Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Saturday, 16 July 2022

Alternative way of sleeping pill to help you sleep better

Suffer from insomnia? Acupuncture can help

Sleep well seems so natural for people. A sound good night sleep is so important to get us refreshed and get our body’s battery recharged for next day’s activity. Why we need sleep? We need sleep because sleep can rest our body and mind. What happens, if we don’t sleep well? We must all have experienced some sleepless nights for some reasons; and then we feel tired and cannot be concentrating well next day. This temporary issue would be over by following a good sleep. Do you ever imagine that someone has never been sleep well for years; every night is sleepless night? About 1 in 2 adults in the UK suffer from some forms of sleep problems and did not get enough sleep.

What is happening to our body, when we are sleeping? Sleep is a natural process of mind and body. It is recurrent. When we sleep, our body is going through cycles. Each cycle lasts about one to two hours and consists of four stages: pre-sleep, light sleep, slow wave sleep and rapid eye movement (REM) sleep. In pre-sleep stage, muscles are relaxed; heart rate and breathing slow down. In light sleep stage, it is easy to wake up. In slow wave sleep stage, it is hard to wake up. In REM stage, dream occurs; eyes move from side to side; muscles are completely relaxed. There are up to five cycles during a night sleep lasting about 8 hours in adults.

During sleep, the consciousness is altered, the sensory activity and all voluntary muscles are inhibited and interactions with surroundings are reduced. This helps to restore immune, endocrine, nervous, skeletal and muscular system function and helps to maintain mood, memory and cognitive function. The brain has most distinct changes during sleep. In quiet waking, the brain is responsible for 20% of the body's energy use, while the brain uses significantly less energy during sleep than it does when awake, especially during non-REM sleep (slow wave sleep). In areas with reduced activity, the brain restores its supply of adenosine triphosphate (ATP), the molecule used for short-term storage and transport of energy. The brain, especially, requires sleep for restoration, while other organs’ restoration can take place during quiescent waking. The sleeping brain has been shown to remove metabolic waste products at a faster rate than during an awake state. Sleep helps facilitate the synthesis of molecules that help repair and protect the brain from these harmful elements generated during waking. Sleep increases the sensory threshold. That is, sleeping persons perceive fewer stimuli, but can generally still respond to strong stimuli, such as loud noises. During slow-wave sleep, the body temperature, heart rate, and brain oxygen consumption decrease.

Sleep deprivation can impair immune function which makes the body reducing the ability to heal. Sleep deprivation tends to cause slower brain waves in the frontal cortex, shortened attention span, higher anxiety, impaired memory, and a grouchy mood. It makes the brain consume more energy causing exhaustion which makes one feeling tired.

Insomnia is a sleep disorder. The symptoms include that 1) it is difficult to fall sleep; 2) it is difficult to stay sleep (often wake up during sleep and difficult to get back to sleep again). 3) Waking up early in the morning. After a sleepless night, one may feel tired, irritable and less concentrating. If this lasts for a long time, it would affect overal heath. Due to lack of sleep you don’t feel refreshed and you feel tired and irritable all the time and have difficulty to concentrate.

The causes of insomnia include two aspects: psychological problems, such as stress, anxiety and depression; physical problems, such as physical chronic pain, asthma, heart problems etc. Recent research showed that people with insomnia have more activities in their central nervous system and/or autonomic nervous system and this keeps them awake.

There are many methods which could self help to improve sleep, such as avoid drinking coffee a few hours before sleep, do regular exercises, take a warm bath before sleep etc. If none of these works, it is easy to turn to sleeping pill for help. However long term taking sleeping pill may lose its effectiveness and cause serious side effects. Here I would recommend acupuncture for you, if you have got insomnia.

Acupuncture is proven to be effective for insomnia because it has direct effects on peripheral nerve system and muscle relaxations; it also regulates autonomic nervous system and central nerve activity. Huang W did a system review for effectiveness of acupuncture in treating insomnia. They analysed 30 clinical trials, 93% of which showed positive treatment effects of acupuncture in improving various aspect of sleep. Acupuncture makes falling sleep faster; increases sleep time; reduces waking up time; improves quality of sleep. Comparing the effects of sleeping pill and acupuncture, they found that sleeping pill has rapid effect, while acupuncture has accumulating effects. Acupuncture can be used for a long time to achieve better effects than that for sleeping pill. The maintenance effects could last as long as 3.5 years at follow-up without side effects.

Tu Jh et al compared the effect of acupuncture and zolpidem in treating primary insomnia. 19 patients received acupuncture once a week and 14 patients received zolpidem treatment. The treatment period was 4 weeks. PSQI was used to evaluate sleep quality. They found that sleep was improved significantly in both groups. Both groups improved over time at a similar rate. They concluded that acupuncture may be an effective alternative treatment compared with zolpidem for primary insomnia.

