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Chinese Medical Journal 2009;122(23):2869-2873 2869

Original article
Electroacupuncture treatment of chronic insomniacs
RUAN Jing-wen, WANG Chu-huai, LIAO Xin-xue, YAN Ying-shuo, HU Yue-hua, RAO Zhong-dong,
WEN Ming, ZENG Xiao-xiang and LAI Xin-sheng

Keywords: electroacupuncture; chronic insomnia; sleep quality; sleep architecture; safety

Background Due to the quick rhythm of life and work pressure, more and more people suffer from sleep quality
problems. In this study, we investigated the effect of electroacupuncture on sleep quality of chronic insomniacs and the
safety of electroacupuncture therapy.
Methods Four courses of electroacupuncture treatment were applied to 47 patients. With pre-treatment and
post-treatment self-control statistical method, Pittsburgh sleep quality index (PSQI) scores were used for evaluating sleep
quality. Polysomnogram was used for detecting insomniacs′ changes in sleep architecture. The safety of
electroacupuncture was evaluated by monitoring the self-designed adverse events and side effects during treatment and
Results Electroacupuncture considerably improved insomniacs′ sleep quality and social function during the daytime.
Electroacupuncture had certain repairing effect on the disruption in sleep architecture. At the same time,
electroacupuncture prolonged slow wave sleep (SWS) time and relatively rapid eye movement sleep (REM sleep) time.
There was no hangover, addiction or decrements in vigilance during the daytime (incidence rate was 0). However,
insomnia rebound rate was about 23% within one month.
Conclusions These results suggest that electroacupuncture has beneficial effect on sleep quality improvement in the
patients with chronic insomnia, which may be associated with repairing sleep architecture, reconstructing sleep continuity,
as well as prolonging SWS time and REM sleep time. Electroacupuncture treatment for chronic insomnia is safe.
Therefore, electroacupuncture therapy could be a promising avenue of treatment for chronic insomnia.
Chin Med J 2009;122(23):2869-2873

W hen visiting doctors, many patients with chronic

insomnia complain about their sleeplessness or
restless sleep during the whole night. In fact,
unable to continue the treatment. The rest 47 patients
participated in all the processes of the research. Their age
ranged from 27 to 65 years (32 women and 15 men; mean
polysomnogram shows that those patients′ subjective age 47.5 years), which met the research standard.
insomnia is inconsistent with objective insomnia.1-10 Professional types of the patients included 29 of mental
According to polysomnogram, a lot of patients have some laborer, 8 of manual worker and 10 of the unemployed.
sleep instead of total sleeplessness all night long. Twenty-five patients had sleeping disorder for 6 to 12
However, their sleep architecture is disrupted. In some
cases, their slow wave sleep (SWS) time of S3 and S4 DOI: 10.3760/cma.j.issn.0366-6999.2009.23.013
stage was shortened. Some patients may have no S3 or S4 Department of Acupuncture and Moxibustion (Ruan JW, Hu YH,
Rao ZD and Wen M), Department of Rehabilitation (Wang CH),
stage or even both stages. Mostly, patients′ sleep is Department of Cardiology (Liao XX), Department of Respiratory
fragmented and belongs to light sleep (S1, S2 stage), Medicine (Yan YS), First Affiliated Hospital of Sun Yat-sen
which results in no strong feeling of sleep by patients. University, Guangzhou, Guangdong 510080, China
Although some patients continuously use hypnotics to Zhuhai People′s Hospital, Zhuhai, Guangdong 519000, China
prolong sleep time, their sleep quality is still poor, and (Zeng XX)
College of Acupuncture and Moxibustion of Guangzhou
they are low-spirited and tired during the daytime. University of Traditional Chinese Medicine, Guangzhou,
Therefore, concerning the curative effect and toxic action Guangdong 510405, China (Lai XS)
or side effects after long-term medication, lots of Correspondence to: Dr. RUAN Jing-wen, Department of
insomniacs turn to the help of acupuncture and the other Acupuncture and Moxibustion, First Affiliated Hospital of Sun
treatments. In this study, we investigated the effects of Yat-sen University, Guangzhou, Guangdong 510080, China (Tel:
86-20-87755766-8390. Fax: 86-20-87332698. Email:
electroacupuncture on sleep quality of chronic insomniacs; Dr. LAI Xin-sheng, College of Acupuncture
and the safety of electroacupuncture therapy. and Moxibustion of Guangzhou University of Traditional Chinese
Medicine, Guangzhou, Guangdong 510405, China
METHODS RUAN Jing-wen and WANG Chu-huai contributed equally to this
Participants This research was supported by the grants from the Science and
Technology Planning Project of Guangdong Province (No.
There were 67 volunteers, who were from outpatient 2004B3300102) and Research Grant of the Administrative Bureau
clinic, participated in the insomnia study. Twenty of them of Traditional Chinese Medicine of Guangdong Province (No.
exited midway during the treatment because they were 1040058).
2870 Chin Med J 2009;122(23):2869-2873

