Part 4 of 8 in the "how TCM assesses poor sleep" series. The other seven are listed at the foot.

"I just don't sleep well" becomes five or six questions in a consultation. This part covers the first two areas — the shape of the sleep itself, and the daytime — and why they are asked in that much detail.

The short version

• A consultation takes "poor sleep" apart: what time you go to bed, how long until you fall asleep, how often you wake, what time you wake, whether you can get back to sleep.
• The daytime gets asked about too: energy, drowsiness, whether concentration has changed. The WHO standard's description of 不寐 covers both the night and the day, so the daytime is half the definition.
• The first two items on Singapore HealthHub's sleep-record list are the same: the time you went to bed and woke up, total sleep hours and perceived quality of sleep — the two lists line up almost one to one.
• The same HealthHub page says that if a sleep problem has persisted for at least a month, caused significant distress and interfered with social or work life, one could consider keeping a sleep record.

First, the things that cannot wait

You snore with pauses in breathing, or wake up gasping; daytime sleepiness is severe enough to affect driving or work safety — see a doctor for investigation first.

Mood is persistently low, anxiety is hard to control, or you have thoughts of harming yourself — this is not something to wait on. Call 999 now, or go to the nearest hospital emergency department. To talk to someone, the Ministry of Health's Talian HEAL 15555 is open every day from 8 am to 12 midnight, public holidays included; Befrienders KL is open 24 hours on 03-7627 2929. You can also contact your doctor.

The full list, and the reason for each, are in part 8. TCM and Western medicine complement each other; it is not a choice between them.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

I. What the practitioner asks, and why

Across a consultation, a practitioner will generally want to understand five areas. After each item is why it matters in TCM theory — with a list from the Western side placed alongside, to see whether the two are asking about the same things.

(What "inquiry" is, is part 1: the WHO's standard terminology for TCM defines it as collecting information on the disease occurrence, progression, previous diagnosis and treatment and present symptoms by talking to the patient or the person who accompanies them.)

Singapore's HealthHub (Ministry of Health), on its Sleeping Well page, puts it this way: if a sleep problem has persisted for at least a month, caused significant distress and interfered with social or work life, one could consider keeping a sleep record; the record could allow one to calculate total sleep time, identify sleep disruptions and other unknown factors that may influence sleep, and it would also serve as useful information for healthcare professionals in deciding whether there is a sleep disorder.

The items it lists for the record line up almost one to one with the areas a TCM consultation asks about. Of our five areas, the first two are in this part, the bodily signals are part 3, and mood and current medication are part 5.

① The shape of the sleep itself — what time you go to bed, how long until you fall asleep, how often you wake, what time you wake, whether you can get back to sleep.

Why it is asked: the Chinese University of Hong Kong's Integrative Medical Centre article files difficulty falling asleep, light sleep with easy waking, much dreaming, early waking and waking still tired all under a disturbance of yang entering yin — one process, which can go wrong in several places, so the shape has to be pinned down. (That process, and the several places, are part 2.)

The first two items on HealthHub's record list are the same: the time you went to bed and woke up, total sleep hours and perceived quality of sleep.

Its third item goes a step further: a record of the time spent awake and what you did in it — its own examples are "got up, had a glass of milk" and "stayed in bed with eyes closed". Those two examples are a concrete answer to why the "woke" column is worth keeping: two wakings spent walking around and two spent lying still are not the same thing in a consultation.

Worth noting: those four or five shapes are descriptions of the sleep, not categories of people. Which shape goes with which situation is a matter for after the inquiry.

② How the daytime goes — energy, drowsiness, whether concentration has changed.

Why it is asked: the WHO standard's description of 不寐 covers both the night and the day — an inability to obtain normal sleep, and drowsiness and low energy during the day. The daytime is half the definition, not a side question. Hours slept and how restored you feel do not always match.

If daytime sleepiness is already affecting driving or work safety, that is a different matter: see a doctor for investigation first — the reason is in part 8.

II. Why the two lists look so alike

TCM theory asks where the process of yang entering yin is being interrupted; HealthHub records total sleep time, sleep disruptions and unknown factors. The two languages do not translate into each other, but both look at the whole day around the sleep, not only the hours of the night.

That is also why keeping a 7-day sleep log before the consultation saves work: the questions above already have their answers on the log. The four columns, and how a log is read, are part 7.

The words in this part

Two of the four come from the World Health Organization's 2022 standard terminology for TCM; two are the HealthHub page's own terms.

• Inquiry (问诊) — the WHO standard: collecting information on the disease occurrence, progression, previous diagnosis and treatment and present symptoms by talking to the patient or the person who accompanies them. The full account is part 1.
• 不寐 (bú mèi) — the same standard's description: an inability to obtain normal sleep, with drowsiness and low energy during the day. The night and the day are both written in, which is why the daytime gets asked about.
• Sleep record (睡眠记录; also sleep diary) — HealthHub's term. It says a record could allow one to calculate total sleep time and identify sleep disruptions and other unknown factors.
• Perceived quality of sleep (自觉的睡眠质量) — one of the items on HealthHub's record list, sitting next to total sleep hours. It is your own assessment, not an instrument reading.

