Insomnia & Sleep Disorders

2021 Evidence-Based Complementary and Alternative Medicine

The comprehensive evaluation results show that scalp acupuncture is effective in treating insomnia.

A total of 21 studies were included in this study, and a total of 1606 cases were included. The comprehensive evaluation results show that scalp acupuncture is effective in treating insomnia. Compared with the control group, scalp acupuncture can significantly improve the effective rate of treating insomnia. The PSQI score subgroup analysis showed that the PSQI score of the head was significantly better than that of the drug and blank group, but there was no significant difference from other acupuncture methods. Sensitivity analysis showed that scalp acupuncture ameliorates the PSQI score better, but excluding any item had high heterogeneity. Meta regression analysis of PSQI score according to different intervention measures in the control group showed that the difference of intervention measures in the control group was the source of heterogeneity. In terms of adverse events, the scalp acupuncture group had no adverse events, which was significantly better than the control group. Based on this study, we found that scalp acupuncture is effective and safe in the treatment of insomnia.

Efficacy and Safety of Scalp Acupuncture for Insomnia: A Systematic Review and Meta-Analysis Fu-gui Liu, Ai-hua Tan, Chao-qun Peng, Yun-xia Tan, Ming-chao Yao

2020 Annals of Palliative Medicine

Acupuncture treatment of insomnia is efficacious, not because of its placebo effect.

Acupuncture is a common alternative therapy for clinical treatment of insomnia. As the underlying mechanism is yet unclear, its efficacy is often considered as placebo effect. To clarify whether acupuncture treatment of insomnia is only due to its placebo effect, a systematic review and a meta-analysis were designed based on the comparison between acupuncture and sham acupuncture.

Compared to the sham groups, acupuncture significantly decreased the PSQI score (P<0.0001). A subgroup analysis showed that the selection of sham acupuncture methods did not affect the results of PSQI. A subgroup of two trials with a total of 141 participants with major depressive disorder did not show any significant reductions in total PSQI scores (P=0.11). In addition, a significant difference was detected in the change of Insomnia Severity Index (ISI) scores (362 adult patients, 4 trials) between acupuncture and sham acupuncture (P<0.0001). The PSG and actigraphy data from acupuncture and the sham did not reveal any significant differences in the sleep structure changes.

For the selection of sham acupuncture, both methods performed similarly in a clinical setting. Moreover, insomnia patients with major depression disorder were not recommended to use only acupuncture treatment.

Placebo effect of acupuncture on insomnia: a systematic review and meta-analysis Liu C, Xi H, Wu W, Wang X, Qin S, Zhao Y, Zheng S, Wan Q, Xu L.

2020 Nature and Science of Sleep

Ten sessions of electroacupuncture can improve the sleep quality of patients with insomnia without serious adverse effects.

Results of the current trial provide supportive evidence that electroacupuncture can be an effective, safe, and well-tolerated non-pharmacological intervention for insomnia, using validated placebo control and validated subjective questionnaires. Further long-term studies with objective sleep measures are needed for a more definitive conclusion.

Efficacy and Safety of Electroacupuncture for Insomnia Disorder: A Multicenter, Randomized, Assessor-Blinded, Controlled Trial Lee B, Kim BK, Kim HJ, Jung IC, Kim AR, Park HJ, Kwon OJ, Lee JH, Kim JH.

2020 BioMedicine

Consumption of jujube seed had a positive impact on improving the sleep quality of postmenopausal women and could be recommended as a useful herbal medication.

The results show that the medicinal jujube seed capsule improved the sleep quality of postmenopausal women. Thus, it could be recommended as a safe plant with fewer complications compared to chemical and hormone drugs for the treatment of sleep disorders. Also, during the period of consuming jujube seed capsule in this study, except for a few cases of gastrointestinal disorders and in similar studies with this herbal medicine, consumers have reported no specific side effects. Therefore, considering that about one-third of adults in the world suffer from sleep disorders, the high prevalence of sleep disorders in postmenopausal women, and the lower cost of treatment by jujube seed capsule compared to other treatments, it is suggested implementing this treatment as a useful method in improving sleep quality in postmenopausal women.

