Does valerian work for insomnia? An umbrella review of the evidence.

Valerian is one of the most used herbal agents (phytotherapeutics) to manage sleep disturbances, in particular, sleep-onset difficulties in young adults. However, the evidence based on primary studies and systematic reviews that supports its use in this domain is weak or inconclusive. In the current study, an umbrella review was performed on the efficacy of valerian for sleep disturbances with a focus on insomnia. As such, only systematic reviews (with or without meta-analysis) were considered for this study. Systematic searches in PubMed, Web of Science, Scopus, Cochrane Database of Systematic Reviews, PROSPERO and CNKI databases retrieved 70 records. Only 8 articles were considered eligible for qualitative analysis. Overall, data suggested that valerian has a good safety profile, however, the results showed no evidence of efficacy for the treatment of insomnia. Moreover, valerian appears to be effective concerning subjective improvement of sleep quality, although its effectiveness has not been demonstrated with quantitative or objective measurements. Despite its widespread use and prescription by general practitioners, psychiatrists and other professionals, valerian does not have empirical support for insomnia. Further studies, in particular high quality randomized controlled trials, are highly recommended since there are scarce studies and the existing ones are quite heterogeneous and with low methodological quality. The implications of our findings for clinical practice are critically discussed.

Effectiveness and safety of acupuncture in treatment of pregnancy-related symptoms: a systematic review and Meta-analysis.

OBJECTIVE: To systematically evaluate the efficacy and safety of acupuncture (AM) in the treatment of pregnancy-related symptoms such as acute vomiting during pregnancy. METHODS: We comprehensively searched the available literature up to November 2021, including PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure Database, for randomized controlled trials (RCTs) on AM for the treatment of severe vomiting, insomnia, pharyngeal and pelvic pain, mood abnormalities, and dyspepsia during pregnancy. RESULTS: Sixteen RCTs with a cumulative sample size of 1178 cases were included. Of these, 964 patients were included in the Meta-analysis. The Meta-analysis results showed that AM was more efficient than Western medicine in treating discomfort during pregnancy [odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.11, 1.28), P < 0.01]. AM was better than the control group in improving the visual analog scale scores [standard mean difference (SMD) = 0.62, 95% CI(0.53, 0.71), P < 0.01]. AM was superior to the control group in improving Numerical Rating Scale (NRS) symptom scores [OR = 7.31, 95% CI(3.36, 15.94), P < 0.01]. There was no significant difference in adverse effects between the AM and sham-AM groups and the analgesic drug group [OR = 0.70, 95% CI(0.39, 1.28), P = 0.25], but the treatment and control groups had mild adverse effects with a low incidence. CONCLUSIONS: AM is more effective than other treatments or pharmacotherapy alone in the treatment of pregnancy-related symptoms, and is relatively safe. However, the quality of the included trials was rather poor, and high-quality studies are required to confirm our findings.

Efficacy of electroacupuncture stimulating Shenmen (HT7), Baihui (GV20), Sanyinjiao (SP6) on spatial learning and memory deficits in rats with insomnia induced by para-chlorophenylalanine: a single acupoint combined acupoints.

