Hi, I’m Virginia Doran, your host for another edition of, To The Point. Very generously produced by the American Acupuncture Council. Today, my guest is Daniel Bernstein. He’s been a licensed acupuncturist in New York city since 1995, and around 2008, he started specializing in insomnia. And this year, 2020, he came out with a book called, Rewired for Sleep: The 28-Day Insomnia Repair Program. And he’s soon also to release a book dedicated to practitioners called, something like beyond hard seven alternate strategies for treating insomnia.
I think you’ll find it very interesting, and it’s something if you don’t have yourself, certainly some of your patients do, especially at this time. So Dan, please welcome, and tell us about your approaches to insomnia, because I know it goes beyond just TCM. Tell us what you think as practitioners we ought to know.
Great. Thank you so much, Virginia. I really appreciate you inviting me to share what I have gathered over the years. And thanks also to the American Acupuncture Council for setting this all up. It’s a great service that you all do. And yes, I’m Daniel Bernstein. I’ve been a licensed acupuncturist since 1995. I have a practice Blue Phoenix Wellness in New York city. And again for the last 12 years or so, I’ve been focusing on sleep and sleep related issues. In February of this year, I was pleased to release a book and I’m going to bring it up, here it is. It’s called, Rewired for Sleep: The 28-Day Insomnia Repair Program.
I’m just going to go to this quote here, which is, “Put your thoughts to sleep, do not let them cast a shadow over the moon of your heart. Let go of thinking.” And I love this quote by the Persian poet Rumi, because, as someone who’s patients are often caught in the crossfire of self-talk when they’re trying to sleep, this quote sings to me, it has an elegance to it that calms my heart down and puts me almost into a meditative state as it is. So I’m going to go on here. Let’s go to the slides please.
And I’m assuming we’re at the slides. So that’s the quote I was talking about, “Put your thoughts to sleep, do not let them cast a shadow over the moon of your heart. Let go of thinking.” Today’s goals are going to be pretty simple. We’re going to talk about the importance of sleep, why healthy sleep matters, treating insomnia, an overview. We’re going to talk about a case history. I’m going to talk about mind traps, is what I call them. And then I’m going to show you all a simple exercise that I show to my patients who have a hard time sleeping.
So, how sleep has changed. This healthy sleep means sleeping eight hours nonstop. And in my first go around with the book, I wanted to do a comprehensive, even exhaustive book on treating sleep issues, including acupuncture strategies, herbs. And instead I wrote a book that was targeted for the lay person, but that acupuncturists can use as a template for helping their patients get a good night’s sleep. Now I’m working on the second one.
And while I was doing research for that book, I began to question what healthy sleep is? Among the ideas that we take for granted right now, is a belief that in order to be fully rested, we’re supposed to sleep continuously for seven and a half, eight, eight and a half hours a night. But this idea that we’re supposed to sleep continuously is really a recent one. And it’s a construct of the industrial revolution. It wasn’t until a vast numbers of people had a report for work at eight o’clock in the morning, that the idea of sleeping eight hours through the night even existed.
You see before that, what was common, was people had first sleep and second sleep. Okay? And in that more natural cycle, a person might wake up at one o’clock in the morning or two or 2:30, and use that in between time, they’d get up and they might feel feed livestock. They might talk, they might meditate. They might eat something and then gently and easily go back to sleep. So this recent idea that we need eight hours continuously and that anything else is frankly wrong, implies that if our sleep patterns stray from the norm, we’re somehow failing at sleep, okay.
Now what that does is, it creates an immediate anxiety. If I wake up 2:30 in the morning, and I think I’m supposed to be sleeping, kicks in some cortisol. It feels like I just drank two cups of espresso and I’m off to the races. So one of the things I tell my patients is, it’s okay if you wake up. In fact, you can just say to yourself, it’s okay if I don’t sleep, you can get up and you can rummage around for 10, 15 minutes. I tell them that they can actually, just do a little odds and ends and then naturally and easily go back to sleep.
When did they start saying that it didn’t have to be uninterrupted?
When did they say that it had to be interrupted? You’re saying.
