Possible mechanisms of acupuncture therapy in insomnia

Insomnia is a sleep disorder that millions of people worldwide have to live with. It is believed that at least a third of people in the UK have episodes of insomnia at sometimes of their life. Insomnia is often defined as difficulty initiating sleep, inability to go back to sleep and frequent waking up during the night. It can be either acute lasting one to several nights, or chronic, even last months to years. A lack of sleep can affect the mood and cause tiredness, fatigue and depression even injury during the day. Severe and chronic insomnia is worse enough to interfere with normal physical, emotional, mental and social functioning. It tends to be more common in women and more likely to occur with age, but more often the sleep disturbance is attributable to some medical conditions. So the first step in treating insomnia is to identify the underlying health problems, such as cold and allergies, high blood pressure and some pain medication, etc. Cognitive behavioural therapy may help some people avoiding the thoughts and behavioural affecting their sleep. Sleeping tablets are considered to be the last source of the treatment due to the side effects and drug dependent effects.

Acupuncture is commonly used to treat insomnia in China. The treatment not only improves sleep problems also treats some causes of underlying conditions, such as depression, anxiety and pain etc. Acupuncture research of insomnia found that acupuncture regulates different components of sleep-related neuron transmitters or mediators. Firstly, acupuncture regulated release of gamma-aminobutyric acid (GABA), a neurotransmitter, important in regulating sleep. Sleeping tablets such as benzodiazepine, zolpidem, and eszopiclone exerted their sleep enhancing effects by regulating GABA neurotransmission. Acupuncture stimulation at certain acupoints increased GABA release, acting as sleep tablet but without side effects. Secondly, it mediated melatonin release. Melatonin is a hormone, secreted from the pineal gland in the brain. Melatonin was reported to be involved in regulating the body’s circadian rhythm of sleep-awake cycle and played an important role in maintaining normal sleep. Clinical trials reported that melatonin was safe component and effective in treating primary insomnia. Acupuncture significantly increased nocturnal melatonin secretion in patients with anxiety, and this was associated with the significantly improvement in total sleep time and sleep efficiency. Thirdly, acupuncture regulated the endogenous opioidergic neurotransmissions which were involved in the mediating sleep-awake cycle. Finally, it is well-known that acupuncture treatment alleviates depression and anxiety and helps sleep. Together, scientific evidence supports acupuncture as an effective treatment for insomnia.

Reference:

K Zhao (2013) Acupuncture for the treatment of insomnia. In BY Zeng, K Zhao & FR Liang (Eds), Neurobiology of Acupuncture (Int Rev Neurobiol. Vol. 111: pp. 217-234). New York: Academic Press. http://www.ncbi.nlm.nih.gov/pubmed/24215925