disrupted: HE & KI-

Yin-Xu (Jueyin-Liver as emissary).

• Phlegm blocking the Heart orifices (Qi or Yang-Xu)

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Modern Life-style and the Impact on the Internal Synchronizers

• Shift-work (circadian sleep disorder)

• Daylight “saving” time

• Traveling across time zones/ “Jet-lag” (circadian

sleep disorder)

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Diagnosis of Insomnia

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Diagnosis

• Define if calm or restless => state of Blood• If somatic symptoms => movement of Wei Qi

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• Define the disturbed phase => initial - middle - end• Explore the emotional state during the night

• Examine the 4 Xi-cleft points (Extraordinary vessels)• Establish the affected level: Tai / Jue / Shao• Check for corresponding Zang-Fu disharmony patterns

Definition of Insomnia = Waking up, feeling tired

• Define if the length or depth of sleep is disturbed

Treatment Strategies

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© Dr. H. Montakab

Reorganizing the “Synchronizers”

© Dr. H. Montakab

Palpation of the Xi-cleft points of theExtraordinary Vessels:

-> Jiaoxin KID-8 for the Yin Qiao (Yin Motility) vessel

-> Fuyang BL-59 for the Yang Qiao (Yang Motility) vessel

-> Zhubin KID-9 on the Yin Wei (Yin Linking) vessel

-> Yangjiao GB-35 on the Yang Wei (Yang Linking) vessel

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© Dr. H. Montakab

Harmonizing the Zang Fu

© Dr. H. Montakab

• State of Blood– Mainly Blood-Xu (vacuity)– Blood-Heat

• Harmonizing the Liver– Liver Qi Stagnation– Liver Blood or Yin-Xu; Liver-Fire (nightmares)

• Calming the Heart– Heart-Heat from emotions; Heart-Fire (nightmares)– Heart-Blood or Yin-Xu; KI & HE communication– Phlegm misting the portals

• Settle the Stomach– Stomach-Qi rising; Stomach-Fire (nightmares)

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Calming the mind

There are 3 causes for Mental agitation; the treatment strategies depend on the state of Blood:

• Calm Shen / An: may be used when there is Blood-Xu, helps move Wei Qi inwards = HE-7

• Quiet Shen / Qing: only if there is enough Blood: PE-4-5-7; HE-7-5; also add points to tonify Blood: LR-8, BL-17, SP-6; ST-30

• Settle Shen / Ding: rooting, involves the Kidney: ST-45, SP-1; KI-1; LU-5

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© Dr. H. Montakab

Regulating Wei Qi

© Dr. H. Montakab 28

- The closing of the eyes is the first manifestation of theWei Qi moving inwards.=> Connection with ST-1 / LI-20 / SI-19 (relaxing of thenose & closing of the ears)=> To relax the portals = BL-1 & BL-62

- The chest is the second area where the Wei Qi has topass through.=> If the chest cannot relax, there could be waking up atnight with feeling of heat and sweating.=> Importance of BL-17-Ge shu & TW-7-Zong hui

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© Dr. H. Montakab

Internal circulation of Wei Qi

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=> Wei Qi helps liberate external & internal PF from theZang/Fu

=> To return the Wei Qi back: Si Chen Cong; ST-12; lower He-Sea points & Jing-well points

=> If the Wei Qi escapes back up, it causes sleep disturbanceswith somatic symptoms “Parasomnia”:

.ST: difficulty falling asleep, irritability, nighttime foodcravings

.LI: teeth-grinding, neck/shoulder tension, difficult bowels inthe morning

.BL: difficulty falling asleep, restlessness (restless legsyndrome, calf cramping); nighttime sweating

.SI: dry mouth, nighttime thirst, enuresis

.GB: bitter taste, itching (head), neck tensions

.TW: drooling, a lot of crust around the eyes

montakabh ps2016 thursdayam presentation · 2016. 10. 14. · consequences of insomnia. •decline...

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