Popping a sleeping pill is the usual treatment for chronic insomnia in the West, with more than 10 million prescriptions for the drugs written each year in England alone. But in China, one of the most common therapies for persistent difficulty in falling or staying asleep is acupuncture.

While sleeping pills are associated with a raft of serious adverse effects and even death, acupuncture has proved to be a remarkably safe form of alternative medicine.

But does it work? Let’s take a look at the evidence.

What is acupuncture?

Acupuncture is an ancient traditional Chinese medicine (TCM) technique based on the idea that all lifeforms are supported by subtle energy known as chi or qi. In TCM, blockages or excesses of energy at certain places and organs of the body are understood to result in illness. These obstructions and accumulations of chi are balanced by inserting incredibly thin needles into acupuncture points—which are specific places along the body’s meridians (energy lines), as identified in TCM.

Clinical trials

Numerous trials have looked at the effects of acupuncture on insomnia, and many have had impressive results. Not only has the technique proved to be better than either no treatment or fake acupuncture—where the patients think they’re receiving real acupuncture, but the needles are actually being placed incorrectly or in the wrong places—but it has also outperformed powerful sleep-inducing (hypnotic) drugs.

In a high-quality six-week study published in the international journal Evidence Based Complementary and Alternative Medicine, researchers compared the effects of true acupuncture, fake acupuncture and the hypnotic drug estazolam in 180 insomniacs.

Those who received either acupuncture or the sleeping pill had significantly greater improvement in their sleep compared with those in the control (fake treatment) group. However,only the acupuncture group reported better sleep quality and vitality, along with less sleepiness and daytime dysfunction. The estazolam group, on the other hand, reported higher levels of daytime dysfunction.

An added benefit of acupuncture was that the positive effects were longer-lasting. “Improvements of sleep quality, total sleep time, sleep efficiency [and] daytime functioning achieved in the [acupuncture] group were well maintained to follow-up,” the researchers noted, “whereas the effect of sham acupuncture and estazolam was not significant when the intervention ended.”1

In another study, just one acupuncture session a week for four weeks was just as effective for insomnia as nightly doses of zolpidem (Ambien), one of the most commonly prescribed sedatives. “We found both groups improved over time at a similar rate,” the researchers said.2

Reviewing the evidence

Several meta-analyses, where the results of multiple studies are pooled together, have been conducted to determine the overall efficacy of acupuncture for insomnia.

In one of the largest, involving 46 randomized controlled trials (or ‘RCTs’, considered the ‘gold standard’ of scientific testing) and more than 3,800 patients with insomnia, acupuncture was significantly superior to no treatment, fake acupuncture and sleeping pills for boosting sleep quality and duration. What’s more, acupuncture combined with medication was better than medication alone.3

Other ‘studies of studies’ have had similar results,4 with one reporting mean“effective rates” of 91 per cent for acupuncture and 75 per cent for hypnotic drugs.

However, reviewers have been cautious in their recommendations because of the poor methodological quality of most trials. Indeed, a recent review by the Cochrane Collaboration concluded that “the current evidence is not sufficiently rigorous to support or refute acupuncture for treating insomnia”.5

A plausible mechanism

While more rigorous, large-scale RCTs are needed, there’s certainly enough evidence to suggest that acupuncture can have beneficial biological effects that can promote sleep. An increased production of melatonin, nitric oxide, beta-endorphins and gamma-aminobutyric acid—all of which are involved in sleep—has been observed in studies of acupuncture in both animals and people.5

Safety and side-effects

One of the biggest draws of acupuncture is its safety. According to the British Acupuncture Council, it’s one of the safest medical treatments on offer in the UK. And there’s independent research to back this up.

Two surveys published in the British Medical Journal in 2001—one of traditional acupuncturists and the other of doctors who practise acupuncture—concluded that the risk of a serious adverse reaction to acupuncture is less than one in 10,000 treatments. When a total of 66,000 treatments were reviewed, only a handful of minor side-effects were reported, such as dizziness or bruising around needle points.6

Similarly, a 2006 UK safety review deemed the risks associated with acupuncture “negligible” and concluded that the treatment is “very safe”, provided it’s administered by competent practitioners.7

In stark contrast, prescription sleeping pills like zolpidem have been linked to a catalogue of catastrophic effects, including amnesia, compulsive repetitive behaviours, delirium, nightmares, hallucinations, overdosing, addiction, falls, cognitive impairment and life-threatening allergic reactions.8

Ironically, zolpidem also appears to cause sleep problems like sleepwalking, sleep-related eating and, most worrying of all, sleep-driving.9

One study found that people taking hypnotic drugs like zolpidem were at least twice as likely—and, with some drugs, up to four times as likely—to be involved in road-traffic accidents.10

This might explain why hypnotics were recently found to dramatically increase the risk of death—even in those who only take them once in a while. According to the researchers, the “meagre benefits” of these drugs—as demonstrated by numerous independent trials—fail to justify their “substantial risks”.11

Getting to the point

With its impressive safety record and the number of positive studies of acupuncture for insomnia so far, we’d say that the TCM technique beats sleeping pills hands down. Nevertheless, no doubt a holistic approach that includes diet and lifestyle changes is the best medicine for tackling insomnia.