How to Treat Insomnia and Improve Sleep Quality

Good sleep is crucial for health, yet poor sleep quality is widespread in modern society. Many physical and mental illnesses are associated with poor sleep, and poor sleep in turn worsens those illnesses, creating a vicious cycle.

Improving sleep quality is very important, and cultivating good sleep habits is the top priority. Before resorting to medication for insomnia, we should first reflect on whether we have bad habits that account for our poor sleep.

Using the phone before bed is a common failing today. Sometimes when I open WeChat Moments at seven in the morning, I see people posting moments from five, six, or seven hours earlier—meaning they were still on their phones at midnight or even one or two in the morning. This badly affects sleep; staying away from computers and phones for two hours before bed greatly improves sleep.

I myself previously set my phone's screen-use downtime from 9 p.m. to 6 a.m., and have now changed it to 6 p.m. to 7 a.m. During these 13 hours I put all phone apps in silent mode, keeping only the call function, so that family can reach me in an emergency. The morning and evening hours are for reading.

My wife also used to sleep poorly and had anxiety, needing medication to fall asleep. Later I forcibly took her phone away after 8 p.m. and placed it, together with mine, far from the bed. I then had her spend the pre-sleep period reading a paper book. With only this adjustment, her sleep improved greatly; she needed no medication and now gets more than seven hours' sleep each night.

Reading a paper book before bed helps sleep a great deal, and the duller the book, the more it helps. Reading romance, wuxia, science fiction, or detective novels may excite the brain, but reading purely theoretical works makes sleep come easily. Before bed I often read bulky purely theoretical tomes such as Practical Internal Medicine, TCM Internal Medicine, and The Biology of Cancer, and I fall asleep while reading. I usually fall asleep before 9 p.m. and now sleep until around 5 a.m., getting eight hours each night.

Some people like to drink alcohol at dinner to aid sleep; although this does help, it does more harm, and once dependent on alcohol, the risk of cancer and cerebrovascular disease rises sharply. Whether baijiu or wine, the harms outweigh the benefits even in tiny amounts, which is why WHO promotes smoking cessation and alcohol restriction. Drinking tea or coffee before bed is not only unhelpful but harmful. Of course, a few people may find tea or coffee helps them sleep; I myself am such a case—coffee, day or night, makes my brain groggy so that I can do nothing but sleep. But the sleep quality is not high, so tea and coffee before bed are not recommended.

People who do not exercise may still sleep poorly even after taking the above measures; they should then gradually increase exercise. Moderate daily exercise is good for sleep. I usually exercise in the afternoon; if I skip exercise for two or three days, my sleep quality drops noticeably. But excessive fatigue also disturbs sleep, because muscle soreness after overexertion leads to poor sleep.

Some people listen to soft music before bed, others do gentle exercise or practice qigong; all help sleep. The above measures work for most normal people. Every medicine has some toxicity; when sleep can be relieved without drugs, one should avoid relying on medication.

People with mental disorders (such as anxiety, depression, obsessive-compulsive disorder, and phobias) can hardly control their behavior and thus find self-discipline hard and cannot change their pre-sleep habits. Some physical illnesses also make it hard to fall asleep—for example, patients with gastric ulcer or Sjögren's syndrome. These patients may need some medication to aid sleep; once the condition lightens, they should still adjust pre-sleep habits to get off the drugs.

The TCM formula with the fewest side effects that I have used as a sleep aid is Gancao Dazao Tang (Licorice and Jujube Decoction): 6g Gancao (Radix Glycyrrhizae), 30g Huaixiaomai (unprocessed wheat from the Huai River basin, requiring online purchase), and 3–7 Dazao (Fructus Jujubae), decocted two hours before bed in one and a half bowls of water down to half a bowl and taken orally. Of these, only Gancao is a medicinal; the other two are foods, and the main component of Gancao is also a common food additive. This formula is excellent for calming the spirit and aiding sleep, though it fails for some people. Severe insomnia may add 6–10g Chao Suan Zao Ren (stir-fried Semen Ziziphi Spinosae); raw Suan Zao Ren is alerting, while stir-fried Suan Zao Ren calms the spirit and aids sleep, so raw Suan Zao Ren may be used for those who sleep too much and stir-fried for insomniacs.

Insomnia caused by severe anxiety and depression may warrant the patent medicine Jieyu Anshen Keli (Depression-Relieving, Spirit-Calming Granules). This product combines Gancao Dazao Tang with herbs that soothe the liver and resolve stagnation; it treats insomnia, anxiety, and forgetfulness due to emotional constraint and liver-qi stagnation. It helps with insomnia caused by depression, anxiety disorders, neurosis, and female menopausal syndrome.

Those who are weak with qi and blood deficiency may use Shengmai Yin and Guipi Wan (Spleen-Restoring Pill) and similar patent medicines for insomnia. Combining Shengmai Yin and Guipi Wan has some effect on palpitations and absent-mindedness, sallow complexion, weakness, fatigue, overthinking, insomnia, and profuse dreaming, and can improve the patient's constitution and blood counts.

For insomnia accompanied by dry mouth and tongue, constipation, vexing heat, and even epistaxis, five-palm heat, hair loss, and alopecia areata, the patent medicine Erzhi Wan (Two-Sole Pill) works well. But this drug can alter women's menstrual cycles, delaying periods in women previously regular, so women with normal menses should use it cautiously or switch to Baihe Gujin Wan (Lily Bulb Metal-Securing Pill) or Zhibai Dihuang Wan (Anemarrhena-Phellodendron Rehmannia Pill). If periods come early, Erzhi Wan treats both insomnia and early menstruation. Moreover, overdosing on Erzhi Wan causes loose stools, so patients who already have loose stools should take it cautiously or reduce the dose each time.

Chinese medicine holds that when the stomach is unsettled, sleep is restless; digestive diseases often cause insomnia, especially reflux esophagitis and gastric ulcer, which are accompanied by acid reflux, heartburn, stomach pain, bloating, bad breath, and foul stools. Such insomnia requires treating the digestive disease at the root.

Most stomach diseases are caused by Helicobacter pylori infection; if a patient has severe stomach symptoms plus insomnia, one should, while taking spirit-calming sleep aids, also eradicate H. pylori, usually with Western medicine's quadruple therapy.

TCM has many formulas for stomach disease, differentiated into stomach cold, stomach heat, and mixed cold-heat patterns. For stomach heat, mild cases may take dandelion root tea; severe cases consider berberine, Huanglian Jiedu Tang (Coptis Detoxifying Decoction), and related drugs. For stomach cold, consider Liangfu Wan, Banxia Shumi Tang (Pinellia and Broomcorn Decoction), Sijunzi Tang (Four Gentlemen Decoction), Liujun Wan, and Xiangsha Liujun Wan. For mixed cold-heat, use Jiaotai Wan or Wumei Wan (Mume Pill).

Terminal cancer patients who stay awake all night are basically untreatable; opioids combined with sleeping pills may be considered to improve quality of life and relieve suffering.

Besides drugs, gentle full-body massage helps sleep. TCM has an extra-meridian acupoint called Anmian (Peaceful Sleep), located at the midpoint of the line between Yifeng (TE17) and Fengchi (GB20), in the middle of the sternocleidomastoid tendon; deep to it lie the splenius capitis, the occipital artery and vein, and branches of the lesser occipital and great auricular nerves. Massaging this point relieves insomnia, dizziness, headache, palpitations, and psychiatric symptoms; it may also be needled perpendicularly 1–1.5 cun.

More complex sleep disorders should be promptly referred to a physician.