Treatment Of Primary Insomnia Research Articles

The Function of Sleep and the Treatment of Primary Insomnia.

Approximately 21 900 women and 35 300 men developed lung cancer in Germany in 2018, and 16 999 women and 27 882 men died of it. The outcome mainly depends on the tumor stage. In early stages (stage I or II), treatment can be curative; unfortunately, because early-stage lung cancers are generally asymptom - atic, 74% of women and 77% of men already have advanced-stage disease (stage III or IV) at the time of diagnosis. Screening with low-dose computed tomography is an option enabling early diagnosis and curative treatment. This review is based on pertinent articles retrieved by a selective search of the literature on screening for lung cancer. In the studies of lung cancer screening that have been published to date, sensitivity ranged from 68.5% to 93.8%, and specificity from 73.4% to 99.2%. A meta-analysis by the German Federal Office for Radiation Protection revealed a 15% reduction in lung cancer mortality when low-dose computed tomography was used in persons who were judged to be at high risk for lung cancer (risk ratio [RR] 0.85, 95% confidence interval [0.77; 0.95]). 1.9% of subjects died in the screening arm of the meta-analysis, and 2.2% in the control group. The observation periods ranged from 6.6 to 10 years; false-positive rates ranged from 84.9% to 96.4%. Malignant findings were confirmed in 45% to 70% of the biopsies or resective procedures that were performed. Systematic lung cancer screening with low-dose CT lowers mortality from lung cancer in (current or former) heavy smokers. This benefit must be weighed against the high rate of false-positive findings and overdiagnoses.

An open label pilot trial of sequential bifrontal low frequency r-TMS in the treatment of primary insomnia

This pilot study examines the therapeutic effects of bifrontal low frequency (LF) TMS on primary insomnia. In this prospective, open-label study 20 patients with primary insomnia and without major depressive disorder received 15 sequential bifrontal LF rTMS stimulation sessions. By week 3, PSQI scores declined from baseline score of 12.57(sd 2.74) to 9.50 (sd 4.27), a large effects size (0.80 (CI 0.29, 1.36)), and CGI-I scores improved for 52.6% of participants. Results of this pilot indicate that the novel bifrontal LF rTMS benefitted this group of patients suffering from primary insomnia, with absence of sham control a significant study limitation.

Clinical research progress of acupuncture combined with repetitive transcranial magnetic therapy in the treatment of primary insomnia

Insomnia, as a common and high incidence disease in modern society, seriously affects the physical and mental health and quality of life of patients. In long-term clinical practice, acupuncture and moxibustion has been proved to be one of the effective treatments for insomnia, with the advantages of fast onset, long-lasting effect, green safety and no side effects. Repetitive transcranial magnetic stimulation (rTMS) is a popular physical therapy method in the treatment of neurological and psychiatric diseases in recent years. It has the advantages of simple operation, significant curative effect and less adverse reactions in the treatment of insomnia, and is widely used in clinic. This paper summarizes the relevant literature of acupuncture combined with repetitive transcranial magnetic stimulation in the treatment of insomnia in recent years, and systematically summarizes the pathological mechanism of insomnia, the mechanism of acupuncture and repetitive transcranial magnetic stimulation and clinical application, in order to provide a better guidance scheme for the clinical treatment of insomnia.

Transcutaneous Vagus Nerve Stimulation Could Improve the Effective Rate on the Quality of Sleep in the Treatment of Primary Insomnia: A Randomized Control Trial.

(1) Background: The purpose of this study was to investigate the efficacy and safety of transcutaneous vagus nerve stimulation (t-VNS) in the treatment of primary insomnia. (2) Methods: This is a single center, randomized, double-blind study. A total of 30 patients diagnosed with primary insomnia were randomly divided into two groups to receive 20 Hz t-VNS in either the auricular concha area (treatment group) or periauricular area (control group), twice a day for 20 min during a one-month study period. The effective rate of treatment, defined as a ≥50% reduction of the Pittsburgh Sleep Index Scale (PSQI) after treatment, was compared between the two groups as the primary outcome. Response rate (defined as ≥10% change in the PSQI score), and changes in the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores were also assessed. (3) Results: After one month of treatment, the PSQI score of the treatment group decreased significantly (p = 0.001). The effective rate of the treatment group (73% vs. 27%, p = 0.027) was significantly higher than that of the control group. No statistical differences in changes of HAMA and HAMD scores were detected between the two groups. There were no complications in all patients. (4) Conclusion: T-VNS appeared to be a safe and effective treatment for primary insomnia.