Investigation the effect of jujube seed capsule on sleep quality of postmenopausal women: A double-blind randomized clinical trial Mahmoudi R, Ansari S, Haghighizadeh MH, Maram NS, Montazeri S.

2020 Nature and Science of Sleep

Acupuncture was shown to significantly improve the sleep quality in pregnant women, possibly through increasing melatonin secretion.

Fifty-five of 72 participants completed the study. There was no statistically significant difference regarding PSQI score and 6-sulfatoxymelatonin level between intervention and control groups at the baseline. At the end of the study period, treatment with acupuncture significantly improved the PSQI score with a large effect size of 3.7, as well as 6-sulfatoxymelatonin level with a medium effect size of 0.6 as compared to the control group. No adverse effects were noted during acupuncture sessions and follow-up visits.

Acupuncture was shown to significantly improve the sleep quality in pregnant women, possibly through increasing melatonin secretion, and could be recommended as a low-cost and low-risk alternative treatment to pharmacological therapies.

Effect of Acupuncture on Pregnancy-Related Insomnia and Melatonin: A Single-Blinded, Randomized, Placebo-Controlled Trial Foroughinia S, Hessami K, Asadi N, Foroughinia L, Hadianfard M, Hajihosseini A, Pirasteh N, Vossoughi M, Vafaei H, Faraji A, Kasraeian M, Doroudchi M, Rafiee Monjezi M, Roozmeh S, Bazrafshan K.

2020 Complementary Therapies in Medicine

Acupuncture was superior to sham/placebo acupuncture in treating insomnia.

A total of 15 studies involving 1108 patients. Meta-analysis results showed that acupuncture therapy was superior to sham/placebo acupuncture in terms of improving Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), total sleep time (TST), sleep-onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), even during the follow-up period, acupuncture therapy was superior to sham/placebo acupuncture on PSQI.

Based on the outcomes included in this study, the efficacy of acupuncture was superior to that of placebo acupuncture in treating insomnia. Types of acupuncture therapy and placebo may underestimate the efficacy of acupuncture in different ways.

The effects of acupuncture versus sham/placebo acupuncture for insomnia: A systematic review and meta-analysis of randomized controlled trials Zhang J, He Y, Huang X, Liu Y, Yu H

2020 BioMed Research International

Acupuncture may be an effective and safe treatment in obstructive sleep apnea patients.

Besides, acupuncture may also reduce apnea-hypopnea index (AHI) and Epworth Sleepiness Score (ESS) and improve LSaO2 of obstructive sleep apnea patients. This result is more significant in moderate and severe obstructive sleep apnea patients patients. These evidences may be useful to clinicians, patients, and health policy makers with regard to the application of acupuncture in obstructive sleep apnea patients. However, further high-quality RCTs are needed to confirm the efficacy and safety of acupuncture for obstructive sleep apnea patients patients.

Acupuncture for Obstructive Sleep Apnea (OSA) in Adults: A Systematic Review and Meta-Analysis Liaoyao Wang, Jia Xu, Yijun Zhan, Jian Pei

2019 Evidence-Based Complementary and Alternative Medicine

Acupuncture therapy is an effective and safe treatment for chronic pain-related insomnia.

In our current study, we pooled the data from nine studies involving 944 patients. Our pooled analysis indicated that acupuncture treatment was significantly better than drugs group in improving effective rate and cure rate and in debasing PSQI score and VAS score. In addition, compared with sham acupuncture, manual acupuncture treatment has an advantage in improving the effective rate and reducing the PSQI score, but the two groups have no statistical significance in improving the cure rate. In this meta-analysis, only four studies reported relevant adverse events. The combined data showed no significant difference in adverse reactions between acupuncture group and control group. Therefore, we can carefully recommend that acupuncture is as safe as control group for CPRI. In addition, adverse events were relatively mild, mainly including bruises, soreness, nausea, dizziness, and other discomforts. These adverse events can be effectively avoided by strengthening the aseptic operation specification, and improving the professional ability of doctors. Based on the findings of our included studies, we propose that acupuncture is an effective and safe therapy for patients with CPRI.

