Acupuncture, Herbs and Nutrients for Insomnia

by Barbara Connor, M.Ac., L.Ac.

I thought I would write a little bit today about how acupuncture, herbs and nutrients can help in the treatment of insomnia. If you or a loved one you know suffers from insomnia I hope you find this article helpful.

Insomnia affects an estimated 10-15% of American adults. Growing awareness of insomnia and other sleep disorders led to a doubling of physician visits for sleeplessness and an over 7-fold increase in visits with insomnia diagnoses from 1993 to 2007. Prescriptions for medications for insomnia have increased accordingly, with a striking 30-fold increase in prescriptions for nonbenzodiazepine sedative hypnotics (e.g., zolpidem) during this time. (Bertisch et al 2014) 

Non-drug therapy including acupuncture is commonly used by patients with insomnia. Acupuncture treatment may work by regulating yin and yang to reinforce health thus improving sleep. In modern medicine, acupuncture can increase the content of γ-amino butyric acid, and thus enhance sleep quality. (Cao et al 2009)

Benefits of Acupuncture for Insomnia

The effect of acupuncture on insomnia is consistently emerging as an alternative treatment for insomnia. In a systematic review by Yeung et al., 20 randomized controlled trials were analyzed to assess the effect of acupuncture on insomnia patients by comparing them with control patients given a benzodiazepine, with results indicating that acupuncture was more effective. Cheuk et al., in a review of 33 clinical trials on the effects of acupuncture on insomnia, conclude that many trials indicate acupuncture treatment improves quality of sleep, but future trials need to be more methodologically rigorous, and that extant trials may be prone to the risk of bias coming from the definition of insomnia, participant characteristics, acupoints, and treatment regimen. (Han et al 2014)

Forty-six randomized trials involving 3811 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding, and intention-to-treat analysis. Acupuncture was superior to medications regarding the number of patients with total sleep duration increased for >3 hours. However, there was no difference between acupuncture and medications in average sleep duration. Acupuncture plus medications showed better effect than medications alone on total sleep duration. Similarly, acupuncture plus herbs was significantly better than herbs alone on increase of sleep rates. There were no serious adverse effects with related to acupuncture treatment in the included trials. Acupuncture appears to be effective in treatment of insomnia. However, further large, rigorous designed trials are warranted. (Cao et al 2009)

An open prepost clinical trial study conducted by Spence DW et al entitled “Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report” and published in J Neuropsychiatry Clin Neurosci 2004 Winter;16(1)19-28 studied the response to acupuncture of 18 anxious adult subjects who complained of insomnia.  The study found that acupuncture treatment may be of value for some categories of anxious patients with insomnia.

A systematic review conducted by Sok SR et al entitled “Effects of acupuncture therapy on insomnia” and published in J Adv Nurs 2003 Nov;44(4):375-84 concluded that acupuncture may be an effective intervention for the relief of insomnia.  Further research, using a randomized clinical trial design, is necessary to determine the effectiveness of acupuncture.

A study conducted by Phillips and Skelton entitled “Effects of individualized acupuncture on sleep quality in HIV disease” was published in J Assoc Nurses AIDS Care in 2001 Jan-Feb;2(1):27-39.  Participating in the study were 21 HIV-infected men and women between the ages of 29 and 50 years who reported sleep disturbance three or more times per week and who scored greater than 5 on the Pittsburgh Sleep Quality Index.  Acupuncture was individualized to address insomnia and other symptoms reported by the participants.  Sleep activity and sleep quality significantly improved following 5 weeks of individualized acupuncture delivered in a group setting.

Benefits of Herbs and Nutrients for Insomnia

Chamomile could provide modest benefits of daytime functioning and mixed benefits on sleep diary measures relative to placebo in adults with chronic primary insomnia. However, further studies in select insomnia patients would be needed to investigate these conclusions. (Zick et al 2011)

Honokiol and magnolol – These results indicate that magnolol increases NREM and REM sleep via the GABAA receptor. Several M. officinalis bark extracts have been approved for use, and their efficacy for the treatment of insomnia has been confirmed; especially honokiol and magnolol as we mentioned, it seems to have a great future for M. officinalis in insomnia treatment. Further studies may focus on isolation of other active ingredients and reveal its sedative-hypnotic mechanism more deeply. In addition, adverse reactions and drug interactions should also be evaluated. (Shi et al 2014)

Jujube red date – The hypnotic effects of Zizyphus jujuba involve the activation of GABAA receptors, serotonin receptor binding, and increased GAD expression levels, which yield positive results, making Zizyphus jujuba a promising herbal medication to treat insomnia without serious adverse effects. (Shi et al 2014)

Lemon balm (Melissa officinalis L.) regulates a number of behavioral measures, such as disturbed sleep and reduced excitability and anxiety.  M. officinalis can greatly influence GABA metabolism by decreasing the level of GABA-T thereby increasing GABA levels, which indicate that M. officinalis could acts as a sedative in a way. But a huge number of researches including animal model analysis and molecular biology studies are still need to be done to provide certitude of its sedative effect before using it  in reality. (Shi et al 2014)

Magnesium – Supplementation of magnesium appears to improve subjective measures of insomnia such as insomnia severity index score, sleep efficiency, sleep time and sleep onset latency, early morning awakening, and likewise, insomnia objective measures such as concentration of serum renin, melatonin, and serum cortisol, in elderly people. (Abbasi et al 2012) Food sources of magnesium include seafood, whole grains, dark green vegetables, molasses and nuts.

