Clinical Cases Disease Index Neurological Disorders

A Case of Insomnia – Acute and Chronic Treatment

Last modified on May 10th, 2018

Thierry Clerc
Written by Thierry Clerc

Homeopath Thierry Clerc discusses his method of treating insomnia and provides a sample case.

sleep.jpgSleep is one of the key elements of optimal health. If you cannot sleep, you cannot heal. When I see clients for the first time, I will always review the state of their digestive system and the quality of their sleep. In my opinion, these are the two most important areas, which can prevent homeostasis and self-healing.

Regarding sleep, it is a medical fact that poor sleep will impact health in the long run. For example, statistics show that people in the UK who are short of sleep are more likely to suffer from an accident in the workplace.

 

So, what is good sleep?

Medically, sleeping patterns are considered to be driven by the hormonal system: the levels of cortisone (“stress hormone”) in the blood tend to rise just before waking up, and fall before going to bed. In parallel, the pineal gland secretes melatonin (“sleep hormone”) when it gets dark around us. However, it is not as simple as that: many people can sleep in full light, or during daytime, and with practice most people can achieve very effective and refreshing “power naps” (a 15/20 minute sleep).

As a rule of thumb, if your patient feels sleepy during the day, or cannot wake up refreshed and full of energy, then some work needs to be done to improve their sleep pattern.

It is however important to understand that individual requirements for sleep actually vary widely. Some people do well with a full night of 9 hours, while others may be happy with 4 hours, with possibly a nap after a meal. A “normal sleep” pattern can also vary depending on the season or the profession of the client.

When querying my patients, I would first ask about their perceived quality of sleep, their state and levels of energy when waking up and also 6-8 hours later (broadly speaking what should be the middle of their waking day).

If I feel that the quality of their sleep is not optimal, I would try and get more details and also investigate more broadly their lifestyles.

 

Obstacles to cure for chronic sleep

If your patient comes with sleep issues that are recent and have a known trigger, then a prompt return to healthy sleep is possible with homeopathic treatment only.

For more long-standing or chronic issues, I have found it necessary to address lifestyle or deeper emotional issues. At least in Western Europe, a combination of stress, emotional issues, poor lifestyle and a diet rich in carbohydrates may need to be addressed.

In terms of lifestyle, it is worth asking your patient to review what they do during the last two hours of their waking time. Review everything with them to see what can be done to promote a relaxed mind before going to bed. Here are some suggestions that can help:

–         If your patient watches TV, computers or plays video-games 1-2 hours before going to bed, and has sleep issues, then suggest they stop, at least a few days a week and instead take a walk or read a book.

–         If this is something, you are attracted to, practice some form of relaxation or meditation to train your mind to “calm down”.

–         Alternatively, some people may feel better after some strenuous exercise, and for them, doing some active sports one or 2 evenings a week may help.

 

The typical modern Western diet can be an obstacle to good sleep. Higher levels of insulin and cortisone tend to reduce the ability of the body to produce melatonin. If this is the case, then improving the diet and the digestive system may be required. Here are some simple suggestions:

– Suggest a diet low in refined carbohydrate, soft drinks, coffee or tea, at least for the latter part of the day.

– Artificial additives like glutamate (MSG) have been linked to sleep issues, and I have found this especially true for children. So if you suspect this to be an issue, suggest that your patient to stay off them for a couple of weeks to see if it makes a difference.

– Drinking at least 1.5 to 2 litres of water a day is a necessity for most people. More than half of the daily fluid intake should be taken before noon to reduce the occurrence of nocturnal urination.

– Finally, recreational drugs or conventional medications may impact the sleep pattern of your clients. If so, you may need to help them wean off, or suggest they take these at earlier parts of the day. Tautopathy (which is giving the drugs back in a homeopathic potency) may be a good approach.

 

People who are also taking medications for their sleep tend to have poor-quality sleep. Many feel drowsy during the day or feel un-refreshed after 8 hours of sleep. They need to understand that their quality of sleep is still not optimal, and they need further support in this area. Showing them the list of side-effects from their medications may help.

 

Acute and Chronic Issue – A case

In my experience, homeopathy is one of the best therapies to help people with sleep issues. My suggestion to fellow homeopaths is to become very well acquainted with the Sleep and Dreams sections of their preferred repertory. This will help you to ask the right questions leading to the correct remedy. As usual, confirm symptoms with the Materia Medica. Some information to gather is :

– Any known cause or traumas, which have triggered the sleep issues.

– Time of going to bed, time of falling to sleep, time when awakening during the night, time when getting up.

– During these key times, are there any significant emotions, thoughts, worries present in the mind of your client?

– Is there a variation of the quality of sleep during weekdays and weekends, holidays and working days?

– Any other issues / information during poor sleep.

 

My therapeutic approach

For sleep issues, I usually suggest a therapeutic to take before going to bed and at night. To help with deeper and broader issues, I will often complement this with lifestyle advice and a more general treatment to be taken during the day, usually in water.