OBJECTIVE: To investiage the effect of electroacupuncture (EA) at a single acupoint of Shenmen (HT7), Baihui (GV20), Sanyinjiao (SP6) and at combined acupoints of Shenmen (HT7) and Baihui (GV20) and Sanyinjiao (SP6) on the PKA/CREB and BDNF/TrkB signaling, as well as neuroapoptosis and neurogenesis in hippocampus and elucidate the underlying mechanism of single and combined acupoints on ameliorating spatial learning and memory deficits in a rat model of primary insomnia. METHODS: Primary insomnia was modeled by intraperitoneal injection of para-chlorophenylalanine (PCPA) once daily for 2 d. EA was applied at Shenmen (HT7), Baihui (GV20), Sanyinjiao (SP6), or Shenmen (HT7) + Baihui (GV20) + Sanyinjiao (SP6) (combined) for 30 min daily for 4 d. Spatial learning and memory function was evaluated by the Morris water maze (MWM) test. Protein expressions of hippocampal cAMP-dependent protein kinase (PKA)-Cß, phosphorylated cAMP-responsive element-binding protein (p-CREB), brain-derived neurotrophic factor (BDNF), and tyrosine kinase receptor B (TrkB) were evaluated by Western blotting. Neuronal apoptosis in the hippocampus was detected with the transferase-mediated dUTP-X nick end labeling assay. Endogenous neurogenesis was examined with bromodeoxyuridine staining. The MWM test and hippocampal p-CREB, BDNF, and TrkB protein levels in the combined acupoints group were evaluated after the administration of a PKA-selective inhibitor (H89). RESULTS: Spatial learning and memory were significantly impaired in rats with insomnia. The spatial learning deficits were ameliorated in the Shenmen (HT7), Baihui (GV20), Sanyinjiao (SP6), and combined groups; this improvement was significantly greater in the combined group than the single acupoint groups. The spatial memory impairment was improved in the combined, Baihui (GV20), and Shenmen (HT7) groups, but not the Sanyinjiao (SP6) group. The expressions of PKA-Cß, p-CREB, BDNF, and TrkB were decreased in rats with insomnia. All these proteins were significantly upregulated in the combined group. PKA/p-CREB protein levels were elevated in the Baihui (GV20) and Shenmen (HT7) groups, whereas BDNF/TrkB expression was upregulated in the Sanyinjiao (SP6) group. The staining results showed significant attenuation of hippocampal cell apoptosis and increased numbers of proliferating cells in the combined group, whereas the single acupoint groups only showed decreased numbers of apoptotic cells. In the combined group, the PKA inhibitor reversed the improvement of spatial memory and upregulation of p-CREB expression caused by EA, but did not affect its activation of BDNF/TrkB signaling. CONCLUSIONS: EA at the single acupoints Baihui (GV20), Shenmen (HT7), or Sanyinjiao (SP6) had an ameliorating effect on the spatial learning and memory deficits induced by insomnia. EA at combined acupoints exerted a synergistic effect on the improvements in spatial learning and memory impairment in rats with insomnia by upregulating the hippocampal PKA/CREB and BDNF/TrkB signaling, facilitating neurogenesis, and inhibiting neuronal apoptosis. These findings indicate that EA at combined acupoints [(Baihui (GV20), Shenmen (HT7), and Sanyinjiao (SP6)] achieves a more pronounced regulation of hippocampal neuroplasticity than EA at single acupoints, which may partly explain the underlying mechanisms by which EA at combined acupoints exerts a better ameliorative effect on the cognitive dysfunction caused by insomnia.

Factors affecting clinical pharmacist decision-making when reviewing and prescribing z-drugs in primary care: a qualitative interview study.

BACKGROUND: Z-drugs (zopiclone, zolpidem and zaleplon) are drugs with dependence forming characteristics licensed for the short-term management of insomnia. Patients regularly prescribed z-drugs are candidates for 'structured medication reviews', routinely delivered by pharmacists employed in general practice or primary care networks in England. AIM: To understand the factors that affect pharmacist decision-making when reviewing and prescribing z-drugs in primary care. METHOD: Qualitative semi-structured interviews with general practice based pharmacists were conducted using MS Teams®. Clinical vignettes to simulate real-world practice were sent to participants and then discussed at interview, followed by structured interview questions. Interview transcripts were thematically analysed to identify themes and sub-themes expressed by participants. RESULTS: Three over-arching themes emerged over the course of qualitative interviews with 10 clinical pharmacists: the perceived role of the pharmacist in deprescribing, the decision-making process, and perceptions of best practice. Pharmacists highlighted that relationships with patients were an important foundation for medication reviews regarding z-drugs and that at times they felt pressure to continue prescribing z-drugs beyond their licensed use. Participants explored rule-based reasoning and compassionate care when rationalising their decision-making for reviewing and prescribing z-drugs. CONCLUSION: Patient factors, time pressures, 'rule-based' beliefs and pharmacist self-efficacy were key practice aspects which can influence the pharmacist decision-making process when reviewing or prescribing z-drugs. Pharmacists believed z-drugs should be short-term interventions for insomnia, with non-pharmacological, holistic treatment being more appropriate for long term management.

Acupuncture and moxibustion for malignant tumor patients with psychological symptoms of insomnia, anxiety and depression: a systematic review and Meta-analysis.

