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Review
. 2012 Sep 12;2012(9):CD005472.
doi: 10.1002/14651858.CD005472.pub3.

Acupuncture for insomnia

Daniel K L Cheuk  1 , Wing-Fai Yeung, K F Chung, Virginia Wong
Affiliations
Review

Acupuncture for insomnia

Daniel K L Cheuk et al. Cochrane Database Syst Rev. .

Abstract

Background: Although conventional non-pharmacological and pharmacological treatments for insomnia are effective in many people, alternative therapies such as acupuncture are widely practised. However, it remains unclear whether current evidence is rigorous enough to support acupuncture for the treatment of insomnia.

Objectives: To determine the efficacy and safety of acupuncture for insomnia.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts International, CINAHL, AMED, the Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS), the World Health Organization (WHO) Trials Portal (ICTRP) and relevant specialised registers of the Cochrane Collaboration in October 2011. We screened reference lists of all eligible reports and contacted trial authors and experts in the field.

Selection criteria: Randomised controlled trials evaluating any form of acupuncture for insomnia. They compared acupuncture with/without additional treatment against placebo or sham or no treatment or same additional treatment. We excluded trials that compared different acupuncture methods or acupuncture against other treatments.

Data collection and analysis: Two review authors independently extracted data and assessed risk of bias. We used odds ratio (OR) and mean difference for binary and continuous outcomes respectively. We combined data in meta-analyses where appropriate.

Main results: Thirty-three trials were included. They recruited 2293 participants with insomnia, aged 15 to 98 years, some with medical conditions contributing to insomnia (stroke, end-stage renal disease, perimenopause, pregnancy, psychiatric diseases). They evaluated needle acupuncture, electroacupuncture, acupressure or magnetic acupressure.Compared with no treatment (two studies, 280 participants) or sham/placebo (two studies, 112 participants), acupressure resulted in more people with improvement in sleep quality (compared to no treatment: OR 13.08, 95% confidence interval (CI) 1.79 to 95.59; compared to sham/placebo: OR 6.62, 95% CI 1.78 to 24.55). However, when assuming that dropouts had a worse outcome in sensitivity analysis the beneficial effect of acupuncture was inconclusive. Compared with other treatment alone, acupuncture as an adjunct to other treatment might marginally increase the proportion of people with improved sleep quality (13 studies, 883 participants, OR 3.08, 95% CI 1.93 to 4.90). On subgroup analysis, only needle acupuncture but not electroacupuncture showed benefits. All trials had high risk of bias and were heterogeneous in the definition of insomnia, participant characteristics, acupoints and treatment regimen. The effect sizes were generally small with wide confidence intervals. Publication bias was likely present. Adverse effects were rarely reported and they were minor.

Authors' conclusions: Due to poor methodological quality, high levels of heterogeneity and publication bias, the current evidence is not sufficiently rigorous to support or refute acupuncture for treating insomnia. Larger high-quality clinical trials are required.