Acupuncture for Chronic Pain-Related Insomnia: A Systematic Review and Meta-Analysis Fushui Liu, Jianyu You, Qi Li, Ting Fang, Mei Chen, Nana Tang, Xiaojun Yan

2019 Integrative Medicine Research

Acupuncture using pattern identification led to significantly improved total effectiveness rate compared to medication for insomnia.

Our main results suggest that both of manual acupuncture and electroacupuncture used with pattern-identification may improve sleep duration, quality of subjective sleep, and daytime function of patients compared with medication. Acupuncture using pattern-identification is one type of individualized therapy and use in actual clinical setting. Our result may provide useful evidence to practitioners in clinical practice because this design may reflect acupuncture treatment in real world.

Acupuncture using pattern-identification for the treatment of insomnia disorder: a systematic review and meta-analysis of randomized controlled trials Sang-Ho Kim, Jin-Hyung Jeong, Jung-Hw Lim, Bo-Kyung Kim

2018 Medicine

Acupuncture might have effect in decreasing the number of micturition episodes, incontinence episodes, and nocturia episodes.

Overactive bladder is stated as the occurrence of urinary urgency which will cause negative impacts and decrease patients’ health-related quality of life. The aim of this systematic review is to assess the efficiency and safety of acupuncture for adults with overactive bladder (OAB) comparing with sham-acupuncture, drugs, and acupuncture plus drugs.

Acupuncture might have effect in decreasing the number of micturition episodes, incontinence episodes, and nocturia episodes. However, the evidence is insufficient to show the effect using acupuncture alone or the additional effect to drugs in treating OAB.

Acupuncture for adults with overactive bladder: A systematic review and meta-analysis of randomized controlled trials Zhao Y, Zhou J, Mo Q, Wang Y, Yu J, Liu Z.

2018 Disability and Rehabilitation

Standard acupuncture was significantly more effective for restless legs syndrome severity than control conditions.

The current management of restless leg syndrome is primarily pharmacological, and medications can have unwanted side effects.

Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture may reduce restless leg syndrome severity.

Vibration pads, cryotherapy, yoga, compression devices, and acupuncture may improve some sleep-related outcomes in restless leg syndrome.

Non-pharmacological interventions for RLS may cause placebo effects and rehabilitation professionals should control for this possibility in future investigations.

Non-pharmacological interventions for restless legs syndrome: a systematic review of randomised controlled trials Harrison EG, Keating JL, Morgan PE.

2018 Sleep Medicine Reviews

The results showed that even fragile populations such as the elderly and dialysis patients can benefit from acupressure to improve sleep quality.

Thirty-two eligible randomized controlled trials of moderate to high quality which employed polysomnography, actigraphy, or self-assessment sleep quality tools were included. We conducted a meta-analysis using a random effects model with the Pittsburgh sleep quality index (PSQI) as the primary outcome measure (968 adult patients, 13 trials) for trials investigating the effects of traditional Chinese medicine acupressure compared with standard and sham treatments.

We performed subgroup analyses to detect sources of heterogeneity, identify the use of acupoints in different populations and explore the contributions of PSQI domains to the total score change. Comparison with the sham group (7 trials with 385 patients) yielded low heterogeneity and an overall effect of 13%–19% improvement in the PSQI score. Based on data from four trials (n = 250), sleep latency and sleep duration were most affected. No adverse effects were reported in any of the reviewed trials.

Acupressure effect on sleep quality: A systematic review and meta-analysis Alexander Waits, You-Ren Tang, Hao-Min Cheng, Chen-Jei Tai, Li-Yin Chien

2017 Journal of Physics Conference Series

Acupuncture treatment effectively improved the quality of sleep and the quality of life for chronic hemodialysis patients.

