The following three insomnia case reviews demonstrate the effects of acupuncture in clinical practice achieving improvement of otherwise intractable insomnia. These cases describe the clinical improvements in sleep using various subjective and functional assessments and objective actigraphic verification.
Insomnia Case Review #1
A 55-year-old woman sought treatment for sleep difficulties six nights a week for a year. She used a combination of melatonin, lorazepam (2–4 mg), and acetaminophen pm nightly to help her sleep. She reported that her sleep difficulties were primarily due to stress, although sometimes to knee pain. Because of her work as a magazine editor, she often read and wrote in bed, had irregular sleeping hours, and reported significant trouble falling and staying asleep.
The patient had never undergone a sleep study, and it is unclear whether she might have had obstructive sleep apnea. Past medical history included ovarian cancer, status post chemotherapy 5.5 years ago, bilateral foot neuropathy due to chemotherapy, bilateral moderate knee osteoarthritis, hypertension, depression, and borderline diabetes. She took medication for hypertension, depression and neuropathy, and high cholesterol. She lived with her husband and did not use tobacco, alcohol, or illicit drugs.
Sleep Details Before Acupuncture
At the time of the presentation, her Pittsburgh Sleep Quality Index (PSQI) was 17, indicating inadequate sleep. Before starting acupuncture, she had two nights of sleep monitoring with a sleep diary and wrist actigraph. She recorded 6 hours of sleep for the first night and 4 hours for the second night and used 4 mg lorazepam the first night and 2 mg lorazepam the second night to assist with sleep. Wrist actigraph recorded sleep efficiency (SE) of 60.5%, total sleep time (TST) of 315 minutes, and wake time after sleep onset (WASO) of 58.5 minutes, averaged across the two nights. In addition, her depression score, as evaluated by the Geriatric Depression Scale (GDS), was 24, suggesting a substantially depressive mood.
Case 1 Acupuncture Treatment
The lead practitioner for these insomnia case reviews based his acupuncture point selection on the Traditional Chinese Medicine (TCM) theory for treating insomnia. Specifically, he selected Ex-HN-3 (Yintang), Ex-HN-22 (Anmian), HT7 (Shenmen), KI3 (Taixi), and LV3 (Taichong). Each session lasted 45–60 minutes, including a brief history, exam, and acupuncture treatment. The patient received 12 sessions twice a week for four weeks, followed by once a week for four weeks.
All needles were sterile and single-use. The practitioner inserted the needles to the appropriate depth and retained them without further manipulation for 30 minutes.
Case 1 Results
Five days after the start of acupuncture treatments, the patient spontaneously reported, “I slept much more (7.5–8.0 hours) than normal and I stayed asleep after I fell asleep. One night I didn’t need medication.” At the end of the 8-week treatment course, the patient continued to report “falling asleep easier” and “staying asleep longer.” She had another two days of post-treatment actigraphy monitoring. During those two nights, she used no medication to assist with sleep.
The patient reported fragmented sleep in her sleep diary that first night due to a “great deal of pain in my knees,” and the second night was still characterized by “some knee pain.” Her mean sleep duration for these two nights was estimated at 7 hours. As a result, her PSQI score decreased to 8, and her GDS dropped to 19. Wrist actigraph recording showed a 2-night average SE 76.7%, TST 490 minutes, and WASO 136 minutes.
In addition, her health-related quality of life (HRQoL) using Medical Outcomes Study 36-item Acute Form (SF-36 Acute) showed the most substantial improvement in the subscales of role limitations due to physical health and social functioning (improvement of 50 points each on a 100-point scale). Furthermore, there were improvements in vitality (10 points), emotional well-being (32 points), and general health (10 points). Finally, she reported decreasing the use of lorazepam from daily to once a week over the 12 weeks.
Insomnia Case Review #2
A 50-year-old male combat veteran was the second patient in these insomnia case reviews. He presented with chronic insomnia and trauma from war injuries. He had a moderate traumatic brain injury (TBI) from a blast injury in 2008, resulting in severe headaches. In addition, he had chronic elbow and forearm pain from injuries sustained from a rocket-propelled grenade attack in 2004, requiring 13 surgeries to repair the damage. His right elbow was in constant pain, and the arm had significant lymphedema, requiring continuous compressive dressings. Other medical conditions included allergic rhinitis, GERD, and hypertension.