PubMed Disclaimer

Conflict of interest statement

One included trial was published by co‐authors of this review. They were not involved in data extraction or risk of bias assessment of their own study.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Acupuncture alone versus no treatment, outcome: 1.1 Frequency of improvement in sleep quality.
4
4
Forest plot of comparison: 2 Acupuncture alone versus placebo or sham acupuncture, outcome: 2.1 Frequency of improvement in sleep quality.
5
5
Forest plot of comparison: 3 Acupuncture as adjunctive to other treatment versus other treatment alone, outcome: 3.1 Frequency of improvement in sleep quality.
6
6
Funnel plot of comparison: 3 Acupuncture as adjunctive to other treatment versus other treatment alone, outcome: 3.1 Frequency of improvement in sleep quality.
1.1
1.1. Analysis
Comparison 1 Acupuncture alone versus no treatment, Outcome 1 Frequency of improvement in sleep quality.
1.2
1.2. Analysis
Comparison 1 Acupuncture alone versus no treatment, Outcome 2 Total sleep duration (hours).
1.3
1.3. Analysis
Comparison 1 Acupuncture alone versus no treatment, Outcome 3 Total score on the Pittsburgh Sleep Quality Index (PSQI).
1.4
1.4. Analysis
Comparison 1 Acupuncture alone versus no treatment, Outcome 4 Sleep score.
1.5
1.5. Analysis
Comparison 1 Acupuncture alone versus no treatment, Outcome 5 Quality of life physical component score on the SF‐36.
1.6
1.6. Analysis
Comparison 1 Acupuncture alone versus no treatment, Outcome 6 Quality of life mental component score on the SF‐36.
2.1
2.1. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 1 Frequency of improvement in sleep quality.
2.2
2.2. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 2 Sleep onset latency (minutes).
2.3
2.3. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 3 Total sleep duration (hours).
2.4
2.4. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 4 Total wake time (minutes).
2.5
2.5. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 5 Wake after sleep onset (minutes).
2.6
2.6. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 6 Number of awakenings.
2.7
2.7. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 7 Arousal index (number of arousals per hour).
2.8
2.8. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 8 Sleep efficiency (%).
2.9
2.9. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 9 Total score on the Pittsburgh Sleep Quality Index (PSQI).
2.10
2.10. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 10 Total score on the Insomnia Severity Index (ISI).
2.11
2.11. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 11 Total score on the Athens Insomnia Scale (AIS).
2.12
2.12. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 12 Total score on the Sleep Quality Scale (SQS).
2.13
2.13. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 13 Quality of sleep score on the Morning Questionnaire (MQ).
2.14
2.14. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 14 Sleep quality score: sleep diary.
2.15
2.15. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 15 Work score on the Sheehan Disability Index (SDI).
2.16
2.16. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 16 Social score on the Sheehan Disability Index (SDI).
2.17
2.17. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 17 Family score on the Sheehan Disability Index (SDI).
2.18
2.18. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 18 Quality of life total score on the General Health Questionnaires (GHQ).
2.19
2.19. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 19 Quality of life physical component score on the SF‐36.
2.20
2.20. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 20 Quality of life mental component score on the SF‐36.
2.21
2.21. Analysis
Comparison 2 Acupuncture alone versus placebo or sham acupuncture, Outcome 21 Frequency of adverse effects.
3.1
3.1. Analysis
Comparison 3 Acupuncture as adjunctive to other treatment versus other treatment alone, Outcome 1 Frequency of improvement in sleep quality.
3.2
3.2. Analysis
Comparison 3 Acupuncture as adjunctive to other treatment versus other treatment alone, Outcome 2 Sleep onset latency (minutes).
3.3
3.3. Analysis
Comparison 3 Acupuncture as adjunctive to other treatment versus other treatment alone, Outcome 3 Total sleep duration (hours).
3.4
3.4. Analysis
Comparison 3 Acupuncture as adjunctive to other treatment versus other treatment alone, Outcome 4 Sleep efficiency (%).
3.5
3.5. Analysis
Comparison 3 Acupuncture as adjunctive to other treatment versus other treatment alone, Outcome 5 Total score on the Pittsburgh Sleep Quality Index (PSQI).
3.6
3.6. Analysis
Comparison 3 Acupuncture as adjunctive to other treatment versus other treatment alone, Outcome 6 Frequency of adverse effects.
4.1
4.1. Analysis
Comparison 4 Sensitivity analysis excluding studies without standardised insomnia diagnosis: acupuncture versus no treatment, Outcome 1 Frequency of improvement in sleep quality.
5.1
5.1. Analysis
Comparison 5 Sensitivity analysis excluding studies without standardised insomnia diagnosis: acupuncture versus sham or placebo acupuncture, Outcome 1 Total sleep duration (hours).
5.2
5.2. Analysis
Comparison 5 Sensitivity analysis excluding studies without standardised insomnia diagnosis: acupuncture versus sham or placebo acupuncture, Outcome 2 Number of awakenings.
5.3
5.3. Analysis
Comparison 5 Sensitivity analysis excluding studies without standardised insomnia diagnosis: acupuncture versus sham or placebo acupuncture, Outcome 3 Sleep efficiency (%).
5.4
5.4. Analysis
Comparison 5 Sensitivity analysis excluding studies without standardised insomnia diagnosis: acupuncture versus sham or placebo acupuncture, Outcome 4 Total score on the Pittsburgh Sleep Quality Index (PSQI).
6.1
6.1. Analysis
Comparison 6 Sensitivity analysis excluding studies without standardised insomnia diagnosis: acupuncture as adjunct to other treatment versus other treatment alone, Outcome 1 Frequency of improvement in sleep quality.
