What's sleep got to do, got to do with it?

A friend called me the other day and said she couldn't sleep. She was recovering from surgery and was worried that if she couldn't sleep she would take longer to heal because her body wasn't getting the rest it needed. Actually there is some truth in this ...

Lots of healing occurs when we sleep. The activity of the lungs and heart is reduced to a minimum, our body's temperature, blood pressure and pulse rate all fall, and our muscles relax. This allows the cells of our bodies to carry out essential repairs, to grow and regenerate. Skin cells, for example, divide and grow twice as fast when we are asleep.

Sleep Matters

Our individual sleep requirements vary although most adults are now thought to need eight hours per night. Restful sleep is as important as exercise or a healthy diet in maintaining overall health, but in spite of evidence showing the value of good sleep, few Americans are getting the rest they need.

It has become fashionable to sleep less ... to get up early to exercise, to work more and to eat and sleep less. The pressure to work often supersedes sleep as a priority. One in four Americans actually believes that you cannot be successful and get enough sleep. Needing more sleep has come to be perceived by many as a weakness to be ignored or even overcome.

A 1998 survey sponsored by the National Sleep Foundation (NSF) found that
40 million Americans suffer from sleep disorders; two out of three people are not getting eight hours of sleep a night and a third are getting less than six hours.

Sleep Loss Costs

Unfortunately, those who are consistently getting less than they need are courting chronic exhaustion. Fatigue can impact all aspects of our lives, from our work and our personal relationships to our ability to concentrate and perform daily tasks. Sleep loss can even be deadly.

The NSF found that more than half of those surveyed had driven drowsy in the previous year. One-third of those adults admitted to having fallen asleep while driving. Of those, one in ten had had an automobile accident because of fatigue or dozing off. The number rose to 80 percent in those who work shifts. Tragically, drowsy driving is the cause of at least
100,000 car crashes and 1,500 fatalities each year (according to the US National Highway Traffic Safety Administration). Unfortunately, 22 percent would rather continue driving when very sleepy than take a break at a rest stop because they fear for their safety.

Established in 1990, the National Sleep Foundation is a nonprofit organization dedicated to improving the quality of life for the millions of Americans who suffer from sleep disorders and to supporting sleep-related education and research to improve public health and safety. The NSF provides free brochures on sleep, drowsy driving and sleep disorders such as sleep apnea; regional listings of accredited sleep centers; and other public education materials and programs.*

Stress Spirals

There is nothing worse than not being able to sleep at night ... we need to be able to recharge our batteries so that when we wake in the morning, even if life looks bleak, we have some energy to deal with the day ahead. I know that when I have slept badly or not slept enough for days on end (e. g., after a transatlantic journey or after attending a birth) I can feel mentally foggy, emotionally irritable and generally exhausted. I can then develop a physical symptom--typically a headache--if I am unable to rest at this point.

This is an ordinary sort of tiredness which can be dealt with fairly easily by taking a nap or going to bed early, although it takes two to three weeks for your internal body clock to fully catch up on a sleep deficit or to adapt to a new schedule. Meanwhile, it is possible to carry on working in spite of feeling like everything is a bit of an effort.

Many increase their caffeine intake at this point. Unfortunately, caffeine simply masks tiredness (as aspirin masks pain). It is useful as a stopgap but you should not rely on it, especially if other people's lives are dependent on your staying awake.

Using tea or coffee or colas to stay awake can mess with our appetites ... we miss meals (especially the hallowed breakfast), or cram in junk foods at erratic times (especially sugar, fat and salt), or eat too much too late in the day. This puts our adrenal glands under more stress which in turn can create a state of exhaustion where rest and sleep are no longer refreshing ... or easy.

Those who keep on going may only stop when an acute illness like a flu knocks at their door. It is a shame to have to take a break because of illness--it is so much nicer to enjoy time off when you aren't sick!

People with chronic exhaustion develop disturbed sleeping patterns which add to their fatigue and which can be hard to change. Maddeningly, they can find it difficult to sleep once their nervous systems become exhausted because relaxing is so hard. They can't switch off at night and/or they wake in the night and can't get back to sleep, or they sleep lightly and restlessly or suffer from sleep apnea or restless legs. Whatever their pattern, sleep is no longer refreshing and they wake tired in the morning.

