Efficacy of Different Acupuncture Therapies for Primary Insomnia

There is a low or very-low certainty of evidence that supports the use of acupuncture for the treatment of insomnia, according to study findings published in Sleep Medicine.

Insomnia is one of the most common health problems, affecting up to 50% of the general population. Primary insomnia presents as a subjective difficulty in initiating or maintaining sleep, lasting for at least a month. Some evidence has suggested that acupuncture may improve symptoms of insomnia.

The researchers of the current study at Lanzhou University in China sought to investigate the body of evidence about acupuncture in insomnia by searching publication databases for relevant randomized controlled trials through March 2021.

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A total of 57 studies comprising 4678 participants were included in this analysis. The study population was aged 20.99-75.67 years and the average proportion of women among cohorts was 36.32%.

The active interventions were fire needle (FN), balance acupuncture, electroacupuncture, auricular acupressure (AP), manual acupuncture (MA), acupoints catgut embedding (ACE), acupoint application, plum blossom needle (PBM), head penetration needling (HPN) , and intradermal needle techniques. Control treatments were sham acupuncture and usual treatment.

In the network meta-analysis, no comparisons produced high certainty evidence.

The comparisons which produced moderate certainty evidence found that compared with usual care, ACE, ACE+MA, MA, AP+MA, HPN, and PBM+MA improved overall efficiency by 2.31-2.83 points and reduced Pittsburgh sleep quality index (PSQI) scores by 4.13-7.22 points. Compared with sham treatment, MA improved efficiency by 1.73 points and ACE, ACE+MA, ACE+AP, FN, and HPN reduced PSQI by 3.58-6.16 points. Within active treatments ACE+MA improved efficiency by 1.12 points compared with MA alone.

All other comparisons were of low or very low certainty quality.

Overall, compared with usual care, the most effective treatment was found to be ACE followed by FN, HPN, ACE+MA, PBN+MA, ACE+AP, and MA. All other active interventions were associated with low certainty of evidence.

Adverse events were reported by 22 trials, comprising 3382 participants, 1179 of whom received usual care or sham treatment. Individuals reported hematoma (n=44 vs 11), pain (n=36 vs 4), headache (n=17 vs 27), bleeding (n=24 vs 3), dizziness (n=8 vs 6), and blood stasis (n=10 vs 1) among the active intervention and control cohorts, respectively. There were no adverse events reported from AP or ACE interventions.

Study limitations included the lack of high-quality evidence as well as the paucity of direct comparisons between active treatment strategies.

“With moderate to low certainty of evidence, multiple acupuncture therapies showed impressive insomnia improvement, especially ACE, AP+MA, and EA+APA,” the researchers stated. However, the quality of the evidence was low. Additional high-quality studies are needed to confirm the efficacy of using acupuncture to treat insomnia.


Lu Y, Zhu H, Wang Q, et al. Comparative effectiveness of multiple acupuncture therapies for primary insomnia: A systematic review and network meta-analysis of randomized trial. Sleep Med. 2022;93:39-48. doi:10.1016/j.sleep.2022.03.012

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