Sleep Links To Blood Pressure - Theory and Acupuncture Treatment of Insomnia and Hypertension

Not getting enough sleep? This is a common problem in many parts of the world, perhaps more so in western developed countries where overwork and lack of rest are often seen as the way to obtain success in your career. Many are aware, at least at a gut level, that poor sleep and lack of sleep are bad for us. And most health care professionals are aware of the many processes in the body related to healing that will not happen unless people have a certain duration and depth of sleep.

Recently published research has shown a strong link between lack of sleep and the risk of developing high blood pressure (1). This research arose from the larger "Coronary Artery Risk Development in Young Adults" (CARDIA) study. The CARDIA researchers are looking at the many risk factors for the development of coronary disease as the need to avoid the long-term health implications of these conditions is crucial. The study found that for each hour of sleep that is deprived there is a 37% increase in the chance of developing hypertension. While all of the mechanisms are not entirely understood from a western perspective, this is a valuable study as sleep is something we have at least some control over. It also points out that in patients with both insomnia and hypertension perhaps treating the insomnia will lead to a natural control of blood pressure thus avoiding unnecessary treatment.

As the mechanisms for this link between lack of sleep and hypertension are not entirely understood by western medicine, I thought an exploration of these two issues from a Chinese Medicine perspective might shed some light. As Chinese Medicine treats patterns and not conditions per se, there are often relationships among a patients conditions and symptoms that make sense within the Traditional Chinese Medicine (TCM) framework yet seem disparate within Western Medical theory. From a patients perspective, this is beneficial as many people have a range of symptoms and would prefer to avoid being medicated for all of them individually - which often leads to medicine interactions and varied side effects which are undesirable.  

Within Chinese Medicine we have the concept of a "root" imbalance, which Western Medicine lacks to varying degrees. The "root" imbalance can be seen as the pattern that is behind the majority of your symptoms or illnesses. The treatment of this pattern, in theory, will resolve the majority of the symptoms that you are experiencing. This instead of treating all symptoms individually. In the case of insomnia and high blood pressure there are a number of related patterns that are worth exploring to see these relationships.

Insomnia in TCM theory is related to the Heart meridian system. The meridian systems which can cause disruptions in the Heart are the Liver (excess stress, anger, fatty goods), the Spleen (excessive thinking, eating quickly/too late at night, overwork, etc.), and the Kidney system (anxiety, fear, overwork, etc.).

With a principle symptom of Insomnia, there are two very common patterns within TCM:

• Kidney Yin Deficiency - Insomnia with difficulty falling asleep a/or waking often along with Yin deficiency signs - heat in the five hearts (hands, feet, chest), palpitations, night sweats, dizziness a/or poor memory. Possibly with KD deficiency signs such as sore lower back a/or knees.
   

• Liver Yang Excess/Liver Fire - Insomnia, usually somewhat chronic, with overall signs of LV Heat - irritability, excessive anger, possibly sub costal pain and/or bitter taste in mouth.

Hypertension in TCM theory has strong relationships to the Liver and Kidney as well.  

with a principle symptom of Hypertension, there are two very common patterns within TCM that match those above for Insomnia:

• Liver Excess with Kidney Deficiency - May have dizziness a/or vertigo, headache, tinnitus, sore back a/or knees, heat in the 5 palms, palpitations, insomnia, dry stools.
   

• Liver Yang Excess - May have dizziness a/or vertigo, distended headache, irritability, bitter taste in the mouth, red eyes, insomnia, constipation.

In general these 4 patterns fall into two basic categories - excess and deficiency. And as you can see from the general signs listed, there are many similarities in the related signs and symptoms between these two conditions. As Chinese Herbal Medicine utilizes the same framework you can see these relationships in herbs as well. In our formula for hypertension, for example, one of the main ingredients is Du Zhong (or Eucommia Bark). Du Zhong is useful for both Liver and Kidney symptoms such as hypertension, low back pain, sore knees... and more.

From all of these relationships you could say not only does lack of sleep contribute to hypertension, but also perhaps to knee pain, low back pain, depression, and many more conditions - and vice versa. While in theory these relationships exist it is less because TCM theory accounts for all possible relationships, but ultimately because our bodies do not exist in isolation. Every action that we perform has an effect and a corresponding reaction. Working ourselves too hard, not resting, eating poorly, being too stressed all have fairly clear repercussions that Chinese Medicine as a whole is well aware of and treats effectively. Western medical studies of this nature serve to validate the TCM views of relationships and to propagate lifestyle interventions that can help many people.

As practitioners we have a responsibility to foster this type of awareness within ourselves and our patients. Our task of performing Chinese Medicine is but one piece of the pie. Sharing information on a level where the general public can begin to take steps to control aspects of their lifestyles and diets which will offer long-term health benefits are important tools for us to offer.

(1) Knutson KL, Van Cauter E, Rathouz PJ, et al. Association between sleep and blood pressure in midlife. The CARDIA sleep study. Arch Intern Med 2009; 169:1055-1061. Abstract .