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Tai Chi for Insomnia

Medical Report: Insomnia and Tai Chi

Author: Eric L. Zielinski 


Introduction

 

Sleepless nights have become characteristic of industrialized Western culture and many Americans have become desensitized to its insidious effects. Sadly, many people cannot go through an entire day without drinking some type of caffeinated beverage like coffee or energy drinks. To reverse this deadly trend, it would benefit Americans to implement time-tested and proven methods like Tai Chi to help people develop a natural source of energy and vitality.

 

Insomnia

 

Insomnia and sleep disorders are one of the most common issues older adults encounter, with 58 percent reporting frequent sleeping difficulties. Sadly, however, the journal Sleep reports, “Sleep problems remain untreated in up to 85 percent of people, and, among those who receive treatment, sedative-hypnotic medications remain the treatment of choice. Unfortunately, such pharmacologic management may have particularly deleterious effects in older adults, including daytime confusion, drowsiness, falls and fractures, and adverse interactions with other medications.” 

 

Not just an issue for the elderly, insomnia has even been linked to cardiovascular disease (CVD). In fact, a study published this past July has likened insomnia to smoking cigarettes and it is now amongst the top-ranking risk factors leading to CVD. It is, therefore, vital for people to monitor their sleeping habits and not confuse insomnia for something “normal.” According to the Mayo Clinic, be alert to the following symptoms and insomnia-related issues:

 

  • Difficulty falling asleep at night.
  • Awakening during the night.
  • Awakening too early.
  • Not feeling well rested after a night's sleep.
  • Daytime fatigue or sleepiness.
  • Irritability, depression or anxiety.
  • Difficulty paying attention or focusing on tasks.
  • Increased errors or accidents.
  • Tension headaches.
  • Gastrointestinal symptoms.
  • Ongoing worries about sleep.

 

Medical Research and Management

 

Like most chronic diseases, medical management contains a varied approach including lifestyle changes and more aggressive drug therapies. Some common behavior treatments for insomnia include:

 

    • Education about good sleeping habits – including: not eating late at night, refraining from drinking caffeinated beverages after 7:00 p.m., only using the bed for sleeping and not for watching T.V. or reading, and sleeping in complete darkness away from electronic devises. 
    • Relaxation techniques –breathing, visualization, and stress-reduction exercises to reduce anxiety at bedtime.

 

  • Cognitive behavioral therapy – positive psychology techniques in which people replace worry about not sleeping with positive thoughts.

 

    • Stimulus control – restricting time spent awake on the bed and in the bedroom for only necessary activities. 

 

  • Sleep restriction – a form of sleep deprivation to make insomniacs more tired and, therefore, more likely to sleep better the next night. Supposedly, decreasing the time people spend in bed improves sleep quality and once that happens people are allowed to gradually increase their time in their bed.

 

  • Light therapy – insomniac’s internal clock are thought to be reset when they use light to their advantage and fall asleep and wake up early.

 

In addition to these natural therapies, several medications are prescribed for insomnia. According to the Mayo Clinic

 

Taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem), also may help you get to sleep. However, in rare cases, these medications may cause severe allergic reactions, facial swelling and unusual behaviors, such as driving or preparing and eating food while asleep. Side effects of prescription sleeping medications are often more pronounced in older people and may include excessive drowsiness, impaired thinking, night wandering, agitation and balance problems.

 

As they are habit forming, physicians generally do not recommend relying on prescription sleeping pills for more than a few weeks. They do, however, often prescribe antidepressants with a sedative effect, such as trazodone, doxepin or mirtazapine (Remeron) for people battling depression in addition to insomnia

 

Research showing Tai Chi’s ability to help with insomnia

 

As insomnia prevalence climbs and well-known side effects of drugs continue to plague people, implementing mind-body interventions like Tai Chi are increasingly in demand. Subsequently, research has taken a good look at why people with insomnia and other sleeping disorders receive such a wide variety of benefits from Tai Chi.

 

    • Revista Brasileira de Psiquiatria published a study in 2010 in which psychobiology researchers from the Universidade Federal de São Paulo, Brazil conducted a review of mind-body interventions like Tai Chi for the treatment of insomnia. Twelve studies were selected to be evaluated and it was that, “Mind-body interventions were able to improve sleep efficiency and total sleep time. Most can ameliorate sleep quality; some can reduce the use of hypnotic drugs in those who are dependent on these drugs.” It is critical to note that in regards to this paper, “Only a few studies about mind-body interventions that are not mainstream (cognitive behavior therapy or sleep hygiene) reached the inclusion criteria for this study. Among them yoga, [Tai Chi], relaxation and music presented positive results in the treatment of insomnia symptoms.” At this point, research has not determined the comparative effectiveness of Tai Chi compared to yoga and music, which would be a worthwhile study to conduct.
    • In 2004, the Journal of American Geriatrics Society printed an article that highlights the work completed by Oregon Research Institute researchers. With the expressed purpose to determine the effectiveness of Tai Chi on sleep quality and daytime sleepiness in older adults who reported moderate sleep complaints in comparison to low-impact exercises, one hundred eighteen women and men aged 60 to 92 were recruited for the trial and the experimental group participated in 24 consecutive weeks of Tai Chi, three times per week, for 60-minute sessions. Researchers discovered that, “Tai Chi participants reported significant improvements in five of the PSQI [Pittsburgh Sleep Quality Index] subscale scores (sleep quality, sleep-onset latency, sleep duration, sleep efficiency, sleep disturbances), PSQI global score, and ESS [Epworth Sleepiness Scale] scores in comparison with the low-impact exercise participants.” In addition, “Tai Chi participants reported sleep-onset latency of about 18 minutes less per night and sleep duration of about 48 minutes more per night than low-impact exercise participants.” Thus, proving Tai Chi can speed the time it takes people to fall asleep, it increases upwards to one hour of precious rest for sleep-deprived people per night.