Twenty-eight hemodialysis patients suffering from insomnia were divided randomly into two groups, an acupuncture group (n = 15) who received acupuncture treatment at the points HT7 Shenmen, PC6 Neiguan, GV20 Baihui, and EX-HN1 Sishenchong, anda control group (n = 13) who underwent a sham procedure in which a needle was inserted into an elastic bandage at the same points. The acupuncture treatment was done during hemodialysis twice a week for five weeks. PSQI scores and the WHOQOL-BREF were assessed before treatment, after the fifth treatment, and at the end of the treatment. Significant differences were found in the PSQI score and in the WHOQOL-BREF between the acupuncture group and the control group by the end of the period of treatment. Acupuncture treatment effectively improved the quality of sleep and the quality of life for these chronic hemodialysis patients.

The effect of acupuncture treatment for insomnia in chronic hemodialysis patients J A Widjaja, C Simadibrata, A Srilestari, M B H Marbun

2017 Sleep Medicine Reviews

The severity of primary restless legs syndrome symptoms can be significantly ameliorated by acupuncture.

Complementary and alternative therapies have been found to be effective in both primary and secondary restless legs syndrome (RLS). The severity of primary RLS symptoms can be significantly ameliorated by exercise training, transcutaneous spinal direct current stimulation, pneumatic compression devices, light therapy, repetitive transcranial magnetic stimulation, and acupuncture. Pneumatic compression devices and yoga also improve RLS-related disorders. Exercise training is highly efficacious in the reduction of symptom severity in uremic RLS and related effects such as poor quality of life. Endovenous laser ablation may be a good choice for patients with concurrent RLS and superficial venous insufficiency.

Complementary and alternative therapies for restless legs syndrome: An evidence-based systematic review Xu XM, Liu Y, Jia SY, Dong MX, Cao D, Wei YD.

2016 Complementary Therapies in Medicine

Acupuncture compared to sham/placebo and pharmacotherapy showed statistically significant results for insomnia.

Acupuncture is widely used in Asia and increasingly in Western countries. We performed a systematic review and meta-analysis to examine the effects of acupuncture for insomnia. Acupuncture compared to sham/placebo and pharmacotherapy showed statistically significant results. However, the evidence is limited by bias in the included studies and heterogeneity. Well-designed studies are needed to confirm the results identified in this review.

A systematic review of acupuncture for sleep quality in people with insomnia Shergis JL, Ni X, Jackson ML, Zhang AL, Guo X, Li Y, et al

2016 BMC Complementary Medicine and Therapies

Our results suggest that acupuncture could be effective for treating insomnia after stroke.

A total of 165 studies were identified; 13 RCTs met our inclusion criteria. Meta-analysis showed that acupuncture appeared to be more effective than drugs for treatment of insomnia after stroke, as assessed by the PSQI and by the efficacy standards of Chinese medicine. Intradermal acupuncture had significant effects compared with sham acupuncture, as assessed by the ISI and the AIS.

Acupuncture for insomnia after stroke: a systematic review and meta-analysis. Lee, SH., Lim, S.M.

2016 Obstetrics & Gynecology

Acupuncture is associated with a significant reduction in sleep disturbances in women experiencing menopause-related sleep disturbances.

We identified 31 randomized controlled trials with 34 effect sizes involving a total of 2,433 participants. Acupuncture is associated with a significant reduction in the likelihood of sleep disturbances, a significant increase in the secretion of serum estradiol, and reduction in the secretion of serum follicle-stimulating hormone and luteinizing hormone. Studies with a large effect size of acupuncture-associated changes in serum estradiol had a significantly lower odds of sleep disturbances than did those with a small-to-moderate effect sizes.

Acupuncture is associated with a significant reduction in sleep disturbances in women experiencing menopause-related sleep disturbances. Our findings suggest that acupuncture should be adopted as part of a multimodal approach for improving sleep disturbances in perimenopausal and postmenopausal women.

Acupuncture to Reduce Sleep Disturbances in Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-analysis Chiu, Hsiao-Yean RN, PhD; Hsieh, Yu-Jung RN, MSN; Tsai, Pei-Shan RN

2016 Evidence-Based Complementary and Alternative Medicine

Both manual acupuncture and electroacupuncture were effective in improving the apnea/hypopnea index and mean SaO2 in the treatment of obstructive sleep apnea.

