Massage Therapy for Insomnia

Insomnia is a common sleep disorder characterized by difficulty falling asleep, staying asleep, or going back to sleep. This results in poor sleep quality and can lead to daytime impairment and distress. For many people, it’s common to experience short-term insomnia at some point in their lives, which can last for a few days or weeks. But for others, insomnia can become chronic, lasting for months or more. 

Most adults need 7 to 9 hours of sleep a night. If the body does not get enough sleep, it will lack the energy and ability to function completely and optimally. This can compromise things like the immune system, physical performance, cognition, hormonal balance, mood swings, and more — virtually all aspects of the human body. 

Causes of Insomnia

Insomnia is often associated with what western medicine refers to as the circadian rhythm. Also called the biological clock, the circadian rhythm is the series of physiological changes an organism experiences over a 24-hour cycle. The biggest influence on the circadian rhythm is light intake, followed by diet, stress, physical activity, temperature, and social environment. 

For example, things that may interfere with the circadian rhythm include:

• Not getting enough daylight during the day 
• Thinking about life concerns that keep the mind up at night
• Bedtime habits that prevent the body from relaxing before trying to sleep (such as working, eating, watching screens, etc.)
• Consuming any food, medication, or substances that contain stimulants (like caffeine) too late or too early in the day
• Medical conditions that cause pain or disrupt sleeping (such as sleep apnea, which inhibits breathing)

Insomnia is one of the most common symptoms of an irregular circadian rhythm. It is a natural consequence of an offset biological clock, reflecting the body’s inability to relax at appropriate times of the day. If the circadian rhythm is offset for an extended amount of time, it will result in negative health effects that may eventually compound into more serious health conditions later on. 

Treating Insomnia

In western medicine, there are two primary ways to treat insomnia: prescription medication, or cognitive behavioral therapy (CBT).

Prescription sleeping pills can help the body fall asleep and stay asleep, but generally doctors do not recommend relying on them for more than a few weeks, as they often come with negative side effects, such as cognitive or physical impairment. 

Alternatively, behavioral therapy, which is usually recommended as the first treatment for insomnia, involves developing habitual strategies to control or stop thoughts and actions that keep the mind awake. This includes stimulus control therapy (which helps associate the bed with sleep, specifically), light therapy, nutrition therapy, and sleep restriction (restricting naps). Some doctors may also prescribe certain relaxation methods, such as breathing exercises, meditation, or massage therapy. 

TCM and Insomnia

Traditional Chinese Medicine (TCM) approaches the causes and treatments for insomnia from a holistic perspective, focusing on the balance of the body's energy (Qi), blood, and organs. TCM recognises different types of insomnia, each with its unique set of causes and symptoms. Depending on the diagnosed type of insomnia, TCM will utilize a combination of herbal medicine, massage, acupuncture, dietary adjustments, and lifestyle modifications. 

From a TCM perspective, insomnia is heavily associated with stress and anxiety, which can correlate with certain organs and their meridians. Here are a few examples of the energetic causes of insomnia, according to TCM:

• Kidney Yin Deficiency. The health of the kidneys reflect the quality of energy, youth, and vitality in the body. A deficiency of yin energy in the kidneys can contribute to insomnia. 
• Heart Disharmony. The heart is affected by all emotions. Both deficiency or excess in the heart may contribute to insomnia by affecting its synergy with other organs. 
• Liver Stagnation and Deficiency. The liver is strongly affected by stress and frustration. Frequent stress can stagnate the liver energy, which can cause insomnia. Deficiency of liver blood can also be a cause.

Massage for Insomnia

Massage therapy can be an effective complementary treatment for insomnia, with no contraindications. However, for the best treatment, it is recommended to use all and any strategies to specifically promote relaxation. 

In the massage room, this can include using a combination of soft lighting, soothing music, and temperate heating. During the intake, using rhetoric that emphasizes thoughts of positivity and healing may also help promote the healing process on a psychological level by directing the mind away from current stressors. For the massage itself, techniques that are generally calming (rather than vigorous or energizing) should be prioritized. 

