Acupuncture for Insomnia

Acupuncture, a traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body, has been investigated in several clinical trials and randomized controlled trials (RCTs) as a potential treatment for insomnia. This interest stems from the purported ability of acupuncture to modulate the nervous system and promote relaxation, suggesting a possible mechanism for improving sleep quality and reducing insomnia symptoms. The existing research offers valuable insight into the efficacy and safety of acupuncture as an intervention for this prevalent sleep disorder.

Protocols Studied in Research

[1] Acupuncture treatment for primary insomnia. (Cited by: 82) (pmid: 28899535)

• Protocol: A single-blinded, randomized controlled trial compared acupuncture to sham acupuncture in 72 patients with primary insomnia. Treatment occurred three times weekly for four weeks, with sleep monitored and questionnaires administered every two weeks for eight weeks.
• Outcome: Acupuncture was significantly more effective than sham acupuncture in improving insomnia severity, sleep efficiency, total sleep time, and depression scores. Improvements in sleep awakenings and anxiety scores were also observed post-treatment.

[2] Real and sham acupuncture for comorbid perimenopausal depression and insomnia. (Cited by: 8) (pmid: 36815166)

• Protocol: A patient-assessor-blinded, randomized, sham-controlled trial involving 70 women with perimenopausal depression and insomnia. Participants received 17 acupuncture sessions over 8 weeks.
• Outcome: Acupuncture showed significant short-term improvement in sleep quality, but not depression, compared to sham acupuncture. No long-term benefits were observed at 16 weeks. The treatment was safe and well-tolerated.

[3] Active acupuncture versus sham acupuncture for chemotherapy-induced insomnia in breast cancer patients. (Cited by: 9) (pmid: 37101228)

• Protocol: A blinded, randomized, sham-controlled trial of 138 breast cancer patients with insomnia. Participants received 15 acupuncture sessions (active or sham) over 18 weeks, followed by 24 weeks of follow-up.
• Outcome: While not statistically superior to sham acupuncture in reducing overall insomnia severity at 6 weeks, active acupuncture showed better improvements in sleep parameters, anxiety, depression, quality of life, and sleeping medication cessation rates in the long term. Adverse events were mild.

[4] Electroacupuncture (EA) for insomnia in patients with depression. (Cited by: 25) (pmid: 35797047)

• Protocol: A 32-week, randomized, sham-controlled trial (8-week intervention, 24-week follow-up) involving 270 patients with insomnia and depression. Participants received EA, sham acupuncture, or standard care. EA/sham involved 3 weekly sessions for 8 weeks.
• Outcome: EA significantly improved sleep quality (PSQI) and reduced depression (Hamilton Depression Rating Scale) and anxiety symptoms compared to sham acupuncture and standard care alone. Improvements were sustained at 32 weeks. No serious adverse events were reported.

[5] Acupuncture and massage for pain in patients with advanced cancer. (Cited by: 4) (pmid: 37962891)

• Protocol: A multicenter, randomized clinical trial comparing acupuncture and massage over 26 weeks in patients with advanced cancer and moderate to severe pain. Weekly treatments were given for 10 weeks with monthly boosters.
• Outcome: Both acupuncture and massage significantly reduced pain and improved fatigue, insomnia, and quality of life. However, no significant difference was found between the two interventions.

[6] Acupuncture and Cognitive Behavioral Therapy for Insomnia (CBT-I) in cancer survivors. (Cited by: 73) (pmid: 31081899)

• Protocol: A randomized controlled trial (RCT) compared 8 weeks of acupuncture (n=80) and CBT-I (n=80) in cancer survivors. Outcomes were measured at 8 and 20 weeks.
• Outcome: CBT-I was more effective than acupuncture for insomnia overall, but both treatments showed significant improvement. CBT-I's effectiveness varied by participant demographics (sex, race, education, baseline pain). CBT-I is recommended as first-line therapy.

[7] Acupuncture for insomnia after ischemic stroke. (Cited by: 6) (pmid: 35317665)

• Protocol: A blinded, randomized controlled trial assigned 144 ischemic stroke patients with insomnia to verum or sham acupuncture (72 per group). Treatment consisted of three sessions per week for four weeks. Outcomes were assessed using several sleep indices and quality of life measures.
• Outcome: Verum acupuncture showed significantly greater improvements in sleep quality, total sleep time, sleep efficiency, quality of life, and reduced depression compared to sham acupuncture, with improvements sustained at follow-up. Adverse events were mild and infrequent.

