Sleep Stages & Cycles - Pacific College · 2016-10-14 · Sleep stages 3-Stage N1 (stage 0 & 1): drowsiness (alpha waves 8-12 Hz to theta waves 3-7 Hz): loss of muscle tone & reduced

10/12/16

1

Diagnosis and treatment of

Insomnia based on the

Extraordinary Channelsby

Hamid Montakab M.D.

Sleep Stages & Cycles

10/12/16

2

© Dr. H. Montakab

Sleep stages

© Dr. H. Montakab 3

- Stage N1 (stage 0 & 1): drowsiness (alpha waves 8-12 Hz to theta waves 3-7 Hz): loss of muscle tone & reduced awareness - Stage N2: superficial sleep (fragmented mundane thoughts marked by sleep spindles (12-14 Hz) and K-complexes- Stage N3 (Stage 3 & 4): slow-wave sleep with delta waves 0.5-4 Hz. Represents deep sleep = simply classified as Delta sleep = sleep efficacy (Parasomnia's may occur, sleep walking /sleep talking, night terrors, bedwetting- Paradoxical Sleep: or REM (Rapid Eye Movement) sleep, when dreaming occurs; very active brain with the body virtually immobile (atonia)

© Dr. H. Montakab

Circadian Cycles

© Dr. H. Montakab

• Synchronized internally (25 h.): Extraordinary Vessels• Synchronized externally (24 h.): Light and dark

4

Pineal gland (Melatonin)

Supra Chiasmatic Nucleus

• Optimum sleep time:

10/12/16

3

© Dr. H. Montakab

Sleep Cycles / Dreams


Ultradian cycle:- Sleep cycles are defined by the occurrence of paradoxical(REM) sleep which occurs after a phase of normal non-REMsleep. And usually during a lowered body temperature phase.- Usually REM sleep occurs about 90 minutes after sleeponset and is followed by a short waking stage which allows usto register our dreams, most are forgotten by the sleeperexcept for the last cycle- Paradoxical sleep (dreams) occupy 15-20 minutes of the lastpart of each cycle.

In total dreams represent 20-25% of the overall sleep time.

Energetics of Sleep in Chinese Medicine

10/12/16

4

© Dr. H. Montakab

Normal sleep


- Normally sleep time is adapted to activity- Balance depends on two parameters: time & space (depth/ intensity)

- These parameters, define our basic inherent rhythms, and are controlled by internal “synchronizers”, the Extraordinary Vessels.

- In a state of health, these synchronizers help adapt perfectly to external variations while keeping our individual characteristic rhythms

Depth (how well we sleep)

Duration (how long we sleep)

© Dr. H. Montakab

Definition of Insomnia

© Dr. H. Montakab

• Normally the length or depth of sleep are adapted to activity

• Insomnia is either an insufficient length (short)

• Or poor quality of sleep (lack of depth; parasomnia; restless mind; excessive dreams)

8

10/12/16

5

© Dr. H. Montakab

Treatment objectives

© Dr. H. Montakab

• Movements of Wei Qi (Liver)

• State of Blood and Yin (Heart & Liver)

• Settling of Shen (Heart)

• Regulation of the “Synchronizers”

• Emotions and dreams (Heart & Liver)

9

© Dr. H. Montakab

Wei qi, concentrates in the jing jin-sinew channels during the day, it ismaintaining muscle tone and mobility, it internalizes at night allowing forthe muscles to relax, which is the first stage of sleep.

Movement of Wei Qi


According to Ling Shu: Wei qi circulates on the surface, predominantly inthe sinew channels, 25 times during the day, penetrates at the ankle inthe evening, circulates in the zangfu 25 cycles during the night,following the Ke cycle, and emerges at the corner of the eye, mostprobably at Jingming BL-1, allowing for the eyes to open.

Wei qi also regulates body temperature which also presents a rhythmicalternation, of about 25 hours. There seems to be an interaction betweensleep and body temperature rhythms. Falling asleep and deep sleep occurduring the lowest temperature dip, whereas waking occurs during theascending phase of the curve.