Insomnia increases in women in menopause period and after this period. Hachul et al studied the effectiveness of acupuncture on women in their postmenopausal period with insomnia. In this study, 18 women aged 50-67 years of age were included. Their period stopped over 1 year and they did not use any antidepressants, hypnotics or hormonal therapy. The participants were divided into two groups: acupuncture group and sham acupuncture group. They received 10 sessions of acupuncture during a period of 5 weeks. Pittsburgh sleep quality index (PSQI) was used to measure the sleep quality before and after the acupuncture treatment. The result showed that women in acupuncture group had better quality of sleep after acupuncture treatment.

A study has shown that acupuncture improves perimenopausal insomnia. In this study a short-term efficacy of acupuncture for the treatment of peri-menopausal insomnia is evaluated. 76 women with perimenopausel insomnia were involved in the study. A 10-session of acupuncture at bilateral Shenshu (BL 23) and Ganshu (BL 18) with unilateral Qimen (LR 14) and Jingmen (GB 25) or Streitberger needles at the same acupoints was performed for over 3 weeks. The results have shown that acupuncture significantly improved the sleep efficiency and total sleep time. Another study has investigated the efficacy and safety of acupuncture treatment on primary insomnia involving in 72 patients with primary insomnia. The treatment was given three times a week for four weeks. Patients were asked to wear sleep monitors and complete questionnaires every two weeks for a total of eight weeks. The significant improvement was seen after acupuncture compared to before acupuncture treatment. The improvement was still seen in 2 weeks and 4 weeks follow up after the course of acupuncture treatment. They concluded that acupuncture is an effective treatment in increasing insomnia patients' sleep quality and improving their psychological health.

Here is a typical case report. A 55 year old woman presents with sleep problem for a year, which related to her stress and knee pain as well. She used some pain killers to help sleep. She had problems of falling sleep as well as staying sleep. Her sleep quality Index was 17 indicating very poor sleep. 2 nights of sleep monitoring showed that 6 hours sleep for the first night using sleeping pill and 4 hours sleep for the second night with fewer amounts of sleeping pills. Her sleep quality is poor. And then she started 12 sessions of acupuncture treatments. Acupuncture was given twice a week for the first 4 weeks and then once a week for the following 4 weeks. Each session lasts for 45-60 minutes. Five days after the start of acupuncture treatment, she slept for 7-5 to 8.0 hours per day without taking sleeping pills. After 8 weeks of acupuncture treatment, she was falling asleep easily and stayed asleep longer. Two days of sleep monitoring showed that 7 hours good sleep per day without taking sleeping pill. The quality of sleep is also improved.

A new research studied the effect of acupuncture for insomnia. 224 people with average age 53 year old were involved in the study. Acupuncture was provided three times a week for 3 weeks and then assessments were conducted at baseline, 1 week, 4 weeks and 13 weeks after treatment. Acupuncture shown has significant effect in reducing insomnia, anxiety/depressive symptoms and fatigue, and improving physiological function compared to the waiting list group. The improvement stayed after 13 weeks treatment.

Acupuncture is effective for insomnia and helps people with this condition to sleep well. The question is how long the effect lasts? A recent study has investigated the long term effect of acupuncture on insomnia. This was a case report. The patient received acupuncture treatment once a week for 12 weeks. Polysomnographic evaluation was performed at baseline and 3 months, and 1 year after acupuncture treatment. After acupuncture treatment, improvements of subjective symptoms such as unrefreshing sleep, sleep disturbances, accompanied symptoms (morning headache, fatigue, and mood worsening) were observed. Remarkable improvement was recorded by polysomnographic parameters.

Primary insomnia means that a person is having sleep problems that are not directly associated with any other health condition or problem such as another medical or psychiatric disorder. The main symptoms include that difficulty falling sleep, waking up often during the night and having trouble going back to sleep again, waking up early in the morning, feeling tired once waking.

Acupuncture can help people with primary insomnia. This is proved by research papers. A very recent review wha analysed the effect of acupuncture on primary insomnia to provide updated evidence from randomized controlled trials (RCTs) on the effectiveness and safety of acupuncturefor primary insomnia. In this paper, 10 years data from 2008-2017) was analysed. A total of 73 RCTs involving 5533 participants were studied. The result has shown that there is significant effect of acupuncture compared with no treatment; acupuncture plus drugs showed better improvement than drugs alone; there is fewer side effects of acupuncture compared to the drugs. This review concluded that acupuncture is effective and safe method for insomnia.


References

Huang W etc (2009) Sleep Med Rev 13:73-104.

Huang W etc Journal of Clinical Sleep Medicine (2011), 7: 95-102

Get sleep problem? Acupuncture could help

Hachul H et al Climacteric (2012)

Tu JH et al Asian Psychiatr. (2012) 5:231-5

Fu C et al (2007) Sleep 40(11). doi: 10.1093/sleep/zsx153.

Yin X et al (2007) Sleep Med 37:193-200

Zhang W et al Medicine (Baltimore) 2017 Dec;96(52):e9471. doi: 10.1097/MD.0000000000009471.

Chung KF et al Acupunct Med (2017) Dec 11. pii: acupmed-2017-011371. doi: 10.1136/acupmed-2017-011371. [Epub ahead of print]

Cao HJ et al J Altern Complement Med. 2019 Apr 23.

How does acupuncture work? Research shows that acupuncture alters brain activities.

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