[8] Real and sham acupuncture for Insomnia Disorder (ID). (Cited by: 0) (pmid: 39169368)

• Protocol: A randomized controlled trial with 60 ID patients (real vs. sham acupuncture) and 30 healthy controls. Participants underwent fMRI scans before and after 4 weeks of acupuncture treatment. Clinical scales (anxiety, depression, sleep quality) and actigraphy were used.
• Outcome: Real acupuncture modulated resting-state functional connectivity within the emotional network in ID patients, particularly in the anterior cingulate cortex, hippocampus, and amygdala. These changes correlated with improvements in anxiety and sleep efficiency.

[9] Transcutaneous auricular vagus nerve stimulation (taVNS) for chronic insomnia disorder. (Cited by: 0) (pmid: 39680406)

• Protocol: A randomized, single-center clinical trial in Beijing compared active taVNS to sham taVNS in 72 participants with chronic insomnia (PSQI ≥8). Treatment involved twice-daily, 30-minute sessions for 8 weeks, followed by 12 weeks of follow-up.
• Outcome: taVNS significantly reduced insomnia severity (PSQI scores) compared to sham, with a clinically meaningful difference maintained for 20 weeks. Positive effects were also seen in mental health and fatigue. Larger, multicenter trials are warranted.

[10] Acupuncture for peri-menopausal insomnia (PMI). (Cited by: 37) (pmid: 29029258)

• Protocol: A randomized, placebo-controlled trial of 76 peri-menopausal women with insomnia. Participants received 10 acupuncture sessions (or placebo acupuncture) over 3 weeks targeting specific acupoints.
• Outcome: Acupuncture significantly improved sleep quality (PSQI, ISI, PSG) compared to placebo acupuncture, showing clinically relevant short-term improvement in PMI symptoms.

[11] Acupuncture combined with Ningshen mixture for climacteric insomnia. (Cited by: 0) (pmid: 38669364)

• Protocol: A randomized controlled trial comparing acupuncture plus Ningshen mixture to conventional Western medicine in 82 climacteric insomnia patients. Neurotransmitter levels, TCM syndrome scores, and PSQI were assessed.
• Outcome: Acupuncture plus Ningshen mixture showed significantly better curative effects, improved neurotransmitter levels (5-HT and beta-endorphin), sleep quality (lower PSQI), and reduced recurrence rates compared to conventional medicine, with no serious adverse events.

[12] Acupuncture for perimenopausal early-wake insomnia. (Cited by: 0) (pmid: 35712942)

• Protocol: A randomized controlled trial comparing acupuncture to oryzanol tablets in 60 perimenopausal women with early-wake insomnia over 4 weeks. Acupuncture targeted specific points; oryzanol was administered orally.
• Outcome: Acupuncture significantly improved sleep parameters (sleep time, quality, wake-up frequency) and PSQI scores compared to oryzanol, demonstrating superior efficacy for treating perimenopausal early-wake insomnia.

[13] Active vs. placebo acupuncture for insomnia and mood disorders. (Cited by: 19) (pmid: 32167794)

• Protocol: A randomized controlled trial (RCT) of 90 Chinese insomnia patients (45 per group) compared active acupuncture (deep needle insertion) to placebo acupuncture (retractable, blunt needle). Treatment lasted 2 weeks with a 1-month follow-up.
• Outcome: Active acupuncture significantly improved insomnia symptoms (PSQI scores), sleep rate, anxiety (SAS), and depression (SDS) compared to placebo acupuncture, with effects lasting at least 6 weeks. The difference was only marginally significant (p<.1).

[14] Electroacupuncture for cancer-related insomnia. (Cited by: 11) (pmid: 35303841)

• Protocol: A multicenter, assessor-blinded, randomized controlled pilot trial comparing electroacupuncture, sham electroacupuncture, and usual care in 22 cancer patients with insomnia. Participants received 10 sessions over 4 weeks.
• Outcome: Electroacupuncture showed statistically significant short-term improvement in insomnia severity compared to sham and usual care, with continued improvement at follow-up. Fatigue also improved significantly. The study was underpowered, necessitating larger trials.

