Insomnia is a common sleep disorder in Singapore, with a high prevalence rate of 15% in the adult population. Unsurprisingly during these unprecedented COVID times, local rates have risen to nearly 27%. Insomnia refers to a condition that affects the quality and/or duration of sleep, negatively impacting daily lives and socio-occupational functions. It does not refer only to difficulty in falling asleep, but also includes difficulty in maintaining deep sleep, waking up repeatedly throughout sleep, and/or trouble returning back to sleep after waking up in the middle of the night. Other than various manifestations in the night, other common signs of insomnia include disruption to daily functions in the day, such as:

  • Fatigue and drowsiness throughout the day
  • Inability to focus on a task during the day
  • Forgetfulness
  • Mood swings
  • Frequent headache and dizziness
  • It has been well established that sleep is essential to many vital physiological functions and psychological health. However, how much sleep do we really need? Our need for sleep changes with age, and of course, this varies significantly between individuals. There is no “magic number” or fixed number of sleep hours that works for everyone. But the recommended sleep time goes as follows:

  • Infants (0-3 months): 14-17 hours per day
  • Infants (4-11 months): 12-15 hours per day
  • Toddlers (1-2 years): 11-14 hours per day
  • Preschool children (3-5 years): 10-13 hours per day
  • School-age children (6-13 years): 9-11 hours per day
  • Teenagers (14-17 years): 8-10 hours per day
  • Adults (18-64 years): 7-9 hours per day (although some may need as few as 6 hours or as many as 10 hours of sleep each day)
  • Older adults (65 years and older): 7-8 hours per day
  • Prolonged period of sleep deprivation can have serious effects on our physical health, increasing our risks of obesity, diabetes and heart diseases, just to name a few. Insomnia is also often coupled with various degrees of mental health disorders. Sleep is a complex and dynamic process, and can be affected by many physiological and psychologic factors. From TCM viewpoint, the reasons for insomnia are:
  • Emotional factors (e.g., mood swings, stress, anxiety)
  • Poor eating habits (e.g., irregular mealtimes, heavy meal before sleep, excessive caffeine intake, unhealthy diet)
  • Unhealthy lifestyle (e.g., lack of exercise, irregular sleep cycle, inconducive sleeping environment)
  • Recovery from illness (e.g., suffering from pain and diseases, side effects from medications)
  • For mild insomniacs, simple lifestyle changes should be the first-line of treatment and can go a long way in improving sleep. Here are some tips to cultivate good sleep hygiene:

    √  Exercise regularly. It is recommended to complete 150mins of moderate-intensity exercise each week (e.g., slow jog, walking, yoga). Not only does exercise keeps you fit and healthy, it will also boost the effects of natural sleep hormones and allow you to sleep better at night.
    √  Eat healthily. Besides having a balanced diet, eat at regular mealtimes, and avoid heavy meals 2 hours before bed. It is never a good idea to go to bed with a grumbling stomach or an overly full belly.
    √  Have a healthy mindset. Reduce anxiety and stress. Daytime troubles can spill over to the night, causing you to feel anxious and unrest. Stress can activate our fight-or-flight response, making it difficult to fall asleep. Give yourself some time to wind down and get into the mood before bedtime.
    √  Create a relaxing environment for sleep. Go to bed and wake up at the same time every day, including weekends, to cultivate a regular sleep cycle. On top of that, make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature. It is best if you can keep electronics away from your bedroom and craft a pre-sleep routine.
    Χ  Avoid coffee and tea after lunch hours. Keep an eye on your caffeine intake. It may be tempting to use caffeine to overcome daytime drowsiness, but this might aggravate your insomnia problems at night and result in a vicious cycle.

    For those who have actively and religiously tried the lifestyle tips above but still find yourself unable to attain satisfactory sleep quality and time, we have some TCM-based dietary recommendations for you to try out. However, do note that as TCM management is highly individualized, seek professional advice from your attending physician to ensure that these diets are suitable for you.

    1.    Longan-Lotus seed porridge
    Ingredients: Dried longans 10g, lotus seeds 15g, rice 100g
    Method: Mash the lotus seeds into smaller pieces. Cook with the dried longans and rice. Serve as porridge.
    Function: Nourish the Heart and Spleen, and calm the mind
    Suitable for insomniac patients who are coupled with symptoms such as palpitations, lethargy, and loose or watery stools.

    2.    Lily bulb-Red date porridge
    Ingredients: Lily bulb 20g, red dates 15 pieces, rice 50g.
    Method: Infuse the lily bulbs in hot water to remove the bitter taste. Simmer with the red dates and rice. Serve as porridge.
    Function: Tonify Qi and Yin, and calm the mind
    Suitable for insomniac patients experiencing menopausal symptoms such as palpitations, irritability, hot flushes and night sweating.

    3.    Chamomile-Lavender Tea
    Ingredients: Chamomile 3g, lavender 3g, water 250mL, honey (optional)
    Methods: Steep chamomile and lavender in hot water using a thermal bottle for 10mins. Add honey to taste and serve as tea. Repeat 1-2times.
    Suitable for most insomnia patients.

    For those who enjoy a pre-sleep massage, here are some acupoints that you can press gently for 3-5 minutes each time to help manage your insomnia.

    1.    Baihui Xue: Located at the top of the head, the midpoint of the imaginary line connecting the apex of both ears
    2.    Anmian Xue: Located at the neck, 3 finger-width distances behind the ear lobe
    3.    Shenmen Xue: Located on the outer end of the wrist crease, directly below the little finger
    4.    Neiguan Xue: Located on the inner side of the forearm, 2 finger-width distances away from the centre of the wrist crease

    We hope that with the above sleeping habits and simple interventions, you will wake up well-rested in the morning after a good night sleep! Say goodbye to “counting sheep” in the middle of the night!

    Health Education