OBJECTIVE: To evaluate the efficacy and safety of acupuncture and moxibustion therapy (AMT) for cancer-related psychological symptoms (CRPS) of insomnia, depression and anxiety. METHODS: Seven databases were searched for randomized controlled trials (RCT) comparing AMT to routine care or conventional drug for alleviating CRPS of insomnia, depression, and anxiety before April 2020. Two independent reviewers performed the data extraction and assessed the risk of bias. RESULTS: A total of 30 RCTs involving 2483 cancer patients were enrolled. The pooled analysis indicated that the treatment group was significantly better than the control group in improving the depression effective rate [= 1.29, 95% (1.12, 1.49), 0.0004], the quality of life (QOL) [1.11, 95% (0.80, 1.42), 0.000 01], and reducing Self-rating Anxiety Scale (SAS) [ï¹£7.75, 95% (ï¹£10.44, ï¹£5.05), 0.000 01]. But there was no statistically significant difference between two groups in improving the insomnia effective rate [= 1.18, 95% (0.93, 1.51), 0.18]. The subgroup analysis showed the effectiveness of different intervention on CRPS. Compared with routine care, AMT helps relieve CRPS better evaluated by Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD), and Self-rating Depression Scale (SDS), and depression effective rate. Compared with conventional drug, AMT performs better evaluated by SDS, depression effective rate and QOL. Moreover, the conventional drug showed higher treatment efficacy on improving insomnia effective rate compared with AMT. Compared to conventional drug, AMT plus conventional drug resulted in a significant reduction on CRPS such as PSQI, HAMD, SDS, and SAS, and also had a meaningful improvement on insomnia effective rate, depression effective rate and QOL. Fewer published reports were found on the adverse events of AMT than the conventional drug. CONCLUSION: The results suggested that AMT might be effective in improving CPRI; however, a definite conclusion could not be drawn because the quality of trials are low. Further large-scale and high-quality RCTs to verify the efficacy and safety of AMT on CRPS are still warranted.

Efficacy of needling Baihui (GV20), Neiguan (PC6), Shenmen (HT7) and Taichong (LR3) on cerebral cortical blood oxygen level in rats with insomnia.

OBJECTIVE: To evaluate the effect of needling Baihui (GV20), Neiguan (PC6), Shenmen (HT7) and Taichong (LR3) on cerebral cortical blood oxygen level in rats with insomnia identified as liver- stagnation pattern in terms of Traditional Chinese Medicine. METHODS: Sixty Wistar rats were randomly divided into blank group ( 10), the rest of the rats were clamped tail as stimulation combined with injected intraperitoneally p-chlorophenylalanine (PCPA) to establish sleep deprivation model. After the successful replication of the model, they were randomly divided into model group, grabbing group, Western Medicine group, acupuncture group and sham acupuncture group, with 10 rats in each group. The model group was given normal saline; The grasping group was grasped in the same way as the two treatment groups; Western medicine group was given estazolam solution; The acupuncture group was treated with the acupuncture method of "soothing the liver and regulating mind" needling Baihui (GV20), Neiguan (PC6), Shenmen (HT7) and Taichong (LR3); The sham acupuncture group were needled with four non-acupoint sites. After 7 d of treatment of rats in each group, sodium pentobarbital sleep experiment was used to evaluate the sleep latency (SL) and sleep time (ST). The percentage of rats entering the open arm (OE%) and the percentage of time entering the open arm (OT%) in each group were monitored by elevated cross maze, and the vertical score, horizontal crossing times, central grid score and modification times were monitored by open field test, functional near infrared spectroscopy (fNIRs) was used to monitor the changes of oxygenated hemoglobin (Oxy-Hb), deoxyhemoglobin (Deoxy-Hb) and total hemoglobin (Total-Hb) in the cerebral cortex of rats in each group under light stimulation and dark stimulation, the statistically significant channel combinations were selected from 8 light sources and 12 detectors (S-D). According to the position of the light source detector covering the cerebral cortex, Preliminarily determine the key brain areas of insomnia (the preliminary experiment found that 6S-8D and 7S-9D were the key channels of insomnia under light stimulation, and the corresponding brain areas were prefrontal lobe and occipital lobe respectively; 7S-7D channel under dark stimulation, and the corresponding brain area was occipital lobe); The hemodynamic map of cerebral cortex was constructed through the absolute value of whole brain blood oxygen level. Further identify key brain regions for insomnia. RESULTS: Compared with the blank group, ST, OE%, OT%, the vertical score, horizontal crossing times, central grid score, the concentration of Deoxy-Hb in prefrontal and occipital lobes were decreased significantly (<0.01), and the concentrations of SL, modification times, Oxy-Hb and Total-Hb were increased significantly (<0.01); There was no difference in the above indexes between the model group and the grabbing group (>0.05); After treatment, ST, OE%, OT%, the vertical score, horizontal crossing times, central grid score and Deoxy-Hb concentration in acupuncture group and Western medicine group increased significantly, while SL, modification times, Oxy-Hb and Total-Hb concentrations were decreased significantly (<0.01, <0.05), Compared with the Western Medicine group, the values of OE% and OT% were more significantly higher in the acupuncture group (<0.05), while the rest of the indexes were not significantly different between the two groups (>0.05); Compared with the acupuncture group, ST, OE%, OT%, the vertical score, horizontal crossing times, central grid score and the concentration of deoxy Hb in the sham acupuncture group decreased significantly (<0.01), and the concentrations of SL, modification times, Oxy-Hb and Total-Hb increased significantly (<0.01). CONCLUSIONS: The needling method for soothing the liver and regulating mind could improve the abnormal behavior of insomnia rats with liver stagnation, and its effect on the improvement of abnormal mood caused by insomnia with liver stagnation is better than that of Western Medicine, and the mechanism of action may be related to the regulation of blood oxygen metabolism in the prefrontal and occipital lobes of the cerebral cortex by acupuncture.

