Comparative Effectiveness of Acupoint Stimulation Therapies for Primary Insomnia
Overview
This systematic review and network meta-analysis of 95 RCTs involving 7,628 patients evaluated 14 acupoint stimulation therapies for primary insomnia. Body acupuncture combined with electroacupuncture ranked highest for total effective rate, while moxibustion combined with tuina and moxibustion alone showed superior improvements in sleep quality scores.
Background
Primary insomnia is a chronic sleep disorder characterized by difficulty initiating or maintaining sleep, affecting approximately 2.5% of adults worldwide. It is associated with cognitive, emotional, and physical health impairments. Pharmacological treatments have limited long-term efficacy and potential side effects, prompting interest in non-pharmacological interventions such as acupoint stimulation therapies. These therapies include body acupuncture, moxibustion, auricular acupressure, and their combinations, which have shown promise in improving sleep outcomes with fewer adverse effects.
Data Highlights
Therapy
Outcome
SUCRA Score
Body acupuncture + Electroacupuncture
Total Effective Rate (TER)
0.874
Moxibustion + Tuina
Total PSQI Score Reduction
0.966
Moxibustion alone
PSQI Score Difference (ΔPSQI)
0.933
Electroacupuncture + Auricular Acupressure
Improvement in all 6 PSQI subcomponents
Not specified
Key Findings
Body acupuncture combined with electroacupuncture achieved the highest total effective rate (SUCRA 0.874) in treating primary insomnia.
Moxibustion combined with tuina was most effective in reducing overall Pittsburgh Sleep Quality Index (PSQI) scores (SUCRA 0.966).
Moxibustion alone showed the greatest improvement in PSQI score changes from baseline (SUCRA 0.933).
Electroacupuncture combined with auricular acupressure improved all six PSQI subcomponents, indicating broad sleep quality benefits.
The most frequently used body acupoints were Shenmen (HT 7), Baihui (GV 20), and Anmian (EX-HN 22); common ear points included Shenmen (TF4), Xin (CO15), and Pizhixia (AT4).
These findings support the use of combined acupoint stimulation therapies tailored to individual patient needs for primary insomnia management. Clinicians may consider body acupuncture with electroacupuncture to maximize treatment response rates, while moxibustion-based therapies may be preferred for improving sleep quality metrics. The identification of common acupoints and compatibility patterns can guide protocol optimization. However, further research is needed to clarify long-term efficacy and tolerability.
Conclusion
Acupoint stimulation therapies demonstrate varying but significant benefits for primary insomnia, with combination approaches showing superior efficacy. This evidence base informs personalized treatment strategies and future research directions to optimize non-pharmacological insomnia management.