I hadn’t heard that before, that it doesn’t matter. I know in certain cultures, people have their siesta, you traditionally have a nap in the afternoon and therefore you’re…
Right. So, you’re asking, when did people say that?
Yeah, I just wondered, where you’ve seen that as a resource or if that’s a standard.
That it need not be eight hours you’re saying?
Or that it need not be uninterrupted.
Well, as I said, historically, it has been such that people did not necessarily need eight hours sleep. That uninterruptedly, it was common. My resource was the New York times. And it is talked about by Cervantes and Don Quixote, where he talks about Pancho, censor, all eight hours in without problem. But he would get up in the middle of the night and rummage around and then go back to sleep. So it’s part of the historical norm. Certainly people who worked in farms and such would understand that it was all part of the larger cycle. Does that answer the question?
Yeah. Can people go into deeper levels of sleep if they are sleeping for shorter periods at a time?
Well, an hour and a half is typically a REM cycle, typical four stage cycle. So if you’re sleeping three hours, then you’ve completed two stages and then you can go back and sleep another two or even three cycles. So yes, as long as you’re working within an hour and a half cycle of the REM cycle, you’re good. It’s just, it’s something people don’t get enough of those cycles in. So in other words, for them, they might get only two cycles in. And so they’re feeling depleted.
I have another question. Are you a proponent of people taking naps? Because some people seem to believe in it. Some their bodies just don’t really work that way. They feel better, not taking naps, some people it’s-
Sure. I am a proponent of somebody knowing their body enough to know what works. I know I’ve had gotten some patients who came from a Cognitive Behavioral Therapy or CBT, which often uses restrictive sleep, not allowing naps, making sure people get in bed a particular hour and out of bed at a particular hour as a way of retraining the body. I’m not a fan of that. But as for naps, I think everybody’s just different. And the body changes. Some people can never take naps, and then 20 years later, all of a sudden they nap beautifully. So, we’re capable of changing our circadian rhythms in that way.
So, and we’re talking about circadian rhythms, they’ve been thrown off by artificial lighting, of course street lights were boon to society and culture, but they also meshed with the pineal gland. And suddenly we were no longer going to sleep at dusk and waking up at dawn. So that was totally out of the window. So that on top of recently, having our iPhones, our tablets, our computers at night, adds another layer of messing with the pineal gland.
So these things have really tended to mess with that most curious organ, the brain. Some sleep facts. Okay. So 44% of Americans report having insomnia, for half of them, the conditions chronic. That’s an interesting thing, because half the people with sleep issues have slept poorly for a long time. They’ve tried every drug under the sun, they’ve done sleep nitrous, they still can’t sleep. Whereas the other half, the acute insomnia sufferers, for them it’s more situational. Okay. Maybe a loss of a job, the death of a loved one, too much responsibility and it’s situational.
And the good news for them is that, it’s easier for them to go back to normal sleep, usually, sometimes not. Over 9 million Americans are addicted to sleep aids. That’s an incredible number. And the tragedy is that most doctors, almost every patient I’ve ever had, I asked them, did your doctor tell you that after 21 days you would be addicted? And to a person, they said no, but that is the simple fact that, after 21 days a person’s, whether it’s Lexapro, Ambien, any of those drugs that are used for sleep, then the person then has to get off that drug, and they are no longer on top of that.
I asked doctors, are sleep aids, risk restorative? Do they actually help the person recuperate? Usually I got a blank stare or a shrug shoulders. It was like, I don’t know. What we do know is that sleep aids, do not take a person past stage two. So this gets us into talking about the stages of sleep. Okay. So stage one is basically, the drowsiness you feel when you’re about to or you’re watching TV. Stage two is like a power nap. Stage three is where all the action is. The restorative stage of sleep, or our brain waves are slow, your body’s busy fortifying your immune system. You’re building tissue and preparing your body for the next day.
This is where also you can add muscle mass. If you’re reaching level three, then the body can add muscle mass. Stage four is REM sleep. This plays an integral part in processing, learning, and memory. And also as a response to stress. So given the stress levels we’ve got these days, it’s a wonderful thing when we get to dreaming. Personally, I think melaton gets a bad rep. Sometimes people talk about job, all these lucid dreams.
