Insomnia and Its Implications

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Information Resources and Links to Scientific Studies

  1. A 2012 overview of the physiology of sleep disorders and insomnia by the National Institute of Neurological Disorders and Stroke, a branch of the U.S. National Institutes of Health (NIH): http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm
  2. A 2007 overview of isomnia is presented here by the Sleep Disorders and Research Center of the Henry Ford Hospital Sleep Center in Detroit, Michigan, with links to many important research summaries: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978319/
  3. A 2001 overview of insomnia medications by the University of Colorado School of Medicine and Sleep Disorders Center of Southern Colorado provides much information: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181172/
  4. A 2011 review of the study of sleep medicine in medical schools published in the Archives of Disease in Childhood found that past studies showed only an average of 2 hours devoted to the subject in undergraduate premedical school study, and 7-13 percent of medical schools undertook no sleep medicine teaching whatsoever: http://adc.bmj.com/content/97/1/90.2.full
  5. A 2011 study of sleeping medications published in the British Medical Journal found a more than fourfold increase in risk of death, even for those taking fewer than 18 doses of sleeping medication per year, and a significant increase in cancer risk, for those taking most of the common sleeping medications, raising alarm among physicians and a changing attitude about safety and the need to find alternatives: http:/group.bmj.com/
  6. A 2006 study of rebound insomnia syndromes at McGill University Clinical Psychopharmacology Unit, in Quebec, Canada, found that psychotropic drugs prescribed for insomnia, anxiety, etc. may lead to desensitization of serotonin (5-HT) receptors and diminished expression of these cell receptors, as well as cholinergic rebound (acetylcholine and other neurotransmitters), explaining persistent rebound insomnia, as well as persistent recurrent anxiety, after discontinuing these medications following chronic use: http://www.ncbi.nlm.nih.gov/pubmed/16456219
  7. A 2003 article by Dr. John W.G. Tiller M.D. PhD, and professor of psychiatry at The University of Melbourne, Melbourne, Australia, recommended that the practice of chronic prescription of hypnotic sleeping medications such as Ambien be ceased, and "in general, hypnotics should only be prescribed if the duration of use is likely to be less than four weeks, and preferably less than one or two weeks". Dr. Tiller recommended that a more conservative and holistic protocol to treat insomnia be used in most cases, and when prescribing sleeping medication an "exit strategy" by discussed with the patient to find a safer way to manage sleep: http://www.australianprescriber.com/magazine/26/4/78/81
  8. A 2012 InTech publication examines the scientific study of drugs and medications that create syndromes of insomnia, both directly and as a rebound effect syndrome. While most of us are aware that caffeine and nicotine may affect our sleep quality, we see that a wide variety of medications, commonly prescribed and often combined, potentially induce insomnia, including hypertension medications, NSAIDS, asthma medications, antidepressants and anti-psychotic medications, corticosteroids, benzodiazepines, and migraine medications: http://cdn.intechopen.com/pdfs-wm/32270.pdf
  9. A 2011 article in the Huffington Post by Nancy Deville, a author of articles and books on sensible healthy living, provides an excellent summary of a sensible approach to both understanding and diagnosis of insomnia syndromes, and a practical; approach to a thorough sleep hygiene protocol: http://www.huffingtonpost.com/nancy-deville/insomnia-treatment_b_900176.html
  10. A landmark 2015 study of sleep habits of cultures that still lived in primitive conditions, or pre-industrial societies, published in Current Biology and conducted by experts at the UCLA Semel Institute of Neuroscience and Human Behavior, found that these societies generally slept from 5.7 to 6.1 hours per night, and were healthy, contrary to all prior belief in science that we need 8 hours per night and that primitive humans went to sleep with sunset and awoke at sunrise. This new study shows that sleep quality is more more important than the amount of sleep, and that many patients using sleeping medications may not need them. The study also found that a lowered temperature was more related to sleep patterns than than the amount of light, or the use of devices such as the computer and TV, and that a simple lowering of temperature at night, common in past practice in homes, may be beneficial to establish better sleep patterns: http://www.independent.co.uk/life-style/health-and-families/health-news/six-hours-sleep-a-night-is-enough-say-scientists-a6696281.html