For chronic insomnia, the homeopath will often need to help the client come to terms with the past or reduce their fears towards the future, and this can take some time.

As a short description of my approach, I would first decide if the issue is either a combination or one of the following: physical, emotional, known cause/trigger. I would always repertorise the main remedies, using around 6-7 rubrics. I would also complement with a set of acute remedies if relevant.

If the issues are emotional or have a known cause, I would use single remedies and high potencies, or LM. If the issues are more physical, then the chronic support may contain vitamins and multiple remedies in low potencies for “organ drainage” or to support the body.

Here is a case of a lady of 28 years old, in good health, who came to see me after a severe bout of insomnia: Unfortunately, I did not keep the repertory rubrics and sheets as I use a repertory software and rarely store them for reference. The summary below is taken from the notes of the consultations.

 

Initial Consultation

Anna was working as an engineer in a firm in Cambridge (UK). For the last 2 or 3 weeks she had severe problems falling asleep. She tries to go to bed at 10PM, but cannot sleep until 3 or 5AM most nights, mainly “thinking” or tossing about. She would do her best to wake up at 8AM. She felt it was getting worse now.

She had a good diet but a stressful job, and she had been required to travel a lot over the last year to France and China, almost on a monthly basis. She told me that she had suffered from poor sleep on and off all her life. She had tried to self-prescribe herbal and homeopathic treatment. She was seriously considering taking a conventional medication, but was worried about the side effects.

Her timeline was as follows:

Born in Belgium, breast-fed, no major health problems

Child           Orthodontist work done – BAD TEETH AS A CHILD

13               Menarche – Never on Birth Control Pill

Teens          Had Mercury fillings – REMOVED a few years ago

17               Father dies (heart attack)

20s              Sleep issues during examinations – student time, took medications for it.

23                Tiredness after vaccination (tetanus)

24               Moves to UK to work

25                Cystitis – bladder infection      had antibiotics

28 (now)     Sleep

 

She was also feeling stress in her tummy, and a mild digestive disturbance like bloating. This had been for several years already, but it got somewhat worse with the sleep issue. Over the last 3 weeks, she was also noticing some heart palpitations when under stress.

She was blaming her stress and work for all her issues. However, those had not increased significantly over the last few months. It was only at the end of the consultation that I got my breakthrough. I kept looking for a 3-4 week-old trigger to the worsening of the sleep as there was no other obvious cause, and then, she said she had gone into a romantic/platonic relationship with an older colleague. The relationship started a few months ago and her colleague decided to have a break up about 3 weeks ago.

I separately repertorised for her general issues (stress, digestive and palpitations) and for the sleep. For the digestive problems, I took into account that this could be a possible effect of the antibiotics (and Arsenicum scores high for this). For sleep, the now obvious cause was the separation. I complemented my rubrics’ search with Anna’s description of her main symptoms and sensations.

Prescription

– Kali Ars 9C, 8 drops a day in one litre of water.

(Arsenicum may have been higher but I preferred Kali Ars as it comes very high for heart palpitations)

– Probiotics and Multivitamins, 1 a day – I gave this mainly as I was concerned about poor absorption. It was not repeated afterwards.

Natrum Muriaticum 200C before sleep and if waking up, every fifteen minutes as needed.

 

2nd Consultation

Because of Anna’s travel schedules and the fact that I felt confident about having found the right remedy, I suggested we meet in a month.

However, after a couple of weeks, she emailed me to say that the remedies had worked very well for a week but that she could not sleep again. She was then in France and I thought of asking her to go to a chemist and get a higher potency of Nat Mur. I instead suggested a Skype consultation. She then explained that she had been trying to make up or become friends with her ex-partner/colleague (who was based in Cambridge), and that he had been blaming her a lot, and she had felt really hurt and angry with him. I did not have to ask many questions as  Anna, at this stage, felt the need to talk. She mentioned that she always had difficulty going into a relationship and feared getting stuck like her mother. She explained a lot about her family background, having a dad who was aggressive, especially towards her mother. She was scared of her dad until he died (when she was 17) and earlier on in her life, she feared that her parents would divorce.

On the initial prescription the heart palpitations and the stressed tummy had improved. However, at night she could really feel her heart bouncing, much more than ever before.

I asked her to continue the daily treatment but to complement with this:

– Sleep: try instead, or as well Staphisagria 200C. Take Staphisagria also if she feels abused during the day.

– Arsenicum 10M: if getting very anxious at night.

– Ignatia 10M: when feeling sad and to help with the separation.

 

For acute conditions, as they can be quite changing and have different triggers, I personally have no problem with giving a set of remedies that can be used by the patient. I feel that the clients are more supported in that way.

Through the Skype conversation we also realised that when Anna was travelling, she would work late at night in her hotel room, and mentioned that this was probably not helping her to sleep. She would also get stressed as she had to perform a busy day of work the day after.

 

3rd, 4th and 5th Consultations

We kept the previous appointment so I met again Anna about 3 weeks ago. The relationship issue was now starting to heal. The sleep had improved but was not great. She could sleep most nights but could see that work issues or her wounded self could disturb it easily. The acute remedies were helping.