And it’s like, yeah, that means you’re actually getting to REM sleep. That’s a good thing. So if you can handle it, I’m not a proponent of knowledge on it, but I also don’t knock it, because a lot of people do. So acupuncture and herbs and self care are bridges to healthy sleep. So that is the response. I wanted to put this in here, it’s maybe a little self serving, but it’s regards to what’s going on with COVID right now.
Okay. This is a quote from Dr. Matthew Walker, author of, why we sleep. “Natural killer cells are critical components of the body’s immune system response, serving as the first line of defense against cancer cells, microbes, and other potential threats. A single night of poor sleep can impair natural killer cells activity by as much as 70%. In the short term, this can put us at risk for developing acute illnesses colds and flu, but in the longterm, it increases our risk for much more serious threats.” And so this is where I say, make sleep a really important part of your practice, because we’re doing so much more than just helping people sleep, we’re really, not only we are increasing their metabolism, we’re really helping their immune system.
That right now is so crucial. And the opposite is well, what happens with lack of nourishing sleep? Well, depression, anxiety, diminished learning, diminished immune system, toxins remain in the body. Nutrients, not going to their intended muscles, an increase in hormones that break down muscle. I believe that’s the catabolic hormones and an increase in the hormones that make us want to eat, which I guess are gremlin. We call it gremlins, but I know it’s not. So treatment strategies. Oops.
I have a question Dan.
You miss some sleep, say, normally you get seven, eight hours sleep. And then because of whatever reason, it may not even be insomnia, it might be travel or whatever, you get four or five hours sleep. Can you make up those hours or is that the little bit of damage to the body that can’t be redone?
I think it’s an interesting question, because science tells us, no, you cannot make up that sleep. That is what sleep scientists tell us. But I think it is a two dimensional way of looking at it, because somebody who’s really not taking care of themselves and they lose those eight hours, that’s going to mess them up. However, somebody is really doing self care, perhaps they’re meditating, maybe doing two gong, maybe eating, well, it sort of gets, I would say, absorbed in the greater good. So, theoretically, technically, no, but that’s a soft no. And I would say that if we’re taking care of ourselves, then it’s not a big deal.
So, getting 10 hours the next night, won’t…
That’s what they tell us. That’s what science tells us. They may find something else out next year, but I don’t worry about it. I’ve certainly lost a lot of sleep, I take. So maybe it’s just deluding myself, but I’d to believe that it all comes out in the wash as long as we’re doing self care.
How did you get into focusing on insomnia or sleep patterns?
Sure. Well, briefly, I had my own sleep issues. I went through a bunch of stuff around 1990, that put me on high anxiety, insomnia, and I went to acupuncture and it helped a lot. There was insomnia in my family, and it took me years to really see that, that I often would wake up in the morning and my mother would be in the dining room, finishing a dress that she’d spent all night working on. And so, it was a pattern of insomnia there in my family and I saw it up close. And so I do believe that, it’s a cliche almost to say, the work we do sometimes as healing our own wounds.
I think there’s a certain truth to that. And whether that is true for me or not, I don’t know, but I do find it interesting going back over many years and seeing that it was something that used to be… It would make me feel weird, because on one hand, you had this very productive mom and she’d make this dress, on the other hand, part of me was like, my God, she’s been up all night and that can’t feel too good. So whether it plays into it, I don’t know, but I think it is interesting.
So, treatment strategies. Over the longer term, helping patients sleep and to be participants in that sleeping process brings greater than success than nearly, and I won’t say merely acupuncture and herbs, because we can definitely get people sleeping again. But as we all know, we go in and out of balance, okay. It’s part of the human condition. And so as we go out of balance, people then start sleeping, not so well again.
And so in my treatment practice, I like to teach them simple stuff, diaphragmatic breathing, what can be better than just teaching somebody who breathes from their chest, to start breathing from their belly? That’s like 50% of everything, right? If they’re open to it, Qi Gong, use of magnets and Japanese tiger warmers. I have that in my book, acupressure, Yintang, Anmian, kidney one, pericardium six, kidney six, the standard sleep points.