  11. A 2015 meta-analysis of all published scientific studies of cognitive behavioral therapy for insomnia (CBT-I) by experts at the Boston University School of Medicine and the Rush University Medical Center, in Boston and Chicago, U.S.A. found that this therapy is effective for all insomnia, but more so for insomnia related to psychiatric conditions and mood disorders. In the study, 36 percent of patients reported remission from an insomnia syndrome, compared to about 17 percent of control subjects. Such study shows that a more holistic approach and integration of therapies could achieve great outcomes: http://archinte.jamanetwork.com/article.aspx?articleid=2363024
  12. A 2004 study by experts at the Sleep Research Laboratory and the Department of Psychiatry at the University of Toronto, Ontario, Canada, showed that acupuncture stimulation reduces anxiety and insomnia, with measurable increases in nocturnal melatonin, and presents a potential solution to the health risks associated with the most widely prescribed treatment for anxiety and insomnia, benzodiazepines. Obviously, the evidence supports short courses of treatment with both Cognitive and Behavioral Therapy (CBT) and acupuncture to achieve a safe and effective solution to insomnia and anxiety: http://www.sunshineih.com/Health/wp-content/uploads/2010/11/Nocturnal-Melatonin.pdf
  13. A 2015 study at the Mannheim Heidelberg University School of Medicine, in Mannheim, Germany, showed with polysomnographic study that patients with nightmares experience poor sleep quality independent of the normal sleep cycles, or sleep architecture, which is not significantly different than that of subjects with restful normal sleep. Prior studies have noted differences in the arousal processes of sleep microarchitecture, with an imbalance of sleep-promoting and arousal mechanisms (Budapest Univ. PMID: 23449753). Such study indicates that a one-size-fits-all approach to insomnia has been a grave mistake, and that a more careful analysis and integration of various therapies is needed: http://www.ncbi.nlm.nih.gov/pubmed/26401306
  14. A 2015 study at the Ponfifica University Catolica School of Medicine, n Porto Alegre, Brazil, and the University of Sapienza, in Rome, Italy, recommended that the analysis and treatment of insomnia in children should adopt a more holistic approach, focus on comorbid conditions and underlying causes, and primarily use sleep hygiene and cognitive behavioral techniques, with sleep medication not adopted as a one-size-fits-all approach: http://www.ncbi.nlm.nih.gov/pubmed/26392218
  15. A large 2013 population study in Taiwan, by the National Yang-Ming University School of Medicine, in Taipei, Taiwan, found that a third of patients randomly sampled from a database of more than 1 million patients used both hypnotic sleep medications and Chinese herbal medicines to achieve better quality sleep, and no reports of adverse effects with integrating these pharmaceuticals and Chinese herbs and formulas was noted. Among the patients who integrated Chinese herbs the number of hip fractures from falls, a concern for older patients using sleep medications, was cut almost in half: http://www.ncbi.nlm.nih.gov/pubmed/24204397
  16. A conservative fact sheet on Valerian from the Office of Dietary Supplements of the National Institutes of Health showed that only a few well-designed placebo-controlled double-blinded studies have been conducted that meet their criteria, but that evidence of significant proven benefit is seen in improvement of insomnia symptoms, equivalence to a pharmaceutical benzodiazepine, no side effects, and no disruption of the sleep cycle. A study showed that a professional aqueous extracts showed significant benefits in time required to fall asleep, sleep quality, and decrease in awakenings for patients, while a commercial product containing a very low dose of valerian combined with hops had no significant effect: http:ods.od.nih.gov//factsheets/valerian/
