Jade Acupuncture Clinic

Insomnia

Insomnia includes difficulty falling asleep, waking up too soon after falling asleep, or both. According to the US Department of Health and Human Services, approximately 60 million people in the United States experience insomnia. About 40 percent of women and 30 percent of men suffer from insomnia, and the rate of insomnia increases with age.  

Insomnia is classified as transient if it lasts from one night to a few weeks. If it occurs from time to time, it is considered to be intermittent.
 Acute insomnia is the inability to consistently sleep well for a period of between three weeks to six months. Insomnia is considered to be chronic if it continues for at least a month. 

Studies have verified the value of treating insomnia with acupuncture and Chinese herbs.
 

Honora Wolfe translated a 2005 article from the Clinical Journal of Acupuncture and Moxibustion titled “Clinical Observations on the Treatment of 70 Cases of Insomnia with Acupuncture”. In this study, seventy patients were enrolled and treated as out-patients. The length of time that the patients suffered from insomnia ranged from ten days to six years. Twenty-four of the patients had a chronic disease, such as hypertension or heart disease, while forty-six patients had simple insomnia. The patients were treated with the following acupuncture points: Heart 7, Stomach 40, Gall Bladder 34, Stomach 36, and Ren Mai 23. Treatment was given once per day for five days, with the afternoon considered to be the best time of day for the treatment. The cure rate was 82.9 percent,(58 cases), with a cure defined as eight hours or more of sleep per night with no recurrence of insomnia on follow-up after one month. Ten cases, (14.3 percent), got a marked effect from the treatment, with an increase of two hours of sleep per night. The remaining 2.8 percent (2 cases), received no benefit from the treatment. [1]


Auricular Acupuncture is also very effective in treating insomnia. Auricular points can be stimulated with needles, pellets, magnetic pearls, electricity, and other forms of manipulation. A systematic review of auricular acupuncture was done by a group of researchers to investigate the safety and efficacy of this treatment method. Only randomized controlled trials using auricular acupuncture as the sole treatment were included. Six studies were included in the review. Four of the trials were based on sleep time and reduction of insomnia as reported by the participants. One trial adopted the effectiveness scale published in the Diagnostic and Curative Criteria: TCM Internal Medicine, which involves clinic symptoms and emotion changes. The remaining trial used wrist actigraphy recording the activity of the participants during sleep and monitored sleep behaviors. Twelve main auricular acupuncture points were used: Shenmen, Heart, Occiput, Subcortex, Brain, Kidney, Liver, Spleen, Anterior Ear Lobe, Forehead, Sympathetic Nerve, and Endocrine. The conclusion of the meta-analysis was that auricular acupuncture has better rates of recovery and improvement than the control approaches used, providing increased nocturnal sleeping up to six hours, with good sleep maintenance and feeling refreshed on awakening. Auricular acupuncture produced better results than using diazepam for treating insomnia. No adverse effects were reported. No follow-up information was provided, leaving the long-term effect of this treatment unknown. [2] 

An additional systematic review of published literature on acupuncture in the treatment of insomnia was done by Kalavapalli and Singareddy. While they found many methodological limitations in all but a few studies, all of the studies consistently indicated significant improvement in insomnia with acupuncture. [3] 

Chinese herbs also have been shown to be effective in treating insomnia.

In a study translated by Bob Flaws, the Chinese herbal formula Bu Zhong Yi Qi Tang was used to treat forty-six patients. All of those included in the study were seen as out-patients. Eight had trouble falling asleep along with sometimes waking during the night, thirty-five had varying degrees of insomnia and insufficient night-time sleep, and three patients had all-night-long insomnia. The patients suffered from insomnia for the length of from ten days to six years. The patients all had some degree of Qi deficiency. One course of treatment was one month. Forty-five of the forty-six patients all experienced marked improvement in their sleep. The night-time sleep for the patients lengthened by from one to seven hours for thirty-five of the participants. After waking, none of the patients experienced any headaches, dizziness, or other adverse reactions. Three months after stopping the herbal formula, only one patient had a relapse.
[4] Bob Flaws notes in his discussion of the study that in clinic, most practioners use heart-nourishing, spirit-quieting herbs, however he states that the therapeutic effects are not good. He recommends that Qi-supplementing formulas, such as Bu Zhong Yi Qi Tang, should not be overlooked. 
 

