Insomnia is more than simply having a bad night’s sleep. For some people it means lying awake for hours before falling asleep. For others, it means waking repeatedly during the night, waking very early in the morning, or sleeping for what seems like a reasonable amount of time but still feeling unrefreshed the following day.
Poor sleep can have a profound effect on everyday life. Concentration becomes more difficult, energy levels fall and irritability can increase. Over time, worrying about sleep itself can become part of the problem: the more we try to force ourselves to sleep, the more alert we can become.
Traditional Chinese Medicine (TCM) takes a somewhat different approach to insomnia from conventional medicine. Rather than treating insomnia as a single condition with a single cause, Chinese medicine looks at the individual pattern underlying the disturbance of sleep.
Acupuncture treatment is therefore tailored to the person rather than simply to the symptom of “insomnia”.
What causes insomnia?
There are many possible reasons for disturbed sleep.
Stress, anxiety, bereavement, changes in circumstances, shift work, physical discomfort, hormonal changes and lifestyle factors can all affect sleep. Sometimes insomnia begins during a particularly stressful period and then continues after the original problem has passed.
There can also be a frustrating cycle:
stress → poor sleep → fatigue → increased worry about sleep → greater difficulty sleeping.
From a conventional medical perspective, persistent insomnia may also occur alongside other conditions or sleep disorders. For this reason, it is important not to assume that every sleep problem is simply “insomnia”. Symptoms such as loud snoring, breathing pauses during sleep, unusual movements during sleep or severe daytime sleepiness may warrant medical assessment.
For long-term insomnia, Cognitive Behavioural Therapy for Insomnia (CBT-I) is currently regarded as the first-line treatment. Sleep hygiene advice is also an important part of managing sleep problems.
Acupuncture can be considered as part of a broader approach to improving sleep, particularly when stress, tension or other symptoms are prominent.
How does Chinese medicine understand insomnia?
In Chinese medicine, sleep is closely connected with the relationship between the Heart, Liver, Spleen and Kidneys, as well as the movement and balance of Qi and Blood.
The traditional Chinese medical understanding is not that one particular organ is simply “causing” insomnia. Instead, different patterns can disturb the normal transition between wakefulness and sleep.
For example, some people have difficulty falling asleep because they feel mentally restless and unable to switch off. Others fall asleep easily but wake repeatedly during the night. Someone else may wake at four or five in the morning and be unable to return to sleep.
These different presentations can correspond to quite different TCM patterns.
Liver Qi stagnation
Stress and emotional tension can interfere with the smooth movement of Qi.
Someone with Liver Qi stagnation may describe feeling tense, frustrated, irritable or emotionally “wound up”. They may find that their mind becomes particularly active when they get into bed.
In these cases, treatment may focus on regulating Liver Qi and reducing the physical and emotional tension associated with it. This can be done with herbal formulas such as Chai Hu Chu Gan san but also very effectively with acupuncture.
Liver Fire
When Liver Qi stagnation becomes more pronounced, Chinese medicine may describe a pattern of Liver Fire.
The person may experience difficulty falling asleep accompanied by irritability, feeling hot, vivid dreams, headaches or a sense of agitation.
Treatment is directed towards clearing the excess heat while regulating the underlying imbalance.
Heart Blood deficiency
Chinese medicine associates the Heart with the mind or Shen.
When Blood is insufficient to nourish the Heart, the mind may be less settled and sleep can become light or easily disturbed.
A person may have difficulty maintaining sleep, vivid dreams, palpitations or anxiety, together with signs of Blood deficiency.
In such cases, treatment may involve nourishing Blood as well as calming the Shen.
Yin deficiency
Some people experience insomnia alongside sensations of heat, night sweating, dry mouth or restlessness.
From a Chinese medicine perspective, this may indicate Yin deficiency. Yin has a cooling, nourishing and anchoring function, and when it becomes insufficient, the mind may become less settled at night.
Treatment may therefore focus on nourishing Yin and restoring balance rather than simply trying to induce sleep.
Spleen Qi deficiency
Poor sleep can also occur alongside fatigue, poor appetite, digestive problems and a tendency to worry.