6.2
6.2. Analysis
Comparison 6 Sensitivity analysis excluding studies without standardised insomnia diagnosis: acupuncture as adjunct to other treatment versus other treatment alone, Outcome 2 Total sleep duration (hours).
6.3
6.3. Analysis
Comparison 6 Sensitivity analysis excluding studies without standardised insomnia diagnosis: acupuncture as adjunct to other treatment versus other treatment alone, Outcome 3 Sleep efficiency (%).
6.4
6.4. Analysis
Comparison 6 Sensitivity analysis excluding studies without standardised insomnia diagnosis: acupuncture as adjunct to other treatment versus other treatment alone, Outcome 4 Total score on the Pittsburgh Sleep Quality Index (PSQI).
7.1
7.1. Analysis
Comparison 7 Sensitivity analysis for dropouts (best‐case scenario): acupuncture alone versus no treatment, Outcome 1 Total score on the Pittsburgh Sleep Quality Index (PSQI).
7.2
7.2. Analysis
Comparison 7 Sensitivity analysis for dropouts (best‐case scenario): acupuncture alone versus no treatment, Outcome 2 Quality of life physical component score on the SF‐36.
7.3
7.3. Analysis
Comparison 7 Sensitivity analysis for dropouts (best‐case scenario): acupuncture alone versus no treatment, Outcome 3 Quality of life mental component score on the SF‐36.
8.1
8.1. Analysis
Comparison 8 Sensitivity analysis for dropouts (worst‐case scenario): acupuncture alone versus no treatment, Outcome 1 Total score on the Pittsburgh Sleep Quality Index (PSQI).
8.2
8.2. Analysis
Comparison 8 Sensitivity analysis for dropouts (worst‐case scenario): acupuncture alone versus no treatment, Outcome 2 Quality of life physical component score on the SF‐36.
8.3
8.3. Analysis
Comparison 8 Sensitivity analysis for dropouts (worst‐case scenario): acupuncture alone versus no treatment, Outcome 3 Quality of life mental component score on the SF‐36.
9.1
9.1. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 1 Frequency of improvement in sleep quality.
9.2
9.2. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 2 Sleep onset latency (minutes).
9.3
9.3. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 3 Total sleep duration (hours).
9.4
9.4. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 4 Total wake time (minutes).
9.5
9.5. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 5 Wake after sleep onset (minutes).
9.6
9.6. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 6 Number of awakenings.
9.7
9.7. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 7 Sleep efficiency (%).
9.8
9.8. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 8 Total score on the Pittsburgh Sleep Quality Index (PSQI).
9.9
9.9. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 9 Total score on the Insomnia Severity Index (ISI).
9.10
9.10. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 10 Total score on the Athens Insomnia Scale (AIS).
9.11
9.11. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 11 Quality of sleep score on the Morning Questionnaire (MQ).
9.12
9.12. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 12 Sleep quality score: sleep diary.
9.13
9.13. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 13 Work score on the Sheehan Disability Index (SDI).
9.14
9.14. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 14 Social score on the Sheehan Disability Index (SDI).
9.15
9.15. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 15 Family score on the Sheehan Disability Index (SDI).
9.16
9.16. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 16 Quality of life total score on the General Health Questionnaires (GHQ).
9.17
9.17. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 17 Quality of life physical component score on the SF‐36.
9.18
9.18. Analysis
Comparison 9 Sensitivity analysis for dropouts (best‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 18 Quality of life mental component score on the SF‐36.
10.1
10.1. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 1 Frequency of improvement in sleep quality.
10.2
10.2. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 2 Sleep onset latency (minutes).
10.3
10.3. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 3 Total sleep duration (hours).
10.4
10.4. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 4 Total wake time (minutes).
10.5
10.5. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 5 Wake after sleep onset (minutes).
10.6
10.6. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 6 Number of awakenings.
10.7
10.7. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 7 Sleep efficiency (%).
10.8
10.8. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 8 Total score on the Pittsburgh Sleep Quality Index (PSQI).
10.9
10.9. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 9 Total score on the Insomnia Severity Index (ISI).
10.10
10.10. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 10 Total score on the Athens Insomnia Scale (AIS).
10.11
10.11. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 11 Quality of sleep score on the Morning Questionnaire (MQ).
10.12
10.12. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 12 Sleep quality score: sleep diary.
10.13
10.13. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 13 Work score on the Sheehan Disability Index (SDI).
10.14
10.14. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 14 Social score on the Sheehan Disability Index (SDI).
10.15
10.15. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 15 Family score on the Sheehan Disability Index (SDI).
10.16
10.16. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 16 Quality of life total score on the General Health Questionnaires (GHQ).
10.17
10.17. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 17 Quality of life physical component score on the SF‐36.
10.18
10.18. Analysis
Comparison 10 Sensitivity analysis for dropouts (worse‐case scenario): acupuncture versus sham or placebo acupuncture, Outcome 18 Quality of life mental component score on the SF‐36.
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References