The E2R (Emotion, regression, repair) method: A case study of this new pragmatic hypnotherapy technique.

The E2R (Emotion, Regression, Repair) method is a pragmatic and innovative technique for treating psychological complaints. It is the result of the professional experience of two caregivers who have been training medical and paramedical colleagues since 2016 in this method. There is always an Emotion in the symptom that a patient presents. During the trance, the hypnotherapist uses it as a thread for age Regressions, often up to 3 years old. The patient can then identify a situation that triggered an identical experience. They self-reorganizes their emotional experience according to their needs, accompanied step by step by the therapist who follows the protocol of the repair loop. This new emotional reality experienced in trance replaces the factual reality of the previous trauma and reduces or even eliminates the present complaint through an adapted Repair. The E2R method works without taking a prior hypnotizability test. The need for change and the desire to engage in hypnotherapy are the only predispositions required, regardless of the complaint. A case study of a patient with chronic severe insomnia who received four sessions of hypnotherapy using the E2R protocol illustrates this approach and its benefits.

Effects of exercise training and exercise plus acupuncture on chronic insomnia: a feasibility study.

Objective: The aim of this study was to investigate the effects of exercise and exercise plus acupuncture on chronic insomnia. Material and Methods: suggest replacing with "effects of" no feasibility things are reported chronic insomnia were randomized to a 12-week treatment with exercise or exercise plus acupuncture. Exercise treatment included 50 minutes of moderate-intensity aerobic exercise (50% of reserve heart rate), on a treadmill, 3 times/wk. Exercise plus acupuncture treatment included the exercise protocol plus acupuncture once per week. Pre- and post-treatments measures included insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), polysomnography (PSG), 10 days-sleep diary, state-trait anxiety inventory, Beck depression inventory, quality of life (SF-36), and morning cortisol level. Results: No group by time interaction was found for insomnia severity, sleep, mood or quality of life. Significant time differences (p<0.05) were observed for ISI, PSQI, and some variables of sleep diary. Polysomnography data showed a decrease in rapid eye movement (REM) latency after the interventions. Significant time improvements were also observed for mood, anxiety, depression, and quality of life. A significant moderate correlation was found between changes in the ISI and morning cortisol level. Conclusion: There were no significant differences between treatments on insomnia severity, sleep, mood or quality of life. Exercise and exercise plus acupuncture were efficacious for decreasing insomnia severity to subthreshold insomnia. Greater reduction in morning cortisol was associated with a greater reduction on insomnia severity across both treatments.

Altered thalamic functional connectivity and cerebral blood flow in insomnia disorder: a resting-state functional magnetic resonance imaging study.

BACKGROUND AND PURPOSE: The thalamus plays a crucial role in sleep regulation, but few studies have examined functional connectivity of the thalamus in insomnia disorder. This study aimed to investigate the connectivity patterns and perfusion of the thalamus in patients with insomnia disorder using resting-state functional connectivity and three-dimensional arterial spin labeling (3D ASL). MATERIALS AND METHODS: In total, 56 patients with insomnia disorder and 59 healthy control participants with a similar age-, gender-, and education lever distribution underwent resting-state functional magnetic resonance imaging (rs-fMRI) and 3D-ASL. The thalamus was selected as the seed region. Whole-brain connectivity was assessed using rs-fMRI. Cerebral blood flow (CBF) of the bilateral thalamus was measured with 3D-ASL using region-of-interest (ROI) analysis. All participants completed a series of neuropsychological assessments. Sleep parameters were assessed via polysomnography (PSG). The relationships between imaging parameters and clinical variables were assessed with Pearson correlation analysis. RESULTS: Compared with healthy controls, patients with insomnia disorder exhibited increased connectivity between the left thalamus and right precentral gyrus, and right thalamus and left middle frontal gyrus (MFG), right superior parietal lobule (SPL) and right superior frontal gyrus (SFG). Whereas decreased connectivity was noted between the right thalamus and left posterior cerebellar lobe including Crus I, Crus II, and VII b/VII. Connectivity between the right thalamus and left Crus I was positively correlated with MoCA scores (r = 0.286, P = 0.036) in insomnia disorder. CONCLUSIONS: Our findings illustrate functional abnormalities in brain connectivity and their relationship with cognitive impairments in insomnia disorder, providing novel insight into the neural mechanisms of insomnia disorder.