Modulation of transcutaneous auricular vagus nerve stimulation on default mode network in patients with primary insomnia

To explore the modulation of transcutaneous auricular vagus nerve stimulation (taVNS) on default mode network (DMN) in patients with primary insomnia (PI). A total of 22 PI patients (one patient dropped off and two patients were excluded) were included and treated with taVNS. The bilateral auricular points of Xin (CO15) and Shen (CO10) were selected and treated with disperse-dense wave at frequency of 4 Hz/20 Hz, the intensity was based on the patient's tolerance. taVNS was given once in the morning and once in the evening for 30 minutes each time. The treatment lasted for at least 5 days a week for 4 weeks. At the same time, 16 healthy subjects matched with gender and age were recruited. The Pittsburgh sleep quality index (PSQI) score was evaluated before and after treatment in PI patients. The resting-state functional magnetic resonance imaging (rs-fMRI) data of PI patients before and after treatment and healthy subjects at baseline period were collected to observe the effect of taVNS on the functional connection (FC) between posterior cingulate cortex (PCC) and whole brain. After treatment, the total score of PSQI in PI patients was lower than that before treatment (P<0.01). Compared with healthy subjects, the FC of the left PCC was increased either with the left orbital superior frontal gyrus or with left middle frontal gyrus (P<0.001), and the FC between right PCC and left middle frontal gyrus was increased in PI patients before treatment (P<0.001). Compared before treatment, the FC between left PCC and left middle frontal gyrus was decreased (P<0.05), and the FC of the right PCC was decreased either with the right medial prefrontal cortex or with the left middle frontal gyrus in PI patients after treatment (P<0.001, P<0.01). taVNS can modulate the FC between anterior and posterior DMN, and between DMN and cognitive control network of PI patients, which may be one of the brain effect mechanisms of taVNS in the treatment of PI patients.

Network Meta-analysis of Chinese patent medicines of Ziziphi Spinosae Semen in treatment of primary insomnia

To systematically evaluate the efficacy of oral Chinese patent medicines of Ziziphi Spinosae Semen in the treatment of primary insomnia by using network Meta-analysis. Nine databases(CNKI, Wanfang, VIP, CBM, PubMed, EMbase, Web of Science, Medline and Cochrane Library) were systematically and comprehensively undertaken to identify the literatures published from the establishment of each database to August, 2020. Randomized controlled trials(RCTs) on oral Chinese patent medicine of Ziziphi Spinosae Semen in the treatment of primary insomnia, either alone or in combination with conventional sedative hypnotics, were screened out according to inclusion criteria and exclusion criteria. Literature screening, data extraction and the evaluation of the risk of bias for the included studies were conducted independently by 2 researchers. Traditional Meta-analysis and Bayesian network Meta-analysis were then conducted with use of Stata 15.0 and R software. Finally, a total of 42 RCTs were included, involving 9 kinds of oral Chinese patent medicines and 4 196 patients. The results of Meta-analysis showed that(1) in terms of improving Pittsburgh sleep quality index scale score, the efficacy of the combination of drugs was significantly superior to that of sedative-hypnotics or most of Chinese patent medicines used alone, and Bailemian Capsules combined with sedative-hypnotics had the best effect; both the efficacy of Shenqi Wuweizi Tablets and Compound Zaoren Anshen Capsules alone were significantly superior to that of conventional sedative-hypnotics treatment, and Shenqi Wuweizi Tablets had the best effect.(2)In terms of safety, single use or combined use of Chinese patent medicine had a certain improvement as compared with conventional sedative-hypnotics treatment. Due to the large clinical heterogeneity, the studies could not be combined quantitatively, and no serious adverse reactions occurred in all patients enrolled in the study. The results showed that Chinese patent medicine of Ziziphi Spinosae Semen combined with conventional sedative-hypnotics could significantly improve the short-term sleep quality of patients with primary insomnia. In the comparison among single use of drugs, Shenqi Wuweizi Tablets had the largest possibility for best effect. However, the lack of evidences for international promotion, the influence of different types of sedative-hypnotics treatment and intervention time on the curative effect, and the patients' different acceptance of combined treatment should be considered before clinical application. Limited by the number and quality of the included studies, the above conclusions need to be further verified by more large sample-size and high-quality studies.