She understood at this stage that she had to do more work on herself, and get support. These consultations were still primarily about her sleep issue. It took about another 6 weeks for the sleep to settle, and the main sleep triggers were then quite clear:

– excessive response to jet-lag when travelling to Asia

– working late and not having time for herself when being abroad

– the separation and unexpressed anger towards men – her ex-partner, her boss and her deceased father in particular

 

At these consultations, the daily chronic treatment was 9 drops of Natrum Muriaticum in LM, going one potency up each time. This was to be put in a bottle of water of one litre and drunk throughout the day. Beside using  strategies to help with the jetlag and working late, Anna was helped by the previous therapeutics, and also Arsenicum and Melatonin.

 

Follow-on Consultations

I saw her for about one more year. From the 6th consultation, the sleep was not a major issue. Anna did suffer sometimes from a couple of bad nights, but she would recover well afterwards with the help of the therapeutics. She could get a full night sleep and feel refreshed from it.

The core issue for Anna was about male figures, and learning to stand her ground. It was in some ways about healing her early relationship with her father. Beside Natrum Muriaticum in LM, Anna also benefited from the  other remedies in her chronic support. These were Staphisagria, Arsenicum, Lycopodium, Pulsatilla and Sepia. Kali Carbonicum was the main remedy at the end of our work.

During one course of chronic treatment, I felt compelled to give her a tautopathic prescription for the drugs, she took for sleep when she was at University. This was complemented with Avena Sativa tincture and Passiflora in low potency, to re-nourish the nervous system.

In the middle of the treatment, I removed the Natrum Muriaticum, feeling that Anna had moved on. However, she felt quite depressed afterwards. The primary cause was that she felt she did not know how to get into the “right romantic relationship”. This is when Pulsatilla came very highest in the repertorisation. I however, kept her on Natrum Muriaticum in parallel for a bit longer.

Anna also got in touch with her ex-colleague as she felt that they needed to spend time together. Anna did not want to get in a romantic relationship with her colleague and but kept him as a colleague-friend. She did not mention any other relationships.

At the end of the treatment, the sleep issue had basically gone, and we were working on deepening her self-confidence. She had decided to look for another job, something that was in her mind quite early in our work. At the end, she  moved back to her home country and retrained as a garden designer. This is when I lost track of her, but it looked like all was well.

 

A Short Therapeutic

The list of homeopathic remedies for sleep issues could be endless. Here is a very short selection of useful remedies. However, as pointed before, I would always repertorise and get a significant number of symptoms on the sleep issue itself. I would also always refrain from prescribing before seeing and knowing a client.

Aconite: Sleeplessness after 12AM with anxiety, restlessness and tossing about from arterial excitement; eyes closed by fear, fright, anxiety, anxious, vivid dreams; sleeplessness from nervous fear and cannot sleep, or from local irritation especially in intestinal tract; sleeplessness of infants and of the aged.

Arnica: Kept awake until 2-3 AM by heat, restlessness and constant desire to change position, > lying across bed, head hanging down; wavelike motions passing through brain; excruciating pains in brain and eyes, which feel as if drawn inward.

Arsenicum: Insomnia from malnutrition, with nervous exhaustion, internal anguish driving out of bed, feels compelled to change from bed to sofa or chair, and then back to bed; cannot rest in any place, changes continually, which exhausts them.

Avena sativa: Chronic insomnia, < convalescence. Sleeplessness after mental exertion. Insomnia, exhaustion aggravates.

Chamomilla: Sleeplessness from nervousness, local irritations or indigestible things in stomach and intestines; during dentition; from hepatic disease; great restlessness; moaning, starting and tossing about; talking in sleep; irritable and peevish.

Colocynthis: Sleeplessness and restlessness after anger; sleeps badly, wakes tired.

Calc Carb: lies awake night after night; visions on closing eyes, restlessness without accomplishing anything. Feels weak; sleeplessness from mind over-activity. Same ideas disturb him; fidgets in arms and legs; insomnia during dentition.

Coffea: Sleeplessness from overexcitement of mind and body, from joy or agreeable surprise, from long watching, from excessive use of coffee; all senses more acute; persistent insomnia of children, without cause.

Crot. hor: Insomnia, as soon as dozes off, dreams of dead persons; sleeplessness from nervous and mental distress, connected with physical suffering, but out of all proportion to suffering; chronic insomnia.

Ferrum met: Insomnia from tea; in pneumonia; anxious tossing in bed after 12AM; can lie only on back at night; remitting pains; < night, driving one out of bed,> motion; child cannot sleep on account of itching from worms; weak nervous persons.

About the author

Thierry Clerc

Thierry Clerc

Thierry Clerc LCPH, MSc practices homeopathy in Cambridge (England). He is a graduate of the College of Practical Homeopathy (London). Prior to this, he enjoyed a successful career as an executive in the telecommunications industry. When fate hit him with a severe bout of arthritis, he went back to France to see his old homeopath, and after prompt cure, decided to study and become one!

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