Thank you to all the lovely people who attended the discussion on Insomnia at the Rubin Museum recently. It made me realize that this is a huge concern for many people and I know that lack of sleep can really affect quality of life. There was only time to have three people come on stage to ask questions and then I only had about 15 or 20 minutes with each person. If I were seeing someone in my office I would have more time to question, examine and prescribe a more thorough treatment protocol. There was so much more to say about this subject but I hope that this discussion helped both to demystify Tibetan Medicine and to provide a few common sense suggestions for dealing with insomnia.
One member of the audience inquired about sleep apnea and I didn’t have a chance to address that so I thought I would say a bit more now. In general there are two types of sleep apnea, obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea occurs when the breathing passage is obstructed and often happens in people who are overweight but can also occur in children with enlarged tonsils or adenoids. Less is known about central sleep apnea but for some reason there is an interruption in the message from the brain to breath.
According to Tibetan medicine the most common reasons for insomnia are an excess or disturbance of rlung or mkrispa, however obstructive sleep apnea is most likely due to excess badkan (phlegm). Normally in Tibetan medicine we don’t think of badkan as causing insomnia because people with excess badkan usually tend to be very heavy sleepers, however, it does happen that the extra weight and tissue can cause obstructive sleep apnea. When we treat excess badkan, in general we treat it with the tastes of hot, rough, and astringent. So this would include spicy foods, lentils, buckwheat, fish, hot water, fresh cooked vegetables, warming spices and herbs such as black pepper, long pepper, ginger, and small amounts of good quality alcohol. Foods to avoid are oily, sweet, heavy and cool, as well as food that is too old and has sat in the fridge for too long, or spoiled food. This would include too much raw foods or salads (some are fine), pork (which is cool-natured and heavy), greasy foods, and cold foods and drink, such as ice cream and sodas. These foods are considered difficult to digest and damage the digestive heat.
Also it is recommended to keep food portions small and to engage in regular daily exercise. This helps to maintain digestive heat and metabolism so that the food we do eat gets metabolized properly and serves to nourish us rather than producing extra weight. Avoid sleeping in the daytime, as well as cool, damp places and sitting or lying for long periods on cold ground but rather be in warm, dry places. All of these foods and behaviors will help to alleviate badkan symptoms, will often help to reduce weight and excess tissue, and thereby alleviate obstructive sleep apnea.
As far as central sleep apnea, from a Tibetan perspective breathing problems can also be due to a disturbance of one of the 5 types of rlung, possibly the Srog-‘dzin (life-sustaining rlung) or the Gyen-rgyu (upward moving) rlung. The Srog-‘dzin rlung is located in the brain and its functions are: swallowing food, inhalation and spitting, burping and sneezing, clearing the senses and intellect, and steadying the mind. The Gyen-rgyu (upward moving) rlung is located in the chest and its functions are responsible for speech, bodily vigor and health, giving luster to the skin, and mental exertion. As the name suggests it moves upwards from the chest into the head. A thorough examination would help to determine whether or not this was the cause. A disturbance of either of these two types of rlung could cause a central sleep apnea and would be treated with a combination of herbs and external treatments such as horme.
Hopefully this short essay offers some suggestions for those suffering from sleep apnea.