And I just tell them to just either use the moxa with tiger warmer or acupressure. At the end, I have complimentary tools for self repair, including an exercise I’ll get into later called the five, five and five. This is Yogi. This is my nemesis. He’s my cat. And essentially he’s also, his attitude is the way most of my patients look when I first suggest that they can actually start taking care of themselves. So I thought, I think we all have patients like Yogi.
And cats have problems with insomnia.
Definitely strange. They definitely have oddball sleep issues. And the beautiful thing about when I work with patients, is if they go for it, when I first suggest they can actually help themselves, the beautiful part is that, if they do, they start getting a sense that they’re not victims, okay. It opens up all sorts of possibilities for that person. I mean, they’re going from, I’m doomed to, what can I do next? Maybe I can quit smoking. Maybe I can lose those 10 pounds. Let’s work on those things too.
And it’s my belief that the more aware our patients are, that they have this ability, the more they see the value of the subtle, yet powerful work that we do. So I don’t believe it’s like, well, they won’t need us later if they’re able to help themselves. No, that means that they will, instead of being 3% of the populous coming to acupuncture, it will be 30% or 50%. And I think it does help to help people, help themselves. Thank you, Yogi. So insomnia is not a disease, it’s a symptom, treat the root and that’s the theme for today.
We know that Western diagnosis tells us a little, and we also know that the main organ systems involved in Chinese medicine or the heart and the liver to a lesser degree, the kidney, the spleen, and perhaps the gallbladder. Okay. And often we see mixed pathologies, perhaps heart yin deficiency with Liberace stagnation. And so we treat those things that we see, and they’re all incredibly valuable.
I would suggest that before we treat what we see, when it comes to sleep, a root treatment is really important. And so unless, we treat the deeper energetic issue involved, the patient will have a much harder, getting better. So some of the root treatments are five elements, eight extraordinary vessels. I call it Kiiko style. Okay. I studied, as did Virginia. We both studied with Kiiko Matsumoto, and she does a lot of root treatments, adrenal deficiency, sympathetic dominance, blood stagnation, all of it is root treatments and then going on to symptom based treatments.
I believe that Dr. Tan’s balanced style is really a combination, as some others are calling doctor, master Tong as well, are a combination root and branch treatments, because they’re rooted in the i-ching and in the five elements. So, treating the extraordinary vessels. And by the way, give me five minutes, if I’m getting dangerously close to going over my 20. So a quote from the Nan Jing, and it talks about the extraordinary vessels being a root treatment. And the ones that are most involved with sleep are Yin and Yang Qiao and the Yin Wei.
The Qiao’s are involved with opening and closing the eyes. And this gets into, it’s not how many hours we sleep, but how rested we are when we wake up. I get people who sleep eight hours and are exhausted. They tell me, I feel I just ran a 10K, while I was sleeping and other people sleep four hours and feel incredible. So it’s clearly not always about time, the distinction is one that’s made clear by Dr. Hamid Montakab in his book, acupuncture for sleep.
He talks about differentiating the quality of sleep versus the quantity of sleep. And we can use the extraordinary vessels as regulators of that sleep. So if it’s an issue of the person, simply not being able to sleep enough, not being able to keep their eyes closed, either theoretically or metaphorically, or literally it tends to be a Qiao issue. And what we want to do, is we may palpate kidney eight, which is the Xi-Cleft or the Qiao. And if it’s tender and everything lines up, then we may treat the Qiao. We may drain UB-62, tonify Yin Qiao.
We may add points to that, since it’s around the kidneys, kidney 27 points, along the kidney channel. However, if there’s more an emotional issue and perhaps a person’s exhausted, emotionally wrung out, they’re anxious, depressed, lethargic. These are all symptoms that the Nan Jing refers to in talking about Wei issues. So, that’s an issue of depth, meaning they’re not sleeping deeply enough. And so, we look to the ways.