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Kang 2006 {published data only}
    1. Kang FH. 78 cases clinical observation of effect of auricular therapy combined acupuncture on treatment of insomnia. Journal of Tianjin University Traditional Chinese Medicine 2005;25:62‐3.
Li 2005b {published data only}
    1. Li HT, Liu JH, Zhu QX. Clinical observation on treatment of senile insomnia with application therapy on shenque acupoint with Ginkgo leaf preparation: a report of 25 cases. Journal of Chinese Integrative Medicine 2005;3(5):398‐9. - PubMed
Li 2007a {published data only}
    1. Li XJ, Bi LP. Differentiation of syndromes and use acupuncture combined auricular therapy on treatment of insomnia: 133 cases clinical observation. Lishizhen Medicine Materia Medica Research 2007;18(3):678.
Li 2007b {published data only}
    1. Li TB. Effect of acupuncture on post‐stroke insomnia. Clinical Journal of Rehabilitation Theory and Practice 2007;13:656‐7.
Li 2007c {published data only}
    1. Li JH, Li JZ. Clinical observation of electroacupuncture treatment for insomnia. Journal of Changzhi Medical College 2007;21:465‐6.
Li 2010 {published data only}
    1. Li LF, Lu JH. Clinical observation on acupuncture treatment of intractable insomnia. Journal of Traditional Chinese Medicine 2010;30(1):21‐2. - PubMed
Lian 1990 {published data only}
    1. Lian N, Yan Q. Insomnia treated by auricular pressing therapy. Journal of Traditional Chinese Medicine 1990;10(3):174‐5. - PubMed
Liu 2000 {published data only}
    1. Liu Q. Acupuncture and auricular therapy for 36 cases of insomnia. Jilin Journal of Traditional Chinese Medicine 2000;20:63.
Liu 2006 {published data only}
    1. Liu JH, Huang XH, Chen XH. 32 cases clinical observation of effect of acupuncture on treatment of post‐stroke insomnia. International Medicine and Health Guidance News 2006;12:107‐8.
Liu 2007 {published data only}
    1. Liu XB, Niu WM. Hairline acupuncture treatment on 160 cases of insomnia. Shanxi Journal of Chinese Medicine 2007;28:716‐7.
Lu 2002 {published data only}
    1. Lu Z. Scalp and body acupuncture for treatment of senile insomnia ‐ a report of 83 cases. Journal of Traditional Chinese Medicine 2002;22(3):193‐4. - PubMed
Lu 2008 {published data only}
    1. Lu M, Liu X. Insomnia due to deficiency of both the heart and spleen treated by acupuncture‐moxibustion and Chinese Tuina. Journal of Traditional Chinese Medicine 2008;28(1):10‐2. - PubMed
Luo 1993 {published data only}
    1. Luo ZP, Li XD, He YN, Han XY. Clinical observation of 367 cases of treating insomnia by oto‐pressure. Heilongjiang Journal of Traditional Chinese Medicine 1993;1:45‐8.
Ma 2006b {published data only}
    1. Ma ZX, Li GH, Duan HM. 31 cases of insomnia treated by acupuncture. Guangming Journal of Chinese Medicine 2006;21(4):25‐6.
Ni 2006 {published data only}
    1. Ni JX, Zhu WZ. Clinical study of 76 cases of insomnia with head acupoints penetration. Journal of Clinical Acupuncture‐Moxibustion 2006;22(12):35‐6.
Pan 2005 {published data only}
    1. Pan QL, Zhang LM, Yang JY, He YL. Results in treatment of obstinate insomnia by acupuncture. China Tropical Medicine 2005;5(8):1705‐6.
Phillips 2001 {published data only}
    1. Philips KD, Skelton WD. Effects of individualized acupuncture on sleep quality in HIV disease. Journal of the Association of Nurses in AIDS Care 2001;12(1):27‐39. - PubMed
Qi 2008 {published data only}
    1. Qi LZ, Ma XP, Yang L. Observation on the therapeutic effect of neck clustered needling on insomnia. Chinese Acupuncture Moxibustion 2008;28(12):861‐4. - PubMed
Qiu 1999 {published data only}
    1. Qiu RJ, Zheng CM, Lun ZX, Zeng WH, Ding MZ. Observation of effect of a kind of massage on treatment of 53 patients of insomnia. New Journal of Traditional Chinese Medicine 1999;31:23.
Ruan 2001 {published data only}
    1. Ruan J. Clinical observation on the treatment of 102 cases of insomnia with point‐application. International Journal of Clinical Acupuncture 2001;12(2):109‐13.
Sang 2004 {published data only}
