We’ve discussed acupuncture for insomnia before on the blog. Here, here and here.
Insomnia Pathogenesis and Multidimensional Mechanisms of Acupuncture: A Narrative Review
- PMID: 42065037
- PMCID: PMC13127439
- DOI: 10.2147/IJGM.S591463
Abstract
Objective: Acupuncture for Insomnia Insomnia is a common sleep disorder marked by difficulties in sleep initiation, maintenance, and daytime performance. Pharmacological treatments offer short-term relief but are limited by tolerance, dependence, and adverse effects. This review aims to evaluate recent advances in acupuncture for insomnia, with emphasis on clinical efficacy and underlying mechanisms.
Methods: This narrative review was conducted through a structured literature search of PubMed, Web of Science, and CNKI databases covering studies published from January 2020 to December 2025. The search combined keywords including “insomnia”, “acupuncture”, “mechanism”, “autonomic nervous system”, “inflammation”, and “HPA axis”. Both clinical and preclinical studies published in English or Chinese were considered. Studies were screened based on relevance to acupuncture interventions for insomnia and mechanistic outcomes. Although a formal systematic review protocol was not applied, emphasis was placed on representative and high-quality evidence to summarize key mechanistic pathways.
Results: Evidence suggests that acupuncture improves subjective sleep quality, alleviates hyperarousal, reduces systemic inflammation, and promotes neuroimmune balance through multidimensional mechanisms. However, limitations remain, including small sample sizes, methodological heterogeneity, inadequate blinding, and insufficient mechanistic exploration.
Conclusion: Acupuncture is a promising integrative intervention for insomnia with both symptomatic and mechanistic benefits. Future studies should prioritize large-scale, multicenter randomized controlled trials and standardized protocols, while incorporating multi-omics, neuroimaging, and precision medicine approaches. Interdisciplinary collaboration may advance acupuncture from empirical therapy to precision medicine, providing new opportunities for comprehensive insomnia management.
Keywords: HPA axis; acupuncture; autonomic nervous system; inflammation; insomnia; precision
Introduction to Acupuncture for Insonmia
Insomnia is a prevalent sleep disorder characterized by difficulty initiating sleep, impaired sleep maintenance, or early awakening, often accompanied by daytime functional impairment.1 In recent years, the accelerated pace of life and increased psychological stress have contributed to a rising incidence of insomnia, imposing a substantial burden on both individual quality of life and public health. The 2023 China Healthy Sleep White Paper reported that approximately 60.4% of the Chinese population experiences varying degrees of sleep disturbances.2 Among these, insomnia is the most common subtype, with about 10% of adults experiencing persistent symptoms; notably, its prevalence is significantly higher in women than in men (17.6% vs 10.1%).3 Evidence indicates that sleep disorders not only cause abnormalities in serological markers and immune dysfunction but are also strongly associated with severe physical and mental illnesses, including hypertension, depression, and cardiovascular disease.4,5 Current clinical treatments primarily include cognitive behavioral therapy for insomnia (CBT-I) and pharmacological interventions.6,7 However, CBT-I faces challenges in terms of specificity and adherence, while pharmacological treatments are often accompanied by side effects, tolerance, and dependency.8,9 Therefore, there is an urgent need for safe, effective, and sustainable therapeutic strategies.
As an integral component of traditional Chinese medicine, acupuncture has gained increasing global attention and recognition. Substantial research supports its application across multiple clinical disciplines, including neurology, musculoskeletal medicine, obstetrics and gynecology, oncology, and gastroenterology.10,11 Acupuncture, a therapy with minimal adverse effects, shows unique advantages in the treatment of insomnia and has gradually achieved international recognition.12 Clinical studies demonstrate that acupuncture can significantly improve sleep quality and duration13 and is superior to sham acupuncture in enhancing sleep efficiency and reducing insomnia severity.14 Basic and translational research further suggests multiple mechanisms underlying these effects: acupuncture stimulates neuronal activity in the brain,15 regulates the synthesis and release of sleep-related neurotransmitters such as catecholamines, glutamate, and melatonin,16 and increases nitric oxide levels in both central and peripheral systems.17 Moreover, accumulating evidence indicates that acupuncture modulates autonomic nervous system function,18 and neuroimaging studies suggest that it alters functional connectivity and activity across brain regions associated with sleep regulation.19,20 Nonetheless, despite robust evidence of its efficacy, the precise central regulatory mechanisms of acupuncture remain incompletely understood, limiting its clinical translation and broader application.
To further clarify the research landscape, we analyzed the number of publications on acupuncture and insomnia indexed in CNKI and PubMed from 2020 to 2025 (Figure 1). The results revealed that CNKI publications have increased rapidly since 2020, especially after 2025, reflecting growing domestic attention and widespread clinical application of acupuncture in insomnia treatment. In contrast, PubMed publications, although fewer in number, have shown a steady increase since the early 2000s, with greater emphasis on randomized controlled trials and mechanistic investigations. This discrepancy highlights differences in research priorities: domestic studies focus mainly on clinical efficacy and practical applications, while international studies emphasize evidence-based validation and mechanistic exploration. These findings suggest that future research should integrate the strengths of both domestic and international perspectives to promote standardization, internationalization, and mechanistic elucidation of acupuncture for insomnia. Despite increasing evidence supporting acupuncture for insomnia, several critical gaps remain. First, the underlying mechanisms of acupuncture are still debated, with inconsistencies reported in neuroimaging findings and biomarker studies, partly due to heterogeneity in study design and stimulation protocols. Second, although cognitive behavioral therapy for insomnia (CBT-I) is recommended as first-line treatment, its long-term adherence and accessibility remain limited, whereas acupuncture may offer a complementary or alternative approach with distinct advantages in certain patient populations. Accordingly, this narrative review was based on literature retrieved from PubMed, Web of Science, and CNKI databases. Relevant studies published in English and Chinese were screened, focusing on clinical efficacy and mechanistic insights of acupuncture in insomnia, including neuroendocrine regulation, autonomic function, and inflammatory pathways. Importantly, this review focuses on three core mechanistic domains—autonomic nervous system (ANS) regulation, inflammatory modulation, and hypothalamic–pituitary–adrenal (HPA) axis activity—because they are central to the hyperarousal model of insomnia. However, other emerging mechanisms, including circadian clock gene regulation and the gut–brain axis, may also contribute to acupuncture effects and warrant further investigation. By defining this scope, we aim to provide a focused yet integrative synthesis of current evidence while highlighting directions for future research.