An additional study translated by Bob Flaws focused on the use of Suan Zao An Shen Tang for the treatment of insomnia. One hundred out-patients were observed in this study, divided into two groups of 50. The observation group was prescribed Suan Zao An Shen Tang, which enriches yin, supplements blood, nourishes the heart and quiets the spirit. One dose was taken daily for fourteen consecutive days. The comparison group was given 0.8 milligrams of alprazolam (Xanax) each night before bed for fourteen consecutive days. The observation group had a total effectiveness of 94 percent, with 18 people cured, 13 people experiencing a marked effect, 16 people with some effect, and 3 people showing no effect. The comparison group had a total effectiveness of 76 percent, with 8 people cured, 12 people with a marked effect, 18 people experiencing some effect, and 12 people showing no effect. [5]
 

A study on the use of the herbal formula of Bai He Qing Xin Tiao Zhi Tang, (Lily Clear the Heart and Regulate the Mind Decoction), to treat menopausal insomnia was translated by Bob Flaws. This herbal formula supplements the kidneys and enriches yin, nourishes the blood, calms the heart, and quiets the spirit. The average age of the thirty women in this study was 50. Their main complaints were hot flashes, sweating, vexation and agitation, and insomnia. Patients with concurrent medical problems were excluded from the study. The herbal formula was given twice per day, with four weeks as one course of treatment. Three successive courses were given before the results were analyzed. The total effectiveness rate of Bai He Qing Xin Tiao in treating menopausal insomnia was 93.8 percent, with 13 women experiencing a marked effect, 16 women obtaining some effect, and 2 women obtaining no effect. [6]
 

Diet
  
A number of ideas are offered in popular literature regarding diet for those who suffer from insomnia; however the suggestions are based on anecdotal evidence rather than research.
 
Suggestions include:
 
Eat several small meals throughout the day. A small bedtime snack may be helpful, but it is recommended that anyone suffering from insomnia avoid eating a large amount of food close to bedtime. Dinner should be eaten several hours prior to bedtime.
 
Eliminate alcohol, or limit alcohol consumption to one drink at least two hours before bedtime.
 
Avoid caffeine in the afternoon or evening
 
Eat complex carbohydrates before going to bed. A snack of whole grain bread, crackers unsweetened cereal, or other complex carbohydrates can increase production of melatonin and encourage sleep. [7]
Avoid snacking on high protein or simple carbohydrates as a bedtime snack.
 
Avoid the intake of liquids in the late evening. Drinking liquids an hour or two before bedtime may disturb sleep, due to the urge to urinate waking the individual.
 

Exercise
 
While physical activity has been shown to be effective to improve sleep for the general population, a study focusing on women during menopause found less effect on this group of women. A four month randomized, controlled trial examined structured exercise in the form of walking or yoga to determine the effects on sleep quality in middle-aged women, (mean age of 49.9 years old). Participants completed body composition and fitness assessments and a battery of psychological measures, including the Pittsburgh Sleep Quality Index, at the beginning and end of the exercise trial. There were three arms to the trial: walking, yoga, and control. The walking group experienced small improvements in sleep quality, however walking and yoga were found to be ineffective in yielding statistically significant improvements in sleep quality in this four month study. The authors concluded that exercise of longer duration or greater intensity might be needed for improvements in sleep quality to occur.
[8] 
 

A study reported on in Prevention magazine, however, found that exercise did benefit postmenopausal women. A three year German study of seventy-eight early postmenopausal women found that those who did an hour of aerobic and strength-training exercises four days a week had fewer migraines, mood swings, and bouts with insomnia than their sedentary peers. The group of women who exercised also maintained bone mass, lost body fat, and reduced their cholesterol, unlike the group who did not exercise. [9]
 

Tai chi has been found to be effective approach to treating sleep complaints. A study by the Oregon Research Institute included one hundred eighteen women and men aged sixty to ninety-two. The participants were randomized into tai chi or low-impact exercise groups, and participated in sixty-minute sessions, three times per week, for twenty-four consecutive weeks. The tai chi group reported significant improvements in sleep in comparison to the low-impact exercise group. The authors concluded that tai chi appears to be effective as a nonpharmacological approach to sleep enhancement for sleep-disturbed elderly individuals. [10]
 

Studies on the benefit of exercise for those with insomnia generally do find benefit in this approach. According to S.D. Youngstedt, no daytime behavior has been more clearly associated with better sleep than exercise. Exercise offers a potential alternative for the treatment of insomnia. While other treatments for insomnia, such as sleeping pills, may have adverse effects, exercise is a healthy, safe, inexpensive, and simple means of improving sleep. [11]
 

Meditation and Relaxation Techniques
 
The effectiveness of mind-body therapies is often doubted by the medical community; however relaxation therapy is suggested by many as a technique to overcome insomnia. There is growing evidence to support the use of meditation and relaxation techniques in the treatment of insomnia.

A comparison of two series of systematic reviews was conducted and reported on in a 2007 issue of “Alternative Therapies in Health and Medicine”. The rules of evidence-based medicine were applied to the studies reviewed, and the authors concluded that that there is now strong evidence to support the use of relaxation therapy for anxiety and insomnia. [12]
 

The Mayo Clinic suggests that some women find that meditation, relaxation exercises, stress-reduction techniques, or yoga can help ease sleep disturbances. [13]
 

Melatonin 
Melatonin is a hormone that is produced nocturnally by the pineal gland. Melatonin serves as a circadian time cue and sleep-anticipating signal in humans. With age, melatonin production declines, and sleep disorders, particularly insomnia, increase.  
Melatonin is commonly suggested as an over-the-counter sleep aid. Suggested doses range from 0.3 to 3 milligrams of melatonin taken one hour before bedtime.