10/12/16

6

© Dr. H. Montakab

Wei Qi moves in from BL-1


- The closing of the eyes is the first manifestation of theWei Qi moving inwards.=> Connection with ST-1 / LI-20 / SI-19 (relaxing of thenose & closing of the ears)=> To relax the orifices = BL-1 & BL-62

- The chest is the second area where the Wei Qi has topass through.=> If the chest cannot relax, there could be waking up atnight with feeling of heat and sweating.=> Importance of BL-17-Ge shu & TW-7-Zong hui

© Dr. H. Montakab

Internal circulation of Wei Qi


=> Wei Qi helps liberate external & internal PF from theZang/Fu

=> To return the Wei Qi back: Si Chen Cong; ST-12; lower He-Sea points & Jing-well points

= At times the Wei Qi escapes back up, causing sleepdisturbances with somatic symptoms:.ST: difficulty falling asleep, irritability, nighttime food cravings.LI: teeth-grinding, neck/shoulder tension, difficult bowels in am.BL: difficulty falling asleep, restlessness (restless leg syndrome,calf cramping); nighttime sweating.SI: dry mouth, nighttime thirst, enuresis.GB: bitter taste, itching (head), neck tensions.TW: drooling, a lot of crust around the eyes

10/12/16

7

© Dr. H. Montakab

Mental Relaxation “Shen”


. During sleep, Shen retires in to the blood, this explains the reduced response to outer stimuli.

• During sleep, Liver mobilizes Wei Qi (& Blood) inwards, resulting in the relaxation of muscle tone and reduced sensory functions (eyes, nose & ears)

• The movement of Hun inwards, helps move Qi away from the mind and helps relax the Shen.

• Periodically the Hun is released “wandering”, producingdreams (rapid eye movement); dreams are necessary forhealth

Sleep OrganizationExtraordinary Vessels

10/12/16

8

© Dr. H. Montakab

Organization of Yin & Yang


DU Mai = Sea of Yang

Yang Wei = Yang Preserver

Yin Wei = Yin Preserver

Dai Mai = Organizer of Yang

Ren Mai = Sea of Yin

Yin Qiao = Accelerator of Yin

Yang Qiao = Yang Accelerator

Chong Mai = Organizer of Yin

© Dr. H. Montakab

Sleep Organization


- Presumption: sleep as a Yin phenomena is synchronized:-> in Time by the Yin Qiao (Yin Motility) vessel -> in Depth (intensity), by Yin Wei (Yin Linking) vessels

- The internal organization of sleep allows for a reduction in the length of sleep by an increase in its depth with no somatic consequences

- Yin Qiao & Yin Wei are naturally in equilibrium with Yang Qiao (Yang Motility) and Yang Wei (Yang Linking) vessels which synchronize wakefulness and activity = balance of sleep & activity

=> the more intense or prolonged the activity, the deeper the sleep

10/12/16

9

© Dr. H. Montakab

Sleep disturbances


- Yin and Yang are constantly maintained in a dynamic state of balance by the regulating function of the

-> Yin and Yang Wei (Linking) vessels, and -> Yin and Yang Qiao (Heel/ Motility) vessels

- A disturbance of Yin, would suggest either -> Weakness of Yin Wei or Yin Qiao Mai, -> or an excess of its opposite Yang Wei or Yang Qiao Mai

- Insomnia is a Yang condition, mostly due to a disturbance of Yin: -> Yin is not deep enough= superficial, dream disturbed sleep-> Reduced sleep= problem falling asleep, early or frequent waking

- The type of insomnia is therefore defined by:-> the length of sleep-> the depth of sleep -> both

© Dr. H. Montakab

Types of Insomnia


- In normal conditions:“A” activity (Yang) = “B” sleep-rest (Yin)

- Insomnia is either:->A reduction in sleep time: A>B

-> Or a reduced sleep quality: A>B

Yin Qiao (& Yang Qiao)

Yin Wei (& Yang Wei)

10/12/16

10

© Dr. H. Montakab

Quantity/Time, Quality/Space


- When the time/quantity of sleep is affected-> the person is wide-awake, and the mind is calm, or if it is

active the thinking is clear

- When the space/quality of sleep is affected:-> either the sleep is very superficial or-> the person feels tired but cannot sleep, mind is racing and

the thinking is not clear

- Each parameter of “time” and “space” is subdivided in to three sections:

=> we can divide the night into thirds of roughly 1.5-3 hours, depending on the length of sleep.

