Category Archives: Acupuncture

piglets asleep together

CALM SLEEP – How to approach Sleep Hygiene for a better nights rest

Sleep is an essential part of our wellbeing. It helps our bodies to recover and regenerate and keeps us sharp and productive. Sleep deprivation is so detrimental to wellbeing that it was utilised in the 1600’s by self styled Witch Hunter General Matthew Hopkins as a means of eliciting confessions from accused witches. Its says something for the pain and torment of sleep that a confession to witchcraft would be seen as a preferable option!

According to the NHS, the average adult human needs around 7-9 hours of sleep per night. According to one survey however, an astonishing 30% of us have had insomnia at some point. There are a myriad of potential causes that lead to insomnia such as shift work, mental health conditions, pain etc.

Acknowledging that the underlying causes can be difficult to control, a common contributor to poor sleep is sleep hygiene. Sleep hygiene is not (as was once suggested to me) how often we clean our nightclothes. Its the routines and habits leading into our bedtime that can influence how we sleep. Addressing these, even if you think that sleeping is not a big problem for you, could ring in the benefits to your mental wellness.

I spend a lot of time talking these things through with my patients so to make things easier I have created a simple mnemonic of sleep habits that could help you to streamline your bedtime. If you are struggling with sleep, or have poor energy that might be linked to quality of sleep, I recommend you try CALM SLEEP, a few simple rules and ideas that could tidy up your sleep hygiene and send you into a more blissful land of nod to help your body and mind recover from the rigours of life!

C – Comfort.
Woman lying on a comfortable bed

Going to bed should be a pleasure and making it comfortable is going to help this no end. To give a balanced view, some researcher in the 1950’s concluded that theres little difference in the amount of sleep time we get between sleeping on a board or sleeping on a sprung mattress. I’m going to be honest, I haven’t read the whole study because I am never going to recommend sleeping on a board. Perhaps the difference between a sprung mattress and a board wasn’t so great in the 1950’s. Whatever this study says, most of us would agree that being comfortable at night enhances our sleep. A decent mattress, bedding and pillows makes our bed a place we want to go to. I know it can run expensive but if we are getting the recommended amount of sleep most nights then we are spending a third of our lives in bed. This has to be worth the investment.

A – Avoid.

There are many avoids before bedtime to aid good sleep but the highlights are caffeine, alcohol and eating too late.

Theres a lot of conflicting advice about the effects of caffeine and alcohol on our general health. Barely a week goes by when I’m not picking up a news article that bestows the benefits or calamities of moderate to heavy consumption. One area of agreement however is the effect on sleep that even moderate consumption can have. With caffeine, as we know, it keeps us awake. The advice I give to maximise sleep is avoid caffeine in the afternoon completely and keep overall consumption moderate. beware also that we aren’t just talking coffee and tea. Unfortunately caffeine can also be found in other places like chocolate so be aware that your evening treat could be having an effect too.

With regard to eating, a full stomach before bed leaves our bodies with a world of work to do when we should be sleeping. You may recall from my last blog on diet the old proverb, “Eat breakfast like an emperor, lunch like a King and dinner like a pauper”. Supporting good sleep is another reason to look at this model of eating. If you can’t face switching your habits, at least make sure you give yourself a few hours between the last mouthfuls and counting the sheep!

L – Light Control.

This is a subject we are becoming moderately aware of but which I feel has a much greater part to play in our overall health. Our bodies respond to light by releasing or suppressing the release of a hormone called melatonin that aids sleep. Studies have found that blue light in particular mimicked daylight (something to do with the wavelength) and guess what? Blue light is emitted by phone, tablets and laptops. How many of us are sitting in bed on devices? This works at both ends of the day. Getting a bit of sunlight in the morning can help to switch off the melatonin and get the body moving.

One of the issues in the western world is that we don’t adapt top our natural environment. Work and school starts at 9 winter summer or fall yet the seasons change and our bodies want to change with it. I believe its a major reason behind Seasonal Affective Disorder as I detailed in an article on the subject some years ago. Regrettably the world is unlikely to change anytime soon so the best we can do in the meantime is to try an mould ourselves around it. Small investments like a natural light clock to wake up to in the morning could help as well as paying attention to getting things switched off at the other end of the day

M – Mellow.