[15] Tiaoshen acupuncture for primary insomnia (PI). (Cited by: 1) (pmid: 37697874)

• Protocol: A randomized controlled pilot trial comparing Tiaoshen acupuncture to sham acupuncture in 60 PI patients. Participants received 3 treatments per week for 4 weeks, with assessments using MoCA, DST, TMT-A, PSQI, and FS-14.
• Outcome: Tiaoshen acupuncture significantly improved cognitive function, sleep quality (PSQI), and reduced daytime fatigue (FS-14) in PI patients compared to sham acupuncture. Improved sleep correlated with improved cognition.

[16] Trigger point acupuncture (TrPA) for chronic neck and shoulder pain (katakori) with work productivity loss in office workers. (Cited by: 1) (pmid: 38273431)

• Protocol: A 4-week, single-blind RCT of 20 female office workers with chronic neck and shoulder pain. The intervention group received TrPA up to 4 times, while the control group received only workplace-recommended presenteeism measures.
• Outcome: TrPA significantly reduced pain intensity (20%) and improved relative presenteeism scores compared to the control group. No significant differences were found in other secondary outcomes (absolute presenteeism, anxiety, depression, catastrophizing, sleep).

[17] Real and sham acupuncture for chronic insomnia disorder (CID). (Cited by: 0) (pmid: 39543627)

• Protocol: A randomized controlled trial comparing real and sham acupuncture in 42 CID patients and 23 healthy controls. Participants underwent fMRI scans to assess hypothalamic functional connectivity and completed the PSQI. Acupuncture was administered for four weeks.
• Outcome: Real acupuncture significantly reduced insomnia severity (measured by PSQI) and normalized altered hypothalamic-frontal connectivity, correlating with clinical improvement. Sham acupuncture showed no significant effect.

[18] Acupuncture for Restless Legs Syndrome (RLS) in hemodialysis patients with end-stage renal disease (ESRD). (Cited by: 0) (pmid: 38770610)

• Protocol: A single-blind, randomized controlled trial of 41 hemodialysis patients with RLS. Participants received either acupuncture (experimental group) or standard care (control group) for four weeks (12 sessions). Outcomes were measured using IRLSRS, ISI, and HRV.
• Outcome: Acupuncture significantly improved RLS symptoms (IRLSRS and ISI scores) compared to the control group, with improvements sustained at one-week follow-up. Acupuncture also positively impacted heart rate variability. No adverse effects were reported.

[19] Acupuncture (with or without auricular acupuncture) for insomnia disorder. (Cited by: 13) (pmid: 29229613)

• Protocol: A randomized, assessor-blinded, waitlist-controlled trial compared acupuncture alone, combined acupuncture (acupuncture plus auricular acupuncture), and a waitlist control in 224 participants with DSM-5 insomnia disorder. Treatment involved three weekly sessions for three weeks.
• Outcome: No significant difference was found between acupuncture alone and combined acupuncture. Both treatments were superior to the waitlist in improving sleep efficiency and reducing insomnia symptoms, with effects lasting 13 weeks. Both treatments were safe.

[20] Acupuncture at HT 7 and KI 7 for chronic insomnia. (Cited by: 9) (pmid: 34675728)

• Protocol: A randomized, single-blind, sham-controlled trial compared acupuncture at specific acupoints versus sham acupuncture in 82 chronic insomnia patients. Treatment involved 10 sessions over 3 weeks.
• Outcome: Acupuncture showed a statistically significant, short-term improvement in sleep quality and insomnia severity compared to sham acupuncture, with improvements in sleep architecture (PSG). However, this difference wasn't maintained at follow-up. No significant between-group differences were found in comorbid symptoms.

[21] Auricular acupoint bloodletting (AB) plus auricular acupressure (AA) for primary insomnia in college students. (Cited by: 5) (pmid: 36327047)

• Protocol: A randomized controlled trial comparing AB+AA to AA alone in 74 college students with primary insomnia. Treatment was twice weekly for four weeks. Sleep quality (PSQI), neuroendocrine levels (melatonin, glutamate, GABA), and Chinese medicine syndrome scores were assessed.
• Outcome: Both AB+AA and AA improved sleep quality and melatonin levels. AB+AA showed a stronger, longer-lasting effect, significantly increasing glutamate and GABA levels compared to AA alone, suggesting a potential mechanism for its superior efficacy.