months and the rest 22 for more than 12 months. continuous wave with the frequency (80/min) was used.
The intensity of EA was adjusted to induce a slight twitch
Diagnostic criteria of the muscles (about 1–3 mA) and lasted for 30 minutes.
Refer to Insomnia′s definition, diagnosis as well as the Continuous 10 days of treatment was considered as a
consensus view among experts on drug treatment course of treatment. There were four courses of treatment
(Protocol)11 was used. in total for each patient. After each course of treatment,
the patients had 3 days for relaxation.
Inclusion criteria
Subjects should have experienced insomnia for more than Evaluation of curative effect and observation of
6 months plus the following subjective criteria: (1) major adverse events and side effects
complaint of sleep physiological dysfunction (sleep Evaluation was made according to Pittsburgh sleep
interruption or sleep disorder by decrease in sleep time); quality index (PSQI).6,16 PSQI comprises 23 items.
(2) sleep disorder due to fatigue, distention of head, Excluding the 5 other-evaluated items in the 10th articles,
dizziness and other symptoms during the daytime. the other items were summarized into 6 questions
Objective criteria (results from polysomnogram): (1) including sleep quality, sleep latency, sleep time, sleep
prolongation of sleep latency (over 30 minutes); (2) efficacy, hypnotic, function during the daytime. PSQI
increase in awareness time (over 30 minutes per night); (3) evaluation and polysomnogram test were respectively
decrease in actual sleep time (less than 6 hours per night). performed 2 times at 2 weeks before and after the
treatment by a specialist for each patient.
Exclusion criteria
Patients were specially excluded if one of the following PARAD ISE P&D9600 Type (USA) polysomnogram
condition occurred: (1) patients with general diseases, respiration monitoring analytical system was applied in
such as pain, fever, cough, operation and so on or with polysomnogram test. Simultaneous monitoring items
which induced by interference factors from the external include electroencephalogram (EEG), electro-oculogram
environment; (2) patients′ age below 18 or above 65 (EOG), electromyogram (EMG). Insomniacs may take
years, women during their pregnancy or lactation; (3) hypnotic before treatment, but they should have no
patients with severe primary diseases such as noontime rest in the treatment day. Subjects were set
cardiovascular, lung, liver, kidney and hematopoietic sleep monitor from 10:00 – 11:00 at night to 06:00 –
system diseases or psychotics;12,13 (4) decrease in sleep 07:00 the next morning. Sleep time, sleep efficacy,
time without discomfort in the daytime (short sleeper); (5) awareness time, non-rapid eye movement (NREM) sleep
score from the Hospital Anxiety and Depression (HAD) including S1, S2, S3, and S4 stages, rapid eye movement
scale14 reaches the severe degree;15 (6) patients who fall (REM) sleep and the percentage of different stages were
short of the standard, or without getting the treatment, or continuously monitored for more than 7 hours. The data
are unable to assess the curative effect or without were automatically stored and processed by a computer.
complete records.
Attentions were paid during the nocturnal sleep
Electroacupuncture (EA) treatment monitoring referring to the results reported by Shao et
Some main acupoints “Sishenchong, Neiguan (PC6), al.17
Shenmen (HT7), Sanyinjiao (SP6), Taixi (KI3), Zhaohai
(KI6), Shenmai (BL62)” were selected during EA During the treatment and one month after treatment, the
treatment. According to traditional Chinese medicine patients were inquired some questions by a questionnaire,
(TCM) syndrome differentiation, the acupoints were such as hangover, addiction, tolerance, fatigue after
modified. For example, Pishu (BL20) and Xinshu wakeup, insomnia rebound state, vigilance during the
(BL15) acupoints were added when blood deficiency of daytime, cognitive function and behavioural capability.
the heart and spleen occurs; Daling (PC7) and Taichong
(LR3) acupoints were added when asthenic yin causing Statistical analysis
excessive fire occurs; Shenting (DU24), Qihai (RN6), and Data of all items were analyzed by adopting SPSS11.0
Yinjiao (RN7) acupoints were added when fright due to package processing. In terms of PSQI scores and the
asthenia of the heart occurs; Zhongwan (RN12), parameters in sleep architecture, the paired t test
Fenglong (ST40), Lidui (ST45) and Yinbai (SP1) (self-contrast control of pre-treatment and post-treatment)
acupoints were added when disorder of the stomach was used. The constituent ratio of sleep architecture was
occurs; Quchi (LI11), Fenglong (ST40), and Jiexi (ST41) analyzed by chi-square of numeration data. The statistical
acupoints were added when phlegm-heat attacking the significance level was set at P <0.05.
heart occurs; Daling (PC7), Yintang, Taichong (LR3) and
Hegu (LI4) acupoints were added when emotional RESULTS
activities disturbing the mind occurs. The stainless silver
needles of 0.25 mm in diameter were inserted into main Effects of electroacupuncture on sleep quality and
points. The needles were connected with the output function during the daytime
terminals of an EA apparatus (KWD-808-1). The As showed in Table 1, the changes in sleep quality
Chinese Medical Journal 2009;122(23):2869-2873 2871