  17. A randomized controlled human clinical trial of 128 patients published in the medical journal Pharmacology Biochemistry and Behavior in 1982, conducted at the Nestle Research Laboratories in Tour-de-Peilz, Switzerland, showed that a standardized professional valerian water extract significantly improved sleep quality as measured by sleep latency scores and subjective sleep quality, without affecting the waking somnolence, dreams or night awakenings. This early study also notes that the drugstore product with valerian was not as effective and showed reports of increased sleepiness on waking, showing the problem with commercial herbal sleep aids. Valerian root, in the the proper dosage and professional quality, has long been proven to be part of a healthy herbal treatment protocol, with other simple extracts achieving even more goals for sleep quality that can be individualized when a professional herbalist prescribes: http://www.sciencedirect.com/science/article/pii/0091305782902647
  18. A randomized clinical study in 2008 at Justin-Liebig University Geissen, Germany, of the effects of a low dose of valerian and hops showed significant benefit to relieve insomnia over placebo. The study used EEG to evaluate the sleep cycle and brain activity, noting improved sleep cycle: http://www.ncbi.nlm.nih.gov/pubmed/18559301
  19. A 2003 review of medical studies of an experimental nature of acupuncture for the treatment of insomnia from the University of Pittsburgh in 2003 showed that of all quality studies found in the databases from 1990 to 2002, a review of the studies shows that acupuncture may be an effective intervention in the relief of insomnia.http://www.ncbi.nlm.nih.gov/pubmed/14651709
  20. A 2012 study at the Chiayin Branch of Taichung Veterans Hospitals in Taiwan, Department of Psychiatry, found that a human randomized controlled clinical trial showed that a course of 4 acupuncture sessions improved insomnia and sleep quality significantly, and as well as patients prescribed Zolpidem (Ambien), based on the Pittsburgh Sleep Quality Index. Ambien (zolpidem) causes dyspepsia and diarrhea in a significant percentage of patients over time, and has sometimes alarming withdrawal effects of nervous agitation, depression, nausea, tremor and/or sweating, prompting many patients and doctors to seek more conservative treatment such as acupuncture and herbal medicine: http://www.ncbi.nlm.nih.gov/pubmed 22981051
  21. A 2009 review of medical studies of acupuncture in the treatment of insomnia, including both clinical trials and case series, by the Emory School of Medicine in Decatur, Georgia, found that of 30 studies meeting criteria, 93% of the studies showed positive treatment effects. Of the twelve clinical trials reviewed, only three were double-blinded (a requirement no longer recommended for acupuncture trials since the creation of a sham treatment that is blinded to the physician performing the treatment is too restrictive a requirment in design). The 12 clinical trials did compare to other treatments or use a placebo, or sham, acupuncture. Of course, although demonstrating significant positive treatment outcomes, these clinical trials were not considered large enough to make a definitive statement. http://www.ncbi.nlm.nih.gov/pubmed/19097814
  22. A 2007 review of medical studies of acupuncture for the treatment of insomnia at Penn State University College of Medicine found that for the clinical trials and case series found in the published literature, or standard medical journals, all of the studies consistently indicated significant improvement for insomnia with acupuncture treatment: http://www.ncbi.nlm.nih.gov/pubmed/17631261
  23. A 2009 review of medical studies of acupuncture for the treatment of insomnia at the University of Hong Kong found that 20 randomized human clinical trials met strict criteria in published journals, and that acupuncture stimulation with traditional needling was found significantly more effective than benzodiazepines for treating insomnia, as was compared to sham acupuncture, showing significant benefits over placebo in a small number of trials. Sham acupuncture, the placebo in these trials, is actual acupuncture stimulation itself, and does have benefits as well, even though the point selection may not be ideal.http://www.ncbi.nlm.nih.gov/pubmed/19303356