[22] Acupuncture (real and sham) for Chemotherapy-Induced Peripheral Neuropathy (CIPN) in solid tumor survivors. (Cited by: 18) (pmid: 34390283)

• Protocol: A randomized controlled trial (RCT) assigned 75 solid tumor survivors with moderate-to-severe CIPN to 8 weeks of real acupuncture, sham acupuncture, or usual care. Quality of life measures were assessed.
• Outcome: Both real and sham acupuncture significantly improved CIPN-related quality of life, anxiety, and insomnia compared to usual care at 8 weeks. No significant difference was found between real and sham acupuncture, suggesting a substantial placebo effect warrants further investigation.

[23] Eye-acupuncture and routine body acupuncture for post-stroke insomnia. (Cited by: 1) (pmid: 29072001)

• Protocol: A randomized controlled trial comparing eye-acupuncture to routine body acupuncture in 60 post-stroke insomnia patients (30 per group). Treatment involved 15 days of daily acupuncture sessions over two courses. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).
• Outcome: Both eye-acupuncture and routine acupuncture improved insomnia symptoms. Eye-acupuncture showed superior efficacy in reducing sleep latency, sleep disturbances, and daytime dysfunction compared to routine acupuncture, although overall effectiveness rates were not significantly different.

[24] Bushen Anshen acupuncture for perimenopausal insomnia (PMI) with kidney-yin deficiency. (Cited by: 0) (pmid: 37313556)

• Protocol: A randomized controlled trial (RCT) with 70 women with PMI and kidney-yin deficiency. The observation group received Bushen Anshen acupuncture; the control group received sham acupuncture. Treatment involved 10 sessions over 2 weeks. Sleep quality was assessed using PSQI and PSG.
• Outcome: Bushen Anshen acupuncture significantly improved both subjective (PSQI) and objective (PSG) sleep quality in women with PMI and kidney-yin deficiency compared to sham acupuncture. Improvements included increased sleep time and efficiency, and reduced sleep latency.

[25] Acupuncture and moxibustion for insomnia. (Cited by: 9) (pmid: 24187860)

• Protocol: A randomized controlled trial of 120 insomnia patients compared acupuncture and moxibustion at specific points (experiment group) versus acupuncture at different points (control group). Treatment was administered daily. The Pittsburgh Sleep Quality Index (PSQI) measured sleep quality.
• Outcome: The acupuncture and moxibustion group showed significantly greater improvement in insomnia symptoms (sleep quality, sleep latency, sleep disturbances, daytime function) compared to the control acupuncture group, as measured by PSQI scores.

[26] Yinyang Ruyin acupuncture, conventional acupuncture, and estazolam for refractory insomnia. (Cited by: 2) (pmid: 31724348)

• Protocol: A randomized controlled trial comparing three treatments for refractory insomnia (n=180): Yinyang Ruyin acupuncture, conventional acupuncture, and oral estazolam. Each group received treatment for four weeks.
• Outcome: Yinyang Ruyin acupuncture showed superior efficacy in improving sleep quality compared to both conventional acupuncture and estazolam, as measured by the PSQI score. Both acupuncture groups outperformed estazolam.

[27] Combined electroacupuncture and auricular acupuncture for primary insomnia. (Cited by: 2) (pmid: 30674705)

• Protocol: A randomized controlled trial investigated the dose-response effect of combined electroacupuncture and auricular acupuncture on primary insomnia. Details regarding participants and administration are absent from the provided abstract.
• Outcome: No outcome information is available because the abstract is missing.

[28] Pricking and penetrating moxibustion therapy for refractory insomnia. (Cited by: 2) (pmid: 32185993)

• Protocol: A randomized controlled trial compared pricking and penetrating moxibustion to penetrating moxibustion alone in 60 patients with refractory insomnia. Treatment was administered daily for 20 sessions.
• Outcome: Pricking and penetrating moxibustion was significantly more effective than penetrating moxibustion alone in improving sleep quality (PSQI) and reducing TCM symptoms associated with insomnia. Both treatments showed improvement compared to baseline.