Stressful events, depressive symptoms, and frailty associated to older adults' survival and mortality.

This study analyzed factors associated with survival and mortality risk of community-dwelling older adults, considering the intensity of stressful life events, depressive symptoms, insomnia, frailty, multimorbidity, and sociodemographic factors. This is a longitudinal study on survival of older adults interviewed between 2008-2009, with follow-up after 8 years. Survival and mortality risks were analyzed using the Kaplan-Meier curve, Log Rank test, and Cox proportional-hazards model (p < 0.05). Stressful events affecting older adults' children or grandchildren were associated with higher mortality risk; depressive symptoms and frailty were associated with lower survival. Comprehensive care for older adults must involve events regarding their family relationships, especially those affecting their progeny, due to the impact they can have on older adults' survival, besides evaluating depressive symptoms and frailty.

Electroacupuncture for treating cancer-related insomnia: a multicenter, assessor-blinded, randomized controlled, pilot clinical trial.

BACKGROUND: Insomnia is one of the most frequent symptoms in people with cancer. Electroacupuncture has been widely used in people with cancer or insomnia. We explored the feasibility and preliminary effectiveness of electroacupuncture for cancer-related insomnia. METHODS: People with cancer and insomnia disorder were randomly allocated to electroacupuncture, sham-electroacupuncture, or usual care groups. Participants received either 10 sessions of electroacupuncture at real acupoints, sham-electroacupuncture at non-acupoints, or usual care in each group for 4 weeks. We calculated the recruitment, adherence, and completion rates of participants. The Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), sleep diary and actigraphy-derived sleep parameters, Functional Assessment of Cancer Therapy-Fatigue (FACT-F), Montreal Cognitive Assessment (MoCA), and salivary levels of cortisol and melatonin were evaluated as outcome measures. RESULTS: Twenty-two participants were enrolled (8, 6, and 8 respectively in the electroacupuncture, sham-electroacupuncture, and usual care groups) and 20 participants completed the trials (8, 4, and 8 respectively). The recruitment, adherence, and completion rates were 78.57% (22/28), 95.45% (21/22), and 90.91% (20/22), respectively. Most of the participants had previously received conventional treatment for insomnia, but few had received Korean medicine treatment, without any demographic or clinical differences between groups. In the electroacupuncture group, there was a statistically significant reduction of 10.13 (mean) ± 8.15 (standard deviation) and 5 ± 3.70 points in mean ISI and PSQI scores at 4 weeks post-treatment (P = .0098 and .0066), compared with sham-electroacupuncture (2.06 ± 7.15 and 1.61 ± 4.34; P = .4796 and .3632) and usual care (3.25 ± 2.60 and 1.38 ± 2.13; P = .0096 and .1112). Although there was no significant difference in ISI score between groups at 4 weeks post-treatment, the electroacupuncture group continued to improve significantly at 4 weeks' follow-up, showing borderline and significant differences compared to the sham-electroacupuncture and usual care (P = .0614 and .0015). The FACT-F scores in electroacupuncture group showed a significant improvement compared with the sham-electroacupuncture group (P = .0305). No electroacupuncture-related adverse events were reported. CONCLUSIONS: Electroacupuncture might be feasible for cancer-related insomnia, despite slow participant recruitment. Additional trials with adequately powered sample sizes and a substantial change to the recruitment procedure are needed. TRIAL REGISTRATION: Clinical Research Information Service, KCT0002162 . Submitted 27 October 2016, Registered 2 December 2016 - Retrospectively registered (The first participant enrolment: 28 November 2016).