BEHAVIORAL SLEEP PROBLEMS IN CHILDREN (BEHAVIORAL INSOMNIA) AND EFFECTIVE METHODS OF THEIR MANAGEMENT

Sleep problems with behavioral origins occur in 20 to 30 percent of children and are especially common in children with medical, neurodevelopmental, or psychiatric disorders. Insomnia related to learned sleep onset associations is most common in infants and toddlers and is characterized by prolonged night waking, requiring parental intervention to restore sleep. It occurs when the child learns to associate falling asleep with specific experiences, such as being rocked or fed. Insomnia related to inadequate limit-setting is a disorder most common in children who are preschool-aged and older and is characterized by active resistance, verbal protests, and repeated demands at bedtime. Guidance to parents about healthy sleep practices helps to prevent sleep problems and is also an important first step in treatment. An integral part of the bedtime routine is the institution of a bedtime and sleep schedule that ensures a developmentally appropriate amount of sleep. A consistent nightly bedtime will help to set the circadian clock and enable the child to fall asleep more easily. Treatment of primary insomnia in older children and adolescents usually involves behavioral interventions that resemble those used in adults. Establishing a consistent sleep schedule is also important for older children and adolescents for whom poor sleep hygiene is a common cause of sleep problems. Pharmacologic therapy for the treatment of childhood insomnia is not a first-line treatment and should always be combined with behavioral therapy.

Effect of exercise intervention on primary insomnia: a meta-analysis.

Exercise can have a positive effect on body functioning and immunity. This study systematically evaluated the effect of exercise intervention on patients diagnosed with primary insomnia. Based on the meta-analysis, we developed exercise recommendations to help improving sleep quality in these patients. Using a combination of manual and electronic retrieval strategies, we examined the CNKI, VIP, Wanfang, Web of Science, SpringerLink, EBSCO, PubMed, Cochrane Library, and Embase databases; and identified randomized controlled trials that addressed the effects of exercise intervention on primary insomnia and were published before October 2019. Risk of bias was assessed based on the Cochrane Handbook 5.1.0, and meta-analysis was conducted using STATA 13.0 (StataCorp LLC; College Station, TX, USA). Data were included for 1269 patients who received exercise interventions and 1203 patients who received drug therapy or no intervention (controls) in 23 trials of high quality. Meta-analysis showed that exercise intervention had a significant effect on the treatment of primary insomnia (SMD: -1.64, 95% CI: -2.08 to -1.19, P<0.001). Subgroup analysis showed significant effect sizes for older patients (>60 years) (SMD: -1.69, 95% CI: -2.40 to -0.97, P<0.001), aerobic exercise (SMD: -2.21, 95% CI: -2.89 to -1.53, P<0.001), interventions lasting 8-12 weeks (SMD: -2.58, 95% CI: -3.61 to -1.54, P<0.001), interventions lasting ≤60 min (SMD: -2.29, 95% CI: -3.66 to -0.92, P=0.001), Asian patients (SMD: -1.86, 95% CI: -2.42 to -1.31, P<0.001), and interventions ≤4 times/week (SMD: -1.70, 95% CI: -2.29 to -1.11, P<0.001). Both bias and sensitivity analyses suggested that our meta-analysis gave robust results. Our results indicate that exercise intervention has a significant positive influence on primary insomnia, especially for older patients. We recommend that an exercise regimen of 60 min 4-5 times a week for 8-12 weeks can improve sleep quality and treat the symptoms of primary insomnia. Future studies should focus on verifying and extending our results by increasing sample size and improving the quality of studies included.