Those who work shifts are more vulnerable to sleep disturbances as are those who are waking several times a night to feed infants or care for sick children or relatives. These people can end up feeling like they are in a constant state of jetlag, a sort of biological vacuum of fatigue. This kind of build-up of tiredness can lead to an increased susceptibility to both acute and chronic disease.

Catching Cat Naps

In the meantime, the only real cure for sleepiness is sleep and if you can't sleep at night then you might benefit from an afternoon siesta--predictably re-labelled "the power nap" in the 1990s, this has become something you "do" and as quickly as possible, so that guess what? ... You can get back to work as quickly as possible! And indeed some people are proficient nappers--falling asleep easily and feeling refreshed after even a couple of minutes of shuteye! Others need something more substantial to recharge their batteries.

A short daytime sleep or nap can be enormously energizing: alertness, productivity and even creativity are all increased in the short term. The ideal length of time for a nap is 15-30 minutes--a longer daytime sleep can cause grogginess. The best time to nap is 8 hours after waking and 8 hours before going to bed to fit in with our natural energy cycles ... our body temperature dips around this time and people often feel tired when this happens.

I asked my friend why she wasn't sleeping. She said she thought the surgery had affected her badly, her body ached all over. She was lying awake for hours and felt desperately sleepy but just couldn't get to sleep. I asked how she was feeling generally and she said fine, or rather she did feel tired of course, and would be fine if only she could

get some sleep ... and wasn't there a remedy that could help?

One Remedy

It was at this point that I took a deep breath and wished that we had specific remedies for specific symptoms. Wouldn't it be great if we had one insomnia remedy, one headache remedy, one allergy remedy? And then again, I guess that would put me out of a job!

Over the two hundred years that homeopathy has been around, homeopaths have repeatedly attempted to simplify the art of selecting a remedy, especially for acute illnesses. Combining remedies is the favorite way to do this (see Homeopathy Today, May 1998, "All Mixed Up," page 4). I guess I could have guided my friend to one of these combination remedies and made my life--and hers--easier ... but something about the tone in her voice made me want to ask more about what had happened at the time of the surgery. That question led to a couple more which showed me clearly and beautifully what she needed in order to heal her whole person.

She had had an investigative procedure which had been unexpectedly painful. I asked her how it had affected her and she said that the surgeon had been rather rough and unsympathetic. She admitted to feeling angry that he hadn't warned her how unpleasant it might be. She said the scar was still painful and was especially sensitive to touch. I asked her what was going through her mind as she lay in bed at night unable to sleep and she laughed. She said rather sheepishly that she couldn't stop thinking about what had happened and was having angry conversations in her head with the surgeon and every other medical professional who had ever treated her badly or hurt her.

Three-legged Stools

Before we go any further I want to share with you one of my favorite ways of selecting a remedy in an acute complaint: that of the three-legged stool. For a (real!) stool to be well-balanced and useful as a piece of furniture--one you can sit on reliably--it must have at least three sturdy, separate legs.

For an acute remedy to be useful and effective, it should have at least three sturdy, separate legs--with each leg representing one or more strong symptoms from a different "part" of the body.

One leg should describe the strong symptoms or characteristic features of the insomnia itself (e. g., whether you are unable to get to sleep or you wake frequently in the night or can't wake in the morning, etc.) This leg can also include any accompanying--or concomitant--symptoms (e. g., restless legs, headache, exhaustion, etc.)

One leg should describe the cause of the insomnia, in other words, any stress factors. What was happening in your life around the time it started? Are you sleeping poorly because of mental strain: too much studying leading up to an exam or too much desk work in order to meet a writing deadline? Is it because of emotional stress: the loss of someone or something dear to you or a huge disappointment or too much excitement? Is it because of physical stress: convalescing from an acute illness or several weeks of broken nights because of a sick child?

One leg needs to describe your feelings or emotional state. Since the advent of the stress or stresses and accompanying insomnia, how have you been feeling in yourself? Have you been more irritable than usual or mildly depressed or spaced out or ... ?

We can add a fourth leg and include any strong general symptoms (responses to weather/temperature, appetite, thirst, etc.) and make this stool one that will not tip over no matter how hard you rock it!