Frequently asked

I can't say how long it takes me to fall asleep — is an estimate all right? Yes. The log in part 7 says in terms that an estimate is fine. The point is not minute-accuracy; it is which nights were different.

How long does a sleep problem have to go on before a log is worth keeping? HealthHub puts it this way: if the issue has persisted for at least a month, caused significant distress and interfered with social or work life, one could consider keeping a sleep record. That is that page's threshold; it also says a record would serve as useful information for healthcare professionals in deciding whether there is a sleep disorder.

Do not: treat "I sleep badly every night" as the whole account — what the inquiry needs is which nights, and in what way.

The other seven parts

• Part 1: What inquiry is, how it works online, what one consultation produces
• Part 2: What TCM theory holds sleep to be
• Part 3: Why appetite, palpitations and mood get asked about
• Part 5: Why mood, stress and your current medication are asked about
• Part 6: Poor sleep: what is usually done
• Part 7: How to keep a 7-day sleep log, and how to read one
• Part 8: When to see a doctor first

👉 If you are not sure where to begin with your own poor sleep, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything in "First, the things that cannot wait" above or in part 8 applies, see a doctor first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• World Health Organization, WHO international standard terminologies on traditional Chinese medicine, 2022 (ISBN 978-92-4-004232-2), entries 725, 1589 — https://www.who.int/publications/i/item/9789240042322
• Integrative Medical Centre, The Chinese University of Hong Kong, 〈失眠因陽氣難入陰　拆解4大對象人群〉, published 1 January 2024 — https://hkiim.cuhk.edu.hk/imc/tc/press/d/%E5%A4%B1%E7%9C%A0%E5%9B%A0%E9%99%BD%E6%B0%A3%E9%9B%A3%E5%85%A5%E9%99%B0%E3%80%80%E6%8B%86%E8%A7%A34%E5%A4%A7%E5%B0%8D%E8%B1%A1%E4%BA%BA%E7%BE%A4
• Singapore HealthHub (MOH), MindSG — Sleeping Well (Adults), no review date shown on the page — https://www.healthhub.sg/programmes/mindsg/caring-for-ourselves/sleeping-well-adults
• Ministry of Health Malaysia, Hospital Pendang (Kedah State Health Department), Info Kesihatan 2024 — https://jknkedah.moh.gov.my/hpendang/index.php?option=com_sppagebuilder&view=page&id=139
• Befrienders Kuala Lumpur — https://www.befrienders.org.my/

本文是「睡不好，中医会怎么评估」系列的第 4 篇，共 8 篇。其余七篇列在文末。

「我就是睡不好」这句话，在问诊里会被拆成五六个问题。这一篇说明头两个方向——睡眠本身的样子、白天的状态——以及为什么要问到这个细度。

一分钟看完

• 一次问诊会把「睡不好」拆开：几点上床、多久才睡着、中间醒几次、几点醒来、醒来后能不能再睡。
• 白天也要问：精神如何、有没有嗜睡、专注力有没有变化。世界卫生组织的标准对「不寐」的描述同时写了夜里与白天，所以白天是定义的一半。
• 新加坡卫生部 HealthHub 的睡眠记录清单，头两项也是上床与起床时间、总睡眠时数与自觉的睡眠质量——两张清单几乎一一对应。
• 同一个 HealthHub 页面说，睡眠问题持续至少一个月、造成明显困扰并影响社交或工作时，可以考虑记睡眠记录。

先说不能等的几件事

睡觉时打鼾伴随呼吸暂停、或被憋醒；白天严重嗜睡，影响驾驶或工作安全——请先就医做检查。

情绪持续低落、焦虑难以控制，或出现伤害自己的念头——这不是可以等的事。请立刻拨打 999，或前往最近的医院急诊部。若想找人谈一谈，卫生部的 Talian HEAL 15555 每天早上 8 时至午夜 12 时开放，包括公共假期；Befrienders KL 24 小时热线：03-7627 2929。您也可以联络您的医生。

完整清单与每一项的理由，见第 8 篇。中医与西医是互相补位的关系，不是二选一。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、医师会问什么、为什么问

一次问诊，医师大致从五个方向了解。每一项后面，是它在中医理论里为什么重要——旁边放一份西医这边的清单，看两边问的是不是同一些事。

（「问诊」是什么，在第 1 篇：世界卫生组织的中医术语标准把它定义为透过与病人或陪同者交谈，收集病情的发生、进展、既往诊治与现有症状的资料。）

新加坡卫生部 HealthHub 的「睡好觉」页面这样说：睡眠问题持续至少一个月、造成明显困扰并影响社交或工作时，可以考虑记睡眠记录；记录可以算出总睡眠时间、找出干扰睡眠的情况与其他未知的因素，也能为医疗人员判断是否有睡眠障碍提供有用的资料。

它列出的记录项目，和中医问诊的方向几乎一一对应。本文的五个方向里，头两个在这一篇，身体线索在第 3 篇，情绪与现有用药在第 5 篇。

① 睡眠本身的样子：几点上床、多久才睡着、中间醒几次、几点醒来、醒来后能不能再睡。

为什么问：香港中文大学中西医结合医务中心的文章把难入睡、眠浅易醒、多梦、早醒难再睡、醒来仍倦，都归为阳气入阴的过程出了问题——同一个过程，可以在不同的地方出问题，所以样子要问清楚。（这个过程与它的几类问题，在第 2 篇。）

