This summer I saw a cousin of mine who lives in San Francisco. He was using acupuncture for insomnia and happy with the results.
Back when I lived on the West Coast, I tried acupuncture for help in managing stress (the usual trigger for my insomnia) and also got results. A single session of acupuncture—followed by use of foul-smelling herbs I was to boil and drink as tea—really helped to calm me down.
I still wonder about acupuncture as a potential treatment for insomnia, so now and then I check the literature. Here’s a summary of recent thinking about it.
Why Might Acupuncture Work for Insomnia?
The underlying problem for people with insomnia is said to be hyperarousal. Insomniacs’ brains are unusually active at night, suggesting hyperarousal of the central nervous system. Whether and how acupuncture could calm the brain is yet to be worked out.
There’s also evidence that insomniacs are more physiologically aroused than normal sleepers. We tend to have elevated metabolic rates and, at night, lower heart rate variability, suggesting involvement of the autonomic nervous system (the system controlling things we can’t consciously direct, such as breathing and heartbeat). Hyperarousal in insomniacs suggests too much activity of the sympathetic branch of the autonomic nervous system (associated with stress and the fight-or-flight response).
Acupuncture has a direct effect on the autonomic nervous system, say Wei Huang and colleagues at the Emory University School of Medicine. It’s been shown to influence known indicators of autonomic activities such as blood pressure, heart rate, and heart rate variability. It’s used to manage cardiovascular diseases such as hypertension and cardiac arrhythmia. It’s also been shown to regulate neurotransmitters and hormones important to the sleep–wake cycle.
Acupuncture may work by tamping down the physiological arousal that makes it harder for insomniacs to go to sleep and stay asleep at night. But how it does so remains unknown.
What About Clinical Trials?
Some reviewers have found that acupuncture has overall positive effects on sleep. Study participants have reported that acupuncture helps them:
- Fall asleep more quickly
- Sleep more efficiently
- Sleep longer
- Have better-quality sleep
Other reviewers have not found convincing evidence that acupuncture helps people sleep longer or better. A survey of literature through 2011 concludes that there’s not enough “high-quality evidence” either to support or refute acupuncture as an effective treatment for insomnia.
A Standard Hard to Meet
By high-quality evidence reviewers often mean the results of double-blinded, randomized clinical trials—the gold standard for studies of a treatment on human beings. This type of study involves comparing an active treatment to a sham treatment (a medication to a placebo pill, for example), assigning participants to either the active treatment or the placebo treatment in a random manner, and making sure that neither participants nor clinicians know who’s getting what.
This standard is hard to meet in studies of acupuncture, David Mischoulon says in a commentary in the Journal of Clinical Psychiatry. Fake acupuncture—needles placed in positions known not to affect sleep, or acupuncture with nonpenetrating needles—is often used as a sham treatment. But acupuncture practitioners always know whether they’re administering active or fake treatment and may subtly communicate this to trial participants, compromising study results.
Also, the contribution of the “placebo effect” to acupuncture study results is apparently considerable. Says Mischoulon, “We found that believing that one was receiving an active intervention seemed to correlate with clinical improvements more so than which intervention was actually received.”
Mischoulon and others have proposed different types of sham treatments for use in future acupuncture trials. Hopefully they will supply the high-quality evidence needed to settle the issue of whether and in which situations acupuncture might work as a treatment for insomnia.
Different Acupuncture Points
Meanwhile, other researchers have trained their attention on which acupuncture points seem to help insomniacs the most. These are believed to have calming effects:
- PC-4 Ximen (in the middle of the forearm with palm side up)
- GV-14 Dazhui (on the back at the base of the neck)
- PC-6 Neiguan (just above the wrist with palm side up)
- EX-HN1 Sishencong (at the top of the head)
- BL-15 Xinshu (on the upper back just right of the spine)
In summary, the evidence on acupuncture’s effectiveness for insomnia is still mixed. But it’s got one big advantage over sleeping pills. Its safety and lack of side effects have been demonstrated again and again.
If you’ve tried acupuncture for relief from insomnia, please let us know how it worked.