True Wellness the Mind

How to Combine the Best of Western and Eastern Medicine for Optimal Health; Sleep Disorders, Anxiety, Depression

Catherine Kurosu, MD, LAc, Dr. Aihan Kuhn, CMD, OBT

• Publisher: YMAA Publication Center
• ISBN:
  9781594396656
• Topic: Medicine
• Subtopic: Sleep Medicine

Emotional health, physical health, and sleep are intertwined, each affecting the others.

True Wellness: The Mind is a step-by-step guide to optimal mental health, blending the best of Western and Eastern medical traditions to address

• Sleep Disorders
• Anxiety
• Depression

The authors recognize that the conventional way of managing sleep disorders, anxiety, and depression may not be sustainable for many who continue to struggle with these problems. In their own practices they have discovered a path to optimal mental health by combining the best of Western and Eastern medicine.

" We have seen among our own patients how chronic stress can wear away at their well-being, often first by stealing their sleep, then dampening their mood, and finally disrupting their health."

With this book you will

• Discover the strengths and benefits of both Western and Eastern medicine
• Combine Western and Eastern healing methods for sleep disorders, anxiety, and depression
• Usequestions, worksheets, checklists, and practical advice to prepare for and begin new, healthy behaviors
• Learn to create a multidisciplinary care team for a strong alliance between your Western health-care providers and Eastern practitioners

The authors explain how exercise, nutritious food, stress management, acupuncture, and qigong affect the body, so you can make healthier choices. To help you move forward on a new path, they provide practical advice and worksheets to start simple daily exercise routines, eat a plant-based diet, and begin qigong practice.

True Wellness: The Mind encourages individual responsibility and prepares you to take the first step on your healing journey. By combining ancient wisdom, cutting-edge scientific discoveries, and practical advice, this book will lead you through a transformation to true well-being in body, mind, and spirit.

 

CHAPTER 1

Emotional Health, Sleep, and Disease

FOR MANY CENTURIES, humans have appreciated the connection between our emotional and physical health. Sleep lies at the interface between these realms, influencing and being influenced by our minds and bodies. When we find our mind troubled, our sleep disrupted, and our body out of balance, it is sometimes difficult to determine the initial cause.

This is like the classic question, “Which came first, the chicken or the egg?” When talking to patients about their medical history, a lot of information can be gained by trying to unravel the “chicken or egg” conundrum. When someone is asked, “When was the last time you felt well?” he will almost always know the month and year. The follow-up question, “What happened in your life during the previous few months?” can shed a lot of light on the problem. Some people have experienced an emotional trauma that has not resolved, leading to anxiety, depression, or difficulty sleeping. Subsequently, they develop physical ailments such as headaches, digestive issues, or chronic pain. Other people suffered a physical trauma that disrupted their sleep and led to anxiety and depression. The physical trauma could have been an accident or an illness, a surgery, or a lifelong disability.

Any initiating trauma, whether physical or emotional, can lead to disrupted sleep. This can be caused by the physiological changes brought about by a medical condition or by the worry and stress caused by a change that the initiating trauma has brought about in relationships or socioeconomic factors. For example, if someone is in a car accident and is injured, she may suffer both physical and emotional trauma. The physical injury may cause pain, disfigurement, or disability, which may result in an inability to work, either inside or outside the home. People injured in this way may be unable to care for their children, parents, or partner. Perhaps now they cannot financially support their family. This can lead to worry, anxiety, and depression. Individuals who are unable to fulfill their usual responsibilities commonly feel ill at ease in their relationships and society at large. These physical and emotional stressors can adversely affect a person’s sleep. Not only can pain from a physical injury disrupt the normal sleep cycle, but the emotional strain of altered circumstances can also lead to insomnia. Head injuries, in particular, can disturb a person’s normal brain function and sleeping pattern. The physical and emotional trauma caused by traumatic brain injury (TBI) can take years to resolve.