And so the way that we look at that is we may palpate kidney nine, which is the Xi-Cleft of the Wei channel, the Yin Wei. And if that’s tender and we look to which one is the most tender, is it the right or left? We needle that, and then we continue treating the Wei channel. So the opening point of the Yin Wei, pericardium six, and we couple that with spleen four. Again, I talk here about, verifying that Yin Wei is the correct treatment, aside from the fact that they’re typically depleted, depressed, wrung out.
Certainly Dr. Manaca used to use the Wei to start a treatment almost constantly. If you read, chasing the Dragon’s tail, he used the Yin Wei a whole lot. So then we may needle PC-6 and spleen four bilaterally, and this is the root treatment, let the patient rest for 15 minutes. At that point, we may expand the treatment in modular fashion. Some people believe in just letting the entire treatment be the root treatment and that’s okay. Certainly it’s the five elements, we see that whether an aggressive energy treatment or external dragons, that treatment is a full treatment in their root treatment.
I have no problem with that. I typically check the pulses and, go from there. What else did I want to say about that? Yeah, I always found it interesting. Let me go back to this, excuse me, considering that the heart is the emperor, I always thought it odd that why is it that there is not a heart point on the extraordinary vessels? You’d think that that would be, top of the list there. And so I went back and I see that a lot of Japanese acupuncturists do not treat the heart typically, they will go to the pericardium and protector of the heart, and certainly points along the pericardium are crucial for sleep, anxiety, palpitations, heat, all the heart stuff.
So for me, opening the Yin Wei, is such a powerful way to begin treating someone who’s having those issues. So let me continue here to, Marianne, this is a case for Yin Wei and Buddha triangle. 38 year old woman, complained of waking up during the night, agitated, palpitations, feeling heat, et cetera. My voice is going. So I’m going to keep it simple. As you can see, those are the fairly often seen pulse tongue, palpatian issues that lead us to believe that it’s a fire and water disharmony, repletion above, vacuity below. Water is not nourishing heart.
So there’s heat above. And so one option is more of, I’ll call it a TCM style. Certainly it’s a wonderful treatment, heart seven, heart six, which does clear heat. Pericardium seven for palpitations and insomnia. Yin Tang, which is a great sleep point, CV-17, heart, et cetera, et cetera. So it’s a terrific treatment. My tendency is, if I were to go that route, I might start with a year, Yin Wei or another would treatment and then go to that. Option two, go to the root treatment, open the Yin Wei, followed by Buddha’s triangle.
So, we start on the dominant hand, pericardium six on the opposite foot, spleen four. Now what I would do often, is expand that to Buddha’s triangle. So I might start first with just the two points, and then I’d expanded to pericardium six, heart seven and long nine, which is also a root treatment. However, I don’t think you can go wrong with it. And then I would add contra-laterally. Some people believe in just those three points and they make a perfect triangle on the wrist. I to add liver four, spleen six and kidney three contra-laterally.
And that is a beautiful treatment. It really handles insomnia, anxiety, palpitations, dream disturbed sleep, and it’s a full treatment. Another one since I promised that I would give them tan treatment, I’m just going to add another one for Fir-Water disharmony, that comes from the playbook of the balance method, Dr. Tan, which is a Shao Yin/Shao Yang treatment. And this goes to heart three and heart seven on the right, gallbladder 34 and 41. And then the left side, we’re treating kidney three and kidney 10 and triple burner three and triple burner 10.
And I’ve used this and it’s a good treatment. It’s an effective treatment. You have to keep doing it. You really need to see the patient for this. You need to see patient like twice a week. It’s true for all. I mean sleep is not an easy fix. Okay. I like to joke that since Sim Yao talked about, that he’d rather treat 10 men than one woman, because of the plumbing. And I to say that as he was leaving, he muttered that I’d rather treat 10 women than one insomnia patient, because they’re paying him my gallbladder 30. I don’t know if that’s true or not, but we move on.
Where does triangle protocol come from?