Multimodality Functional Magnetic Resonance Imaging Assisted Treatment of Primary Insomnia and Anxiety and Depression

Based on multimodal functional magnetic resonance imaging technology, explore the changes of local brain function in the whole brain range of patients with primary insomnia at rest, and conduct correlation analysis to explore the relationship between this locality and function and clinical features. Provide further imaging evidence for the exploration of the neural mechanism of primary insomnia. Using multimodal functional magnetic resonance imaging, self-rating anxiety scale, self-rating depression scale to assess the status anxiety factor and trait anxiety of STAI in patients with primary insomnia (88 cases) and normal sleepers (82 cases). Factors and total scores, depressive mental disorders and total scores were statistically significantly different from the normal sleep group. The study found that patients with primary insomnia under the multimodal functional magnetic resonance imaging assisted treatment have abnormal local functional activities in multiple brain regions such as emotions and sensorimotor regions. We explored the brain of patients with primary insomnia from the perspective of functional differentiation. Changes in nerve activity are conducive to further understanding the characteristics of nerve activity in primary insomnia.

Brain Functional Mechanisms Determining the Efficacy of Transcutaneous Auricular Vagus Nerve Stimulation in Primary Insomnia.

Transcutaneous auricular vagus nerve stimulation (taVNS) has been reported to be effective in the treatment of primary insomnia (PI); however, its efficacy varies considerably across individuals for reasons that are unclear. In order to clarify the underlying mechanisms, this study investigated the effects of taVNS on spontaneous neuronal activity and autonomic nervous system function by functional magnetic resonance imaging (fMRI) and measurement of heart rate variability (HRV), respectively, in patients with PI. Forty patients with PI were divided into effective (group A) and ineffective (group B) groups based on their response to taVNS as determined by Pittsburgh Sleep Quality Index score reduction rate (group A ≥ 25% and group B < 25%). Spontaneous neuronal activity was measured by fractional amplitude of low-frequency fluctuations (fALFF) and HRV values and was compared between the two groups as well as before vs after taVNS. We then analyzed the correlations among efficacy of taVNS for 4 weeks, the fALFF and HRV values during continuous taVNS state. The results showed that the HRV parameter values (i.e., root mean square of successive differences, percentage of adjacent NN intervals differing by >50 ms, and high frequency) of group A were higher than those of group B during continuous taVNS state. In the fMRI scan, the fALFF values of the right cerebellum, right medial superior frontal gyrus, and bilateral supplementary motor area—which belong to the sensorimotor network (SMN)—were lower in group A than in group B during continuous taVNS state. The correlation analysis revealed that the efficacy of continuous taVNS and HRV and fALFF values were interrelated. These findings demonstrate that differential regulation of the SMN by the autonomic nervous system may be responsible for inter-individual variations in the efficacy of taVNS and suggest that HRV and fALFF are potential biomarkers for predicting PI patients’ response to taVNS treatment.

Instant adjustive effect of auricular electroacupuncture on brain default model network of patients with primary insomnia

To investigate the immediate brain effect of auricular electroacupuncture (EA) in the treatment of primary insomnia (PI). In this study, 15 subjects with PI who were diagnosed according to Pitsburgh Sleep Quality Index (PSQI), and other 15 age- and gender-matched subjects without insomnia were recruited in the present study. The PI patients received EA (4 Hz/20 Hz, a tolerable electrical current strength) of auricular concha for 30 min, and their resting state functional magnetic resonance imaging (fMRI) data before and after treatment were collected. The healthy subjects received no any treatment and their resting state fMRI data were collected. The diffe-rence of default mode network functional connectivity between the patients and healthy subjects, and changes of the patient's brain functional connectivity after EA treatment were estimated by using seed-point-based analysis (SPBA). Analysis by taking the posterior cingulate gyrus as the seed-point showed that compared with the healthy participants before treatment, the patient's brain functional connectivity between the posterior cingulate gyrus and the right insula, or the inferior frontal gyrus of the right opercularis region, or the right rolandic operculum was increased. After 30 minutes' EA treatment, the functional connectivity between the posterior cingulate gyrus and the precuneus, the left angular gyrus, the left frontal superior gyrus, the left frontal middle cortex, the right temporalis inferior gyrus, the right temporalis middle gyrus or the left medial orbitofrontal cortex was decreased, while the functional connectivity between the posterior cingulate gyrus and the right lingual gyrus, or the cortex surrounding the right calcarine fissure was increased. EA of auricular concha has an instant effect in modulating the brain default mode network in PI patients, which may be its brain mechanism underlying improvement of PI.

