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

Natural Therapies for Insomnia

Natural Therapies for Insomnia
Acupuncture & Herbs
Massage Therapy
Energy Healing
Meditation / QiGong
Essential Oils & Ear Reflexology

Sleep disorders plague millions of Americans and can be attributed to a variety of causes. Perhaps the main cause of insomnia and restless sleep is the whirlwind pace that most modern people live with day in and day out. Our society emphasizes ‘doing’ much more than ‘being’.

From the perspective of acupuncture, the yin aspect of life is quite depleted for the average modern American.  [

In case you have never heard of yin and yang, these are the polar forces that are reflected in everything in the natural world. Yin is related to stillness, tranquility, and contemplation. Yang is related to movement, accomplishment, and function. We need yin and yang to be in balance within ourselves in order to experience true health and wellbeing.

When we are yin deficient, we easily become restless, irritable, and excessively busy. Our ability to rest and restore is compromised, as we never seem to get a break from the constant activity in our minds and our lives.

This is one of the main dilemmas that we face in terms of experiencing deep states of continuous sleep. We have forgotten how to turn our minds off due to the frantic speed of everything around us and we have become yin deficient.

The common word is stress, but there is a lot more to this picture than is implied. Another way to look at this is that the sympathetic nervous system is on overdrive. We are stuck in fight or flight mode, as we are trying to keep up with our hectic schedules and myriad responsibilities. We have excessive amounts of cortisol and adrenaline in our systems, which keep us feeling amped up and unable to rest.

With the pattern of yin deficiency and a hyperactive sympathetic nervous system, we often feel too warm, excessively thirsty, dried out, and anxious. This pattern is extremely common in menopausal women. Due to the fact that we are in fight or flight, we sometimes can’t tell if we are tired. We often feel wired or manic. Yet other times a deep-seated exhaustion is felt that penetrates into our bones.

There are many other factors that contribute to insomnia, but this is the primary issue that many people are facing. Other potential inputs are nutritional imbalances, suppressed emotions, relationship troubles, hormonal imbalances, and energetic imbalances.

Let’s take a look at a few of the top natural treatment options for insomnia:

1) Acupuncture: All of the major organs of the body are related to specific kinds of insomnia. For instance, there is a liver/gall bladder insomnia in which one is kept awake strategizing, planning and scheduling their lives at night. This person often can’t turn their minds off unless they read or watch TV before bed. Likewise, there are kidney, heart, lung and spleen forms of insomnia that all have specific manifestations. Acupuncture is an excellent treatment option for insomnia, regardless of its etiology.

For chronic insomnia, we generally recommend receiving acupuncture once a week for 4-6 weeks, then we can assess for progress. Acupuncture helps to restore balance to the central nervous system and harmonize Qi, the functional energy that underlies our general state of health. Qi can either become stagnant, meaning that too much energy is locked up in a certain area or organ, or it can become deficient, meaning that there is not enough energy in an area or organ. Either pattern can cause insomnia and both are treatable with acupuncture.

2) Herbs: There are many Chinese and Western herbs that can be very helpful for insomnia. Chinese herbs are typically used in combination to create formulas that treat specific patterns of disharmony. Western herbs are frequently used on their own. The great thing about herbs is that they don’t cause the drowsiness and disorientation that many of the Western sedative drugs do. Here is a great list, and our Acupuncturist can help you make an appropriate selection.

·         Valerian: Has mild sedative properties that help to relax the nervous system and calm the mind.

·         Chamomile: Has a mild tranquilizing and calming effect that soothes all major systems of the body.

·         Kava: A highly prized medicinal that is used to alleviate anxiety and induce deeper sleeping patterns. Kava is contraindicated for those with Liver disease.

·         Gui pi tang: A Chinese formula that nourishes the heart and spleen, for insomnia with low energy, nightmares, anxiety, depression, and possibly night sweats.

·         Tian wan bu xin dan: A Chinese formula that balances the relationship between the heart and kidneys, for symptoms such as insomnia, low back pain, anxiety, feeling of heat, thirst, and night sweats.

·         Suan zao ren tang: A Chinese formula that nourishes the heart and liver, for insomnia irritability.

·         An mian pian: A Chinese formula translated as peaceful sleep, for insomnia due to heart blood deficiency.

3) Massage Therapy:  This is the ultimate way of teaching our body how to go into a deeply relaxed state.  Through massage, our muscles relax, circulation flows smoothly, and our mind quiets.  For insomnia, we recommend getting a massage once per week for 5-8 weeks to start making full relaxation a welcome change. We like to reassess at this point to see if continued  weekly massage is still needed, or changing the frequency to a massage every 2-4 weeks would be of better benefit.  The goal is to re-train the body to attain and maintain a state of pure relaxation and great sleep on its own.