Using "WeChat Sports" program to explore the relationship between number of steps and insomnia in patients with chronic insomnia / 中国基层医药

Objective:To investigate the relationship between number of daily steps and insomnia in patients with chronic insomnia using "WeChat Sports" program.Methods:A total of 190 patients with insomnia who received treatment in Department of Neurology, Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou Hospital between October 2017 and October 2019. General data (age, sex, body mass index, history of smoking and alcohol use) and the number of daily steps recorded by "WeChat Sports" program were collected. Patients whose average number of daily steps was greater than 7500 were assigned to the sufficient exercise group ( n = 68), and the remaining patients were assigned to the insufficient exercise group ( n = 122). Patient symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), The Patient Health Questionnaire-9, and generalized Anxiety Disorder scale-7. Scale evaluation and data collection were performed by two trained investigators. Data were compared between the two groups. The correlation between average number of daily steps and each scale score was analyzed. Results:Total PSQI score in the sufficient exercise group was significantly lower than that in the insufficient exercise group [(12.94 ± 3.14) points vs. (14.93 ± 2.99) points, t = 4.31, P < 0.001]. Scores of subjective sleep quality, sleep latency, habitual sleep efficiency, use of sleep medication, and daytime dysfunction were significantly lower in the sufficient exercise group than those in the insufficient exercise group ( P = 0.011, 0.008, 0.025, 0.039, 0.006). The Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7 scores in the sufficient exercise group were significantly lower than those in the insufficient exercise group ( P = 0.011, P = 0.002). The average number of daily steps was significantly negatively correlated with total PSQI score, Patient Health Questionnaire-9 score, Generalized Anxiety Disorder Scale-7 score, and score of each PSQI component (subjective sleep quality, sleep latency, habitual sleep efficiency, and daytime dysfunction) ( r = -0.29, -0.16, -0.19, -0.24, -0.15, -0.18, -0.23). Conclusion:Insomnia patients with insufficient daily exercise have more serious insomnia and emotional symptoms than those with sufficient daily exercise. Daily average exercise is correlated with the severity of insomnia and emotional symptom.

Physical exercise as a therapeutic approach for adults with insomnia: systematic review and meta-analysis

ABSTRACT Objective To systematically review the effects (benefits and harms) of different types of physical exercise on insomnia outcomes in adult populations with no mood disorders. Objective and subjective sleep outcomes and related mismatches were analyzed. Methods Systematic review and meta-analysis. Quality of evidence was also examined. Results Six studies including 295 participants with insomnia diagnosis were selected. Yoga, Tai Chi, resistance exercise and aerobic exercise were used in protocols with different duration, intensity and frequency. Studies involved different populations, including inactive or sedentary individuals, older adults and postmenopausal women. Physical exercise improved subjective sleep quality (very low quality of evidence) and reduced insomnia severity (high quality of evidence). Conclusion Findings suggest individualized physical exercise must be addressed to design optimal protocols, with standardized type, duration, intensity, and frequency. For the time being, physical exercise may be considered an alternative and/or ancillary therapeutic modality for patients diagnosed with insomnia. Physical exercise can be used to improve subjective complaints, but not objective sleep outcomes.

Efficacy and Safety of Auricular Acupuncture for the Treatment of Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial.

Among women, breast cancer is the most commonly diagnosed cancer worldwide. Sleep problems impair 40-70% of breast cancer survivors. This randomized controlled trial evaluates the effect of auricular acupuncture on sleep quality in breast cancer survivors suffering from insomnia. Fifty-two female breast cancer survivors with insomnia (mean age 55.73 ± 8.10 years) were randomized either to 10 treatments of auricular acupuncture within five weeks (n = 26), or to a single session of psychoeducation plus an insomnia advice booklet (n = 26). The primary outcome was sleep quality (measured by the Pittsburgh Sleep Quality Index) at week 5. Secondary outcomes were inflammation parameter (interleukin-6), stress, anxiety, depression, quality of life, and fatigue at week 5, and sleep quality, stress, anxiety, depression, quality of life, and fatigue 17 and 29 weeks after randomization. Intention-to-treat analysis showed a significantly stronger increase in sleep quality in the auricular acupuncture group compared to the psychoeducation group (p = 0.031; η2p = 0.094) at week 5. Furthermore, auricular acupuncture improved stress (p = 0.030; η2p = 0.094), anxiety (p = 0.001; η2p = 0.192), and fatigue (p = 0.006; η2p = 0.148) at week 5 compared to psychoeducation. No significant group difference was found concerning the other outcomes at week 5, or in any outcome at week 17 or week 29. No serious adverse events occurred during the study period. In conclusion, a semi-standardized group auricular acupuncture might be an effective and safe intervention in treating insomnia in breast cancer survivors in the short term, and may reduce stress, anxiety, and fatigue as well. Long-term effects remain questionable.

Light therapy for the treatment of delayed sleep-wake phase disorder in adults: a systematic review.

