Read this first
When to worry
Most insomnia is unpleasant rather than dangerous. Two presentations on this page are exceptions and belong at the top: sleep loss with low mood can be part of a depressive episode, and sleep loss with unusual energy can be the beginning of a manic one. Read this list before the rest.
Get help now — same day or emergency
- Thoughts of harming yourself, or the sense that you cannot go on. This is a medical emergency rather than a sleep problem — contact emergency services or a crisis line now.
- Very little sleep together with unusual energy, racing thoughts and a reduced need for sleep. This can be the start of a manic episode and needs urgent assessment.
- Severe insomnia after a head injury, or with a new and severe headache.
- Insomnia with chest pain, breathlessness lying flat, or a racing irregular heartbeat.
Get it looked at within days
- Loud snoring with witnessed pauses in breathing, or falling asleep during the day.
- Insomnia that began with a new medicine or a change in dose.
- Restless legs, or pain that reliably wakes you.
- Low mood, loss of interest and early waking together for more than two weeks.
- New and severe insomnia in pregnancy.
Sleeping tablets are not the answer to most of what is on this page, and stopping them abruptly is its own problem. If you are already taking one, speak to the prescriber rather than to a website.
One rule for this whole list: if you are not sure whether a line applies to you, treat it as though it does — and get it checked. Uncertainty is a reason to be seen, not a reason to wait.
Three kinds of not sleeping
The classical literature treats these as different complaints with different mechanisms, and modern sleep medicine agrees. Which one you have is the first thing to establish, because the first step differs for each.
Cannot fall asleep
Lying awake for an hour or more, mind busy, body tired but wired. Often worse when you go to bed earlier than usual in an attempt to catch up.
Points to Traditionally heart or liver fire, or blood deficiency failing to anchor the spirit. In modern terms, conditioned arousal: the bed has become a place of effort.
Wake in the night
Falling asleep is fine, but you wake at two or three, sometimes repeatedly, and struggle to get back.
Points to Often constraint with heat, or spleen deficiency if it follows a late meal. Alcohol, blood sugar and apnoea are the medical checks.
Wake early
Sleep is short, ending at four or five with no return, and the day starts already tired.
Points to Traditionally kidney or heart deficiency. In modern terms, early waking is one of the more reliable signs of depression and should be asked about directly rather than treated as a pattern.
What the patterns describe
The classical account of sleep is mechanical rather than psychological. During the day the defensive qi circulates at the surface; at night it should move inward, and sleep is what happens when it does. Insomnia is described as that movement failing: the qi stays outside, the interior stays empty, and the eyes do not close. It is a description of a rhythm rather than a lesion, and it explains why the traditional advice is so concentrated on timing, food and digestion rather than on the contents of the mind.
Two of the classical statements are worth knowing because they are testable at home. The first is that a late heavy meal disturbs sleep — stomach and sleep rhythm are treated as connected, not separate, and the remedy is a three-hour gap rather than a tablet. The second is subtler: the tradition is more interested in what is preventing the inward movement than in what you happen to be thinking about while it fails. That is not a dismissal of worry; it is a different place to intervene.
What the tradition does not do is separate depression from insomnia, and that separation matters more than any pattern on this page. Early waking with low mood, loss of interest, and a flat sense of everything is not a spleen problem. It is a condition with effective treatment, and it should be assessed by someone qualified to assess it. The self-check on this site is not built to catch that, and it will not.
Which patterns it belongs to
These are the patterns this symptom is conventionally grouped under. They are not competing diagnoses — most people meet one, and the point of the list is to show you which questions separate them.
Difficulty falling asleep with a busy mind, rib-side tightness, sighing, irritability, a wiry pulse.
Best fit for sleep that breaks in tense periods.
Read the pattern page →Light sleep with vivid dreams, palpitations, pallor, numbness, a thin pulse, a pale tongue.
Common with heavy periods, after childbirth, and in long-term under-eating.
Read the pattern page →Waking after a late dinner, fullness, loose stools, tiredness in the morning, teeth-marked tongue.
When sleep is broken by a late meal or by digestive discomfort.
Read the pattern page →Waking with heat or sweats, sore lower back, tinnitus, five-palm heat, a red tongue with little coat.
Common around menopause, and after years of late nights.
Read the pattern page →The signs behind it
Each line below is one entry in the sign table — the same table the self-check draws its follow-up questions from. The tier says how strongly that sign points at the pattern: a defining sign is expected, a common one is usual, a supporting one is optional.
- Difficulty falling or staying asleep Blood deficiencycommon ·Kidney yin deficiencycommon ·Liver yin deficiencycommon ·Liver yang risingcommon ·Liver qi stagnationsupporting ·Damp-heatsupporting
- Dream-disturbed sleep Blood deficiencycommon ·Liver yang risingcommon ·Liver qi stagnationsupporting ·Kidney yin deficiencysupporting
Not every sign listed here will apply to you — a sign only counts alongside the others. The self-check is the place to weigh them against your own answers.