4) Energy Healing:  Many people find light touch/no touch energy healing helps them to reach a mind state that is so relaxed it becomes a mentally transformed experience.  In this altered state, it can feel like floating, energetic sensations throughout the body or in focused areas, and simultaneously being in a deep sleep while being aware of not being asleep.  Medical QiGong Energy Healing uses the same energy pathways as acupuncture, and externally re-balances energy (Qi) flow to assist in healing symptoms.

5) Meditation and QiGong: Meditation – either still or gently moving like QiGong, is a deeply restorative practice and can replicate many of the benefits of sleep. In fact, meditation is often considered to be even more beneficial because it can lead to a state of non-thought, which is said by many spiritual traditions to be the deepest state of relaxation and healing possible for human beings. In sleep, our minds are still processing and dreaming. Spend 15 minutes before bed meditating and it will quite likely allow you to fall asleep faster and to sleep more peacefully. Not sure how to do this? We can teach you, and there are many excellent guided meditations.

6) See our YouTube video on Essential Oil and Ear Reflexology for Insomnia. Click the image to access the video.

Insomnia - Essential Oils and Ear Reflexology

Q:  What kind of essential oils and things can I use for insomnia?

A:  First, let’s look at insomnia energetically in terms of Yin and Yang.

The light side is Yang, and the dark side is Yin.  Yin is very quiet, calm, peaceful, and Yang is awake, alive, active.  With insomnia, you get into a place where these are supposed to change into each other, and the Yang is having a problem transforming into the Yin.

All the Yang activity in the body is having a hard time changing and transforming into the quiet Yin aspect. The ability to attain and maintain a state of Yin is our goal for treatment purposes.

There are a number of different things that can be the root of insomnia, however that’s more detail than we’re going to get into here.  Let’s look at some things that we can definitely try that will work in many cases.

Step #1 is to look for some essential oils that tonify (strengthen) Yin. Remember, Yin is the cooling, calm, peaceful state that we want. Five oils that are fairly common that we can use are:

• Sage
• Spikenard
• Coriander
• Lavender
• German Chamomile

We can use one single oil above, or blend 2-3 together. Of course, there are other oils that will work, but these five are fairly easy to find on the market. See if you have one or more of these oils on hand.

Once we have the oil(s) ready, we’ll dilute them down into some carrier oil. Then there are specific areas of the body that we can apply them to.

Spikenard is a super relaxing oil, and if you use this in massage, you may want to have somebody just sit for a little while afterward so they don’t have to drive immediately.

Coriander is another one that’s a very calming, cooling oil. In the video I chose to use Coriander and Lavender together. They smell beautiful and really give us a nice, relaxing blend.

DILUTING THE ESSENTIAL OILS

For single use, which is a very small amount to use right now, place 1/2 tsp of carrier oil in a small bowl, and then add 2 drops of Coriander plus 2 drops of Lavender.  This is a total of 4 drops essential oil for a one-time use which is strong.

To make a larger 1-oz. blend to use on a more regular basis, use 1-oz. carrier oil and add 20 to 24 drops total of essential oils.

After mixing up the diluted essential oils, we’re going to apply it on the body as follows:

Apply to the inner wrist on both arms.  There are several acupoints in this area that calm and quiet the Heart. (Pericardium-6 and 7,and Heart-4 to7)

Next, apply the oil around the ankle area, focusing on the top of the ankle joint area and the inner ankles. (Stomach-41, Liver-4, Spleen-5, Kidney-3)

If you are a Massage Therapist and you want to add this into a treatment, or maybe you want to do this at home on your family member, apply in this order:

-       inner wrists

-       inner ankles and top of the ankles

-       then do a nice application on the back, especially along the spine

-       end with an entire 10-15 minute foot massage

It will be really hard for somebody to stay awake after this!

If you’d like, follow the video here for a visual demonstration of the ear acupressure massage.  You can do this on yourself or on somebody else.

Ear reflexology, also called Auricular Therapy when done with acupuncture, is a powerful technique. We use this extensively in the acupuncture clinic because it works amazingly well. Instead of needles you can also use your hand to do acupressure on the same areas.

There are more than 100 acupoints on our ear. We’re going to use some special points on the ear beneficial for insomnia. See below for Insomnia area 1, Insomnia area 2, the Tranquilizer point area, and the whole ear lobe.

This is Insomnia area 1, towards the rim  and slightly above the lobe.  I generally use this area when someone can’t sleep because they are thinking too much.

