Is There Evidence That Acupuncture Helps with Insomnia?

Key points in 30 seconds

1. There are 46 studies pooled together on acupuncture helping with insomnia.
2. Acupuncture came out ahead in the share of people whose sleep time increased.
3. However, the authors stated that the evidence for Suanzaoren decoction is not yet sufficient.
4. Trouble sleeping can be caused by thyroid problems or sleep apnea, so those are checked first.
5. Don't stop sleeping pills on your own; talk with the doctor who prescribed them.

References

Cao H, et al. Acupuncture for treatment of insomnia: a systematic review of randomized
controlled trials. J Altern Complement Med. 2009;15(11):1171-86. PMID 19922248

Xie CL, et al. Efficacy and safety of Suanzaoren decoction for primary insomnia.
BMC Complement Altern Med. 2013;13:18. PMID 23336848

What we often hear

• "I fall asleep, but I wake up at 3 a.m. every night."
• "Once I wake up, all sorts of thoughts rush in and I toss and turn until morning."
• "Is it really true that acupuncture can improve sleep?"

Is there evidence that acupuncture helps with insomnia?

Yes. An analysis of 46 randomized studies found that a higher share of people in the acupuncture groups had their total sleep time increase by more than 3 hours. However, the quality of the pooled studies is uneven.

"I can't sleep" covers several different problems. Some people lie awake for a long time before falling asleep, some wake up in the early morning, and some sleep but don't feel rested. These are all different. We need to make the same distinction when looking at the evidence.

What kind of study is it?

It pooled and analyzed 46 randomized studies on insomnia, with 3,811 participants. It compared acupuncture with medication.

Here's what it found. In the number of people whose total sleep time increased by more than 3 hours, acupuncture came out ahead. There was also a finding that using medication and acupuncture together did better on total sleep time than medication alone.

Study	Design	Participants	Main results	Level of evidence
Cao 2009
J Altern Complement Med
15(11):1171-86
PMID 19922248	Meta-analysis
46 randomized studies	3,811 people
Insomnia	In the number of patients whose total
sleep time increased by 3+ hours, acupuncture ahead of medication
RR 1.53 (95% CI 1.24–1.88, p<0.0001)	Moderate
Xie 2013
BMC Complement Altern Med
13:18
PMID 23336848	Systematic review
12 randomized studies	1,376 people
Primary insomnia	Authors' conclusion: due to the low quality of the studies,
the evidence is insufficient to support
the effect of Suanzaoren decoction	Low

What about herbal medicine?

There's a study on Suanzaoren decoction, an herbal formula often used for insomnia, but its authors concluded that the evidence isn't sufficient, because the pooled studies were of low quality.

There's a reason we don't skip over this part. If we picked only the favorable results, readers would expect more than is real. This doesn't mean Suanzaoren decoction doesn't work; it means well-designed studies are still lacking.

What are the limits of this evidence?

Both studies were published more than 10 years ago. Better studies may have come out since then, and they aren't reflected here.

A few more points. First, the design and quality of the 46 acupuncture studies vary. Second, "sleep time increased by 3 hours" only looks at the length of sleep. How rested you feel and how your day goes are separate questions. Third, trouble sleeping can have causes that need their own care, such as thyroid disease, sleep apnea, or depression. Those need to be checked first.

So what do you do in the clinic?

First we sort out what kind of insomnia it is. Not being able to fall asleep, waking up early in the morning, and not feeling rested after sleep each call for a different approach.

If you take sleeping pills, we ask you not to stop suddenly. Stopping is something to discuss with the doctor who prescribed them; it isn't our decision to make. If you snore heavily or stop breathing during sleep, we recommend a sleep study first.

Before we place a single needle, we sort out what kind of insomnia you have. Not being able to fall asleep and waking up during the night call for looking at different things.

If poor sleep is wrecking your days, come see us. We start by sorting out which kind it is.

Sleep problems have many causes, so even with the same treatment, results differ from person to person.