I contemplated making this one meditate but I accept that not everyone has or is going to start this journey. What we can all do however is look at how we slow down in the evenings.

When I ask the question – “How do you relax” to my patients, the most popular answer by a country mile is watching TV. I always challenge this. When was the last time you watched something truly relaxing on TV? Its not designed for that. TV is meant to get its audience engaged, whatever your choice of programme. Documentaries get us thinking, soap operas draw us into the drama and don’t even get me started on the news. The only truly disengaging thing i can ever remember seeing on TV in the last 46 years was the test card and even that had an annoying high pitched noise accompanying it.

Our minds have got enough to do at night filing away a days worth of memories. Calming things down before we go to sleep is going to help avoid that tumultuous brain working overtime when we are trying to drop off. Try listening to relaxing music or reading if meditations not your thing but do try to avoid the Uber excitement at least an hour before lights out.

S – Schedule.

Following a routine is the first thing to look at with sleep. The body has a natural clock called the circadian rhythm which adapts according to our habits. Following a routine at night, especially with regard to the time we go to bed and the time we rise helps our body to take care of the natural functions that aid this such as releasing the sleep hormone melatonin.

L – Leave.

Woman clinging onto a large clockThis really belongs further down but then the mnemonic wouldn’t work! Leave is for those struggling to sleep and what it means is get up, remove yourself for the bedroom and go somewhere else if you cant sleep. The rationale behind this is that we start to develop negative associations with our bedroom and the insomnia cycle becomes self perpetuating. Experts advise going somewhere quiet, reading a book for a few minutes and then returning to your bed to try again.

E – Exercise.

The relationship between exercise and sleep is well made with the advice being that even moderate activity improves duration and quality of sleep. it also helps us to wake and get going.

I always understood there was a caveat to when you exercise because too vigorous too close to bed had an opposite effect. According to the sleep foundation however, recent studies suggest that this doesn’t apply to everyone so I guess its a case of what works for you.

E – Environment.

This is something I feel very strongly about. Now I’m not a Feng Shui expert by any manner or means but it makes complete sense to me that our bedrooms should reflect the peace and tranquility we would hope to associate with a good nights sleep. Lots of clutter cannot allow for a free flowing energy.

baby sleeping on someones armRemember, our bedrooms are places to sleep. They are not for watching TV, or evoking memories or anything else. I recommend tidying up, Marie Kondo the drawers and leave only a few calming objects or pictures out.

I’d also like to discuss the issue of mirrors. According to some traditional belief, our ethereal soul leaves the body at night to wander (it is further believed that if you dream about someone your ethereal souls have met!). If it sees a reflection in the mirror it becomes startled which in can cause us to have nightmares. I recommend draping something over the mirror at night or better still, just don’t have one in there.

P – Professionals.

If you’ve done all of this and you are still struggling it might be time to speak to the professionals. Sleep deprivation is linked to a number of physical and mental health disorders and we should suffer in silence.

So there you have it.  A summary of sleep in a neat little mnemonic.  Please bear in mind that as with everything, if we spend a lifetime developing bad habits, transforming to new ones and seeing the benefit won’t happen over night.  With tenacity however you will ring in the changes.

Tony is a qualified acupuncturist with clinics across east Anglia. He is also the founder and a director of Talking FreEly, an organisation campaigning to break down the stigma of mental illness through honest and open conversations.

If you are interested in learning more about how Tony could help you to achieve your well being goals please get in touch or book an appointment at one of his clinics.

Acupuncture treatment

How does Acupuncture Work?

How does acupuncture work, this question is again best answered by looking at the two predominant theories.