    1. Sang P, Wang S. 40 cases of insomnia treated by head acupuncture. Heilongjiang Journal of Traditional Chinese Medicine 2004;33(3):43.
Shang 2000 {published data only}
    1. Shang YT. Ear pressing for insomnia: observation of 82 cases. International Journal of Clinical Acupuncture 2000;11(1):65‐7.
Shen 2004 {published data only}
    1. Shen P. Two hundred cases of insomnia treated by otopoint pressure plus acupuncture. Journal of Traditional Chinese Medicine 2004;24(3):168‐9. - PubMed
Shi 2003 {published data only}
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Sjoling 2008 {published data only}
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Su 2004 {published data only}
    1. Su X, Wu Z. 166 cases of secondary insomnia caused by cervical spondylosis using acupuncture at neck Jiaji. Chinese Journal of Current Traditional and Western Medicine 2005;3:426.
Suen 2003 {published data only}
    1. Suen LK, Wong TK, Leung AW, Ip WC. The long‐term effects of auricular therapy using magnetic pearls on elderly with insomnia. Complementary Therapies in Medicine 2003;11(2):85‐92. - PubMed
Tang 2007b {published data only}
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Wang 1993 {published data only}
    1. Wang XM. The comparative analysis between using auriculo‐pressing therapy and oral diazepam for treating insomnia. Journal of Clinical Psychiatry 1993;3:189.
Wang 2000 {published data only}
    1. Wang F. Treatment of insomnia by pressing Yongquan and pinching toes. International Journal of Clinical Acupuncture 2000;11(1):69‐70.
Wang 2002 {published data only}
    1. Wang ST. An observation on efficacy of auricular acupressure on insomnia using magnetic pearls. Anhui Clinical Journal of Traditional Chinese Medicine 2002;14:165.
Wang 2003a {published data only}
    1. Wang MZ, Wei Y. 115 cases of insomnia treated by acupuncture in Jiannao using Anshen granule. Journal of Clinical Acupuncture and Moxibustion 2003;19:32‐3.
Wang 2003b {published data only}
    1. Wang QQ, Chen HL. Observations on the curative effect of combined acupoint injection and electroacupuncture on 40 insomnia cases. Shanghai Journal of Acupuncture and Moxibustion 2003;22:27‐8.
Wang 2004 {published data only}
    1. Wang Y, Zhao ZF, Wu Y. Clinical therapeutic effect of acupuncture on post‐stroke depression with insomnia. Chinese Acupuncture and Moxibustion 2004;24:603‐6.
Wang 2006 {published data only}
    1. Wang J, Jiang JF, Wang LL. Clinical observation on Governor vessel Daoqi method for treatment of dyssomnia in the treatment of depression. Chinese Acupuncture and Moxibustion 2006;26(5):328‐30. - PubMed
Wang 2008 {published data only}
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Wei 2006 {published data only}
    1. Wei J, Zhao Y, Wei J. 30 cases of obstinate insomnia treated by acupuncture through Beixue and jiaji acupoints. Journal of Gansu College of Traditional Chinese Medicine 2006;23(2):47.
Wei 2010 {published data only}
    1. Wei Y. Clinical observation on acupoint catgut embedding at head‐acupoint combined with massage of sole for treatment of refractory insomnia. Chinese Acupuncture and Moxibustion 2010;30(2):117‐20. - PubMed
Weng 2007 {published data only}
    1. Weng M, Liao HQ. Efficacy of electroacupuncture treatment for insomnia in the elderly using scale analysis. Journal of Clinical Acupuncture and Moxibustion 2007;23:33‐4.
Xiong 2003 {published data only}
    1. Xiong X, Chen Y, Liang D, Xu X, Fang Y. 45 cases of insomnia treated by shallow acupuncture. Journal of Fujian College of Traditional Chinese Medicine 2003;13:44‐5.
Xu 1997 {published data only}
    1. Xu G. 45 cases of insomnia treated by acupuncture. Shanghai Journal of Acupuncture and Moxibustion 1997;16(6):10.
Xuan 2007 {published data only}
    1. Xuan YB, Guo J, Wang LP, Wu X. Randomized and controlled study on effect of acupuncture on sleep quality in the patient of primary insomnia. Chinese Acupuncture and Moxibustion 2007;27(12):886‐8. - PubMed
Yan 2010 {published data only}