HealthHub 的记录清单头两项，也是上床与起床时间、总睡眠时数与自觉的睡眠质量。

它的第三项走得更远一点：醒着的时间有多长，以及那段时间做了什么——它举的例子是「起来喝了一杯奶」「闭着眼躺在床上」。这两个例子很具体地说明了「醒几次」那一栏为什么要记：同样是醒了两次，起来走动过和躺着没动，在问诊里不是同一件事。

要留意的是：这四五种样子是对睡眠的描述，不是对人的分类。哪一种对应哪一种情况，是问诊之后的事。

② 白天的状态：精神如何、有没有嗜睡、专注力有没有变化。

为什么问：世界卫生组织的标准对「不寐」的描述同时写了夜里与白天——无法获得正常睡眠，以及白天困倦、精力不足。白天是定义的一半，不是附带的问题。睡眠时数与实际恢复程度并不总是一致。

白天的嗜睡如果已经影响驾驶或工作安全，那是另一件事：请先就医做检查——理由在第 8 篇。

二、两张清单为什么这么像

中医理论问的是阳气入阴的过程在哪里被打断；HealthHub 记录的是总睡眠时间、干扰睡眠的情况与未知的因素。两套语言不互译，但都要看睡眠周围的一整天，不只看夜里那几个小时。

这也是为什么看诊前记一份 7 天睡眠记录会让问诊省事：上面那些问题，记录上本来就有答案。四栏怎么记、一份记录怎么读，在第 7 篇。

这篇出现的几个词

四个词里，两个来自世界卫生组织 2022 年的中医术语标准，两个是 HealthHub 页面上的用语。

• 问诊（inquiry）——世界卫生组织的标准：透过与病人或陪同者交谈，收集病情的发生、进展、既往诊治与现有症状的资料。完整说明在第 1 篇。
• 不寐（bú mèi）——同一份标准的描述：无法获得正常睡眠，白天困倦、精力不足。夜里与白天都写在里面，这是白天要问的原因。
• 睡眠记录（sleep record / sleep diary）——HealthHub 的用词。它说记录可以算出总睡眠时间、找出干扰睡眠的情况与其他未知的因素。
• 自觉的睡眠质量（perceived quality of sleep）——HealthHub 记录清单上的项目之一，和「总睡眠时数」并列。它是您自己的评价，不是仪器读数。

常见问题

我说不出「多久才睡着」，估计可以吗？ 可以。第 7 篇的记录表就写明「估计就好」。重点不是分钟数精确，而是哪几晚不一样。

睡眠问题要持续多久才值得记记录？ HealthHub 的说法是：持续至少一个月、造成明显困扰并影响社交或工作时，可以考虑记睡眠记录。这是那个页面的门槛；它也说，记录能为医疗人员判断是否有睡眠障碍提供有用的资料。

不要这样做： 不要把「我每晚都睡不好」当成已经说清楚了——问诊要问的是哪几晚、什么样子。

这个系列的另外七篇

• 第 1 篇：问诊是什么、线上怎么看，一次问诊会得到什么
• 第 2 篇：中医理论怎么理解「睡」
• 第 3 篇：为什么问食欲、心悸和情绪
• 第 5 篇：为什么问情绪、压力和我在吃的药
• 第 6 篇：睡不好，一般怎么做
• 第 7 篇：7 天睡眠记录怎么记、怎么读
• 第 8 篇：什么时候要先看西医

👉 如果您不确定「我这种睡不好，该从哪里谈起」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您有本文「先说不能等的几件事」与第 8 篇列出的情况，请先看医生。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 世界卫生组织，WHO international standard terminologies on traditional Chinese medicine，2022（ISBN 978-92-4-004232-2），词条 725、1589 — https://www.who.int/publications/i/item/9789240042322
• 香港中文大学中西医结合医务中心〈失眠因阳气难入阴　拆解4大对象人群〉，发布于 2024 年 1 月 1 日 — https://hkiim.cuhk.edu.hk/imc/tc/press/d/%E5%A4%B1%E7%9C%A0%E5%9B%A0%E9%99%BD%E6%B0%A3%E9%9B%A3%E5%85%A5%E9%99%B0%E3%80%80%E6%8B%86%E8%A7%A34%E5%A4%A7%E5%B0%8D%E8%B1%A1%E4%BA%BA%E7%BE%A4
• 新加坡卫生部 HealthHub，MindSG — Sleeping Well (Adults)，页面未标示审阅日期 — https://www.healthhub.sg/programmes/mindsg/caring-for-ourselves/sleeping-well-adults
• 马来西亚卫生部，Hospital Pendang（吉打州卫生局）Info Kesihatan 2024 — https://jknkedah.moh.gov.my/hpendang/index.php?option=com_sppagebuilder&view=page&id=139
• Befrienders Kuala Lumpur — https://www.befrienders.org.my/