[29] Abdominal acupuncture for insomnia in Chinese women. (Cited by: 7) (pmid: 18672743)

• Protocol: A randomized, single-blind trial compared abdominal acupuncture (four master and four adjunctive acupoints, daily for 3 days, then every 3 days for 11 days, plus placebo pill) to estazolam (plus sham acupuncture) in 44 women (22-56 years old) with insomnia. Leeds Sleep Evaluation Questionnaire (LSEQ) measured outcomes.
• Outcome: Abdominal acupuncture significantly reduced LSEQ scores, demonstrating greater effectiveness than estazolam in relieving insomnia in adult women with minimal side effects.

[30] Multi-point acupuncture versus single-point acupuncture versus sham acupuncture for primary insomnia. (Cited by: 12) (pmid: 32807158)

• Protocol: A randomized, sham-controlled trial with 5 weeks of acupuncture treatment. Participants completed sleep questionnaires and polysomnography; resting-state fMRI measured brain activity.
• Outcome: Multi-point acupuncture showed greater efficacy in improving insomnia symptoms compared to single-point acupuncture and sham acupuncture, potentially by modulating brain activity in sleep-related regions.

[31] Electroacupuncture (EA) for managing neuropsychiatric symptom clusters in cancer patients and survivors. (Cited by: 2) (pmid: 36973688)

• Protocol: A randomized, sham-controlled, blinded clinical trial (n=64) comparing verum EA (13 acupoints) to sham EA (7 acupoints) administered weekly for 10 weeks, followed by a 4-12 week follow-up. Participants were cancer patients/survivors with at least one neuropsychiatric symptom.
• Outcome: The EAST study aims to determine the efficacy, safety, and feasibility of EA in mitigating neuropsychiatric symptom clusters in cancer patients and survivors; results are not yet reported in this abstract.

[32] Auricular acupuncture (AA) and cognitive behavioral therapy for insomnia (CBT-i) for insomnia disorder. (Cited by: 9) (pmid: 28779933)

• Protocol: A randomized controlled trial comparing AA and CBT-i in 60 insomnia patients (mostly women, mean age 60.5). Actigraphy measured sleep patterns at baseline, post-treatment, and 6-month follow-up.
• Outcome: CBT-i improved several sleep parameters (time in bed, sleep latency, etc.). AA increased sleep time and time in bed post-treatment. However, between-group differences disappeared at 6-month follow-up; objective sleep improvement didn't always correlate with subjective insomnia perception.

[33] Optimized vs. conventional acupuncture for comorbid depression and insomnia. (Cited by: 0) (pmid: 38867621)

• Protocol: A randomized controlled trial (RCT) with 140 patients (70 per group) receiving 6 weeks of twice-weekly acupuncture. Optimized acupuncture included additional acupoints and intradermal needling. HAMD-24 and PSQI scores measured depression and sleep quality.
• Outcome: Optimized acupuncture primarily improved insomnia, leading to improved depression. This improvement was more significant in patients with mild depression and insomnia symptoms compared to conventional acupuncture.

[34] Acupuncture for primary insomnia. (Cited by: 2) (pmid: 10077713)

• Protocol: A randomized controlled trial of 40 insomnia patients (diagnosed via Traditional Chinese Medicine) comparing true acupuncture versus sham acupuncture (non-acupuncture points) over 3-5 weekly sessions. Sleep quality was objectively measured via polysomnography.
• Outcome: True acupuncture demonstrated statistically significant improvement in objective sleep quality measures compared to sham acupuncture. Subjective improvements favored true acupuncture but weren't statistically analyzed. The therapist's influence couldn't be ruled out.

[35] Examining the relationship between trait hyperarousal and insomnia in cancer survivors. (Cited by: 5) (pmid: 33629219)

• Protocol: Cross-sectional study using questionnaires (Insomnia Severity Index and Hyperarousal Scale) on 160 cancer survivors diagnosed with insomnia disorder. Data was from a baseline assessment of a larger RCT comparing CBT-I and acupuncture for insomnia.
• Outcome: Hyperarousal correlated with psychological appraisal of insomnia (worry, dissatisfaction), not sleep patterns. Younger age and longer insomnia duration predicted hyperarousal. Findings suggest incorporating hyperarousal treatment into insomnia interventions.