This is Insomnia area 2, just over half way up the area just inside the rim.  I generally use this area when someone can’t sleep and they toss and turn or move around a lot, or if there is any kind of agitation involved.

This is the Tranquilizer point area.  It is very calming.

You can choose to focus on one area, but it won’t hurt to massage all of them.

We’re also going to use the entire earlobe where many points correspond to the face and the head, the whole brain area, and it’s extremely calming to the head.

HOW TO DO THE EAR MASSAGE

You can massage both ears together, or one at a time – whichever is more comfortable for you. This massage can be done to someone else, or to yourself.

Apply a small amount of the diluted essential oil blend to your fingers.

Start by just squeezing the lobe and then gently squeezing up around the whole ear, including the inside.

Stop and incorporate the Insomnia areas and the Tranquilizer point.  You can focus on these by rubbing or pressing them about 24 times each.  Be sure to use gentle pressure that is relaxing.

Continue to massage the entire ear, coming back to the 4 special areas several times.

This massage should last 2-5 minutes.

QIGONG EXERCISE – JOINING FIRE AND WATER

In order to help change Yang (active) into Yin (peaceful), try the following QiGong exercise.  This is great to do either right before bed, or you can also do it even while you’re in bed.

Focus on breathing to your Dan Tian – the area below your navel – is very calming and helps to strengthen the Yin aspect.

Slowly, gently, move with your breath.

Inhale and guide your hands up.  This brings Water energy from the Dan Tian up to the Heart Center.

Exhale and guide your hands back down.  This calms the Yang energy down and settles it.

Continue to inhale up. Exhale down. Just keep on moving with your own rhythm, your own breath.

Do this anywhere from 8 to 24 times, and if it feels really good, up to 5 minutes.

Have a good night.

Featuring Essential Oil and Oriental Medicine Instructor, Cynthia McMullen, LMT, MQT, SM

Cynthia's Top 10 List for Insomnia

Sleep is so incredibly important to our health in ways that we often forget. Good sleep helps us lose weight, improves our creativity, and even lifts our mood. Because the lack of quality sleep is such a common complaint, I would like to offer my top 10 suggestions for insomnia. None of these have any bizarre or undesirable side effects like many of the medications prescribed, and they all help your body get back to doing what it's naturally supposed to do, sleep like a baby:

1. Massage Therapy - on a regular basis if needed. Once a week for 2 months can work wonders to re-train your body into a relaxed state that can be maintained.


2. Meditation - the slow, deep abdominal breathing and gentle calming of the mind quiets the heart and preps the spirit for good sleep.


3. Self Acupressure - first, use your middle and index fingers to rub the area at the bottom and behind your ears. Second, massage your inner wrist crease at the indentation on your pinky side. Third, massage along your shin bone from your inner ankle, up about 4 inches and back down. Last, rub the bottom of your feet with special attention to the area just under the ball of your foot and also the middle of your heel. Spend 1-5 minutes on each of the above areas just before you go to sleep.


4. Essential Oils - Try Lavender, Rose, Vetiver, or Sandalwood. Either use topically by diluting them in a carrier oil or lotion and applying to the above acupressure areas, or diffuse them into the air by adding about 4-5 drops to a bowl next to your bed, then fill with boiling water.


5. QiQong or Yoga Practice - both of these mind-body exercises are excellent to smooth your energy and make you more aware of unhealthy responses to stress you may have. The breathing involved, like in meditation, gives you a different response to that stress.


6. Valerian Tea or Tincture - Valerian is a strongly relaxing herb that can even be used for anxiety attacks. Drink a cup of tea or put several tincture drops in water and drink just before going to bed, but don't use it for more than about 2 months. If too much valerian builds up in your system it can cause anxiety or nervous symptoms instead of relieving them.


7. "Body Like Jello" Relaxation - Go through each bodypart head to foot and focus on it while saying, for example "I feel my right arm. Release and relax. My right arm is so relaxed it feels like jello." Your mind is actually strong enough to evoke this physical response in your body.


8. Chinese Herbs - these formulas are very individual. Consult a professional herbalist or acupuncturist for a formula appropriate for you.


9. Hot Foot Bath - get a home foot bath/spa, fill it up with hot water, add 4 drops of Lavender essential oil, and turn it on. If you have the time, a full body hot bath works great too.


10. Just Turn It Off! - make the decision and follow through with just turning off your TV or computer. It's a choice and you're in charge.

Learn more about these topics from our On-Line Courses. You can study here at our school in Alaska from anywhere in the world!

ALASKA INSTITUTE OF ORIENTAL MEDICINE
ON-LINE COURSES