© Dr. H. Montakab

Diagnosis of Insomnia Patterns


= Sleep phases depend on the interaction of Yin (& Yang) Qiao Mai with Yin (& Yang) Wei: time /space

- Insomnia patterns -> Initial insomnia would involve: Shaoyin (time) or Taiyin (depth) -> Mid-segment would reflect on: Taiyin (time) or Jueyin (depth) -> End insomnia would refer to: Jueyin (time) or Shaoyin (depth)

- Diagnosis of insomnia:-> The timing of the disturbance: initial, middle or end -> The state of mind:

. calm & or active but clear => Qiao Mai (Yin or Yang)

. tired, spinning mind, fright, dreams, or physical manifestations (restless legs, itching, hunger, etc. => Wei Mai (Yin or Yang)

10/12/16

11

© Dr. H. Montakab

Diagnostic confirmation

© Dr. H. Montakab

• Palpation of the Xi-cleft points of the Extraordinary Channels:

• -> Jiaoxin KID-8 for the Yin Qiao (Yin Motility) vessel

• -> Fuyang BL-59 for the Yang Qiao (Yang Motility) vessel

• -> Zhubin KID-9 on the Yin Wei (Yin Linking) vessel

• -> Yangjiao GB-35 on the Yang Wei (Yang Linking) vessel

21

© Dr. H. Montakab

Yin Wei & Sleep


Insomnia 1st stage; worry, emotions, tension, physical symptoms, restlessness

Insomnia 2nd stage, cramps restless legs, dreams

Insomnia 3rd stage, anxiety, fright, nightmares

Sp 13-14-15 + Sp1- St45

Liv 14, GB 2-12

Ki 9, Ren 23

Pe 6 / Sp 4Ki 9

10/12/16

12

© Dr. H. Montakab

Yin Qiao & Sleep


Insomnia 1st stage; clear mind, reading, mental activity

Insomnia 2nd stage, Waking 1-3, wide awake, waking with ones problems

Insomnia 3rd stage, Waking early, active

He 7, Ki 3; Ren 23; Ki 21-23-24-25

Pe 5, Liv 8-3, GB 12

Ki 6 / Lu 7Ki 8

Lu 1, Sp 6, Sp 1, St 45

Treatment Protocols

10/12/16

13

© Dr. H. Montakab

Treatment: Onset insomnia = “Timing”

© Dr. H. Montakab

• Calm insomnia: difficulty in falling asleep; body is relaxed, no somatic symptoms but there is mental restlessness (HE-blood)

• Palpate the 4 Xi-cleft points:

25

• If KI-8 or BL-59 are sensitive• = 1) BL-62 (s) / KI-6 (t), Yin Tang (s)• = 2) Regulate Shao Yin; calm Shen: HE-7/ KI-3; RM-23;

KI-23-25-26-27; An Mien • = 3) Tonify HE-Blood = HE-7-5; BL-15-17-20; SP-6

© Dr. H. Montakab

Treatment: Onset insomnia= “Quality”

© Dr. H. Montakab

• = 1) PE-6 (t) / TW-5 (s), Si Shen Cong (s) / or DM-20• = 2) Regulate Tai Yin: SP-6; SP-1 & ST-45 • = 3) Tonify LR-Blood = LR-8; BL-18-17-20• If there are somatic symptoms add: ST-12 and:• - ST-45 / ST-21 / ST-36 for food cravings

- LI-1/ ST-37: teeth-grinding, neck/shoulder tension- BL-67-40: restless leg syndrome, cramping, night sweating- SI-1/ ST-37: dry mouth, thirst, enuresis- GB-44-34: bitter taste, itching (head), neck tensions- TW-1/ BL-39: drooling, a lot of crust around the eyes

26

• Restlessness: tossing and turning; muscular tension (LR-blood); there may be somatic symptoms

• Palpate KI-9 and GB-35, if sensitive:

10/12/16

14

© Dr. H. Montakab

Insomnia: Middle of the night

© Dr. H. Montakab

• If the mind is clear & KI-8 is sensitive (Timing) => Tai Yin

• = 1) KI-6/ LU-7; LU-1, SP-6-1, ST-45• = 2) Regulate Tai Yin: SP-6-3; LU-9; RM-12• = 3) Treat Zang-Fu pattern

27

• If the mind is unclear + restlessness with dreams & KI-9 is sensitive (Quality) => Jue Yin

• = 1) PE-6; LR-14, GB-2-12 • = 2) Regulate Jue Yin: LR-3-8; PE-7-5; RM-18 =

= 3) Treat Zang-Fu pattern

© Dr. H. Montakab© Dr. H. Montakab

Insomnia: End of the night

28

• If the mind is clear (wide awake) & KI-8 sensitive (Timing) => Jue Yin

• = 1) KI-6; Pe 5, GB-12• = 2) Regulate Jue Yin: LR-8-3; PE-7-5; RM-18

• If the mind is unclear + restlessness/ dreams/ anxiety, fright & KI-9 is sensitive (Quality) => Shao Yin

• = 1) PE-6; KI-9-1; HE-7 • = 2) Regulate Shao Yin: HE-7-5; KI-3-10; RM-23

10/12/16

15

Resetting the “Clock”

© Dr. H. Montakab

Resetting the Inner clock


• Re-harmonizing Pre-and Post-Heaven Qi

• Resetting the Yin & Yang Qiao Mai:

KI-6 / BL-62 / BL-1 (or Yin Tang)

10/12/16

16

© Dr. H. Montakab

Extra Points for Insomnia


- Yintang: insomnia

- Yiming / Anmien: insomnia, agitation & restlessness

- Anmien I & II: insomnia, sleep walking

- Sishencong: insomnia

© Dr. H. Montakab

Auriculotherapy for insomnia


10/12/16

17

Clinical examples

© Dr. H. Montakab

Clinical examples


2) Difficulty in falling asleep, the person is too tired to read, or cannot fall asleep from worry or restlessness- Diagnosis:- Treatment

1) Difficulty in falling asleep, the person has a clear mind, reads for an hour before falling asleep. - Diagnosis:- Treatment:

Yin Qiao => palpate KI-8 or Bl-59KI-6 (t)-8 / LU-7 or Bl-62 (s)- Bl-59 / SI-3Possibly add: Shao Yin: KI & HE points / HE-7-8 / KI-3-21-23-24-25-26-27+ Bl-1 / Yin Tang

Yin Wei => palpate KI-9PE-6, KI-9 / SP-4Possibly add: Tai Yin SP & LU points / SP-1-2-4-6- / LU-1 (2-9-10-11)

10/12/16

18

© Dr. H. Montakab

Clinical examples-2


4) Waking between 1-3 a.m., or restless sleep with nightmares- Diagnosis:- Treatment:

3) Waking between 1-3 a.m. with a busy mind, thinking about problems- Diagnosis:- Treatment:

5) Early waking, wide awake and active- Diagnosis:- Treatment:

Yin Qiao => palpate KI-8 or Bl-59KI-6 (t)-8 / LU-7 or Bl-62 (s)- Bl-59 / SI-3Possibly add: Tai Yin: Tai Yin SP & LU points / SP-1-2-4-6- / LU-1 (2-9-10-11)

Yin Wei => palpate KI-9PE-6, KI-9 / SP-4Possibly add: Jue Yin LR & PE points / PE-1-5-7-(8-9) / LR-3-10

Yin Qiao => palpate KI-8 or Bl-59

KI-6 (t)-8 / LU-7 or Bl-62 (s)- Bl-59 / SI-3Possibly add: Jue Yin: LR & PE points / PE-1-5-7-(8-9) / LR-3-10

Documents

Sleep Stages & Cycles - Pacific College · 2016-10-14 · Sleep stages 3-Stage N1 (stage 0 & 1): drowsiness (alpha waves 8-12 Hz to theta waves 3-7 Hz): loss of muscle tone & reduced