2023 Sleep Medicine Clinics

Acupuncture may enhance the effectiveness of cognitive-behavioral therapy for people suffering from insomnia and related conditions.

The research methodology used in this paper is mainly a theoretical analysis and discussion of the potential synergistic effects of combining cognitive-behavioral therapy for insomnia (CBT-I) and acupuncture. This involves analysis of the current evidence base for the efficacy of acupuncture in treating insomnia and related conditions, along with examination of the practical, logistical, and regulatory aspects of combining these two treatments.

In the discussion of their results, the researchers found that there is a growing body of evidence that supports the potential benefit of acupuncture in treating insomnia and its comorbidities, enhancing the current standard treatment approach of CBT-I. This appears to be an innovative approach that could potentially enhance the treatment effectiveness and outcomes for those struggling with insomnia, though it concurrently raises complex issues in terms of its practical and regulatory implementation.

Acupuncture as an Adjunct Treatment to Cognitive-Behavioral Therapy for Insomnia Kutana S, Mao JJ, Garland SN

2022 Medicine

High prevalence of insomnia, anxiety, and depression among perimenopausal women, emphasizing the importance of exploring acupuncture as a potential green therapy for effectively addressing these interconnected issues.

This passage discusses the prevalence of insomnia among perimenopausal women, its association with anxiety and depression, and the potential of acupuncture as a green therapy for treating these issues. The passage outlines the objectives and methods of a systematic review aiming to evaluate the efficacy of acupuncture in improving sleep quality and alleviating anxiety and depression in perimenopausal women, highlighting the need for safer alternatives to conventional medications and the significance of such a study.

Can acupuncture improve sleep quality and anxiety among women during perimenopause? Ping Y, Liang C, Fan X, Zhang L, Ying D, Wang Z

2022 Frontiers in Psychiatry

Acupuncture can be a safe and effective alternative therapy to conventional drugs for improving sleep quality and relieving symptoms in patients with active depression.

The research methodology involved a systematic review of randomized controlled trials focusing on the effect of acupuncture on depression-related insomnia. These studies were identified from seven different databases, dating up until December 2021. The papers included compared acupuncture to controls (waiting list or placebo/sham acupuncture) and conventional treatments (Western pharmacotherapy and/or cognitive-behavioral therapy) either alone or in combination with acupuncture. The analysis followed Cochrane criteria and encompassed a total of 21 trials, including 1,571 participants.

Regarding results, it was found that acupuncture significantly reduced severity metrics of sleep quality and depression for patients who have active depression, compared with placebo-acupuncture. When contrasted with standard care (antidepressants and/or sleeping aids), acupuncture led to improvements in sleep quality and depressive symptom scores. However, for those suffering from the lingering symptoms of past or partially treated depression, the therapeutic benefits of acupuncture were minor and not statistically noteworthy. Unfortunately, no studies were found to review acupuncture's efficacy compared to cognitive-behavioral therapy or its potential synergistic effect when used concurrently.

The Role of Acupuncture in the Management of Insomnia as a Major or Residual Symptom Among Patients With Active or Previous Depression: A Systematic Review and Meta-Analysis Zhao FY, Kennedy GA, Spencer SJ, Conduit R, Zhang WJ, Fu QQ, Zheng Z

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

2021 Frontiers in Aging Neuroscience

Stroke patients who received acupuncture had a lesser risk of insomnia across various demographic and medical variables.

The study data was derived from the case database of a Chinese hospital, featuring stroke patients diagnosed between 2010 and 2019. These patients were sorted into two groups: one which received acupuncture and one which did not. The sorting was performed using a propensity score matching technique. Comparisons were made between the two groups using the incidence of insomnia as the primary indicator, with Cox regression analysis and the Kaplan-Meier method serving as the main analytical tools.

The results indicated that stroke patients who underwent acupuncture treatments were less susceptible to insomnia as compared to counterparts who didn't receive acupuncture treatment. This decrease in the incidence of insomnia was observed across various categories such as genders, age groups, stroke types and stroke locations, with the acupuncture group displaying a significantly lesser cumulative incidence of insomnia.

Acupuncture Reduced the Risk for Insomnia in Stroke Patients: A Propensity-Score Matched Cohort Study Qiu X, Han NS, Yao JX, Yu FR, Lin YY, Zhuang X

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 Integrative Cancer Therapies

Tian Wang Bu Xin Dan can potentially alleviate symptoms of cancer-related insomnia similarly to cognitive-behavioral therapy.

In this study, 22 participants were divided equally between a group given Cheonwangbosimdan and a control group who received cognitive-behavioral therapy for insomnia. Participants in the Cheonwangbosimdan group were required to consume the herbal liquid daily and participate in weekly visits for a period of four weeks. Conversely, the control group underwent behavioral therapy sessions 4 times over the same four-week period.

The outcomes from these interventions were evaluated using key indices that measured participants' insomnia severity, sleep quality, fatigue, anxiety, and overall performance status. With the focus being on changes observed from the inception of the trial to the end, these measurements were taken at the conclusion of the fifth week. While no significant difference was found between the two study groups, both displayed a positive trend towards alleviating the symptoms of cancer-related insomnia, with anxiety levels markedly lower in the treatment group.

Comparative Effectiveness of Cheonwangbosimdan (Tian Wang Bu Xin Dan) Versus Cognitive-Behavioral Therapy for Insomnia in Cancer Patients: A Randomized, Controlled, Open-Label, Parallel-Group, Pilot Trial Moon SY, Jerng UM, Kwon OJ, Jung SY, Lee JY, Yoon SW, Shin WC, Byun JI, Lee JH

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

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.

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 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 SM

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.