It is often recommended that melatonin be used only on a short-term basis.
 

A randomized, double blind, placebo-controlled study on the use of a 2 milligram prolonged release melatonin formulation investigated its use in insomnia for patients 55 years and older. There were a total of 177 people in the active medication group, and 177 people in the placebo group. The study lasted for five weeks, during which time patients received either one 2 milligram tablet of melatonin or a placebo two hours prior to bedtime. The results indicated that there were significant differences between the use of melatonin vs. the placebo treatment, with melatonin improving sleep quality, morning alertness, sleep onset latency and quality of life in primary onset patients. [16]
 

Common cautions for melatonin include that it should not be used by anyone with an autoimmune disorder, if there is a tendency for depression, if there is a hormonal imbalance, or if diagnosed with diabetes. Some studies have shown that melatonin is an anti-convulsant, while other studies have found a pro-convulsant effect, making it unwise for anyone with a seizure disorder to take melatonin without the advice of their physician. Melatonin may cause blood vessels to constrict, making it potentially dangerous to use            
 


Copyright 2008 by Jeri Petz, MSOM, L.Ac., Dipl. Ac. (NCCAOM), Dipl. OM (NCCAOM)
Jade Acupuncture Clinic Ltd.      



[1] Wolfe, Honora. “Insomnia and Acupuncture”. 2006. <http://www.bluepoppy.com/cfwebstorefb/index.cfm?fuseaction=feature.display&feature.display&feature_id=881>. (8 October 2007). 
[2] Chen, Hqi Yong, Yan Shi, Chi Sun Ng, Sai Man Chan, Ken Kin Lam Yung, and Qing Ling Zhang. “Auricular Acupuncture Treatment for Insomnia: A Systematic Revew”, The Journal of Alternative and Complementary Medicine”; 2007, Vol. 13, Number 6:669-676.
[3] Kalavapalli, R., R. Singareddy. “Complementary Therapeutic Clinical Practice”: August 2007; Volume 13, Issue 3:184-193.  
[4] Flaws, Bob. “Treating Insomnia with Modified Bu Zhong Yi Qi Tang”, 2006. . (8 October, 2007). 
[5] Flaws, Bob. “Insomnia & Suan Zao An Shen Tang (Zizyphus Quiet the Spirit Decoction)”,2006. .  (8 October, 2007). 
[6] Flaws, Bob. “Menopausal Insomnia”, 2005.  .  (8 October, 2007). 
[7] Taylor, Nadine. Natural Menopause Remedies. New York, New York, 2004, p. 214.
[8] Elavsky, S., E. McAuley. “Lack of Perceived Sleep Improvement after 4-month Structured Exercise Programs”, Menopause, May-June 2007; Volume 14, Issue 3:535-40. 
[9] S.Y., “Exercise Eases Menopause”, Prevention; August 2005, Volume 57, Issue 8:52. 
[10] Li, F., K.J. Fisher, P. Harmer, D. Irbe, R.G. Tearse, C. Weimer. “Tai Chi and Self-Rated Quality of Sleep and Daytime Sleepiness in Older Adults: A Randomized Controlled Trial”, Journal of American Geriatric Society; June 2004; Issue 52, Volume 6: 892:900. 
[11] Youngstedt, S.D. “Effects of Exercise on Sleep”, Clinical Sports Medicine: April 2005, Volume 24, Issue 2: 355-65. 
[12] Ernst, Edzard, Max H. Pittler, Barbara Wider, Kate Boddy. “Mind-Body Therapies: Are the Trial Data Getting Stronger?”. Alternative Therapies in Health and Medicine; Sept./Oct. 2007, 13(5): 62-64. 
[13] Flaws, Bob. Menopause and Chinese Medicine.  1st ed. Boulder: Blue Poppy Press, 2006, p. 200. 
[14] Bent, Stephen, Amy Padula, Dan Moore, Michael Patterson, Wolf Mehling. “Valerian for Sleep: A Systematic Review and Meta-Analysis.” American Journal of Medicine; Dec. 2006, Volume 119, Issue 12: 1005-1012.  
[15] Koetter, U., E. Schrader, R. Kaufeler, A. Brattstrom. “A Randomized, Double-Blind Placebo-Controlled Prospective Clinical Study to Demonstrate Clinical Efficacy of a Fixed Valerian Hops Extract Combination in Patients Suffering from Non-Organic Sleep Disorder”. Phytother. Res., Sept. 2007, Volume 21, Issue 9: 847-51. 
[16] Wade, AG, I. Ford, G. Crawford, A.D. McMahon, T. Nir, M. Laudon, N. Zisapel. “Efficacy of prolonged release melatonin in insomnia patients aged 55-80 years: quality of sleep and next-day alertness outcomes.” Curr Med Res Opin., October 2007, Volume 23, Issue 10: 2597-2605.