Efficacy Comparison of Different Acupuncture Treatments for Primary Insomnia: A Bayesian Analysis.

Background Acupuncture treatments are used frequently in the treatment of primary insomnia considering its less side effect. However, most treatment choices are made just based on personal experience among different forms of acupuncture. This study compared the effectiveness of different forms of acupuncture for primary insomnia by using network meta-analysis. Methods All randomized controlled trials (RCTs) of acupuncture treatments for primary insomnia were searched in seven databases from the date of database inception to January 6, 2019, including PubMed, Web of Science, Embase, Cochrane Library, Wanfang database, China National Knowledge Infrastructure (CNKI) database, and VIP Chinese Science and Technique Journals (CQVIP) database. After screening, the effectiveness rate was extracted from the included RCTs as primary outcomes. The network meta-analysis was performed by Review Manager 5.3, Stata13.0, and GeMTC 0.14.3. Results Forty-two studies were included, which contained 3304 participants among 6 interventions. Based on the ranking probability and compared to western medicine, scalp acupuncture (OR = 8.12, 95% CI (4.07,16.81)) is considered to be the most effective method, followed by electroacupuncture (OR = 6.29, 95% CI (3.36, 12.67)), electroacupuncture combined scalp acupuncture (OR = 5.20, 95% CI (2.43,11.28)), warm acupuncture (OR = 3.79, 95% CI (1.85,8.16)), and conventional acupuncture (OR = 2.86, 95% CI (2.05,3.95)). There was no significant difference between the results of direct and indirect comparisons. Conclusions The finding indicated that five acupuncture methods may be all effective in the treatment of primary insomnia, and scalp acupuncture seems to be the best treatment. However, the overall quality of the included trials could only be ranked as medium to low quality, and higher quality RCTs are warranted for sufficient evidence.

The Effectiveness of Music Therapy on Insomnia Using Persian Traditional Music

Objectives: Although some studies have shown the effectiveness of music therapy on insomnia (secondary insomnia), no study has so far investigated the effectiveness of music therapy with Persian traditional music on the treatment of primary insomnia. Therefore, the purpose of this study was to evaluate the effectiveness of music therapy with Persian traditional music on the treatment of primary insomnia. Methods: This study was a controlled clinical trial with 30 participants with primary insomnia. Participants were randomly assigned to intervention (N = 15) and control (N = 15) groups. Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), and depression, anxiety and stress scales (DASS-21) were used to evaluate the intervention results. Anxiety, stress, depression, insomnia and sleep quality were measured before and six weeks after the intervention. Results: One-way ANCOVA results showed that music therapy with Persian traditional music significantly improved insomnia, sleep quality and depression in the intervention group. There was however no significant difference between the two groups in terms of anxiety and stress. Conclusions: Persian traditional music can be used as an effective and cost-effective way to improve sleep quality and reduce depression associated with primary insomnia.