Melatonin, magnesium, and zinc – The administration of nightly melatonin, magnesium, and zinc appears to improve the quality of sleep and the quality of life in long-term care facility residents with primary insomnia. (Rondanelli et al 2011)

Scutellaria baicalensis is a traditional Chinese medicinal herb, especially its dried roots, Scutellariae Radix, which has been documented to possess therapeutic effects for hundreds of years. Its main active components of anti-inflammatory are baicalin, baicalein, and wogonin. It has been widely used in China and other Asian countries for its anti-inflammatory, anti-pyretic, anti-bacterial, anti-hypertensive, anti-allergic and sedating effects. Recently, several studies have demonstrated the effectiveness of Scutellariae Radix in insomnia treatment, nevertheless, the clinical practice focus on the CNS regulation function of Scutellaria baicalensis is limited. (Shi et al 2014)

Valeriana officinalis (valerian) and Humulus lupulus (hops) – Twelve of the AMED and MEDLINE databases studies published between 1950 and 2009 found that the use of valerian, on its own, or in combination with hops, is associated with improvements in some sleep parameters (eg. sleep latency and quality of sleep). However, these results need to be interpreted cautiously as there were significant differences in design between the studies. (Salter & Brownie 2010)

Valeriana officinalis (valerian) and Humulus lupulus (hops) – Repetitive administrations of valerian/hops combinations have been widely used for self-administered therapy of sleep disturbances. This investigation focuses on the question if a single administration can be an effective sleep aid.  The present investigation has shown evidence that a valerian/hops fluid extract can be used successfully using a single administration. (Dimpfel & Suter 2008)

Valerian – The evidence for the use of valerian in insomnia is limited by the contradictory results of studies reviewed and their methodological problems, although it seems to have some effect in mild to moderate insomnia. Despite that, valerian is a safe substance. More RCT are needed, with samples of adequate size, with standardization of measures to assess quality of sleep and levels of anxiety and standardization of dose, type of preparation of valerian used and the time for its use. (Nunes & Sousa 2011)

Vitamin D receptors are abundantly expressed in the anterior and posterior hypothalamus, substantia nigra, midbrain central gray, raphe nuclei, and the nucleus reticularis pontis oralis and caudalis, which appear to coordinate the sleep-wake state and the paralysis of the bulbar and somatic musculature during sleep. There may be a narrow range of 25(OH)vitamin D3 blood levels that are necessary to produce normal sleep and clinical trials are needed to determine the effects of Vitamin D3 replacement in the prevention of sleep disorders such as insomnia, obstructive sleep apnea and rapid eye movement related apnea. (Beydoun et al 2014)

Benefits of Exercise on Sleep

The results of this study indicate that the sedentary population who participated in this 12 week Pilates program experienced improvements in sleep quality and quality of life. (Leopoldino et al 2013)

Exercise has been recommended for enhancing sleep; a claim linked to the belief that sleep need – defined by sleep duration and depth – is increased post-exercise to allow tissue recovery. We investigated the role of exercise on the sleep need of sedentary adults, after controlling for exercise mode, timing and duration. Two findings emerged: vigorous exercise did not increase sleep need; however, this level of exercise increased light sleep. (Wong et al 2013)

Thirty minutes of running in the morning during weekdays for 3 consecutive weeks impacted positively on sleep and psychological functioning in healthy adolescents compared with control subjects. Running is inexpensive and easy to implement during school schedules, and as both objective and subjective improvements were observed within 3 weeks, regular physical exercise should be promoted. (Kalak et al 2012)

Findings suggest that chronic vigorous exercising is positively related to adolescents’ sleep and psychological functioning. Results also indicate that males with low exercise levels are at risk for increased sleep complaints and poorer psychological functioning. (Brand et al 2010)

Eleven Suggestions for a Good Night’s Sleep

1. Don’t drink coffee or tea after 3 o‘clock in the afternoon.
2. Don’t watch TV in your bedroom and if you do watch TV watch something light, cheerful, funny or inspiring.
3. Drink a gentle relaxing herbal tea before bed.
4. Read something inspirational or spiritual.  
5. Write down your inspirational or spiritual thoughts.
6. Listen to relaxation CDs of nature sounds, such as the ocean or the sound of crickets, or listen to deep relaxing spiritual music.
7. Take a hot Epsom salt bath (1-2 cups of Epsom salts) with essential oils such as lavender.
8. Exercise outdoors in the fresh air regularly. 
9. Avoid eating foods high in fats or refined sugars. 
10. Sleep in darkness or as close as possible to darkness. When light hits your eyes, it disrupts the circadian rhythm of the pineal gland and production of melatonin.
11. Try to go to bed before 12 midnight and to get up early enough to get sun exposure whenever possible.  This can help to normalize circadian rhythm.  

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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-475-1005.