Brief History of Acupuncture and Traditional Chinese Medicine
Traditional Chinese Medicine (TCM), with its roots in ancient philosophy, has been nurturing health and healing for over two millennia. Central to TCM is the belief in Qi (vital energy) that circulates through meridians in the body, maintaining health and vitality. Acupuncture, one of the key modalities of TCM, involves the insertion of fine needles at specific points (acupoints) along these meridians to balance Qi and thus, promote healing.
What is Insomnia
Insomnia, a prevalent sleep disorder, manifests as persistent difficulty in falling asleep, staying asleep, or obtaining restorative sleep, leading to daytime impairment. Its etiology is multifactorial, involving psychological, environmental, and physiological factors. Stress, anxiety, lifestyle habits, and underlying health conditions can disrupt the natural sleep-wake cycle, contributing to the pathology of insomnia. TCM perceives insomnia as a disharmony in the balance of Yin and Yang, often linked to disturbances in the Heart, Liver, and Spleen meridians that affect the mind (Shen) and the flow of Qi.
Modern medicine approaches insomnia with a range of treatments, including pharmacological interventions such as benzodiazepines and non-benzodiazepine hypnotics, and non-pharmacological therapies like cognitive-behavioral therapy (CBT) for insomnia. These treatments aim to improve sleep quality and quantity but may come with side effects or only offer temporary relief.
Updates of Insomnia
According to the Journal of Family Practice
Shaha, DP, Insomnia Management: A Review and Update, J Fam Pract. 2023 Jul; 72(6 Suppl): S31–S36.
- Insomnia is a distinct disorder that is common, yet underrecognized and undertreated in primary care.
- Treating insomnia has been shown to improve outcomes, including reduced risk of developing cardiovascular and mental health disorders.
- Insomnia is influenced by the brain’s regulation of sleep and wake, which are mutually exclusive events.
- Insomnia should be treated as a distinct condition, even when occurring with a comorbid diagnosis such as depression or anxiety.
- Clinicians should implement a multimodal approach to insomnia management, including nonpharmacologic interventions and pharmacologic therapy (when indicated).
- Pharmacologic agents that are approved by the US Food and Drug Administration for insomnia include benzodiazepine receptor agonists (zolpidem, eszopiclone, and zaleplon), low-dose doxepin (tricyclic antidepressant), ramelteon (melatonin receptor agonist), and dual orexin receptor agonists (DORAs, daridorexant, lemborexant, and suvorexant).
- Unlike other pharmacologic agents, DORAs inhibit wakefulness rather than induce sedation. Additionally, these medications have no evidence of rebound insomnia or withdrawal, and little to no abuse potential.
- Daridorexant is the newest DORA, has an ideal half-life of 8 hours, and has demonstrated continued efficacy over a 12-month period.
- Selection of pharmacologic agents should be based on the patient’s comorbid conditions, treatment goals and preferences, and other clinical characteristics.
Research on Acupuncture for Insomnia
Emerging research bridges the ancient practice of acupuncture with the scientific understanding of insomnia. Several studies have demonstrated acupuncture’s efficacy in improving sleep quality and duration. A systematic review and meta-analysis published in the “Journal of Alternative and Complementary Medicine” found acupuncture to be an effective treatment for insomnia, often showing improvements comparable to or better than conventional pharmacotherapy, but without the associated side effects.
Mechanistically, acupuncture is thought to modulate neurotransmitter activity, such as increasing serotonin levels, which plays a crucial role in sleep regulation. Additionally, acupuncture may exert its effects by stimulating the production of endogenous opioids, thereby inducing relaxation and sleep.
Clinical trials also suggest that acupuncture can address the root causes of insomnia according to TCM, such as Qi deficiency and imbalance between Yin and Yang, thereby offering a holistic approach to treatment. For instance, targeting specific acupoints may calm the mind (Shen) and harmonize the Heart, Liver, and Spleen meridians, leading to improved sleep patterns.
Insomnia after ischemic stroke
Acupuncture appears to be efficacious, in terms of improving insomnia, related quality of life, and affective symptoms, for patients with ischemic stroke.
Cao Y et al. Acupuncture for insomnia after ischemic stroke: an assessor-participant blinded, randomized controlled trial. Acupunct Med. 2022 Oct;40(5):443-452.
Insomnia in Patients With Depression
In this randomized clinical trial of Electroacupuncture treatment for insomnia in patients with depression, the quality of sleep improved significantly in the Electroacupuncturegroup compared with the SA or control group at week 8 and was sustained at week 32.
Yin et al. Effect of Electroacupuncture on Insomnia in Patients With Depression: A Randomized Clinical Trial. JAMA Netw Open. 2022 Jul 1;5(7):e2220563.
and many more…..
Conclusion
The synthesis of TCM’s holistic approach with modern research on acupuncture for insomnia offers promising avenues for those seeking alternatives to conventional treatments. While further research is needed to fully elucidate the mechanisms and optimize treatment protocols, acupuncture represents a valuable and effective option for managing insomnia, rooted in centuries of tradition and supported by contemporary science. As always, individuals should consult healthcare professionals to determine the most appropriate treatment strategy for their specific needs.