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Huang 2011 Autonomic activation in insomnia: the case for acupuncture.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041619/?tool=pubmed Research done at the VA.


J Clin Sleep Med. 2011 Feb 15;7(1):95-102.

Autonomic activation in insomnia: the case for acupuncture.

Huang W, Kutner N, Bliwise DL.




Atlanta VA Medical Center, Atlanta, GA, USA.


Abstract at http://www.ncbi.nlm.nih.gov/pubmed/21344045 Full text at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041619/?tool=pubmed


Current conceptualizations of the biological basis for insomnia typically invoke central nervous system and/or autonomic nervous system arousal. Acupuncture may represent a unique avenue of treatment for poor sleep by virtue of its direct effects on peripheral nerves and muscles, which, in turn, modulate autonomic tone and central activation. In this review, we summarize both basic and clinical research indicating that acupuncture exerts profound influences via a wide variety of potential neural and/or hormonal mechanisms that have great relevance for the modulation of sleep and wakefulness. We illustrate principles of acupuncture intervention applied to cases of otherwise intractable insomnia that document successful application of this component of Traditional Chinese Medicine to the treatment of poor sleep. Our review indicates the necessity for further research in the relationship between the effects of acupuncture on insomnia and autonomic regulation, which might guide better selective use of this treatment modality for insomnia.


From the full text at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041619/?tool=pubmed :


Hyperarousal has been examined as a correlate of insomnia in cross-sectional studies,2–4 with substantial evidence for associated pathophysiology involving both the central nervous system (CNS) and the autonomic nervous system (ANS). CNS arousal is supported by descriptive evidence suggesting that individuals with poor sleep are chronically more alert on tests of daytime alertness, such as the multiple sleep latency test (MSLT),5–7 and have elevated measures of high-frequency electroencephalographic activity (beta or gamma range) during nocturnal sleep,8–11 as well as experimental evidence indicating greater reactivity among individuals predisposed to poor sleep.12 More recently, functional neuroimaging studies involving single photon emission computed tomography (SPECT),13 positron emission tomography (PET),14 or proton magnetic resonance spectroscopy (MRS)15 have suggested that individuals with insomnia may have enhanced activation in particular brain regions as well. ANS arousal is supported by a long history of evidence of higher metabolic rates,6 body temperatures,16–18 electrodermal activity,19 and heart rates17,18 in individuals with chronically poor sleep, as well as studies demonstrating increased low-frequency power and decreased high-frequency power in heart rate intervals20 in insomniacs. Elevated sympathetic tone is also implicated by raised cortisol levels and activation of the hypothalamic-pituitary-adrenal (HPA) axis in chronic insomniacs.21 Elevations in the HPA may be mediated in part by corticotrophin-releasing hormone (CRH), and this neuropeptide may represent an important link between ANS and CNS activation in insomnia.22 Taken together, these studies raise the intriguing possibility that interventions directly influencing peripheral hyperarousal and balancing sympathetic and parasympathetic tone may afford unique opportunities to successfully modify chronically poor sleep.



As we have reviewed here and elsewhere, many studies have documented physiological effects of acupuncture using the standards of contemporary Western science. In all likelihood some of those improvements are mediated by autonomic activities. Our cases further illustrate that acupuncture may have substantial and dramatic effects in patients who report substantially disturbed sleep. Future clinical trials employing both site- and stimulation-specific controls should be undertaken to attest that this ancient medical practice may have impact on sleep. Monitoring autonomic activation may represent a novel attempt both to understand how acupuncture works and to assess current mediational models for insomnia.

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