[36] Fang's scalp acupuncture combined with conventional acupuncture for insomnia. (Cited by: 0) (pmid: 35403393)

• Protocol: A randomized controlled trial compared Fang's scalp acupuncture plus conventional acupuncture to conventional acupuncture alone in 66 insomnia patients. Treatment lasted two weeks. Sleep quality, perceived stress, and polysomnographic sleep parameters were assessed.
• Outcome: Fang's scalp acupuncture significantly improved sleep quality, reduced perceived stress, and favorably altered sleep structure compared to conventional acupuncture alone. The combined approach showed a higher effective rate.

[37] Acupuncture for Delayed Sleep-Wake Phase Disorder (DSWPD). (Cited by: 2) (pmid: 36858383)

• Protocol: A randomized controlled trial comparing acupuncture versus placebo acupuncture in 84 DSWPD patients. Treatment involved specific acupoints and lasted 8 weeks. Sleep parameters and questionnaires were assessed before, after, and at follow-up.
• Outcome: Acupuncture significantly improved sleep parameters (total sleep time, sleep efficiency), reduced daytime sleepiness and fatigue, and lowered cortisol levels compared to placebo, with effects sustained at follow-up.

[38] Acupuncture for residual insomnia in Major Depressive Disorder (MDD). (Cited by: 29) (pmid: 26132682)

• Protocol: A randomized, placebo- and sham-controlled trial of 150 MDD patients with chronic insomnia. Participants received 9 acupuncture sessions (true, minimal, or placebo) over 3 weeks.
• Outcome: Acupuncture showed only mild improvement in sleep efficiency, similar to minimal and placebo acupuncture. Significant improvements were limited to sleep-onset latency, and a substantial portion of patients remained insomniac post-treatment.

[39] Acupuncture combined with low-frequency rTMS for comorbid mild-to-moderate depressive disorder and insomnia. (Cited by: 3) (pmid: 37068811)

• Protocol: A randomized controlled trial (RCT) with 60 patients. The observation group received acupuncture at specific points and low-frequency rTMS to the R-DLPFC; the control group received sham acupuncture and rTMS. Treatment lasted 4 weeks.
• Outcome: Combined acupuncture and rTMS significantly reduced depression (HAMD-17) and improved sleep quality (PSQI) compared to sham acupuncture and rTMS, potentially via increased BDNF and GABA levels.

[40] 830 nm laser photobiomodulation therapy for improving quality of life and sleep quality in hemodialysis patients with end-stage renal disease (ESRD). (Cited by: 0) (pmid: 38958682)

• Protocol: A randomized controlled trial involving 40 ESRD patients undergoing hemodialysis. Participants received 830 nm laser irradiation to the palm, ST 36, and KI 1 acupoints. QoL and sleep quality were assessed using questionnaires before and after treatment.
• Outcome: 830 nm laser treatment significantly improved sleep quality (lower Pittsburgh Sleep Quality Index and Athens Insomnia Scale scores), quality of life (higher MOS SF-36 and WHOQOL-BREF scores), and reduced pain in hemodialysis patients. The findings suggest this laser therapy could be a useful complementary treatment.

Research Interpretation: Summary and Conclusion

Multiple randomized controlled trials (RCTs) investigated acupuncture's efficacy for insomnia, employing various protocols including sham-controlled designs, different acupuncture techniques (e.g., electroacupuncture, scalp acupuncture), and comparisons to other interventions like CBT-I and medication. While many studies demonstrated statistically significant improvements in sleep quality, sleep efficiency, and total sleep time with acupuncture compared to sham or control conditions, the magnitude of effect and longevity of benefits varied considerably. Some studies showed sustained improvements at follow-up, while others observed only short-term effects. Several trials highlighted positive impacts on associated symptoms like anxiety and depression. However, direct comparisons with CBT-I often favored CBT-I as a first-line therapy. Inconsistencies across studies suggest the need for standardized acupuncture protocols and larger, multi-center trials to clarify the optimal approach and identify patient subgroups who may benefit most from acupuncture for insomnia. The role of placebo effects also requires further investigation.

Publications

[1] Yin X; Gou M; Xu J; Dong B; Yin P; Masquelin F; Wu J; Lao L; Xu S (2017). Efficacy and safety of acupuncture treatment on primary insomnia: a randomized controlled trial Sleep medicine 37 :193-200.

