I can't fall asleep easily and don't want to take sleeping pills. Please help

Sleep disorders in the elderly are probably due to poor function of the stomach, spleen, heart, kidneys and liver.

Q: I am a 73-year-old man who has not had more than three hours of continuous sleep every night for the past one to two years.

I have no difficulty falling asleep at my normal bedtime at 11pm or midnight. But after one to two hours, I wake up to go to the toilet and then I am unable to fall asleep easily. I end up doing something for 30 to 45 minutes until about 2am or 3am. Then I am able to fall asleep till about 6am or 8am.

Sometimes, I may wake up a second time and take a long time to fall asleep again. I do exercise - walk daily and play badminton or table-tennis weekly - but it does not help.

I do not want to take the sleeping pills prescribed by my doctor as I do not want to rely on them. I will be grateful for any advice that can help me overcome this sleep disturbance.

A: Sleep disorders in the elderly are probably due to poor function of the stomach, spleen, heart, kidneys and liver.

In traditional Chinese medicine (TCM), the stomach receives and digests food.

When the stomach is weakened due to ageing and chronic illnesses, it will not be able to digest the food. This will result in fullness and distension of the upper abdomen, nausea, vomiting, poor appetite and the inability to sleep.

The spleen converts the nutrients from food into qi (energy) and blood. When the spleen is weakened - due to ageing, poor diet, over exertion, weak constitution and chronic illnesses - it will convert the nutrients into phlegm and "dampness" instead.

When accumulated in the body for a prolonged period, phlegm and "dampness" will create "heat" and "fire". All four pathogenic (disease-causing) factors will circulate to the heart, which controls the mind and governs blood.

This will lead to fidgeting and waking up in fright from dreams and being unable to go back to sleep. These will be accompanied by congestion in the chest, bitterness in the mouth, nausea, vomiting and dizziness.

Qi and blood make up the foundation for mental activity. If qi and blood are insufficient - due to ageing, anaemia and poor spleen function - to nourish the heart, it will also create "heat" and "fire" in the heart.

These will lead to sleep disorders with lots of dreams, frequent awakening, the inability to go back to sleep after waking up, poor memory, fatigue, restlessness, palpitations, sore throat and ulcers.

The nutrients from food are also used to form qi and yin in the kidneys. Yin is the aspect linked to coldness and moisture. In TCM, a balance of yin and yang, which is linked to heat and dryness, is required for good health.

The qi and yin in the kidneys support all the organs and have to be strong to allow the organs to communicate with the heart.

When the kidneys are weakened, it will trigger sleep disorders with irritability, dizziness, buzzing in the ear, hot hands and feet, aching in the lower back and knees, sweating during the night and dryness of the throat.

The liver is responsible for storing blood and ensuring the smooth flow of qi in the body. If there is stagnation or hyperactivity of qi in the liver, it will trigger insomnia, dream-disturbed sleep, irritability, anger, dizziness and vertigo.

Chinese herbal medicine, acupuncture, moxibustion and cupping therapy can help to improve your condition by strengthening your organs and dispelling the pathogenic factors.

Moxibustion involves burning a small herb above acupuncture points to help healing.

Cupping involves using fire and cups to create a vacuum on the skin to enhance blood and qi circulation.

Chinese medicine such as medicinal changium root, Indian bread, largehead atractylodes rhizome, milkvetch root and liquorice root are used to strengthen the spleen and stomach.

Nacre, Chinese arborvitae kernel, oyster shell and albizia flower calm the heart.

Processed rehmannia root, white peony root, Chinese thorowax root and cape jasmine fruit strengthen the liver and kidneys.

Spine date seed, longan aril, Chinese angelica and Sichuan lovage rhizome are used to increase the amount of blood.

Pinellia tuber, bile arisaema, thinleaf milkwort root, thunberg fritillary bulb and bamboo shavings dispel phlegm and "dampness".

Golden thread, baical skullcap root, common anemarrhena rhizome, honeysuckle stem and gypsum dispel "fire" in the stomach and heart.

You should abstain from alcohol. Though it can temporarily help you sleep, it will create "heat" and "dampness", which can further affect your sleep quality.

You should also avoid smoking, caffeinated drinks (such as coffee and tea) and spicy and oily food to enhance your quality of sleep.

Consume easily digested food, such as chicken porridge, fish soup, green beans, sweet corn and vegetables to provide more qi and blood. Have light dinners to avoid indigestion which can cause insomnia. If you are hungry before sleep, drink half a glass of warm milk.

Before sleeping, reduce the noise level and lower the temperature of the room. Do some breathing exercises, meditation or yoga to relax your mind.

Taking a short nap between 12pm and 1pm will help strengthen the heart. Sleeping before 10pm can help to increase yin and reduce "heat" and "fire" in your body.

Ms Lim Lay BengTraditional Chinese medicine practitioner at YS Healthcare TCM Clinic

Doctor says

Doctor says:

A: An inability to maintain sleep may be part of the normal process of ageing.

It is likely that the melatonin level in your brain is now lower than when you were younger.

Melatonin is a sleep hormone that is produced in the pineal gland of the brain. It is normally secreted at around 11pm to midnight and peaks at about 1am to 2am. Its concentration would dwindle thereafter.

Due to the lower concentration of melatonin in your body at your age, the likelihood of waking up during the night is high.

Hence, some older people may sleep from 10pm to 1am or 2am and get to sleep again only at 3am to 4am till morning. This may be normal for some.

So it may not always be possible for you to sleep seven to eight hours continuously. Do not get too upset as commanding yourself to sleep may be worse (you probably will not sleep this way).

Taking your time to relax before going to bed is a good routine.

Remember to avoid any stimulants with caffeine, such as coffee or tea. You should avoid drinking alcohol. Keeping to a healthy diet and exercising regularly also helps.

If you do not wish to take sleeping pills, you may want to try some melatonin supplements. You can get these from any pharmacy.

There are numerous scientific articles available to show that taking melatonin supplements improves sleep quality and helps patients sleep longer as well.

But bear in mind that these parameters (quality and quantity of sleep) are subjective and a placebo effect is often included within the results themselves.

The placebo effect refers to a perceived or actual improvement in a patient's medical condition, after the patient has taken simulated or medically ineffectual treatment but believes it can make them feel or get better.

Psychological dependence on drugs is variable from patient to patient.

But melatonin supplements are very safe. There have not been reported cases of addiction.

Dr Kenny PangEar, nose and throat surgeon at Asia Sleep Centre