  24. A 2009 study or auricular acupuncture for the treatment of severe insomnia at the Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, found that 100 percent of patients obtained significant benefits over sham acupuncture treatments as measured with polysomnography and a followup showed longterm benefits. http://www.medicalacupuncture.org/aama_marf/journal/vol13_3/article4.html
  25. A 2009 listing of acupuncture studies related to insomnia and the comorbid conditions often seen is presented on this acupuncture website from Portland, Oregon. http://www.bodyinbloomacupuncture.com/articles
  26. A 2013 randomized controlled human clinical trial of acupuncture to treat insomnia and improve sleep quality in postmenopause, at the Federal University of Sao Paulo, in Sao Paulo, Brazil, found that acupuncture was effective for both of these goals with measurements by polysomnography (sleep studies), and standard subjective questionnaires: http://www.ncbi.nlm.nih.gov/pubmed/22943846
  27. A 2014 randomized controlled functional MRI study of acupuncture stimulation effects on sleep-deprived brain function, at Nanchang University, Xi'an Jiaotong University, and the Jiangxi University of Traditional Chinese Medicine, in China, found that stimulation of just one common point, SP6, significantly increased brain activity in key areas of the brain that were negatively affected by sleep deprivation, showing the potential for restorative effects for these patients: http://www.ncbi.nlm.nih.gov/pubmed/25024729
  28. A 2015 randomized controlled study in China measured the changes in the sympathetic nervous system and adrenal axis with the most common acupuncture point combination used to treat insomnia, HT7 and SP6. This study showed that the laboratory animals receiving electroacupuncture at these points had beneficial modulation of norepinephrine (adrenaline) and dopamine in the brain and blood circulation over control subjects, with reduction in the circulation, thalamus and brainstem correlated with improved sleep at night and improved daytime activity. Such study demonstrates that acupuncture stimulation does more than just induce sleep, like drugs, and is beneficial to overall health and homeostasis. Such study also should be put into perspective, with this one treatment protocol just a part of a typical clinical protocol, combined with other treatments that are safe, gentle and good for the patient: http://www.ncbi.nlm.nih.gov/pubmed/26721150
  29. A 2011 study of the effects of moderate daily aerobic exercise, performed either in the morning or late afternoon, on chronic primary insomnia found significant benefits as measured with polysomnography at the Federal University of Sao Paolo, Brazil, Department of Psychobiology. http://www.ncbi.nlm.nih.gov/pubmed/22019457
  30. A 2012 randomized clinical study of acupuncture versus the medication zolpidem, called Ambien, at the Chiayi Branch of Taichung Veterans Hospital in Chiayi, Taiwan, found that standard acupuncture treatment once a week for four weeks produced the same significant benefits to improve sleep in primary insomnia, as measured on the Pittsburgh Sleep Quality Index, as Ambien. U.S. FDA drug warnings in 2009 for Ambien included abnormal thinking and behavioral changes, "sleep-driving", fatigue, anxiety, nervousness, dyspepsia (poor gastric function), frequent joint and muscle pain, rhinitis, headache, and more frequent urinary tract infections: http://www.ncbi.nlm.nih.gov/pubmed/22981051
  31. A 2012 randomized, controlled study of acupuncture protocols to treat insomnia at the Peking University Third Hospital, in Beijing, China, found that a combination of anmian acupuncture points (base of the occipital skull) with standard meridian acupuncture points, proved more effective than standard meridian acupuncture points alone. The standard course of therapy was 4 weeks, with treatment twice per week: http://www.ncbi.nlm.nih.gov/pubmed/22903446
  32. A 2012 randomized, controlled study of acupuncture protocols to treat insomnia and stress-related anxiety/depression in college students at the Fluminense Federal University Community Health Institute in Rio de Janeiro, Brazil, found that electroacupuncture therapy applied to the scalp, ear, face and extremities, once a week for 8 weeks, resulted in a significantly better improvement in sleep quality, and depression, over controls: http://www.ncbi.nlm.nih.gov/pubmed/22459648