 

  • A 2008 article in the journal Sleep describes another study in which improving sleep quality in older adults with moderate sleep complaints was discovered after practicing Tai Chi. UCLA researchers took 112 healthy older adults aged 59 to 86 years and compared Tai Chi to health education for 25 weeks. In comparison to the health education group, “Subjects in the Tai Chi condition with poor sleep quality showed significant improvements in PSQI global score as well as in the sleep parameters of rated sleep quality, habitual sleep efficiency, sleep duration, and sleep disturbance.”

 

  • Fibromyalgia is a common syndrome characterized by chronic and widespread musculoskeletal pain, fatigue, sleep disturbance, and physical and psychological impairment; all of which affect sleep and cause insomnia. Thus, in a paper published in the New England Journal of Medicine, it is no surprise that researchers were able to determine significant sleep benefits for people participating in a Tai Chi program during a fibromyalgia trial. Sixty-six people were separated into three groups: classic Yang-style Tai Chi and control intervention consisting of wellness education and stretching for the treatment of fibromyalgia. Sessions lasted 60 minutes and took place twice a week for 12 weeks for each of the groups. Not only did the Tai Chi group receive more significant benefits in sleep quality as determined by the Pittsburgh Sleep Quality Index, the improvements were sustained at 24 weeks indicating that the benefits of Tai Chi for people suffering from insomnia and sleeping disorders are long-standing with regular care.
  • In 2010, the British Journal of Sports Medicine published a preliminary study of the effects of Tai Chi and Qigong on indicators of metabolic syndrome – a group of symptoms including hypertension and high blood glucose which are associated with coronary artery disease, stroke and type 2 diabetes. Specifically, the researchers evaluated for body mass index (BMI); waist circumference; blood pressure; triglycerides; HDL-cholesterol; glucose control (three month glucose levels, fasting insulin); insulin resistance; health-related quality of life; stress and depressive symptoms. Thirteen participants with metabolic syndrome were recruited to be part of a 12-week program of Tai Chi and Qigong for 1 to 1.5 hours up to three times a week. In addition, they were encouraged to perform the exercises outside of the study parameters at home and during their personal time.  After the 12 weeks, significant improvements were recorded in four of the seven indicators of metabolic syndrome including: BMI (losing on average 3 kg per), waist circumference (2.80 cm average decrease), systolic and diastolic blood pressure decrease (11.64 mmHg, 9.73 mmHg) and glucose control (0.32 percent decrease in three month glucose test. In addition, insulin resistance fell, indicating a decreased predisposition for type 2 diabetes and the participants claimed the following: decreased stress, less depression symptoms, overall increased mental health, increased vitality, better sleep, less pain, and fewer cravings for food while participating in the program. Notably, three patients no longer met the criteria for metabolic syndrome after this test. It cannot be stressed enough the importance of chronic disease reversal for proper sleep function and to correct insomnia. This study highlights the global benefits insomniacs can receive from Tai Chi.
  • Research has also proven that Tai Chi can help improve sleep quality even amongst people with chronic heart failure. Printed in Medicine and Sport Science in 2008, Harvard Medical School researchers took 30 people with chronic heart failure and split them into two groups: one in which volunteers actively participated in a 12-week Tai Chi program and continued usual medical care; and one group in which they continued usual medical care only. The results evaluated the following: quality of life, exercise capacity, B-type natriuretic peptide (a neurohormone secreted by the ventricles indicating volume expansion and pressure overload), catecholamine levels (dopamine, norepinephrine, and epinephrine – hormones produced by the kidneys that indicate high levels of stress), heart rate variability, and sleep stability. To determine quality of life the Minnesota Living With Heart Failure® Questionnaire was used – containing 21 questions with possible answers ranging from 0 to 5; the higher the score the worse the quality of life reported with 105 being the highest score possible. According to the study, the Tai Chi group reported fantastic results including: improved quality of life, increased exercise capacity via 6-minute walk test, and decreased B-type natriuretic peptide in comparison to the control group. In addition, those in the Tai Chi group experienced a significant increase in sleep quality as measured by an increase in high-frequency coupling and a reduction of low-frequency coupling in comparison to the control group. 
  • In regards to younger people, the Journal of Pediatric Health Care published a study in 2005 describing a clinical project that used combined Tai Chi and mindfulness-based stress reduction as an educational program for middle school-aged children. Both boys and girls participated in a five-week program and statements made by the students “suggested that they experienced well-being, calmness, relaxation, improved sleep, less reactivity, increased self-care, self-awareness, and a sense of interconnection or interdependence with nature.” Subjective by design, this study offers much hope that people of all ages will benefit from practicing Tai Chi in regards to sleep management. 



Conclusion

 

While conducting literature reviews of Tai Chi’s ability to help mange and prevent chronic disease processes like insomnia, it is fascinating to the global inter-relatedness of each body system. Some articles study Tai Chi in relation to insomnia specifically, while others report indirect benefits to sleep disorders while studying issues like heart disease and fibromyalgia. These widespread benefits to overall health and wellness should not be overlooked as time – and now numerous scientific studies – have proven Tai Chi’s ability to help improve function throughout the entire body.





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