Delayed sleep-wake phase disorder (DSWPD) is characterized by sleep onset times, beyond the usual schedules and social conveniences, which potentially impacts on health as well as on school and professional performance. The most common treatment for DSWPD is the light administration (light therapy), through light devices, with or without behavioral instructions. Since there is no consensus in the literature about its efficacy and how it should be processed, this study aims to evaluate the light therapy effectiveness in the delayed sleep-wake phase disorder therapeutics. A systematic review was conducted using the MEDLINE/PubMed, Virtual Health Library Brazil, PsycINFO, Web of Science and Scopus databases along with a hand search until September 2020. The included studies presented participants diagnosed with insomnia or DSWPD, over 18-years old, treated only with morning light therapy, mentioning the light intensity (lux) used, and investigations with a control group. Studies reporting individuals with neurological or psychiatric disorders, shift-workers, or evaluating other sleep disorders were excluded. Among the 411 studies identified, five were selected for this review, resulting in a total sample of 140 individuals. Only two studies produced long-term results, showing that the benefits did not persist. In most studies, there were no statistically significant differences in the variables when comparing the intervention group and the control group. However, there were substantial clinical and laboratory advances in the sleep phase using light therapy when comparing phase advances for the same group concerning baseline values of sleep variables.

Efficacy of intradermal acupuncture for insomnia: a meta-analysis.

OBJECTIVES: To provide updated evidence from randomized controlled trials (RCTs) on the efficacy of intradermal acupuncture for insomnia. METHODS: A search of relevant literatures was performed on major medical databases, including the Cochrane Library, PubMed, EMBASE, CBM, CNKI, VIP, Wanfang Data and so on. Risk of bias evaluation, meta-analysis, sensitivity analysis and evidence rating of all extracted information were also conducted. RESULTS: A total of 508 studies were initially identified. However, only 45 studies were deemed eligible for the present review. Meta-analyses were conducted in three comparisons separately: intradermal versus acupuncture, Effective rate (RR = 0.08, 95% CI -0.02 to 0.19), Global scales score (points) (SMD = -0.52, 95% CI: -0.81,-0.24, P = 0.02); intradermal acupuncture versus non acupuncture, Effective rate(RR = 1.22, 95% CI 1.04 to 1.42), Global scales score (points) (SMD = -0.81, 95% CI: -1.23,-0.38, P < 0.00001); control group versus control add intradermal acupuncture. Effective rate(RR = 1.27, 95% CI 1.13 to 1.42), Global scales score (points) (SMD = -1.15, 95% CI: -1.46,-0.84, P < 0.00001). Although these results suggested benefits of intradermal acupuncture, the overall quality of evidence rated was low. CONCLUSIONS: The summary estimates indicate that it improved the clinical effective rate and lowered PSQI or other scales score, when compared to sham acupuncture or placebo/conventional medications/herbs.Also,it significantly improved the clinical effective rate and lowered PSQI or other scales score, when the control groups add intradermal acupuncture. However, the quality of the evidence is varied from very low to low due to the potential risk of bias and inconsistency among included trials. The more larger sample size and much more rigorous designed RCTs are still further studied.

Qualitative Impressions of a Yoga Nidra Practice for Insomnia: An Exploratory Mixed-Methods Design.

Introduction: Insomnia affects up to half of the U.S. population, and due to limitations of current treatments, there is a growing interest in mind-body practices to reduce insomnia. To understand how a guided meditation practice, Yoga Nidra, may affect relaxation and align with current descriptions of nonpharmaceutical practices that could improve sleep, qualitative and quantitative methods were used to explore participant experience of a single Yoga Nidra practice, administered in a group setting. Methods: Current insomnia (Insomnia Severity Index), sleep practices, and mood (positive and negative affect schedule [PANAS]) were measured at intake. After 30 min of Yoga Nidra practice, the PANAS was readministered. In a focus group that followed, participants discussed their experience before, during, and after the practice and the likelihood of repeating it. Six groups were conducted. All interested adults were welcome to join. Results: In the final sample of 33 individuals (79% female), 80% of participants reported insomnia at intake and 45% reported a regular mind-body practice, supporting the prevalence of insomnia in the society as well as the interest in mind-body practices. After the Yoga Nidra intervention, mean negative affect decreased 5.6 ± 4.5 points, a 31% decrease from baseline, and positive affect decreased 3.5 ± 9.7 points, a 13% decrease. Three major themes were identified from focus group discussions: response to the practice (relaxation, perceived sleep, and sense withdrawal); factors that affect engagement (delivery method and intrapersonal factors); and potential as a clinical intervention (for conditions including sleep, anxiety, and pain). Conclusion: Yoga Nidra appeared tolerable within the sample, and descriptions suggest it may be useful for enhancing relaxation, facilitating sleep, easing anxiety, and reducing pain. Results from this study will inform the design of future studies of Yoga Nidra for insomnia and related conditions.