Table 1. The comparison of PSQI between pre-treatment and Table 3. The comparison of parameters in sleep architecture
post-treatment of 47 patients (means ± SD) between pre-treatment and post-treatment of 47 patients
PSQI Number Pre-treatment Post-treatment (means ± SD)
Sleep quality 47 2.63±0.56 1.21±0.74 * Sleep parameters Number Pre-treatment Post-treatment
Sleep latency (minutes) 47 69.74±15.73 37.36±11.33* Total sleep time (minutes) 47 291.50±23.51 375.73±37.45*
Sleep time (minutes) 47 291.5±54.86 375.73±36.43* NREM (minutes)
Sleep efficacy (%) 47 69.04±8.01 84.96±6.69* S1 stage 47 24.74±3.50 19.11±2.31*
Times of awareness 47 10.57±4.86 4.36±3.17* S2 stage 47 173.81±8.73 208.09±19.76*
(>5 minutes/every night ) S3 stage 47 10.91±2.15 25.09±3.10*
Function during the daytime 47 2.27±0.80 1.15±0.72* S4 stage 47 9.89±1.82 23.72±3.47*
Paired t test: *P <0.05 vs pre-treatment. REM stage (minutes) 47 72.15±7.28 99.72±8.81*
Paired t test: *P <0.01 vs pre-treatment.
between pre-treatment and post-treatment were
Table 4. The percentage of sleep parameters in sleep architecture
significant (P <0.05) in the PSQI scores, sleep latency, between pre-treatment and post-treatment of 47 patients
sleep time and sleep efficacy. In addition, the sleep The percentage of The percentage of
efficacy was improved from 69.04% to 84.96%, and the Sleep parameters Number
pre-treatment (%) post-treatment (%)
sleep latency shortened obviously. Moreover, the time of Total sleep 47 100 100
nocturnal awareness (more than 5 minutes) was obviously NREM
S1 stage 47 8.49±1.21 5.09±0.61*
reduced. All the above mentioned changes suggest that
S2 stage 47 59.63±2.99 55.37±5.26*
EA may improve the sleep quality of insomniacs. At the S3 stage 47 3.74±0.74 6.68±0.83*
same time, patients′ function during the daytime was also S4 stage 47 3.39±0.62 6.32±0.92*
improved obviously, suggesting that EA could improve REM stage 47 24.75±2.50 26.54±2.34*
the sleep quality and work efficiency by shortening sleep Paired t test: *P <0.01 vs pre-treatment.
latency, improving patients′ fragmented sleep and
enhancing sleep continuity. provided room for prolonging NREM and REM. This is
the reason why some patients did not have longer total
Effect of EA on sleep architecture sleep time but had improvement in their sleep quality.
As demonstrated in Table 2, the pre-treatment sleep
architecture in the large part of patients was incomplete. Incidence rate of adverse events and side effects
Some patients lost S3 or S4 stage or both stages. After Table 5 shows the incidence rate of adverse events and
treatment, the sleep architecture in some patients was side effects. Insomnia rebound occurred only in about
