🌿 Folk Prescriptions

Mr. Hu, in his fifties, tends to worry over trivial matters, is easily tense and anxious, and has generally poor sleep quality. In recent years, economic downturn and business difficulties have caused him great concern. During the day, he worries constantly about work performance, remains tense, and feels exhausted. At night, he continues calling to check on matters. Finally, when he can rest, he endlessly thinks about today’s events and plans for tomorrow, tossing and turning, waking intermittently, and experiencing frequent dreams. To secure adequate sleep, he began taking sleeping pills. Initially, one pill was effective, but after two years, now three pills only bring shallow sleep. Mr. Hu is a typical case of chronic insomnia.
Causes of Insomnia
Insomnia has many causes, broadly categorized as follows:
◎ Insomnia due to violation of circadian rhythm: e.g., rotating shift work, international travel across different latitudes. Extreme excitement—like crying from joy—can also cause temporary sleeplessness.
◎ Sudden impact from major life events: e.g., death of a loved one, divorce, accidents, unemployment, company bankruptcy, stock market fluctuations, or the recent earthquake. These cause emotional instability, grief, panic, lasting for weeks or months, resulting in persistent sleeplessness. Most cases resolve within one to two months, though some evolve into chronic insomnia.
◎ Primary insomnia: Patients have no specific internal medical or psychiatric conditions. They are typically naturally anxious, tense, and prone to worry. Their sleep quality is often poor. Under major stress or increased mental load, they struggle to sleep. Over time, this becomes chronic insomnia. Even after stress ends, deep, restful sleep never returns. Mr. Hu fits this category. Some primary insomnia patients may have no identifiable cause.
◎ Mental disorders: Depression often accompanies insomnia, characterized by waking up at 2–3 AM and being unable to fall back asleep. Manic patients don’t want to sleep at night, full of energy, calling friends at midnight, endlessly going out, hallucinating, communicating with spirits, unable to stay still. Other conditions like generalized anxiety disorder, panic disorder, and schizophrenia patients may also frequently suffer from insomnia.
◎ Internal diseases: Arthritis and various pains can keep patients awake at night. Heart failure patients experience worsened breathlessness when lying flat, requiring sitting to sleep, severely affecting sleep quality. Other conditions like thyroid disease, lung disease, and uremia may also cause insomnia.
◎ Menopause in women: Women during menopause may experience hot flashes, night sweats, and insomnia. Some premenstrual syndrome patients suffer severe anxiety, unease, pain, and even insomnia.
◎ Medications: Drugs like corticosteroids (e.g., American “Xian Dan”) can cause insomnia even in small doses; large doses may lead to mental disturbances. Asthma medications such as bronchodilators increase heart rate and stimulate nerves, preventing sleep. Other drugs like marijuana, heroin, and amphetamines affect neurotransmitters, excite the central nervous system, and cause insomnia and hallucinations.
◎ Stimulating beverages: Tea and coffee disrupt normal sleep. Alcohol initially promotes sleep but leads to dependency over time, similar to sleeping pills. Long-term use impairs normal sleep patterns. Alcohol metabolizes quickly, eliminating its sedative effect in the second half of the night, accompanied by headaches, sweating, palpitations, and other side effects, worsening patient discomfort.
◎ Medical origin: Doctors prescribing sleeping pills or patients self-administering them can lead to habitual use. Eventually, sleeping pills lose effectiveness, resulting in nightly insomnia.
◎ Sleep-wake cycle disorders: Humans naturally enter sleep after a day of work, sleep for 6–9 hours, then wake at dawn. This daily cycle, known as “circadian rhythm,” is essential. Some people have delayed circadian rhythms, sleeping only at 3–4 AM and waking at noon. If they set their own schedule, they don’t have insomnia—but cannot align with societal routines, requiring correction.
These are the various causes of insomnia. We must carefully analyze them, see the right doctor, take the right medicine, and solve insomnia effectively. Otherwise, relying solely on sleeping pills may worsen the condition.
Treatment of Insomnia
In Taiwan, one-third of people over 60 have sleep disorders. With faster lifestyles and increased work pressure, young people seeking help for insomnia are growing. Conservatively estimated, there are over a million insomniacs in Taiwan. Insomnia causes unhappiness, lack of concentration, and seriously impacts daily life and work. Therefore, treating insomnia is a crucial issue in modern society.
◎ Drug Therapy: Why do sleeping pills stop working? Since the introduction of benzodiazepines in the 1960s, their high safety profile quickly replaced barbiturates. These drugs bind to specific receptors in brain neurons, suppressing brain activity, producing sedative, hypnotic, muscle-relaxant, and anticonvulsant effects. Initially very effective, the brain eventually adapts—remembering the presence of sleeping pills. After long-term use, receptors become fully occupied, rendering the drugs ineffective. Long-term use has the following drawbacks: a. Tolerance and addiction develop within about two weeks, requiring dose increases. Eventually, even large doses prove ineffective. b. Inability to achieve deep sleep—patients often complain of feeling unrefreshed. c. Memory loss, low mood—since sleeping pills suppress brain activity to induce sleep, they also inhibit other brain functions, causing memory loss, poor concentration, fatigue, and low mood.
Antidepressants: Some traditional antidepressants and drugs like mianserin have strong sedative effects and can be used for insomnia patients, especially those with concurrent anxiety or depression. Treating both simultaneously offers dual benefits without developing tolerance or addiction—this is strongly recommended by the author. However, careful use is needed to avoid side effects.
Other drugs like antihistamines or tranquilizers also have sleep-promoting effects and can be used for mild insomnia or combined with other sleep aids.
◎ Daily Lifestyle Habits That Help Improve Sleep:
a. Maintain regular routines—go to bed at the same time every day.
b. Exercise regularly—minimum four times per week, at least 30 minutes each session.
c. Avoid noisy environments for sleep. Those with sleep disorders cannot withstand noise, which disrupts deep sleep.
d. Extremely cold or hot environments hinder falling asleep.
e. Avoid alcohol, coffee, tea, and heavy meals before bedtime.
f. Avoid watching tense, stimulating TV programs, movies, or reading newspapers involving crimes, kidnappings, etc., which cause psychological unease and interfere with sleep.
g. If unable to sleep after a few restless moments, get up and do light activities. Lying in bed will only increase tension and worsen sleeplessness.
In modern cities, many people should be sleeping at night but remain awake, tossing and turning, their minds filled with past, present, and future thoughts—sadness, anger, worry, fear… The more they try not to think about it, the more it haunts them. Insomnia is extremely frustrating. Those without insomnia cannot understand its torment. In long, sleepless nights, insomniacs desperately desire a peaceful, carefree, calm night. Insomnia is not merely psychological—it involves complex hormonal changes in the brain. Both physiological and psychological adjustment are vital. Medication use should be guided by a physician, not avoided out of fear. Otherwise, the condition may worsen.
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