Telling them apart
Four questions do most of the work. Each one splits the field in half, and after two or three the pattern is usually clear enough to act on — or clear enough to know that the answer is medical rather than traditional.
| Question | If yes | If no |
|---|---|---|
| Can you fall asleep in the first place? | No, the struggle is at the start → the reading is usually fire or blood deficiency. In modern terms, conditioned arousal. | Yes, but sleep breaks → the reading is usually constraint, spleen, or kidney, depending on when it breaks. |
| Does a late or heavy meal make it worse? | Yes, reliably → the stomach and sleep link described in the classical texts. Move the last meal three hours earlier for two weeks. | No relation to meals → look at the other questions. |
| Is the mind busy with worry, or blank? | Busy, circling, planning → constraint with heat. The measures are about winding down and about the load you are carrying. | Blank but unable to sleep, with palpitations → blood deficiency is the closer reading. |
| Do you wake at four or five with low mood? | Yes, and the mood stays low through the day → this is not primarily a pattern question. Have it assessed for depression. | Waking early but mood is normal → kidney or heart deficiency is a reasonable reading. |
What you can do at home
None of this treats a named condition, and none of it replaces assessment. These are the ordinary measures attached to this symptom — low risk, and worth doing while you work out what is actually going on.
- Fix the rising time first, including at weekends, and accept a few tired days while the rhythm resets. This is the single measure with the strongest evidence and the least cost.
- Use the bed for sleep only. If you are awake for more than about twenty minutes, get up, sit somewhere dim and dull until sleepy, then return. The point is to stop the bed becoming the place where you try.
- Leave three hours between the last meal and lying down. This is the practical content of the classical statement that stomach disturbance and poor sleep travel together.
- Get daylight in the first hour after waking, ideally outdoors. Fifteen minutes is enough, and it does more for the rhythm than any evening measure.
- Do not use alcohol to fall asleep. It shortens the time to sleep and then fragments the second half of the night, which is exactly the pattern most people are trying to fix.
Classical sources
Quoted in the original, with our own translation and the chapter it comes from. We do not reproduce existing English translations — they are someone else's reading.
阳明者，胃脉也，胃者，六腑之海，其气亦下行。阳明逆，不得从其道，故不得卧也。下经曰：胃不和则卧不安。此之谓也。 yáng míng zhě, wèi mài yě, wèi zhě, liù fǔ zhī hǎi, qí qì yì xià xíng. yáng míng nì, bù dé cóng qí dào, gù bù dé wò yě. xià jīng yuē: wèi bù hé zé wò bù ān. cǐ zhī wèi yě
Yangming is the vessel of the stomach; the stomach is the sea of the six fu, and its qi also moves downward. When yangming rebels and cannot follow its course, one cannot lie down. The Lower Classic says: when the stomach is not harmonious, lying down is not peaceful. This is what that means.
卫气不得入于阴，常留于阳。留于阳则阳气满，阳气满则阳跷盛；不得入于阴则阴气虚，故目不瞑矣。 wèi qì bù dé rù yú yīn, cháng liú yú yáng. liú yú yáng zé yáng qì mǎn, yáng qì mǎn zé yáng qiáo shèng; bù dé rù yú yīn zé yīn qì xū, gù mù bù míng yǐ
The defensive qi cannot enter the yin and stays in the yang. Staying in the yang, the yang qi becomes full; the yang qi being full, the yangqiao vessel is excessive. Unable to enter the yin, the yin qi is deficient — and so the eyes do not close.
虚劳虚烦不得眠，酸枣仁汤主之。 xū láo xū fán bù dé mián, suān zǎo rén tāng zhǔ zhī
For consumptive disease with empty irritability and inability to sleep, the Sour Jujube Seed decoction governs it.
The third citation names a formula. It is included because it is the classical statement that empty irritability and sleeplessness belong together, not as a recommendation: the formula is a prescription, and prescriptions belong to a practitioner who has examined you. Nothing on this site should be taken as an instruction to take one.
Terms used on this page
One concept, several names. The standard term comes first; pinyin and characters are there so you can search and cross-check; older aliases are what you will meet in other people's writing.
| Standard term | Pinyin | 中文 | Also written as |
|---|---|---|---|
| Insomnia | bù mèi | 不寐 | 失眠 (shī mián), 目不瞑 (eyes that do not close) |
| Defensive qi | wèi qì | 卫气 | 卫阳 (defensive yang) |
| Yin-yang pivot | yáng bù rù yīn | 阳不入阴 | 阴阳不交 (yin and yang not connecting) |
| Empty irritability | xū fán | 虚烦 | 虚热内扰 (empty heat disturbing internally) |
Check your own pattern
Insomnia is a symptom, and symptoms appear in several patterns. The self-check weighs twelve questions against all twelve patterns and shows you what fits — and what doesn't quite.
Start the self-checkAbout four minutes. No account, nothing stored on a server, and an address for the printable report is optional.