To the best of our knowledge, this is the first meta-analysis aiming to assess the clinical effect of acupuncture therapy in the treatment of obstructive sleep apnea; six studies involving 362 subjects were selected in our study.

The findings of our work suggest that manual acupuncture was more effective in the improvement of apnea/hypopnea index, apnea index, hypopnea index, and mean SaO2 when compared with nonspecific treatment; electroacupuncture could further improve apnea/hypopnea index and apnea index; there was no significant difference regarding the improvement of hypopnea index and SaO2. Regarding the comparison of manual acupuncture and nasal continuous positive airway pressure (nCPAP) therapy, manual acupuncture was more effective in improving apnea/hypopnea index. No adverse events associated with acupuncture therapy were documented.

The Clinical Effect of Acupuncture in the Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Zheng-tao Lv, Wen-xiu Jiang, Jun-ming Huang, Jin-ming Zhang, An-min Chen

2015 Sleep Medicine

Chinese herbal medicine was superior to placebo and benzodiazepine drugs and was superior to benzodiazepines and psychotherapy alone as an adjunct therapy in terms of subjective sleep quality and quantity and safety.

In this study, we systematically reviewed 79 RCTs investigating a variety of Chinese herbal medicine (CHM) treatments for participants with insomnia. We also performed meta-analyses to estimate the efficacy of CHM on subjective sleep quality assessed by validated instruments, patient-rated sleep parameters, clinician-reported severity, and PSG results, as well as to determine the safety of CHM.

Overall, this systematic review and meta-analysis showed that CHM was superior to placebo and benzodiazepine drugs (BZDs) when used as a monotherapy and was superior to BZDs and psychotherapy alone as an adjunct therapy in terms of subjective sleep quality and quantity and safety. CHM was not associated with more benefit than non-BZDs, although the risks were less. These results suggest that CHM could be a promising alternative therapy with a good benefit–risk ratio.

Updated clinical evidence of Chinese herbal medicine for insomnia: a systematic review and meta-analysis of randomized controlled trials Xiaojia Ni, Johannah Linda Shergis, Xinfeng Guo, Anthony Lin Zhang, Yan Li, Chuanjian Lu, Charlie Changli Xue

2013 International Review of Neurobiology

The clinical efficacy of acupuncture appeared to be supported by evidence obtained from basic neuroendocrinological studies.

A number of studies have demonstrated that acupuncture may modulate a wide range of neuroendocrinological factors following stimulation of acupoints. Evidence has suggested that the clinical efficacy of acupuncture in treatment of insomnia is potentially mediated by a variety of neurotransmitters including norepinephrine, melatonin, gamma-aminobutyric acid, and β-endorphin. However, due to the complexity, these findings are far from conclusive. More research is necessary. More rigors methodology and integrated approach to evaluate both clinical and basic research evidence are required for future studies.

Acupuncture for the treatment of insomnia Kaicun Zhao

2009 The Journal of Alternative and Complementary Medicine

Clinical studies have shown that acupuncture may have a beneficial effect on insomnia compared with Western medication.

Forty-six (46) randomized trials involving 3811 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding, and intention-to-treat analysis. Meta-analyses showed a beneficial effect of acupuncture compared with no treatment and real acupressure compared with sham acupressure on total scores of Pittsburgh Sleep Quality Index. Acupuncture was superior to medications regarding the number of patients with total sleep duration increased for >3 hours. However, there was no difference between acupuncture and medications in average sleep duration. Acupuncture plus medications showed better effect than medications alone on total sleep duration. Similarly, acupuncture plus herbs was significantly better than herbs alone on increase of sleep rates. There were no serious adverse effects with related to acupuncture treatment in the included trials.

Acupuncture for Treatment of Insomnia: A Systematic Review of Randomized Controlled Trials Cao H, Pan X, Li H, Liu J.