repaired to some extent with the constituent ratio of 23% patients. The other events were 0 in all listed adverse
pre-treatment and post-treatment sleep architecture (P events and side effects of EA treatment. This suggests
<0.05). All these indicated that acupuncture has certain that EA treatment for insomnia has its unique advantages.
repairing effect on patients with sleep architecture Unlike sedative hypnotic, it has no side effects such as
disruption. In addition, it can restore the sleep continuity. hangover, addiction, cognitive function or decrease in
behavioral capability.
Table 2. The comparison of sleep architecture between
pre-treatment and post-treatment of 47 patients Table 5. The incidence rate of adverse events and side effects
Sleep architecture Number Pre-treatment Post-treatment Positive Incidence
Manifestation Number
REM 47 47 47 number (n) rate (% )
NREM Hangover 47 0 0
S1 47 47 47 Insomnia rebound 47 11 23
S2 47 47 47 Tolerance 47 0 0
S3 47 21 41* Addiction 47 0 0
S4 47 16 35* Fatigue after wakeup 47 0 0
Decrement in vigilance during the daytime 47 0 0
Chi-square test: *P <0.05 vs pre-treatment.
Decrease in cognitive function 47 0 0
Decrease in behavioral capability 47 0 0
Moreover, Table 3 shows the comparison of parameters in
sleep architecture between pre-treatment and post- DISCUSSION
treatment of the 47 patients. The results showed that EA
treatment obviously improved sleep quality. Especially, Effects of EA treatment on sleep quality and social
the increase in SWS (S3+S4) and prolongation of REM function during the daytime and its safety
release ensured good sleep. Table 4 also shows the Sedative hypnotics and anti-anxiety drugs are mostly
percentage of S3 and S4 stage in total sleep time was used clinically in the treatment for insomnia. However,
increased. Table 4 shows that the percentages of S1 and S2 these two types of drugs have obvious advantages as well
stage time in post-treatment were significantly lower than as disadvantages. In terms of advantages, they all have
those in pre-treatment. Although the time of S2 stage in immediate effects which can obviously shorten patients′
post-treatment was longer than that in pre-treatment sleep latency and prolong patients′ sleep time. In terms of
(Table 3), the percentage of S2 stage in total sleep time in disadvantages, they mainly prolong the light sleep time
post-treatment was lower than that in pre-treatment and reduce the sleep quality by shortening the deep sleep
(Table 4). The relatively shorter light sleep (S1+S2) and REM sleep in varying degrees in over 95% of the
2872 Chin Med J 2009;122(23):2869-2873