    1. Yan XK, Zhang Y, Yu L, Yang B, Chen C, Wang FC. Effect of "tranquillization needling" on the sleep quality in patients with insomnia of heart‐spleen deficiency type. Acupuncture Research 2010;35(3):222‐5. - PubMed
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Yao 1999 {published data only}
    1. Yao S. 46 cases of insomnia treated by semiconductor laser irradiation on auricular points. Journal of Traditional Chinese Medicine 1999;19(4):298‐9. - PubMed
Yu 1997 {published data only}
    1. Yu GX. Through puncture to Huatuojiaji points plus wrist ‐ ankle needling in treatment of insomnia. International Journal of Clinical Acupuncture 1997;8(1):69‐71.
Zhang 2000 {published data only}
    1. Zhang J, Li J, Li YS, Pan JL, Zhang M. A controlled study of treating insomnia by auricular acupressure and diazepam. Yunan Journal of Traditional Chinese Medicine 2000;21:37‐8.
Zhang 2002 {published data only}
    1. Zhang Q. Clinical observation on intractable insomnia treated by point pressure in 42 cases. Journal of Traditional Chinese Medicine 2002;22(4):276‐7. - PubMed
Zhang 2003a {published data only}
    1. Zhang Q. Clinical observation on acupuncture treatment of insomnia in 35 cases. Journal of Traditional Chinese Medicine 2003;23(2):125‐6. - PubMed
Zhang 2003b {published data only}
    1. Zhang H, Deng H, Xiong K. Acupuncture regulating Yinqiao meridians for treatment of 89 cases of insomnia. Chinese Acupuncture and Moxibustion 2003;23:394‐6.
Zhang 2005 {published data only}
    1. Zhang XY. Effect of acupuncture on 45 cases of insomnia. Journal of Clinical Acupuncture and Moxibustion 2005;21:24.
Zhang 2008 {published data only}
    1. Zhang GX. Analysis on the treatment of insomnia by auricular point imbedding therapy in college students. Chinese Journal of School Health 2008;29(6):568.
Zhang 2010 {published data only}
    1. Zhang YF, Ren GF, Zhang XC. Acupuncture plus cupping for treating insomnia in college students. Journal of Traditional Chinese Medicine 2010;30(3):185‐9. - PubMed
Zhong 2008 {published data only}
    1. Zhong ZG, Cai H, Li XL, Lv D. Effect of acupuncture combined with massage of the sole on sleeping quality of the patient with insomnia. Chinese Acupuncture and Moxibustion 2008;28(6):4113. - PubMed
Zhou 2010 {published data only}
    1. Zhou ZL, Shi X, Li SD, Guan L. Effect of scalp point penetration needling on sleep quality and sleep structure of insomnia patients. Chinese Acupuncture and Moxibustion 2010;30(9):721‐4. - PubMed
    1. Zhou ZL, Shi X, Li SD, Guan L. Scalp penetration acupuncture for insomnia: a randomized controlled trial. Journal of Chinese Integrative Medicine 2010;8(2):126‐30. - PubMed
Zhu 2002 {published data only}
    1. Zhu H. Acupuncture treating refractory insomnia by balancing Yin Yang Qiao Meridian. Journal of Traditional Chinese Medicine 2002;22:55‐6.
Zou 2008 {published data only}
    1. Zou Y. Clinical observation on the treatment of insomnia by tranquillizing electroacupuncture. Heilongjiang Journal of Traditional Chinese Medicine 2008;37:40‐1.

References to ongoing studies

ISRCTN12585433 {published data only}
    1. Guo J. The effect of acupuncture compared with sham acupuncture and estazolam in primary insomnia. World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) 2010.
NCT00838994 {published data only}
    1. Chung KF. Acupuncture for residual insomnia associated with major depressive disorder. World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) 2009.
NCT00855140 {published data only}
    1. Glick RM. Acupuncture for the treatment of insomnia. World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) 2010.
NCT00868517 {published data only}
    1. Prisco MK. Examining the effect of acupuncture on sleep difficulties related to post traumatic stress disorder. World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) 2010.
NCT01162018 {published data only}
    1. Spiegel D. Acupuncture for sleep disruption in cancer survivors. World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) 2010.

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