[2] Zhao FY; Zheng Z; Fu QQ; Conduit R; Xu H; Wang HR; Huang YL; Jiang T; Zhang WJ; Kennedy GA (2023). Acupuncture for comorbid depression and insomnia in perimenopause: A feasibility patient-assessor-blinded, randomized, and sham-controlled clinical trial Frontiers in public health 11 :1120567.

[3] Zhang J; Qin Z; So TH; Chang TY; Yang S; Chen H; Yeung WF; Chung KF; Chan PY; Huang Y; Xu S; Chiang CY; Lao L; Zhang ZJ (2023). Acupuncture for chemotherapy-associated insomnia in breast cancer patients: an assessor-participant blinded, randomized, sham-controlled trial Breast cancer research : BCR 25 (1) :49.

[4] Yin X; Li W; Liang T; Lu B; Yue H; Li S; Zhong VW; Zhang W; Li X; Zhou S; Mi Y; Wu H; Xu S (2022). Effect of Electroacupuncture on Insomnia in Patients With Depression: A Randomized Clinical Trial JAMA network open 5 (7) :e2220563.

[5] Epstein AS; Liou KT; Romero SAD; Baser RE; Wong G; Xiao H; Mo Z; Walker D; MacLeod J; Li Q; Barton-Burke M; Deng GE; Panageas KS; Farrar JT; Mao JJ (2023). Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer: The IMPACT Randomized Clinical Trial JAMA network open 6 (11) :e2342482.

[6] Garland SN; Xie SX; DuHamel K; Bao T; Li Q; Barg FK; Song S; Kantoff P; Gehrman P; Mao JJ (2019). Acupuncture Versus Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: A Randomized Clinical Trial Journal of the National Cancer Institute 111 (12) :1323-1331.

[7] Cao Y; Yan YJ; Xu JY; Liwayiding A; Liu YP; Yin X; Lao LX; Zhang ZJ; Xu SF (2022). Acupuncture for insomnia after ischemic stroke: an assessor-participant blinded, randomized controlled trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 40 (5) :443-452.

[8] Jiang TF; Chen ZY; Liu J; Yin XJ; Tan ZJ; Wang GL; Li B; Guo J (2024). Acupuncture modulates emotional network resting-state functional connectivity in patients with insomnia disorder: a randomized controlled trial and fMRI study BMC complementary medicine and therapies 24 (1) :311.

[9] Zhang S; Zhao Y; Qin Z; Han Y; He J; Zhao B; Wang L; Duan Y; Huo J; Wang T; Wang Y; Rong P (2024). Transcutaneous Auricular Vagus Nerve Stimulation for Chronic Insomnia Disorder: A Randomized Clinical Trial JAMA network open 7 (12) :e2451217.

[10] Fu C; Zhao N; Liu Z; Yuan LH; Xie C; Yang WJ; Yu XT; Yu H; Chen YF (2017). Acupuncture Improves Peri-menopausal Insomnia: A Randomized Controlled Trial Sleep 40 (11).

[11] Cai Y; Zhang X; Li J; Yang W (2024). Effect of acupuncture combined with Ningshen mixture on climacteric insomnia: A randomized controlled trial Medicine 103 (17) :e37930.

[12] Zhu JF; Liu T; Hu F; Sheng JL; Jin YY (2022). [Acupuncture for perimenopausal early-wake insomnia: a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 42 (6) :608-12.

[13] Zhang L; Tang Y; Hui R; Zheng H; Deng Y; Shi Y; Xiao X; Zheng Q; Zhou S; Yu S; Cao W; Liu Y; Hu Y; Li Y (2020). The effects of active acupuncture and placebo acupuncture on insomnia patients: a randomized controlled trial Psychology, health & medicine 25 (10) :1201-1215.

[14] Lee B; Kim BK; Kim M; Kim AR; Park HJ; Kwon OJ; Lee JH; Kim JH (2022). Electroacupuncture for treating cancer-related insomnia: a multicenter, assessor-blinded, randomized controlled, pilot clinical trial BMC complementary medicine and therapies 22 (1) :77.

[15] Huo YS; Chen ZY; Yin XJ; Jiang TF; Wang GL; Cui YX; Guo J (2023). [Tiaoshen acupuncture for primary insomnia: a pilot randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 43 (9) :1008-13.