patients. As a result, lack of sleep during the daytime (or circadian rhythm. This artificially impaired the
hangover), social dysfunction during the daytime, drug physiological function of sleep, which would disrupt
dependence and abstinent symptom18 still occurred even sleep architecture and induce lots of adverse effects. On
under therapeutic dosage. Therefore, the aim of the the contrary, this study showed the simulative effect of
present clinical research was to find safer and more EA on sleep was basically the same as the research and
effective therapeutic strategies. development of the present new hypnotics. EA could
repair the disrupted sleep architecture instead of further
As a natural treatment with long history, EA is regarded disrupting it. It could also reduce the times of nocturnal
as a kind of treatment with little toxic action or side awareness, which could help in the sleep continuity. All
effects and basically without permanent lesion.19 It has these results were proved by the significant difference in
been applied in insomnia for a long time with good constituent ratio between pre-treatment and
curative effects.7,8 In addition, it has become an important post-treatment sleep architecture.
means and object in the clinical research of chronic
insomnia treatment. In addition, our data (Table 3 and Table 4) showed that
the reason why most insomniacs had poor sleep was that
The results of this study revealed that sleep quality could their S3, S4 and REM sleep time was proportionally or
be improved by EA on certain acupoints. Similar to actually shortened.23 Although EA treatment was not a
hypnotics, it could shorten sleep latency, prolong sleep real drug treatment, sleep latency, S1+S2 stage sleep time
time and improve sleep efficacy, which was demonstrated relatively was shortened after 4 courses of treatment. As a
by comparison among PSQI scores. Unlike hypnotics, EA result, S3, S4 stage sleep time and REM sleep time were
treatment prolongs deep sleep time (Table 3). Therefore, absolutely prolonged, which was the fundamental cause
although some patients did not have obvious increase in for the improvement of sleep efficacy and sleep quality. It
their total sleep time, their sleep quality was improved by was important to emphasize that though some patients did
prolonging their deep sleep time (comparatively longer not have obvious prolongation of sleep time, S3 and S4
than that of pre-treatment). Another difference from using stages were comparatively prolonged and REM sleep was
hypnotics is that EA treatment does not have immediate comparatively released. Therefore, patients′ sleep quality
effect and it needs the accumulation of therapeutic dose.20 was comparatively improved. This is why some patients
In addition, our previous study also revealed that EA has felt delightful and fresh and obvious improvement of
the effect of reducing the time and dosage of hypnotics social function during the daytime without having
even let the patient become drug-free.21 Moreover, there obvious prolongation of sleep time. This indicated that
is no abstinent symptom during the course, which is the prolongation of S3+S4 stage time was more important
consistent with the previously reported study.22 At the than prolongation of total sleep time (mainly light sleep).
same time, there are no side effects such as hangover,
dependence, decrease in cognitive function and Material basis of EA treatment for chronic insomnia
behavioral capability, which occur in hypnotic users. All It is obvious that the main mechanism of EA treatment for
these data demonstrated that EA treatment is safe. chronic insomnia is repair of sleep architecture and
However, insomnia rebound occurred in some patients prolongation or release deep sleep time and REM sleep
soon after treatment (about one month). So, further time in S3 and S4 stages, which leads their proportion
research is still needed for long-term curative effect of EA back to normal. All these functions of EA may be related
on the treatment for insomnia. to certain neurotransmitters secreted by the brain center
through stimulating some special acupoints by EA. For
Effect of EA on sleep architecture example, scalp acupoints (Sishenchong, Taiyang point,
The continuity and integrity of sleep architecture is the Yintang point and so on) can obviously increase the
fundamental guarantee for sleep quality. It is well known content of 5-HT, γ-aminobutyric acid in rat′s brain and
that REM sleep and NREM sleep are the connotation of obviously decrease norepinephrine (NE).2,24 As reported
sleep architecture. A complete sleep contains 4 to 6 cycles by Li et al,5 the substance P in rabbit′s cerebrospinal fluid
of REM sleep and NREM sleep per night with 90 minutes was obviously increased by electrically acupuncturing its
for each cycle. Clinically, due to sleep architecture certain scalp points. At the same time, it was reported that
disruption (Table 2), many insomniacs lacked sleep the release of substance P could be promoted by
integrity and reduced their sleep quality. Therefore, the acupuncturing certain body points (such as Neiguan
aim of developing new hypnotic at present is to maintain point).9,25 The modern research indicated that human
or repair the integrity of sleep architecture and effectively sleep is closely related to hormones, transmitters and
prolong SWS time at the same time. As a natural neuropeptides mentioned above and so on.3,26 Their
treatment, EA induced patients′ sleep to go into a natural content directly influences sleep, awareness and the sleep
sleep state, which was different from exogenous architecture. For example, NE and 5-HT have decisive
hypnotics′ compulsory sleep. Hypnotics achieved the aim effects on maintaining sleep-awareness state. The normal
of passively falling asleep mainly by forcedly inhibiting or up-regulating of NE content and down-regulating of
brain cells′ excitability through drugs. The length of sleep 5-HT content in the brain can cause insomnia. The
time dependeds on drugs′ demi period, which had no normal or up-regulating of 5-HT content and
Chinese Medical Journal 2009;122(23):2869-2873 2873

down-regulating of NE content in the brain can cause (Protocol). Chin J Neurol (Chin) 2006; 39: 141-143.
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