Using benzodiazepines and Z-drugs for managing primary insomnia in adults in Saudi Arabia: an e-Delphi study to aid the development of clinical guidelines

PurposeThis study aims to obtain consensus statements required for the development of clinical guidelines for the use of benzodiazepines (BZDs) and Z-drugs for the management of primary insomnia in adults in Saudi Arabia.MethodsThree rounds of the e-Delphi technique using a Bristol Online Survey (BOS) were conducted between May and August 2018. The Director of the Saudi Sleep Medicine Group helped recruit the country’s sleep medicine experts. Snowballing was used to forward invitation emails, information sheets, and the survey to known sleep medicine experts and physicians deemed to be interested in the field. All participants’ details were anonymised except to the researcher.ResultsFifteen experts from four different regions and specialities in Saudi Arabia participated in Round 1. Twenty-one statements originated from participants’ responses. In Round 2, there were 17 respondents and 16 of the statements obtained the required consensus of 70% or higher. Eleven experts participated in Round 3 and eight statements received 100% agreement, two received 91%, and six received 82%. Having obtained the required consensus of 80% or higher in Round 3, these 16 statements fulfilled the criteria to be included in future guidelines. The five statements that failed to attain the required consensus were rejected as inappropriate for inclusion in Saudi Arabian clinical guidelines.ConclusionsThe items that achieved the required consensus can be included in future guidelines for the use of BZDs and Z-drugs in the treatment of primary insomnia in adults to standardize best practices in sleep medicine in Saudi Arabia.

Repetitive transcranial magnetic stimulation (rTMS) modulates time-varying electroencephalography (EEG) network in primary insomnia patients: a TMS-EEG study

IntroductionRepetitive transcranial magnetic stimulation (rTMS) is a noninvasive method, and its application in the treatment of primary insomnia (PI) is poorly researched. PI is considered to be a functional disorder with abnormal brain network connections. TMS combined electroencephalography (EEG) is a valuable method for directly probing excitability and dynamic connectivity of different regions in the brain. We aimed to investigate the therapeutic efficacy of rTMS and its impact on brain network connections in PI patients. MethodsTwenty patients with PI were recruited in this study and received 1 Hz rTMS treatment for 14 consecutive days. The severity of symptoms was evaluated using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS). Twenty minutes TMS-EEG were performed before and immediately after treatment. EEG data was collected by 10-20 EEG system with the sample rate of 1024 Hz. Time-varying EEG network was analyzed using the adaptive directed transfer function. The EEG network results of patients were compared with those of 20 healthy subjects. ResultsIn the present study, we found that PSQI, ISI, and ESS ratings of the patients decreased significantly (P＜0.05) after rTMS treatment, and the improvement in ratings lasted one month. Compared with healthy subjects, single-pulse TMS targeting right posterior parietal cortex of PI patients before therapy showed excessive information outflow from the left occipital region, the frontal mid-line region and the right posterior temporal region, in succession. Meanwhile, inadequate information outflow was seen in the right central region, right parietal region, as well as in the right temporal region. Compared with prior treatment, PI patients showed increased information outflow in the left temporal region and decreased information outflow in the frontal mid-line region. ConclusionLow frequency rTMS targeting the right posterior parietal cortex has significant positive effects on the treatment of PI that can last for at least one month and can reverse abnormal changes of time-varying EEG networks.

Wendan decoction for primary insomnia: Protocol for a systematic review and meta-analysis.

Insomnia is a widespread complaint in the general population. Wendan decoction has been widely applied in the treatment of primary insomnia. However, to our knowledge, there has been no systematic review or meta-analysis of randomized controlled trails regarding the effectiveness of this treatment. Here, we provide a protocol to evaluate the efficacy and safety of Wendan decoction for primary insomnia. Relevant randomized controlled trials in 5 English databases [EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, the Allied and Complementary Medicine Databases (AMED), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)], 4 Chinese databases [Chinese Biomedical Literature Database (CBM), Chinese Medical Current Content (CMCC), China National Knowledge Infrastructure (CNKI), and Wanfang Database] will be comprehensively searched by 2 researchers in October 2017. The therapeutic effects according to the Pittsburgh Sleep Quality Index (PSQI) will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a metaanalysis is allowed. This study will provide a high-quality synthesis of current evidence of Wendan decoction for primary insomnia from several aspects including PSQI, the total scores of the Insomnia Severity Index (ISI), syndrome according to standards for assessing Traditional Chinese medicine and adverse events. The conclusion of our systematic review will provide evidence to judge whether Wendan decoction is an effective intervention for patient with primary insomnia. The outcomes of this systematic review will offer implications of the use of Wendan decoction treatment for primary insomnia patients. This knowledge informing recommendations will be provided by researchers who are interested in the treatment of primary insomnia. The results of this study will be disseminated through presentation at a conference and publication of the data in a peer-reviewed journal. PROSPERO CRD 42017065664.