One- or Two-legged Stools

Some home prescribers often make the mistake of selecting a remedy based on only a couple of symptoms. If the symptoms belong to one area alone (i. e., there are two strong symptoms relating to the insomnia and no symptoms relating to the mental state, the cause or the general state) then there may be only one leg to the poor stool! One or two legs are usually not enough to be confident that an acute homeopathic remedy is going to help ... to hold up as it were!

It can be hard to see your own "legs" ... even the most observant of folk can be understandably dim-witted about their own symptoms, so get someone else to help you sort out what is sturdy and what is rickety in terms of your own legs if you are having difficulty choosing a remedy because you can't sleep!

A Sturdy Three-legged Stool

So ... what did my friend's three-legged stool look like? One leg was the insomnia with sleepiness and the aching in the body. One leg was plainly the injury from surgery with the painful scar that was sensitive to touch. The third leg was the internalized hurt and the feelings of resentment (or unexpressed anger) that were churning around in her mind at night preventing her from sleeping. Together these legs made a strong three-legged stool of Staphysagria.

I suggested she take a single dose of Staphysagria 200C, and she felt better in herself almost immediately although very tired (a sensible and necessary response). And her sleep improved over the following week. She wrote a letter to the surgeon that was true to her experience without alienating him with her anger. She made a reasonable request for an apology, which she duly received and was able to heal some more.

Had she taken an over-the-counter "insomnia remedy" combination, she might have slept better for a while but her overall state would probably have remained the same and the insomnia would probably have kept returning until she got the healing she really needed. Staphysagria healed the emotional as well as the physical wound and allowed her vital force to recover its former sturdiness. There really is nothing quite like healing that takes the whole person into account--and includes all their legs!

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My Favorite Acute Insomnia Remedies

You can treat yourself for simple, acute insomnia, as long as it is truly acute and hasn't been lingering on as a chronic complaint over many months or years ... in which case you need a professional homeopath to work out a constitutional remedy that takes all of you into account.

If you are caught up in a vicious cycle of not being able to rest or sleep deeply because your sleep has been broken or disturbed recently, then one of these remedies might ease you back into a healthy sleep pattern. The following are brief highlights to act as reminders. Each remedy has a much bigger symptom profile than shown here and you will find it helpful to check them out in one of the home prescribing books or Materia Medica before choosing one for yourself or someone close to you who can't sleep.

Calcarea phosphorica
Cause: convalescence (insomnia after an illness), growth spurts in children
(who become tired and have difficulty sleeping.)
Symptoms: difficulty getting to sleep before midnight, feels tired on waking even after sleeping later than usual, tension in neck and shoulders makes relaxing difficult.
State: restless and sluggish; discontented and complains constantly.

China
Cause: loss of fluids (sweating, vomiting, diarrhoea or even breastfeeding); tea.
Symptoms: insomnia with restless sleep.
State: tired and irritable and more sensitive than usual to noise.

Cocculus
Cause: loss of sleep from nursing the sick or breastfeeding, long distance travel, etc.
Symptoms: insomnia with dizziness and headache, sleep is restless and unrefreshing, with anxious dreams or even nightmares.
State: generally anxious; especially anxious about others if caring for the sick, feels spaced out--dazed and confused.

Coffea
Cause: over-excitement or too much caffeine.
Symptoms: difficulty getting to sleep because of an overactive mind, can't switch off and then sleep is light and full of vivid dreams.
State: excessively cheerful and even euphoric, mind races with ideas and thoughts that whir around uncontrollably.

Gelsemium
Cause: bad news; anticipatory anxiety (exam or interview nerves, fear of public speaking, etc.).
Symptoms: dull and sleepy but cannot sleep.
State: extremely anxious, trembly and cannot gather thoughts ... feels dull and confused.

Ignatia
Cause: loss, grief, emotional shock, disappointment, homesickness.
Symptoms: insomnia with busy dreams.
State: they suffer alone, they don't want comforting after a loss but holding their feelings in causes a feeling of a lump in the throat or constriction in the chest.

Kali phosphoricum
Cause: nervous strain, over-excitement or too much mental work and/or study.
Symptoms: empty feeling in the pit of the stomach.
State: mildly depressed and has difficulty concentrating.