During his intake, his PSQI score was 11, with an average of 5 hours of sleep per night and habitual sleep efficiency of 63%. His Modified Post-Traumatic Stress Disease (PTSD) Symptoms Scale Self-Report (MPSS-SR) was 20 (Range: 0–51 on 17 items, with a higher score representing worse symptoms). Headaches were 9/10 in intensity, with a frequency of 1–3 per week. He reported that the headaches “moderately” affected his work, life, and sleep.
Case 2 Acupuncture Treatment
The patient received ten acupuncture treatments during a five-and-half-month period, at a frequency of about once every two weeks. The acupuncture point selection varied to address his headaches, anxiety, and sleep, all guided by TCM meridian theories. The number of needles ranged from 8 to 18.
Case 2 Results
After these treatments, the patient reported “overall” improvements. Headaches went down to 3/10 in intensity at a frequency of 1–2 per month. He reported that the headaches “moderately” affected his work but “mildly” affected his life and sleep. His PTSD MPSS-SR scored 15. His PSQI score also improved to 8, with 6 hours of sleep per night on average and habitual sleep efficiency of 75%. The patient rated acupuncture’s effectiveness in helping his conditions as 5.0 on a visual analog scale from 0 to 10.
Insomnia Case Review #3
A 47-year-old female veteran was the third patient in these insomnia case reviews. She presented with chronic insomnia and prolonged PTSD symptoms after military service, with an initial MPSS-SR score of 40 out of 51. Her initial PSQI was 18. She also complained of severe headaches twice a week at a 10/10 level lasting an average of 72 hours, along with regular “daily” headaches at a 4/10 level for the past 18 years. She was using lamotrigine and sumatriptan at the time of this case. Other medical conditions included hypertension treated with medications, myofascial pain syndrome, and degenerative joint problems with pain over five body parts (left shoulder, right elbow, mid-back, low-back, and knees), treated with trigger point injections and topical cream.
Case 3 Acupuncture Treatment
The practitioner performed ten acupuncture treatments over five months at a frequency of about once every two weeks. Acupuncture points addressed anxiety, headaches, and sleep, guided by TCM meridian theory and auricular mapping. The number of needles varied from 10 to 20.
Case 3 Results
Treatments reduced the patient’s PTSD MPSS-SR score to 22. Her headaches wholly resolved after six sessions. She discontinued all headache medications with no rebound at follow-up four months after the end of the last treatment. Her PSQI score also improved to 13, with sleep duration increased from 3 hours per night on average to 4 hours, and habitual sleep efficiency improved from 27% to 40%. In addition, she decreased the use of sleep medication (zolpidem 10 mg) from “three or more times a week” to “once or twice a week.” Finally, the patient rated the effectiveness of acupuncture in helping her conditions as 9.5 on a visual analog scale from 0 to 10.
Insomnia Case Reviews – Discussion
These three cases represented a diverse sample of patients with chronic insomnia: a middle-aged patient with osteoarthritic knee pain, a middle-aged veteran with polytrauma, and a younger veteran with PTSD, who reported chronic disturbance in sleep. However, these three cases were also selected by a common theme—having comorbid insomnia and clinical manifestations of hyperarousal, e.g., PTSD, anxiety, and hypertension.
The practitioner tailored acupuncture points for the patient’s specific conditions, with certain points frequently used, such as Ex-HN-3 (Yintang), GV24 (Shenting), GV20 (Baihui), PC6 (Neiguan), LV3 (Taichong), auricular Shenmen, or auricular Heart. He chose these points primarily for their sedating effects in treating anxiety, PTSD, and sleep complaints. In addition, some acupoints assisted in headache treatments, such as Ex-HN-3 (Yintang), GV20 (Baihui), and LV3 (Taichong).
Clinical Success of Acupuncture Treatments
The clinical success in these insomnia case reviews included sleep improvements, prolonged sleep duration, increased sleep efficiency, reduced anxiety, headache relief, functional improvement, and less need for medication. These cases illustrate acupuncture’s benefit for sleep problems.