State of the Art Reviews: Nonpharmacologic Approaches for the Treatment of Insomnia

Insomnia is a common condition resulting in significant clinical and economic consequences. This review discusses the efficacy of nonpharmacologic treatment options commonly recommended for sleep onset and sleep maintenance insomnia. In addition, the efficacy of these approaches as part of a multifaceted intervention and in comparison to that of pharmacologic options is reviewed. The primary literature and review articles on the nonpharmacologic treatment of insomnia were identified through a MEDLINE search between 1966 and August 2006. Articles on the nonpharmacologic treatment of primary insomnia, including clinical trials on the efficacy of individual and combination treatment options, were reviewed. The nonpharmacologic treatment options for insomnia include stimulus control, sleep hygiene educations, sleep restriction, paradoxical intention, relaxation therapy, biofeedback, and cognitive-behavioral therapy. These treatment strategies produce significant changes in several sleep parameters of chronic ...

Feasibility and Effects of Touch Massage and Nurse Led Sleep Counselling in the Treatment of Primary Insomnia

Cognitive Behavioral Therapy (CBT) is basically the only evidence based treatment both in short- as well as long term treatment of insomnia. Previous studies suggest that massage may have a role in ...

Current evidence is not yet adequate to provide support for the use of auricular acupuncture in the treatment of primary insomnia

Current evidence is not yet adequate to provide support for the use of auricular acupuncture in the treatment of primary insomnia

Auricular acupuncture with seed or pellet attachments for primary insomnia: a systematic review and meta-analysis.

BackgroundPrimary insomnia is a common health issue in the modern world. We conducted a systematic review of the auricular therapy, aiming to evaluate whether there are advantages of auricular acupuncture with seed or pellet attachments for the treatment of primary insomnia.MethodsA search of relevant literatures was performed on major medical databases, including Medline, Embase, CENTRAL, CBM, CNKI, VIP, Wanfang Data and so on. Risk of bias evaluation, meta-analysis, sensitivity analysis and evidence rating of all extracted information were conducted also.ResultsA total of 1381 records were identified, with 15 studies deemed eligible for the present review. Meta-analyses were conducted in two comparisons separately: participants received auricular acupuncture were more likely to make an improvement in clinical effective rate (RR = 1.40, 95% CI 1.07 to 1.83), sleep duration (MD = 56.46, 95% CI 45.61 to 67.31), sleep efficiency(MD = 12.86, 95% CI 9.67 to 16.06), global score on PSQI (MD = -3.41, 95% CI -3.93 to -2.89), number of awakenings( MD = -3.27, 95% CI -6.30 to -0.25) and sleep onset latency(MD = -10.35, 95% CI -14.37 to -6.33) when compared to sham auricular acupuncture or placebo; while in auricular acupuncture VS medications comparison, a better effective rate (RR = 1.24, 95% CI 1.15 to 1.34), better sleep efficiency(MD = 21.44, 95% CI 16.30 to 26.58), lower PSQI score (MD = -3.62, 95% CI -4.59 to -2.65) and less adverse effect (RR = 0.11, 95% CI 0.04 to 0.26) can be seen also in auricular acupuncture group. Although these results suggested benefits of auricular acupuncture, the overall quality of evidence rated by the GRADE system was low.ConclusionStatistical analyses of the outcomes revealed a positive effect of auricular acupuncture for primary insomnia. Nonetheless, considering the poor methodological quality, insufficient sample size and possible publication bias, current evidence is not yet adequate to provide a strong support for the use of auricular acupuncture in the treatment of primary insomnia. More strictly designed clinical studies will be needed to obtain a more explicit conclusion.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-015-0606-7) contains supplementary material, which is available to authorized users.