Stimulated by Zhu et al 2026.[1]
CID – chronic insomnia disorder
IF – impact factor
ICSD-3 – international classification for sleep disorders 3
ISI – insomnia severity index
CIs – confidence intervals (generally 95% CIs)– key to acronyms
This paper was published online at the beginning of September in the Journal of Affective Disorders (IF 5.7). I am not a big fan of treating insomnia with acupuncture despite the fact that a substantial minority of patients come back after their first session reporting improved sleep.
We often remember the very rare but remarkable cases, and I did have one patient who claimed to have slept so soundly and so long that she slept through an entire day – she went to sleep on the Tuesday evening after her first acupuncture session with me and did not wake up until Thursday morning. It sounds more like a legend than a case report now, but it is hard to see how I could have invented such a memory. In this case the patient was not seeking acupuncture for insomnia.
My experience with insomnia patients was rather unsatisfactory. Basically, it just didn’t seem to work the way I did it, and as the data on insomnia treatment from the East increased, it became clear that treating patients once a week was unlikely to influence such a conditions.
This paper is unusual in that it is a moderately large RCT (n=201) that compares the effects of 3 different courses of acupuncture treatment – 4, 6, and 8 weeks of treatment, with all groups receiving the same protocol 3 times a week. So, that is a comparison between 12, 18, and 24 sessions within a 2-month period.
The points used were very familiar ones – GV20, Yintang, Anmian (halfway between GB20 and TE17 at the back of the mastoid process), HT7, PC6, SP6. So, that makes 10 needles with 2 midline points and 4 bilateral ones. Chinese needles of 0.25mm diameter and 25mm or 50mm length were used and they were stimulated once to achieve typical needling sensation.
The patients had to meet the diagnostic criteria for CID in the ICSD-3 and have an ISI score of 10 or more to be included. The primary outcome was the ISI score at the end of treatment. There were a raft of secondary outcomes and follow-up at 1 and 3 months after the end of treatment. It seems that they actually used the ISI change scores rather than the absolute values as the primary outcome, which probably does not matter, but should have been clarified. I note that it is not clear in the protocol either, which simply refers to ISI as the primary outcome. The baseline ISI score in all 3 groups was well balanced, so in this trial using change scores rather than end scores would not give any group an advantage.
All three groups improved to a clinically relevant degree at the end of treatment, but the 6- and 8-week groups were significantly improved compared with the 4-week group.
The proportion of patients who were essentially cured of their insomnia at the end of treatment (ISI <8) were 21%, 42%, and 50% for the 4-, 6-, and 8-week groups respectively.
The proportion of patients who had a clinically meaningful reduction in insomnia (ISI reduction of 6 or more) were 61%, 81%, and 81% respectively.
So, there appears to be quite a big difference between 4- and 6-week courses of treatment, with a further 2 weeks of treatment not appearing to add much, at least when assessed at the end of the treatment phase.
I get an impression from looking at the absolute ISI figures that the longer course may give more stable long-term results, but that comment is speculative and not supported by the data due to rather too wide and overlapping CIs.
References
1 Zhu F, Wang Y, Liu J, et al. Comparative effectiveness of different acupuncture courses for chronic insomnia disorder: a randomized controlled trial. J Affect Disord. 2026;122469. doi: 10.1016/j.jad.2026.122469
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