[16] Minakawa Y; Miyazaki S; Waki H; Akimoto Y; Itoh K (2024). Clinical effectiveness of trigger point acupuncture on chronic neck and shoulder pain (katakori) with work productivity loss in office workers: a randomized clinical trial Journal of occupational health 66 (1).

[17] Peng W; Xu H; Zhang C; Hu Y; Yu S (2024). The altered hypothalamic network functional connectivity in chronic insomnia disorder and regulation effect of acupuncture: a randomized controlled neuroimaging study BMC complementary medicine and therapies 24 (1) :396.

[18] Chen JM; Chang CC; Li YL; Chiu PF; Chiang JY; Hsu PC; Lo LC (2024). Efficacy and Safety of Acupuncture for Restless Legs Syndrome in Patients with End-Stage Renal Disease: A Randomized-Controlled Trial at Hospital-Based Hemodialysis Center Journal of integrative and complementary medicine 30 (10) :978-985.

[19] Chung KF; Yeung WF; Yu BY; Leung FC; Zhang SP; Zhang ZJ; Ng RM; Yiu GC (2018). Acupuncture with or without combined auricular acupuncture for insomnia: a randomised, waitlist-controlled trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 36 (1) :2-13.

[20] Wang C; Xu WL; Li GW; Fu C; Li JJ; Wang J; Chen XY; Liu Z; Chen YF (2021). Impact of Acupuncture on Sleep and Comorbid Symptoms for Chronic Insomnia: A Randomized Clinical Trial Nature and science of sleep 13 :1807-1822.

[21] Chen H; Zhang MJ; Wu JA; She YF; Yuan XR; Huo YX; Sun H; Liu DN; Shi XL (2022). Effect of Auricular Acupoint Bloodletting plus Auricular Acupressure on Sleep Quality and Neuroendocrine Level in College Students with Primary Insomnia: A Randomized Controlled Trial Chinese journal of integrative medicine 28 (12) :1096-1104.

[22] Bao T; Baser R; Chen C; Weitzman M; Zhang YL; Seluzicki C; Li QS; Piulson L; Zhi WI (2021). Health-Related Quality of Life in Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy: A Randomized Clinical Trial The oncologist 26 (11) :e2070-e2078.

[23] Liu LY; Wang PQ (2017). [Randomized Controlled Clinical Trials of Eye-acupuncture Therapy for Patients with Post-stroke Insomnia] Zhen ci yan jiu = Acupuncture research 42 (1) :67-71.

[24] Yang WJ; Zhao N; Yu XT; Xie C; Li JJ; Zhang CY; Chen YF (2023). [Bushen Anshen acupuncture for perimenopausal insomnia of kidney-yin deficiency: a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 43 (6) :634-8.

[25] Gao X; Xu C; Wang P; Ren S; Zhou Y; Yang X; Gao L (2013). Curative effect of acupuncture and moxibustion on insomnia: a randomized clinical trial Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 33 (4) :428-32.

[26] Wang YP; Wen X; Feng XL; He TY (2019). [Yinyang Ruyin acupuncture on refractory insomnia: a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 39 (11) :1155-9.

[27] Chung KF; Yeung WF; Yu BYM; Zhang SP; Zhang ZJ (2019). Combined electroacupuncture and auricular acupuncture for primary insomnia: a randomised controlled trial of dose-response effect Hong Kong medical journal = Xianggang yi xue za zhi 25 Suppl 2 (1) :28-33.

[28] Chen Y; Gao X; Sun C (2018). Pricking and penetrating moxibustion therapy in patients with refractory insomnia: a randomized and controlled clinical trial Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 38 (5) :754-762.

[29] Wang XY; Yuan SH; Yang HY; Sun YM; Cheng FP; Zhang CL; Huang XC (2008). Abdominal acupuncture for insomnia in women: a randomized controlled clinical trial Acupuncture & electro-therapeutics research 33 (1-2) :33-41.

[30] Wang YK; Li T; Ha LJ; Lv ZW; Wang FC; Wang ZH; Mang J; Xu ZX (2020). Effectiveness and cerebral responses of multi-points acupuncture for primary insomnia: a preliminary randomized clinical trial and fMRI study BMC complementary medicine and therapies 20 (1) :254.

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