SLEEP CLINIC Q & A
Difficulty initiating and/or maintaining sleep is a common issue. Patients experiencing insomnia symptoms frequently self-treat their symptoms with sleep medications. However, there remains concern regarding the short- and long-term health impacts of sleep medications.
Integrative Medicine Approaches to insomnia treatment, including Cognitive-Behavioral Therapy and Mind-Body Therapies (Meditation, Yoga, Tai Chi), as well as other approaches (Dietary Supplements, Acupuncture).
How Integrative Medicine can help with Sleep Problem?
Conventional Medicine Approaches (CMA) to Insomnia fall short primarily because they encourage medicalization—a misconstrued notion of sleep as an essentially biomedical phenomenon. This posture encourages over reliance on sedative-hypnotics (the most common treatment for Insomnia). And it likely discourages patients from availing themselves of more effective Integrative Medicine Approach (IMA) for Insomnia.
Integrative Medicine is not an alternative to Conventional Medicine; it is an essential augmentation of it. Bringing together the best of evidence-based Conventional Medicine and Integrative Medicine significantly expands both our understanding of and treatment options for Insomnia.
More specifically, an Integrative Medicine approach to Insomnia de-medicalizes sleep by 1) restoring our regard for the sleeper, 2) significantly expanding the range of effective interventions, and 3) reframing Insomnia and sleep health as lifestyle issues.
CMA has taught us much about the biomedical view of sleep, but it has all but forgotten the sleeper. IMA has strived to balance this medicalized view of sleep with a focus on critical role of the mind in health and illness, encourages renewed regard for the personal, subjective experience of the sleeper.
The best antidote to medicalization is personalization. Sir William Osler reminded us that “it is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” It is arrogant to dismiss the phenomenological experiences of our patients.
Let’s remember that scientific definitions of sleep are artificial parameters that frequently fail to coalesce with reports of subjective experiences. What has long been called sleep state misperception, for example, may well be sleep state perception. Our willingness to intentionally integrate objective data with subjective experience can help us triangulate a sharper scientific as well as a more personally meaningful picture of sleep.
Personalization begins by complementing standard insomnia evaluation procedures with an invitation to patients to tell their personal “sleep stories.”
Integrative Medicine emphasizes the importance of the doctor-patient partnership in healing. Our willingness to respectfully attend to and empathize with our patients’ sleep stories conveys an important sense of regard for their subjective experiences, countering the common tendency to treat the chart.
Integrative Medicine also emphasizes the critical role of endogenous healing—the acknowledgement of an individual’s natural inclination to heal. Helping a patient to feel heard, regarded, and understood not only increases disclosure, but also promotes self-efficacy and improves treatment adherence.
I routinely ask Insomnia patients about their beliefs and experiences regarding dreams. Obviously, dreaming is the most evident and personally meaningful conscious experience of sleep. How much of WASO (wake after sleep onset) might actually be WADO (wake after dream onset)? Disregarding dreams in an insomnia consult is like disregarding the taste of food in a nutritional consult. At a minimum, I believe we should affirm dreaming as an essential component of sleep and even normalize occasional bad dreams and nightmares. Ideally, we should also explore the meaning patients attribute to their dreams.
As evidenced in the global ubiquity of bedtime prayers for safety and protection through the night, nonscientific views of sleep have traditionally been framed in spiritual terms.
Integrative Medicine suggests that scientific and spiritual takes on sleep are not mutually exclusive. In fact, given that the vast majority of people have religious beliefs, considering and incorporating these into treatment could enhance standard IM. I have found it very useful, for example, to address sleep effort in terms of patients’ spiritual beliefs. The elusive process of letting go required for healthy sleep onset can be reframed and addressed as a spiritual practice or an act of faith.
Can Acupuncture help your sleep?
Using Acupuncture was significantly better on improving parameters in sleep quality and duration, and the combination of acupuncture and other interventions appears more effective than those interventions alone.
Does Meditation reduce sleep?
Meditation by bringing your mind’s attention to the present without drifting into concerns about the past or future. It helps you break the train of your everyday thoughts to evoke the relaxation response.
The idea is to create a reflex to more easily bring forth a sense of relaxation. That way, it’s easier to evoke the relaxation response at night when you can’t sleep.
Can your Diet affect your sleep?
Dietary patterns and foods show promise as sleep modulators. As a Integrative Practitioner it is important to educate patients on the role of sleep on dietary intakes and health but also to initiate discussions about how diet could be modified to improve sleep quality.