Nitric acid
Cause: broken sleep from shift work (including nursing infants/the sick).
Symptoms: sleepless until the early hours (typically around 2 a. m.) and then wakes feeling tired; many anxious dreams.
State: extremely irritable, anxious about their health, sensitive to noise.

Nux vomica
Cause: overwork, mental strain (from overwork/study/exams, etc.); caffeine, sedentary lifestyle.
Symptoms: can't get to sleep easily in spite of feeling tired, wakes around 3 a. m. and can't get back to sleep, drifts off into a deep sleep just before the alarm goes off and wakes feeling tense and exhausted.

State: tense and highly strung, impatient and easily offended, angry over trifles.

Phosphoric acid
Cause: mental strain (from overwork/study/exams, etc.); disappointment; convalescence; loss of fluids.
Symptoms: wakes frequently and then can't fall asleep after midnight; sleep is unrefreshing.
State: deeply apathetic ... indifferent to everything; sluggish and uncommunicative (doesn't want to talk).

Staphysagria
Cause: resentment (with suppressed hurt and anger); injury/surgery.
Symptoms: sleepy all day and sleepless at night, body aches all over.
State: touchy and easily offended, they say nothing but boil inside with hurt feelings and angry thoughts that keep them awake at night.

Zincum metallicum
Cause: mental strain (from overwork/study/exams, etc.).
Symptoms: sleep is light and unrefreshing, restless legs jerk as they fall asleep and wake them up each time.
State: tense and depressed and sensitive to noise.

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Deep Sleep Reminders

• Plan on a minimum of eight hours sleep.
• Decide on a reasonable time to go to sleep and stick to it ... even on the weekends.
• Go to bed when you begin to feel tired rather than missing that moment and getting a second wind.
• Make sure your bedroom isn't too hot or too cold, has a good supply of fresh air and isn't too noisy (wear ear plugs if it is).
• Make sure your mattress is firm enough to support you without being too hard and making you sore (this will cause you to wake more frequently and make deep sleep difficult).
• Make sure your bedding isn't too heavy (or too light).
• Take some evening exercise, especially if you are sedentary during the day ... but take it 3 hours before going to bed or earlier as it can be too energizing if taken late in the evening.
• Avoid caffeine in any form (coffee, tea, cola) after midday--or altogether if you know you are sensitive to it.
• Eat your evening meal at least 3 hours before going to bed.
• Have a bath or shower only if you know that it is relaxing for you (some people find it wakes them up!)
• Don't watch TV in bed.
• Don't take work to bed with you ... make your bedroom a haven where you go to relax and rest ... and sleep.
• Take a hot drink (no caffeine or alcohol) to bed with you or a glass of milk.
• Take a book (not too exciting and not work-related) to bed or listen to music for a half hour or so or until you feel sleepy.
• Don't TRY to sleep--allow yourself to relax, imagine your body is heavy and warm and breathe evenly.
• Pick a simple prayer or a favorite or meaningful and relaxing saying and let the words run through your mind over and over without paying any special attention to them.
• Run through your day backwards starting with the present--many people find they fall asleep before they reach the morning.
• Write down any worries or persistent thoughts, especially if they are stopping you from sleeping ... getting them off your mind can be really helpful.
• Writing in a journal last thing at night can help you unwind and relax.
• If you still can't sleep and you haven't eaten for more than three hours then get a light snack and a drink and go through your bedtime routine again.
• If you wake in the night and can't get back to sleep then get up and putter about: make a hot drink and take it back to bed with a boring book until your next natural sleep cycle comes along (up to two hours later).
• Try an herbal tincture (one that contains passiflora, valeriana, hops and/or humulus) as a stopgap ... they can be helpful for those who find it difficult to fall asleep.
• Try one of the remedies in this article if your insomnia is fairly recent. If you have a history of insomnia it is wise to consult a professional homeopath who can treat the whole person and not just your sleeping problems.
• Ask your doctor to refer you to a sleep clinic if nothing has worked.

National Sleep Foundation
729 15th Street NW, 4th floor Washington, DC 20005
(202) 347-3471
www.sleepfoundation.org

First published in Homeopathy Today in 1998

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