Not Being Able to Fall Asleep Is Not the Same as Sleep Not Coming

"I can barely sleep unless I take a sleeping pill. But even after I sleep and wake, I don't feel refreshed."

The answer is contained within these words. Because it means you fell asleep by medicine, but you did not sleep.

Sleep is not a switching off

We think of sleep as a switch turning off. Consciousness disappears, and we call that sleep.

But from the body's point of view, sleep is the exact opposite. Sleep is the time when the body is most defenseless. It cannot move, cannot flee, cannot notice danger.

So the body does not fall asleep at just any time. Only when the judgment "it is safe now" is made does it open the door to sleep.

The one that makes this judgment is the autonomic nervous system.

Two switches

The autonomic nervous system has two axes.

The tension switch — the heart beats faster, the vessels narrow, digestion stops. It is preparation to flee or fight.

The calm switch — the heart slows, digestion returns, recovery begins. Sleep begins only here.

These two are commonly drawn as a seesaw — one goes up, the other comes down. In reality they do not move that way. Both can rise together, and the situation differs from place to place. But at the place where sleep begins, the tension side has to step back for the calm side to do its work. So where sleep is concerned, I look first at whether tension is still switched on.

Sleeping pills do not turn on the calm switch. They only suppress the brain's activity and blur consciousness. So sleep comes, but recovery does not. That is why you don't feel refreshed even after sleeping and waking.

Why the tension switch won't turn off

Here I ask this: what is the body still judging to be dangerous?

It is not only the mind's worries. The body judges through several routes that "it is not safe right now."

When breathing is shallow and rushed — the heart speeds up when you breathe in and slows when you breathe out. Breathing is not a switch that turns the autonomic nervous system on and off. It is, though, one of the few handles we can consciously take hold of. Short, rushed breathing keeps the tension side turned on. The body reads it as danger.

When a pain signal keeps rising from somewhere — hardened tissue, pooled fluid, inflammation that won't cool. At night, as the daytime stimuli decrease, this signal is heard more loudly. This is why it hurts especially at night.

When the gut cannot do its work — when the body judges there is danger, it puts digestion off for later. When that state becomes chronic, the gut having stopped itself feeds back again as a signal of tension.

When a low-grade inflammation remains — the inflammation signal tells the body to keep up its guard.

In other words, sleep not coming is not a problem of the brain alone. Reports of "not safe yet" keep rising from all over the body.

So I approach it differently

To someone who comes for a sleep problem, I do not begin with talk of sleep.

First I watch the breathing. Whether only the chest heaves, or the belly moves. If the diaphragm cannot do its share, it becomes harder for the calm side to do its own work.

I ask about digestion and bowel movements. When I talk about stool to someone who came saying they can't sleep, most are puzzled. But these two are regulated by the same nerves.

I ask whether something hurts at night. If the source of the signal remains, the circuit keeps being stimulated.

And I trace back to when it began. What happened just before the sleep started to fall apart — usually the patient's own memory tells the most.

There is an order

I set the order like this.

1. Reduce the source of the signal — release what is hardened, drain what is pooled, calm the inflammation
2. Let the breath reach the belly — lower the pressure inside the abdomen to make room for the diaphragm to descend
3. Let the gut work again — this is a clear sign that the calm switch has turned on
4. Herbal medicine bridges the gaps — it works in the hours after you leave the treatment room. It does not put the body to sleep, but creates the conditions under which the body itself judges it is safe

Putting to sleep and making it possible to fall asleep are different. I aim for the latter.

The signs of recovery

When sleep returns, usually sleep is not the first thing to improve.

First digestion becomes easier. Then there is less stiffness in the morning. Then there is less fatigue during the day. Sleep usually comes last.

Many people give up midway because they don't know this order. "But my sleep is the same." At that point I check the digestion and the morning stiffness together with them. If those moved first, the direction is right.

The calm switch does not turn on starting with sleep. It turns on starting with digestion.

Not how much sleep, but what kind

I do not tell people to stop sleeping pills unconditionally. A body that has long gone without sleep is itself in danger. When help is needed, it should be received. I only plan together the order of tapering down — I do not recommend stopping abruptly.

And there are clearly cases that need a separate diagnosis and treatment, such as sleep apnea, restless legs, thyroid dysfunction, depression, and anxiety disorders. When I see such signs, I first recommend care in that direction.

The breathing, the gut, and the pain I have spoken of here are not threaded together by sleep alone. Each has its own circumstances, and sleep is closer to the place where they happen to meet.

But if you say "even after I sleep and wake, I don't feel refreshed," that is a matter not of the amount of sleep but of the kind of sleep. The body has not yet judged itself to be safe.

Let us find together what is still dangerous.

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Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)