Efficacy of Flower Therapy for Anxiety in Overweight or Obese Adults: A Randomized Placebo-Controlled Clinical Trial.

Objective: The aim of this study was to compare the efficacy of flower therapy for the treatment of anxiety in overweight or obese adults with that of a placebo. The authors examined improvement in sleep patterns, reduction in binge eating, and change in resting heart rate (RHR). Design: This was a randomized, double-blind, placebo-controlled clinical trial with a parallel-group design and two arms. Setting/Location: Clinical Research Unit, Medical School, São Paulo State University, Botucatu, SP, Brazil. Subjects: The study included 40 participants in the placebo group and 41 in the intervention group. Participants were of both genders, from 20 to 59 years of age, overweight or obese, with moderate to high anxiety. Interventions: The participants were divided into two random groups: one group was treated with Bach flower remedies (BFR) (bottles containing 30 mL of 30% hydro-brandy solution with two drops each of Impatiens, White Chestnut, Cherry Plum, Chicory, Crab Apple, and Pine), and the other group was given a placebo (same solution without BFR). The patients were instructed to orally ingest the solution by placing four drops directly in the mouth four times a day for 4 weeks. Outcome measures: The primary outcome was anxiety (State-Trait Anxiety Inventory [STAI]). Secondary outcomes were sleep (Pittsburgh Sleep Quality Index [PSQI]), binge eating (Binge Eating Scale [BES]), and RHR (electrocardiogram). Results: Multivariate analysis showed significant reductions in scores for the following variables in the intervention group when compared with the placebo group: STAI (ß = -0.190; p < 0.001), PSQI (ß = -0.160; p = 0.027), BES (ß = -0.226; p = 0.001), and RHR (ß = -0.07; p = 0.003). Conclusions: The anxiety symptoms, binge eating, and RHRs of the individuals treated with flower therapy decreased, and their sleep patterns improved when compared with those treated with the placebo. Registered at the Brazilian Registry of Clinical Trials (no. RBR-47-kfxh).

Efficacy and Safety of Electroacupuncture for Insomnia Disorder: A Multicenter, Randomized, Assessor-Blinded, Controlled Trial.

PURPOSE: To evaluate the efficacy and safety of electroacupuncture in treating insomnia. PATIENTS AND METHODS: In a multicenter, randomized, assessor-blinded, controlled trial, 150 patients with DSM-5-diagnosed insomnia with Insomnia Severity Index (ISI) scores ≥ 15 were randomly assigned to three different groups that underwent 10 sessions of electroacupuncture, sham-electroacupuncture, or usual care for 4 weeks from October 2015 to June 2016 at four Korean medicine hospitals, Republic of Korea. The primary outcome included the ISI score at Week 4; the secondary outcomes included evaluations of Pittsburgh Sleep Quality Index (PSQI), sleep diary, Hospital Anxiety and Depression Scale (HADS), EuroQoL five dimension (EQ-5D), Patient Global Impression of Change (PGIC), and salivary melatonin and cortisol levels. Assessments were performed at baseline (Week 0) and at Weeks 2, 4, 8, and 12. RESULTS: Compared with the usual care group, electroacupuncture group showed a greater improvement in ISI, PSQI, sleep diary-derived variables and HADS and EQ-5D scores at Week 4. The effects mostly persisted until Week 12. There were no significant differences between electroacupuncture and sham-electroacupuncture groups at Week 4 in all outcome measures, except sleep diary-derived sleep efficiency. However, the ISI score showed a significant difference between these groups at Weeks 8 and 12. Treatment success as per PGIC was significantly and borderline higher for electroacupuncture compared with usual care and sham-electroacupuncture, respectively. No significant changes in salivary melatonin and cortisol levels before and after treatment were observed in all groups. No serious adverse events were reported. Blinding was maintained in the sham-electroacupuncture group. CONCLUSION: Ten sessions of electroacupuncture can improve the sleep quality of patients with insomnia without serious adverse effects. Thus, it can be recommended as an effective, safe, and well-tolerated intervention.

[Treatment of insomnia in old age]. / Therapie der Insomnie im höheren Lebensalter.

Insomnia is one of the most frequent health disorders in old age. It causes suffering and numerous health problems. Therefore, treatment is often indicated. Behavioral therapy is the treatment of choice even in older individuals. In addition, light therapy also has an important role. Pharmacological treatment measures are less well studied, the benefits in long-term use are unclear and should only be applied in the short term to reduce suffering as well as being integrated into a comprehensive treatment concept.