Overall, any general relaxation massage will help treat insomnia. However, by identifying the organs involved with insomnia, according to TCM, certain acupressure points can be integrated into the massage pattern, thus improving the effectiveness of the treatment. Here are some acupressure points that can help insomnia, taken from “Acupuncture Points Handbook” by Deborah Bleecker: 

Head

• Du 20. Top of the head, aligned with top of ears. (p.71)
• Si Shen Cong – Four Alert Spirit. A group of four points located one finger (1 cun) away from Du 20 in each direction. (p.247)
• Yin Tang – Hall of Impression, or Spirit Gate. Midway between medial ends of eyebrows. (p.251)
• An Mian – Peaceful Sleep. Calms the spirit. Treats insomnia. Located 1 finger behind the earlobe. (p.236)

Hands

• Heart 7. Important point for calming the body. Located in the ulnar side (little flinger) wrist crease, on the later side of the tendon. (p.103)
• Heart 8. Between fourth and fifth metacarpal bones, where the little finger can touch the palm. (p.104)
• Pericardium 6 – The Insomnia Point. “Acupressure done with a magnetic pellet is very effective to treat insomnia. Just place the magnetic pellet on the point an hour or so before bed, and take it off in the morning. It will help you get to sleep and stay asleep all night.” Located 2 fingers (2 cun) above the wrist crease, between the tendons in the midline of forearm. (p. 159).
• Pericardium 7. In the middle of the wrist crease, between the tendons. (p.161)

Feet

• Kidney 1. Sole of foot in center depression when the foot is flexed. (p.106)
• Kidney 3. The “most important point of the Kidney”. Treats insomnia due to kidney weakness. Located in the depression in midpoint between the medial ankle bone and back of leg. (p.107)
• Kidney 6. Major point for insomnia. Located in depression directly below ankle bone. (p.111)
• Spleen 6. A multifunctional point that regulates and strengthens the Spleen, Stomach, Kidneys, and Liver. Very calming and treats the underlying cause of insomnia. Located 3-4 fingers (3 cun) above the tip of the medial ankle bone. (p.189)
• Liver 2. Major point that treats stress and excess liver energy. Located between the big toe and second toe, in the web margin. (p.137)
• Liver 3. Relieves stress and anger. Very relaxing. Slightly above the web of Liver 2. (p.139)

Back

• Bladder 15. On back erectors, between T5 and T6. (p.42)

References

Insomnia. https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167

The beneficial effects of massage therapy for insomnia in postmenopausal women. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521661/

Circadian Rhythms. https://www.nigms.nih.gov/education/fact-sheets/Pages/circadian-rhythms.aspx#:~:text=Study%20Circadian%20Rhythms-,What%20Are%20Circadian%20Rhythms%3F,and%20temperature%20also%20affect%20them.

Circadian Rhythm Sleep Disorders. https://my.clevelandclinic.org/health/diseases/12115-circadian-rhythm-disorders

The Different Types of Insomnia in Chinese Medicine. https://healthinflow.com.au/the-different-types-of-insomnia-in-chinese-medicine/

The effect of classical foot massage on insomnia and anxiety in preeclamptic pregnant women: a randomized controlled study. https://pubmed.ncbi.nlm.nih.gov/38422316/ 

Massage Therapy Can Help Improve Sleep. amtamassage.org/about/position-statements/massage-therapy-can-help-improve-sleep/

New Research Continues to Support Massage for Improving Sleep Quality. amtamassage.org/about/news/massage-for-sleep-research/

Randomized control trial evidence for the benefits of massage and relaxation therapy on sleep in cancer survivors—a systematic review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448699/

Sleep Toolkit: Tools for Optimizing Sleep & Sleep-Wake Timing | Huberman Lab Podcast #84. https://www.youtube.com/watch?v=h2aWYjSA1Jc