  33. A 2011 study of the effects of acupuncture for reducing sleep disturbances and hot flashes in postmenopausal breast cancer survivors at Indiana University, in Bloomington, Indiana, found that acupuncture stimulation at 10 points for 8 weeks resulted in less waking and a decrease in the number of hot flashes during the night. This preliminary study was successful, and will be followed by a larger randomized trial: http://www.ncbi.nlm.nih.gov/pubmed/22366695
  34. A 2010 study of the effects of electroacupuncture at just two points, P5 and P6, on the wrist, showed that this stimulation inhibits sympathetic nervous system excitability, a hallmark of waking insomnia. This study, at the Susan Samueli Center for Integrative Medicine, at the University of California at Irvine, California, near Los Angeles, showed how this acupuncture stimulation activated serotonin-containing neurons in the nucleus raphe pallidus and brainstem to inhibit autonomic reactions of increased heart rate and blood pressure during periods of excitability, which are highly correlated with waking episodes during deep sleep REM. The research also showed how the standard research model to gauge neuroexcitability in these brain centers, injection of kainic acid overdose to induce neural excitability (commonly use to simulate anxiety and epileptic episodes in the laboratory), reversed this electroacupuncture effect, proving that the electroacupuncture stimulation indeed acted to inhibit specific neuronal chemical effects: http://www.ncbi.nlm.nih.gov/pubmed/20133441
  35. A 2010 study of the effects of moderate daily aerobic exercise combined with sleep hygiene education compare to sleep hygeine education alone showe significant benefits from moderate aerobic exercise in a study at Northwestern University in Chicago, Illinois. http://www.ncbi.nlm.nih.gov/pubmed/20813580
  36. A 2004 study of the effects of Tai Chi (Tai Ji) exercises for the aging population with chronic insomnia demonstrated significant benefits at the Oregon Research Institute in Eugene, Oregon. http://www.ncbi.nlm.nih.gov/pubmed/15161452
  37. A 2008 randomized controlled human study of relaxing music played before sleep, by experts at Semmelweiss University, in Budapest, Hungary, noted that this technique improved sleep quality, as well as depressive symptoms: http://www.ncbi.nlm.nih.gov/pubmed/18426457
  38. A 2012 study at Capital Medical University, Beijing, China, utilized more advanced brain imaging and EEG testing to find that decreased connectivity between key regulatory centers in the limbic system of the brain, between the amygdala and the complex of the thalamus, insula and corpus striatum, may lie at the heart of the physiological homeostatic dysfunction causing primary insomnia. These experts note that emotionally charged memories and reactions highlight this dysfunction. This study also noted that patients with primary chronic insomnia demonstrated increased connectivity between the amygdala and the premotor and sensorimotor cortex in the brain, demonstrating that these brains may struggle to find a compensatory mechanism to maintain function in sleep disorders. Such study highlights the need to restore brain function holistically to achieve lasting success, both stimulating these brain centers with modulatory acupuncture and electroacupuncture stimulation, utilizing herbs and nutrient medicines to restore neurohormonal bioavailability, and working with patients to cognitively and behaviorally improve emotional reactions and sort out areas of emotional contraint and sublimation> http://www.ncbi.nlm.nih.gov/pubmed/21458943
  39. A 2010 study of the effects of simple electroacupuncture stimulation on modulation of key areas of the temporal lobe, and connectivity between these regulatory centers, especially the amygdala, cingulate cortex, hypothalamus, and insula, demonstrates the proven capacity of acupuncture to normalize brain function. This study, at the Chinese Academy of Sciences, in Beijing, China, utilized functional MRI studies to demonstrate these modulatory effects, which have been duplicated now in many such studies: http://www.ncbi.nlm.nih.gov/pubmed/21044291