Traditional Theory

Traditional acupuncture has many different styles but all have the central theory that the body is covered in channels of Qi (pronounced chee). Qi translates as energy or life force that guides all of the bodies functions.  There are twelve primary channels in the body which pass through the main organ systems.  They are responsible for bodily functions.  In health, the flow of Qi through these channels is smooth and seamless.  In ill health there is a problem, either a blockage, a deficiency or some other disruption to the smooth flow.  Acupuncture needles at certain points of the body can manipulate the flow of Qi, either nourishing and encouraging it or calming and sedating.  In doing so, health is restored.

Medical Theory

Scientific theory on the mechanism behind acupuncture is rich and varied.  In summary it is believed to act on the central nervous system.  Studies, predominantly focused on pain mechanisms, have noted changes in the release of certain neuropeptides and “significant modulatory effects at widespread cerebrocerebellar brain regions” (Bia, 2013). 

How the two come together

In the face of the highly intelligent and frankly daunting language of science it is easy to feel that traditional theory has no place in modern acupuncture.  In fact, the emergence of a scientific basis for acupuncture in my opinion places even more validity on traditional practises.

Firstly, we must remember that language behind traditional medicine is primitive.  It was developed centuries before scientific knowledge and reflects observation on the human body and its interaction with variations in emotion, the environment and disease. 

For example, if the weather was cold and people started to experience stiff joints the assumption was that the body had experienced an invasion of cold which disrupted the normal function of the body.  We may find the concept difficult to equate but I’m sure we can grasp the sentiment behind it.  Cold invasion in this context describes the nature of symptoms and offers a potential explanation for how the problem arises.  The treatment may include warming the area.  Setting aside the language, applying heat to joint pain remains a valid treatment across a range of medical disciplines.   Much can be taken from the traditional theory of medicine if we take time to contextualise the language.  

Secondly, we must also consider what scientific research has discovered.  Medical Acupuncture is not a new invention, rather an investigation into an existing practise to explain if, why and how it works.  The two practises may focus differently but much of the practise is similar.  For example, whilst medical acupuncture is less specific about the choice of acupuncture point in comparison to traditional acupuncture many of its practitioners never the less use traditional acupuncture points because they assume they probably give the best stimulation of the nervous system (AIM, 2009). In other words, traditional acupuncturists may needle a point because it moves stagnation, medical acupuncturists may needle because it activates the central nervous system.  Both are needling the point to treat pain.

References

Bai, L., & Lao, L. (2013). Neurobiological foundations of acupuncture: the relevance and future prospect based on neuroimaging evidence. Evidence-based complementary and alternative medicine : eCAM, 2013, 812568.

Western medical acupuncture: a definition Acupuncture in Medicine 2009;27:33-35.

A Word about Evidence

The Detective

Photo by paurian on Flickr and used here with Creative Commons license.

The issue of science and evidence based medicine has interested me since I first entered the profession of traditional acupuncture.  I am fascinated by the far reaching capabilities of science, particularly how modern thought correlates with the traditional philosophical concepts of health that still form the main foundation of traditional Chinese Medicine.  It is through this respect however that I have also learnt the limitations of what human beings can explain or understand.

The evidence base for acupuncture is a big subject in which many pitch battles are fought, usually between the relatively niche worlds of scientific skepticism and research savvy complementary therapists.  Its dominated by big brains and personalities and an arena into which I feel intimidated to even dip my toe.  However! The recent episode of BBC’s “Trust me, I’m a Doctor”, in which they tackled the question “does acupuncture work” in about 8 minutes has convinced me to offer some observations that may better equip people to make a more informed decision for themselves.

Historical context

Acupuncture has been researched since the 19th Century and appeared in the first ever issue of the world acclaimed medical journal The Lancet.  The scientific interest however gathered momentum in the 1950’s when Chairman Mao established a number of acupuncture research institutes as part of a “reinvention” of traditional medicine”.  This and an increasing interest in acupuncture from the scientifically minded west led to a substantial amount of acupuncture research.  It is now most likely the most widely researched complementary medicine in common use.