The example of a car accident is a common one, but any serious illness or life change can lead to emotional problems and sleep disorders. Some people are able to bounce back from these situations and get right back on course. Others, because of the severity of their injury or illness, never truly recover and may carry the secondary burden of poor sleep and emotional distress for the rest of their lives. Yet again, some people are genetically predisposed to suffer from emotional or sleep disturbances; such conditions are known to run in families. With increasingly sophisticated tests such as gene sequencing and functional magnetic resonance imaging of the brain (fMRI), and a greater understanding of how brain cells actually work, scientists are able to pinpoint the reason some people are affected with these disorders and others are not. For instance, generalized anxiety disorder carries a moderate genetic risk, with a 30 percent risk of inheritance.¹ A 2018 meta-analysis found 44 genes that may predispose an individual toward major depression.² Continued research into sleep reveals that it is under genetic control. Sleep involves many layers of biochemical processes, and genetic abnormalities can account for various types of sleep disorders.³ It is important to note, however, that the authors of these studies, and many more, point out that anxiety, depression, and sleep problems are significantly influenced by environmental, societal, and lifestyle factors. This means that even though a person’s genetics might make them susceptible to these conditions, they may not actually experience any symptoms of these illnesses. In Western medicine we call this “gene expression.” Whether certain genes are expressed depends on where, how, and with whom a person lives. If you live in a crowded, polluted area, if you suffer from loneliness and isolation, and if you eat poorly and rarely exercise, the genetic information stored in the cells of your body can be expressed in such a way as to allow some diseases to occur.

Even if you have been fortunate and have avoided a major crisis, like an accident or illness, the way you live your life day to day makes a significant difference to your health. One of the main contributors to good health is adequate restful sleep. Humans have always realized that sleep is important, but we are just starting to understand exactly why. We all know that when we sleep well, we wake up refreshed and energized. Our thinking is clear and our memory is sharp. We also know that the reverse is true. When we are sleep-deprived, we feel sluggish, our reaction times are slower, and we have difficulty with problem solving. In fact, one British study that compared sleep deprivation to alcohol consumption found that seventeen to nineteen hours without sleep resulted in the same level of performance on speed and accuracy testing as having a blood alcohol level of 0.05 percent. After twenty-three hours, the performance levels were the same as if a person had a blood alcohol level of 0.1 percent, which is well past being legally intoxicated.⁴

So why is sleep so important to the brain? What happens to our brain when we sleep? It gets cleaned. In the body, the system that removes the waste products of cellular metabolism is the lymphatic system. A fluid called lymph picks up these waste products and takes them through lymph vessels to the nodes and organs, such as the spleen, to be processed. But the brain does not have lymph vessels or nodes like the rest of the body. The equivalent of lymph in the brain is known as cerebrospinal fluid (CSF). The CSF carries the waste products of the brain cells; it was recently discovered that the way the CSF travels between cells deep in the brain is through spaces between the walls of the blood vessels and the projections of a type of brain glial cell called an astrocyte. Glial cells are not neurons. The various types of glial cells support the functioning of the neurons that make up your brain. So, instead of a totally separate system of vessels to transport waste products, as is found in the lymphatic system of the body, the brain uses the space between the outside of the blood vessel and the specialized glial cells to clear the brain of toxic by-products. Scientists have named these channels the glymphatic system, meshing the words “glial” and “lymphatic” to convey its function and form.⁵

This is all very interesting, but you may be thinking, “What does this have to do with sleep?” It turns out that the glymphatic system is incredibly active when we are asleep and is almost completely suppressed when we are awake. In order for harmful substances to be cleared from the brain, you must be asleep. If these toxic by-products accumulate in the brain, over time, diseases like Alzheimer’s and other forms of dementia may occur. The glymphatic system may also distribute nutrients and neurotransmitters that keep the brain functioning normally. Since the activity of the glymphatic system is enhanced during sleep, it is no wonder that we need adequate amounts of sleep to feel alert and well rested on waking.

Even our mood improves after sleeping well. In fact, normal sleeping patterns are linked to normal mental health. Among people with illnesses such as depression, anxiety, bipolar disorder, or schizophrenia, sleep disturbances are common and may actually precede mental illness in susceptible individuals. Fortunately, because sleep and emotional well-being are so closely intertwined, improving sleep quality in such patients can decrease the symptoms of psychiatric illness by as much as 50 percent.⁶

Sleep is one of the principal resources you need to keep your body and mind functioning well. Along with nutritious food and a safe and supportive living environment, sleep is essential to maintain your equilibrium in life. Another word for this equilibrium is “homeostasis,” your ability to sustain all the physiological processes your body needs to stay healthy and in balance.

Homeostasis or balance set points change over time and circumstances. Everyone has been through periods when life seems off-kilter. Maybe you had to sleep less or work harder to accomplish a goal. Perhaps you lost your job or got a promotion. You may have married, divorced, or lost a loved one. All these events may require you to use more of your resources—your time, your money, your strength. All these events and more are considered stressors. We have not even discussed environmental stressors such as pollution and overcrowding; societal stressors such as racism, gender bias, and poverty; and catastrophic stressors such as war, violence, and abuse. The word “stress” often has a negative connotation, but even normally joyful events, such as the birth of a baby, can be stressful.

