Acupuncture is effective for insomnia relief. Research published by Zhejiang Chinese Medical University finds acupuncture more effective than a powerful sleep drug for improving sleep duration, quality, latency, efficiency, and daytime functioning. Acupuncture achieved a 92.9% total effective rate and the drug zopiclone achieved a 67.9% total effective rate.

Zopiclone is a central nervous system depressant used for helping patients fall asleep and maintaining sleep throughout the night. The Zhejiang Chinese Medical University research indicates that acupuncture is more effective than zopiclone for improving these sleep parameters. Zopiclone is limited to short-term use because patients develop tolerance or dependence, risking the possibility of addiction. Although a nonbenzodiazepine hypnotic agent used as a sedative, zopiclone enhances GABA (gamma-aminobutyric acid) via benzodiazepine receptors. Consequently, withdrawal symptoms are similar to those of benzodiazepines. The research indicates that acupuncture is an effective alternative without the adverse effects associated with drug intake.

Acupuncture improved sleep latency for patients in the study. This is the time to transition from wakefulness to sleep. Acupuncture also improves sleep efficiency. This is the percentage of total time spent sleeping at night while in bed. In Traditional Chinese Medicine (TCM), these parameters are paramount to an accurate differential diagnosis. Imbalances preventing falling asleep and imbalances causing patients to wake have differing causes within TCM. As a result, acupuncture and herbal medicine modifications are based on how easily patients fall asleep, how often they wake, and what times of day they wake.

A total of 112 patients with primary insomnia were randomized into an acupuncture group and a zopiclone group. For the drug group, zopiclone was administered in 7.5 mg doses, once per day, for 30 days. All patients receiving acupuncture had the following acupoints inserted with 0.25 mm diameter, 40 mm length filiform acupuncture needles:
Baihui (GV20)
Sishencong (EX-HN 1)

Anmian (extra, midpoint of Fengchi (GB20) and Yiming)
Secondary acupuncture points were added based on diagnostic considerations. For patients with heart and sleep deficiency, the following acupoints were added:
Shenmen (HT7)
Taibai (SP3)
Zhizheng (SI7)
Fenglong (ST40)

For heart deficiency related timidity, the following acupoints were added:
Shenmen (HT7)
Zhizheng (SI7)
Qiuxu (GB40)
Guangming (GB37)

For liver qi depression transforming into fire, the following acupoints were added:
Taichong (LV3)
Yangfu (GB 38)

For phlegm heat, the following acupoints were added:
Fenglong (ST 40)
Neiting (ST 44)
Quchi (LI 11)

For patients with blood stasis, the following acupoints were added:
Xuehai (SP10)
Geshu (BL17)

Standards of manual acupuncture needle manipulation were maintained according to accepted TCM principles. An even reinforcing and reducing technique (ping bu ping xie) was applied to the three primary acupuncture points administered to all patients. Reinforcing or reducing techniques were applied to the secondary acupoints based on differential diagnostic considerations. One course of treatment was comprised of one acupuncture treatment per day for 10 days. A one day break between each course was observed. Patients received three courses of care. Needles were retained during each acupuncture session for 30 minutes.

Acupuncture, achieving a 92.9% total effective rate, significantly outperformed the medication, which achieved a 67.9% total effective rate. A closer look at the numbers reveals important findings. In the acupuncture group, 10 patients completely recovered, whereas there were only 3 complete recoveries in the drug group. On the other end of the spectrum, only 4 acupuncture patients did not improve, whereas 18 drug patients did not improve.

In the middle range of improvements, patients receiving acupuncture had more significant improvements across a wider array of parameters. Patients receiving drug therapy had improvements limited to sleep quality, latency, and duration. Acupuncture caused improvements across these parameters plus daytime functioning, sleep efficiency, and reduction of sleep disturbances.

The research presents historical insight into TCM theoretical principles. Insomnia is classified as Bu Mei or Bu De Wo (sleeplessness). The research indicates that "Scholars in history made rich discussion on physiology and pathogenesis of insomnia, mostly based on the theory of imbalance between yin and yang, in which it holds that change of yin and yang within human body determines the sleep and awake cycle, and it is an inevitable phenomenon of yin yang alternation." They add that the "brain is the house of the original spirit," which is linked to mental states. As a result, regulation of yin, yang, and spirit (shen) is indicated for patients with insomnia.

In a detailed analysis of each acupoint, the research presents the reasons for each point selection. GV20 was chosen because yang gathers at this point; it is a crossing point of the hand and foot yang channels with the Governing Vessel. GV20 is designated as the sea of yang channels; it regulates the qi and blood of all yang channels. As a results, the research notes that the "pathological state of yang failing to enter yin can be corrected." The research also notes that GV20 is effective for "relieving fright and calming spirit."

Sishencong shares similar therapeutic properties on the two acupoints of the four point combination that are located on the Governing Vessel. In addition, the lateral points are within 0.5 cun of the Bladder Channel, which connects with the kidneys and also enters the brain. As a result, the research indicates that the lateral points of the Sishencong combination refresh the brain and tonify essence. The acupoint Anmian, translated as peaceful sleep, was noted for its ability to improve sleep by regulating excitatory responses in the brain and for improving micro-circulation.

The research was conducted at the Hospital of Integrated Traditional Chinese and Western Medicine (Zhejiang Chinese Medical University). Based on the data, acupuncture is more effective than zopiclone for the treatment of insomnia. An additional benefit is that acupuncture is non-addictive whereas the drug presents tolerance and dependence risks.
 

Notes:
1. Shao, Yue. "Clinical study on acupuncture for primary insomnia." Journal of Acupuncture and Tuina Science 15, no. 6 (2017): 410-414.

2. Xu F, Feng ZT, Wang ZN. Heart-spleen deficiency insomnia treated by five notes syndrome differentiation cooperate Guipi Anmei decoction. Jilin Zhongyiyao, 2014, 34(6): 582-585.

3. Xue DX, Zhang ZJ. Discussion of the syndromes and treatment of insomnia in Shang Han Lun (Treatise on Cold Damage Diseases). Xin Zhongyi, 2014, 46(8): 232-234.

4. Shao, Yue. "Clinical study on acupuncture for primary insomnia." Journal of Acupuncture and Tuina Science 15, no. 6 (2017): 410-414.