I think it’s part of the five elements universe, that is where I saw it originally and I couldn’t swear to it. So I hope a lot of 5E people don’t bite me on the neck for claiming it’s part of them. But I do use it as part of that, because I do believe it’s a beautiful… To me it’s a crossover between five element and balance method, it’s got a lot of stuff going for it. I didn’t get into it, but I also will add to that, sometimes again, contra-laterally, Yang points to those two, right hand, left foot. I will add, typical as to Richard Tan, I’ll do a right foot, Yang points, left hand Yang points, depending on the secondary stuff that needs to be treated.
So, herb formula for Marianne would be, Tian Wang Bu Xin Dan. Okay. That is typically for people with heart and kidney issues that wakes them up, their palpitations. They can’t sleep, they have heat issues. And just to differentiate that, let’s say from something that’s just more kidney, like Jo bi di wang wang, that’s more kidney or something that is more blood based. That would be Suan Zao Ren Tang. The Suan Zao Ren Tang is terrific, because it also addresses heat issues. But again, it’s more blood rather than Yin deficiency, which I think Marianne was presenting with.
Again, some food cures, asparagus, chicken egg, wheat, if you want to go the Chinese formula style, banana, bamboo shoot, these are all for Yin deficiency. And then finally I gave Marianne some homework. In this case, it was the five, five and five exercise. Before we get to it. Actually, I’m just going to skip it over, we may be running out of time. Yes. Or how are we doing?
I think they’re pretty self explanatory those.
Yes. Okay. So basically I treat the sleep-disordered mind a lot, and it falls into those five categories, distractions, daily regrets, real life problems, overwhelms, things I didn’t do yesterday and things I won’t be able to get done tomorrow. And then finally disconnecting from phone, computer and TV. So one of the treatments that I like to do is, and it’s so simple. It’s called the five, five and five. Okay. It helps unwind the sympathetic nervous system and it takes 15 minutes. Okay.
Basically for five minutes I have the person write down regrets, resentments fears, overwhelms clogging their mind, all this stuff that we typically start churning at night. We’re great during the day, but when we close our eyes, they start unfolding. So I tell them, spend five minutes and no more, then fold the paper, place it aside and say, out loud. “These are tomorrow’s problems.” For five minutes, close the eyes and gently massage Yintang, whatever you wish to do. I like Yintang. And at the same time, I’d tell the person, imagine that you’re in a garden, a rain forest, someplace where you feel safe, it could be in your little den.
And then for the last five minutes, I tell them to become mindful of breath. And so these are ways that we open them up to the idea of meditation without having to call it meditation. So just follow the path of your breath with your mind, down into your lungs, back up through your nostrils and just keep doing that for five minutes. And so these are, I feel stress free ways of getting someone to begin the process of unwinding the sympathetic nervous system and engaging their parasympathetic nerve system at night.
And then finally, I use something called autogenic training, and it was invented by a German cardiologists in 1931, who frankly was tired of seeing his patients dying. So he invented a calming technique that would reduce their levels of stress. It’s an eight week program. And it really helped in the way that no other Western method had, using a version of a progressive muscle relaxation.
And so I have that on my website, which is rewiredforsleep.com. If you go to the Explorer page, you’ll see that, and I think three other recordings, that’s all free to listen to. And well, I mentioned before the exercise and rewired to give for the sleep disorder, I think any acupuncturist wanting to provide their patients with tools to combat insomnia, anxiety, stress, and PTSD can really benefit from it as well for their patients and for themselves.
Have I missed anything? So, finally, I have already popped my little book. I’ll do it one more time. Rewired for Sleep: The 28-Day Insomnia Repair Program. It’s available on Amazon in both digital and paper. And if you’d to know when the next book is coming out, please feel free to email me at email@example.com. I’m going to say one last, thank you to American Acupuncture Council and to Virginia for allowing me to visit and give my little talk. Thanks again.
Thanks Dan. It was really lovely having you and I’m sure people will get a lot of benefit from this book, practitioners and patients.
Thank you. Thanks.
All right, so we’ll see you all soon. Thanks for tuning in, again, I’m Virginia Doran, luminousbeauty.com , and sayonara.
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