Many research studies have documented the physiological effects of acupuncture using the standards of contemporary Western science. Some of these improvements are due to autonomic activities. These insomnia case reviews demonstrate acupuncture’s substantial and dramatic effects on people who struggle with insomnia. Monitoring autonomic activation represents a new and promising way of understanding how acupuncture works and assessing current treatment modes for insomnia.
Next Steps for Treating Insomnia
At Raleigh Acupuncture, we’ve had success helping patients with entrenched insomnia. These three insomnia case reviews are indicative of our own experience. In addition, below are links to more cases and research studies exploring acupuncture’s beneficial effects on sleep.
BOOK NOW to schedule an appointment online.
Learn More About Raleigh Acupuncture’s Insomnia Treatment (Video).
Insomnia Acupuncture Case Study.
First Insomnia Acupuncture Research Study.
Second Insomnia Acupuncture Research Study.
Depression and Insomnia Research Study.
Hot Flashes Insomnia Acupuncture Research.
Learn about all the conditions we treat.
REFERENCE
Huang W; Kutner N; Bliwise DL. Autonomic activation in insomnia: the case for acupuncture. J Clin Sleep Med 2011;7(1):95-102.
Focus Keyphrase: Insomnia Case Reviews
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What our Clients are Saying
Turning to acupuncture was my last resort to battling insomnia. I had been prescribed two heavy sleep aids with no success. After the third appointment, I went from averaging less than 2.5 hours of sleep to over seven, without any sleep aids. I still go and pretty sure I wouldn’t be here today without success from Raleigh Acupuncture.
Raleigh Acupuncture was recommended by a friend after I mentioned my insomnia and dependency on a sleeping pill. My apprehension was short lived because of the results of my visits to Dr. Mark. With acupuncture treatments and Chinese herbs I was able to begin sleeping well and continue to do so. Dr. Mark is a good listener and encourages his patients in all health issues as well as the original purpose for treatment. Consequently, my knees are stronger and I’m walking better and with more confidence. I haven’t had the need for a cortisone shot in a year and a half. Occasionally, I would use a cane and it’s now somewhere gathering dust. Also, I had a persistent headache that my primary physician had no solution for, and after two acupuncture treatments it’s a thing of the past. Hot flashes were another issue that was treated successfully. I am so grateful to have found a knowledgeable and caring person to treat my ailments, many of which I thought would only grow worse as I aged. Generally, I feel healthier.
I would like to thank Raleigh Acupuncture for the wonderful and very helpful treatments. I had been seeing them for my insomnia, which was making excellent progress at the time and has since been cured. On a previous Monday I was involved in a minor traffic accident. Due to the stress of the accident on Tuesday I awoke in a severe flare-up of my fibromyalgia. The pain was so bad I took pain killers and stayed in bed for the day. The following day I had an appointment with Dr. Mark which I wanted to cancel. My husband suggested I keep the appointment and tell Dr. Mark about the pain. After our discussion, he modified the treatment he had planned for me and treated the pain. I came home, took another pain pill and went back to bed. The following morning I woke pain free and have been since, which is about 2 to 3 months. Thanks again Raleigh Acupuncture!
I became a patient of Raleigh Acupuncture in 2007. I did a lot of research prior to selecting them and I never regretted it. Over the years, I have been treated for various conditions – insomnia, an auto-immune disease, a herniated disk, etc. I have recommended Raleigh Acupuncture to various friends and family members.
I highly recommend the practitioners of Raleigh Acupuncture. I’ve seen them for several years and have always recommended them highly and without hesitation to many of my friends, all of whom have been equally thrilled with the care provided. They are genuinely interested in your health and general well-being, with a focus on getting you healed quickly and gently. My hot flashes are GONE! and the Chinese herbs for sleeplessness are awesome too!
I haven’t slept well for 20 years. That all changed when I was treated at Raleigh Acupuncture for my insomnia. They said it would take 12 treatments, so I took a leap of faith and tried it. I saw changes start to happen after just a few treatments. Over the course of three months I was able to sleep better and better. I weaned myself off of Ambien, and am now sleeping like a baby again. I never thought I’d see the day! It really worked. And guess what? I’ve got more energy now. Imagine that – a good night sleep gives you more energy! Rocket science! Thanks guys!