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Photo by Jeremy Shultz on Flickr and used here with Creative Commons license

The Gold Standard of Evidence

When we hear about scientific evidence in medical terms it is really defined by the Randomised Control Trial (RCT) which is considered the Gold Standard of evidenced. In order to establish how well a particular treatment or intervention works it is studied alongside one or more “control groups”. Trial subjects are randomly allocated to one of the groups or “streams” in which they will receive either a treatment or a control treatment.   In the best studies one of the control groups will be treated with a placebo i.e. designed so that the person giving and receiving it cannot differentiate from the active treatment.  In a blind trial they will have no idea which treatment they are getting.  In a double blind study the practitioner will also be blind as to which treatment they are giving.  In its simplest terms a positive outcome would see the tested treatment or intervention outperforming the controls in a statistically significant way.  Sounds simple?  Its not.  Its a complex time and resource intensive process. There are numerous quality indicators within the process and any deviation risks invalidating or at least undermining the entire study.

Difficulties of designing and RCT of Acupuncture

Firstly, there are a lot of poorly designed studies out there and I’m not decrying the ones that say acupuncture doesn’t work.  Actually the opposite.  Some of the early studies of acupuncture that consistently found it to be better than sliced bread aren’t worth the paper they are written on.

There are of course good ones too and it is in some of the larger and better quality studies of acupuncture that we hear one of the commonly cited criticisms that ‘whilst acupuncture outperforms “usual care” with statistical significance, it fails to compare so well to sham acupuncture’.  This is interpreted by many as meaning it is no better than a placebo.  I think we should consider more information before leaping to this conclusion.

Lets be clear, RCTs are designed for and lend themselves to researching drugs.  In this type of research, creating a placebo is a simple matter of handing the subject a pill or liquid without any active ingredients, usually a sugar pill.  The subject takes it as they would any other drug and in the main, this is a direct representation of how a patient would be treated with drugs.

_DSC0027For interventions using holistic therapies like acupuncture it is far more complex.  Typical clinical practise for a traditional acupuncturist involves a great deal more than just needling.  Palpation, case history, lifestyle advice, the list goes on.  And then there’s the needling, tailored individually to the patient and their unique presentation.  Many trials of acupuncture use pre-defined acupuncture points and seek to isolate it from the other parts of treatment like lifestyle advice etc.  You end up with a highly sanitised treatment that bears little if any resemblance to a typical clinical encounter.

The issue of using a placebo control is also highly controversial.  Creating a placebo for acupuncture means designing an “act” for real and false acupuncture that nobody can differentiate. The favoured methods are retractable needles that don’t penetrate the skin or normal needling on “non” acupuncture points.  The latter at least involves needling which arguably activates a bodily response making it far from inert.  The former is also far from infallible.  During a practise sessions with various types of non-penatrative placebo needles I found that in fact they frequently break the skin and this corresponds with the experience of research acupuncturists too.  If they penetrate the skin, can it be considered as a placebo or non-active intervention?

I’d suggest not so what you end up with is a placebo that may not be inert and an intervention that does not represent normal clinical practise.  Yet in spite of this, both still outperform usual care. What does this say?  My interpretation is that even bad acupuncture is better than usual care or no treatment.  Imagine the potential for proper acupuncture!

Other evidence

What really grates on me is not the never ending argument of the wether or not an RCT has proved one thing or another.  Its the hailing of an RCT as the be all and end all of evidence like nothing else in the world matters. I think this is demonstrative of a far larger cultural shift driven by advances in technology, not just our attitude to medical science.  For example, in my previous profession of law and order we used to solve crime long before CCTV and DNA evidence (I hear the cynics amongst you! Lets have that debate another time!)  Now it seems that witness testimony doesn’t really cut it.  We need concrete proof and undisputed computer audit trails.  Does this mean that without them the crime never took place, that the evidence of a witness was wrong?  No, its just that we now have a higher expectation.  The same is true of medical science.  The old evidence is still evidence and actually, if theres enough of it or the “new” evidence is poor evidence it is arguably still “best” evidence!  Thats not to knock progress, just to encourage some humility because our expectations now are so high we seem to forget that in the greater scheme of things we actually still know very little.  Anyone who has suffered a migraine will back me up here.  Drugs may work, they may not, they may work for a time then stop working.  Actually, this commonly occurring but painfully debilitating illness is very poorly understood in spite of countless studies and amazing scientific developments.