When you live through these stressful life events, changes occur in all aspects of your physiology. This “gearing up” to face the increased demands on your metabolism, intellect, or psyche has been referred to as “allostasis,” meaning “achieving stability through change.”⁷ These stressors could be good, tolerable, or toxic. Whether “good” or “bad,” the cumulative effects of such stressors are referred to as the “allostatic load.”⁸ Under usual circumstances, this state of heightened functioning resolves and your immune, endocrine, and nervous systems are taken off high alert. Ordinarily, we are able to cope with these periods of allostasis, especially if we have been attentive to the needs of our bodies and minds, staying healthy, active, and well rested. This is much like topping up your bank account, saving for the proverbial rainy day.

But not everyone has the same reserves. Your fiscal, physical, or emotional state can vary throughout your life. Sometimes uncontrollable events occur one on top of the other. Sometimes we simply do not take the time or make the effort to care for ourselves as we know we should. Whatever the reason, when stressors overwhelm your resources, the body and mind are unable to return to a state of homeostasis, or balance. In this condition, dysregulation of the immune, endocrine, and nervous systems occurs. Essentially, you get “stuck” in overdrive. This is called “allostatic overload,” and it can create havoc.⁹ Prolonged exposure to abnormal levels of immune modulators, hormones, and neurotransmitters results in physical changes throughout the body, leading to chronic inflammation and chronic diseases such as diabetes, heart disease, autoimmune conditions, pain syndromes, and psychological problems. In the brain, exposure to the biochemical profile produced by allostatic overload can actually change its structure. Three brain regions affected by such toxic stress are the hippocampus, the amygdala, and the prefrontal cortex. These areas communicate with each other and modulate cognitive function, fear, aggression, and self-regulation. The interaction among these three regions also plays a part in turning on and turning off the neural and endocrine systems’ response to stress.

The hippocampus is involved in memory of daily events, special memory, and mood regulation. The prefrontal cortex deals with decision making, working memory, and self-regulatory behaviors such as mood and impulse control. Both of these structures help shut off the stress response, but under prolonged allostatic overload, the brain cells in these regions shrink and some of the connections between other brain cells are lost, allowing the chemical mediators of toxic stress to continue.

In contrast, the amygdala is the portion of the brain responsible for the autonomic nervous system’s response to memories and emotions, particularly involving fear, anxiety, and aggression. The amygdala turns on stress hormones and causes the heart to beat faster. Under chronic stress, the cells in the amygdala enlarge and create more connections among other brain cells, further driving the physical and emotional aspects of the fight-or-flight response.

By understanding how the architecture of the brain changes under chronic stress, you can see how difficult it can be to recover from a period of extreme stress. Sleep deprivation can make matters even worse. In people with depression or anxiety disorders, it is as though the nervous system is locked in this abnormal physiological state. Although it is tempting to rely solely on medications to correct this imbalance, numerous studies cite the effectiveness of the concurrent use of behavioral interventions to restore normal central nervous system activity and structure, as much as possible. Such interventions include physical activity, cognitive-behavioral therapy, meditation, and the cultivation of strong social support and integration.¹⁰

As we shall see in chapter 2, Eastern healing modalities such as meditation, tai chi, qigong, and yoga are able to transform the architecture of the brain and modulate the neuroendocrine-immune system to restore normal function, behavior, and sleep. By using effective treatments from both Eastern and Western traditions, you may see prompt and long-lasting improvements in your emotional and physical health. Although an understanding of the history and philosophy of Western and Eastern medical systems is not required to utilize their beneficial treatments, it will give you an appreciation of these approaches to patient care.

CHAPTER 2

The Continuum of Medicine

WHEN WE GET SICK, physically or emotionally, often the first questions we ask are how and why did this misfortune befall us? These questions have been asked for millennia. In ancient times, illness was attributed to the supernatural. Afflicted people thought they were being punished by a god, possessed by an evil spirit, or hexed by some malignant force. Various legends and myths were created in all societies in an effort to explain the how and why of disease. “Cures” were generally ritualistic and of a spiritual nature, administered by the “doctor” of the group. These healers went by different names in different cultures—shaman, curandero, kahuna—but they all blended their understanding of culture, community, and physical environment to create rituals and remedies to treat illness within their tribes.

Over time, as nature was better understood, the realization came that diseases were caused by real-world phenomena and not by supernatural forces. With this awareness came a shift in the role of the shaman. The shaman continued to be the spiritual leader of the group, but the physical health of the community was left to others—the herbalists, the bonesetters, and the surgeons who were the doctors of the tribe. Even though the shaman and the doctor now had different responsibilities, there remained a consistent understanding of health and healing. They knew that the health of an individual was mor...