  40. A 2010 study of the mechanisms of acupuncture on modulation of brain function was conducted at Harvard Medical School and Massachusetts General Hospital with fMRI studies, concluding that different techniques of needle stimulation produced differing modulatory effects on correlated areas of the brain, especially the amygdala and hypothalamus, and that acupuncture appears to mobilize these brain centers to functionally achieve improved correlation, to mediate dysfunction. This study is just one of series of studies being conducted at Harvard that supports professional acupuncture needle stimulation to achieve significant benefits in restoring brain homeostasis. This study also notes that the psychophysical response of the patient plays a part in this treatment effect, which supports the utilization of acupuncture in a traditional TCM setting, with time-intensive interaction between patient and practitioner. Use of the acupuncture in standard medicine often relies upon too-short of sessions, too little rapport between patient and physician, and medical doctors with little training in the subtle needle manipulations. In TCM practice in the United States, too much emphasis has also been made concerning avoidance of stimulatory responses in treatment, decreasing the effectiveness of acupuncture to avoid momentary unpleasant reaction to needle stimulation. These studies support acupuncture practice as it is performed in China, by professionals that are highly trained in technique, and patients who understand the value of the needle stimulation and responses: http://www.ncbi.nlm.nih.gov/pubmed/20494627
  41. A 2012 meta-review of scientific studies of acupuncture stimuli and its effects on the brain, by Charite University Medical Center, in Berlin, Germany, also confirms that fMRI studies, also utilizing other objective measurements, clearly proved that acupuncture had broad affects on brain function, not just sensory areas associated with pain perception. These studies proved that acupuncture stimulation affected regulatory centers (affective) as well as cognitive processing, and showed that the effects were modulating, or restorative of homeostatic balance, rather than just increasing or decreasing brain functions. These studies, 34 meeting the highest standards in review, clearly showed that acupuncture stimulation affected the limbic system, brain stem, and basal ganglia, which are integral to the dysfunctions seen in syndromes involving insomnia: http://www.ncbi.nlm.nih.gov/pubmed/22496739
  42. A 2001 study at the Kyoto University Graduate School of Medicine, in Kyoto, Japan, found that high circulating levels of leptin are found in obese humans and study animals, indicating that leptin resistance to this hormone has occurred, both at the brain blood barrier, and at receptor neurons of the hypothalamus. Decreased levels of leptin in the brain, as a result of leptin resistance, as well as reduced effects of leptin in regulating sleep, contribute to insomnia, poor sleep quality, parasomnias, and sleep apnea: http://www.ncbi.nlm.nih.gov/pubmed/11268595
  43. Numerous studies, such as this 2011 study at Harvard Medical School, in Boston, Massachusetts, U.S.A., find that in pathologies with leptin imbalance, such as obesity with leptin resistance and decreased leptin and leptin effects in the brain, that administration of leptin to the blood circulation results in a reversal of the associated symptoms, such as hypothalamic amenorrhea, osteoporosis, hypothyroidism, etc. While administration of leptin has been problematic in therapy, correction of leptin resistance and imbalance with acacia gum esters and resolution of insulin resistance and Metabolic Syndrome may resolve deficient leptin effects in the brain: http://www.ncbi.nlm.nih.gov/pubmed/21791620
  44. A comprehensive study of the neuropeptide neurohormones orexin and hypocretin, integral to control of wakefulness in the hypothalamic adrenal axis, and the target of new sleep medications that block the orexin receptors, by experts at the Sleep Disorders Centre at St. Thomas' Hospital in London, UK, in 2002, shows that these chemicals and their receptors, a key to the narcolepsy pathology, are actually part of a network of regulatory dysfunction that involves not only the hypothalamic adrenal axis, but key centers in the brain, such as the amygdala and limbic system, involving a whole cycle of dysfunction in the cholinergic and amine balance of serotonin, dopamine and adrenaline, and may involve mild neurodegenerative dysfunction as well. It is easy to see the potential for acupuncture and TCM herbal and nutrient medicine to restore this complex system: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1279673/