Traditional acupuncture does not rely solely on what can and can’t be proved scientifically.  It is built primarily on the collective knowledge of recorded clinical practise over 2,000 years. It is good evidence stood next to science which has only really developed in the last 60 years and still has a long way to go.  I wonder then why some people would be so quick to dismiss it.

Conclusion

Wooden justice gavel and block with brass

Photo by Tori Rector on Flickr and used here with Creative Commons license

I hope that I have been able to give a good overview of the strength and potential weaknesses of scientific evidence in the field of acupuncture.  In my opinion, whilst science has a huge part to play in our future, it still stands very much in support of the historical knowledge and philosophy that is the bed rock of traditional acupuncture.  That doesn’t mean Im not excited about what it can and will bring to my profession as we make more and more advancements .  I simply advocate tempering this with an awareness of our own limitations and the openness of possibilities beyond our own limited knowledge.

In the meantime I will continue to be guided by “all of the evidence” to treat individual health needs with traditional acupuncture for as long as it continues to help people.  I have a feeling I won’t be retiring anytime soon!

Insomnia

A video from 2 years ago of Toyah Willcox talking to the British Acupuncture Council about insomnia and how acupuncture helped her.

Acupuncture – A brief History

The exact origin of Acupunctures is difficult to date as references of varying evidential value can be cited.

For example, there was much excitement amongst the world of acupuncture following the  1991 discovery of  “Otzi the iceman” in the Italian Alps.  This near perfectly preserved and mummified neolithic man had tattoo’s on his body that correspond to known acupuncture channels.   Carbon dating showed that he had lived 5,000 years ago.

Even before this however some believe that stone needles or “Bian Shi”, recovered during archaeological digs in inner Mongolia, could place the practise at a much earlier point in history.

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What is clearer is the written record which started approximately  2,000 years ago in the 3 Sovereigns period with the Huang Di Nei Jing, or Yellow Emperors Internal Cannon, a book on which the traditional practise of Chinese Medicine is founded and which remains a significant source of knowledge and inspiration to this day.  Indeed a copy can be found in the personal library of many practitioners, including my own.

Since this book many other texts and schools of thought have been committed to paper to establish an unbroken literary record.  Whilst remaining unbroken, it has however suffered over the years.  The “Fen Shu Keng Ru” a dark period in Chinese History during the Qin dynasty when the emperor ordered the burning of books and scholars, did not succeed in wiping the history but it never the less delivered a serious blow.  The extent of damage and amount of information lost during this time can only be imagined but could be assumed to be significant.

Acupuncture first started its journey out of China via the silk roads and is believed to have been brought back to Europe by French Jesuit missionaries.  Whilst practised for many years, popularity in the west saw substantial growth in 1971 following the appendectomy of New York Times reporter James Reston who became ill whilst covering President Nixon’s impending visit to China.  The surgery took place in a Chinese hospital where he received acupuncture during post operative recuperation, an integrated approach still practised in Chinese hospitals and much envied by western practitioners.  He was so impressed with the treatment he wrote an article on it for the newspaper awakening the western audience to this little known form of healing.

Acupuncture has continued to grow in popularity and is now practised in a variety of styles and setting across the world. In a modern world of stress and resistance to drugs, many are seeing the benefits of holistic, natural healing as practised for nearly 2,000 years.

I hope you enjoyed reading my post.  In the coming weeks I will be blogging about some of the historical influences that contributed to the development Traditional Chinese Medicine and its many philosophies.

Scared of needles? – YouTube

Scared of needles? – YouTube.

Acupuncture during pregnancy

pregnancyOk so recently one of my friends asked, what can acupuncture do during pregnancy? Lets start at the beginning. Lots of people want to known if Acupuncture can help you to get pregnant? Well, Celion Dion and Mariah Carey certainly think so. Both were reported to use it to help them conceive, article here
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