Chinese medicine may understand this combination as Spleen Qi deficiency, sometimes with Blood deficiency developing as a consequence.
Here the treatment is not simply to “calm the mind”. Supporting digestion and strengthening Qi may be an important part of improving sleep.
Kidney deficiency
In some people, particularly as they get older, insomnia occurs alongside fatigue, weakness, lower back discomfort or other signs of declining vitality.
Chinese medicine may consider Kidney deficiency as part of the underlying pattern.
Again, the treatment depends upon the particular presentation rather than the diagnosis of insomnia alone.
Why is the treatment different for each person?
Two people can both say, “I have insomnia,” while having completely different symptoms.
One person may lie awake with a racing mind and feel tense and irritable.
Another may fall asleep immediately but wake at 3am and remain awake for the rest of the night.
Another may sleep lightly, dream excessively and wake feeling exhausted.
In Western medicine these may all be described under the broad heading of insomnia. In Chinese medicine, however, the differences are clinically important.
During an acupuncture consultation I would therefore ask about much more than sleep itself. This may include:
- What time you go to bed and wake up
- How long it takes you to fall asleep
- Whether you wake during the night
- What time you tend to wake
- Whether you can return to sleep
- Your dreams
- Your energy levels during the day
- Stress and emotional tension
- Digestion and appetite
- Menstrual or hormonal symptoms where relevant
- Feeling hot or cold
- Pain or physical discomfort
- Your general state of health
The tongue and pulse are also traditionally used as part of the Chinese medicine diagnosis.
The aim is to understand why your sleep is disturbed, rather than simply treating the fact that you are not sleeping.
How can acupuncture help with insomnia?
Acupuncture treatment involves the insertion of very fine needles into selected acupuncture points.
For insomnia, points may be chosen to regulate Qi, nourish Blood or Yin, settle the Shen, reduce tension or address another underlying pattern identified during the consultation.
Treatment may therefore include points on the limbs, abdomen, back, head or ears, depending on the individual diagnosis.
Many people find acupuncture treatment deeply relaxing. Some become very relaxed during treatment or feel sleepy afterwards. However, acupuncture should not be thought of simply as a sedative.
The intention of Chinese medicine is to address the pattern contributing to the disturbed sleep and help restore a more balanced physiological and emotional state.
There is some clinical evidence supporting acupuncture for insomnia. For example, a 2024 systematic review and meta-analysis of 13 trials involving 849 people found that a particular TCM acupuncture approach, Tiaoshen acupuncture, improved measures including sleep quality compared with control acupuncture. The authors also noted limitations in the evidence, including publication bias and the need for higher-quality trials.
This is encouraging, but it is important not to overstate what the research shows. Acupuncture should not be presented as a replacement for established treatments for chronic insomnia.
Acupuncture and sleep hygiene
Acupuncture works best as part of a broader approach to sleep.
Simple changes can sometimes make a considerable difference. These include keeping regular sleeping and waking times, creating a relaxing bedtime routine and avoiding factors that interfere with sleep.
NICE recommends sleep-hygiene advice for adults with insomnia, while current guidance identifies CBT-I as the first-line treatment for chronic insomnia.
During treatment, it can therefore be useful to look at both the Chinese medicine pattern and the practical circumstances surrounding your sleep.
For example, if someone is going to bed at different times every night, spending long periods awake in bed and worrying about whether they will sleep, acupuncture alone may not address all of the factors maintaining the problem.
How many acupuncture treatments will I need?
There is no fixed number of treatments for insomnia.
Some people notice a change in their sleep relatively quickly. For others, particularly when insomnia has been present for months or years, improvement may be more gradual.
The appropriate treatment frequency depends upon the severity and duration of the problem and the wider pattern identified during diagnosis.
Treatment is normally reviewed as it progresses. As sleep improves, the emphasis of treatment can change and appointments may become less frequent.
Can acupuncture be used alongside conventional treatment?
Yes. Acupuncture does not have to be an alternative to conventional healthcare.
If you are taking medication for sleep, anxiety, depression or another condition, you should not stop or alter your medication without discussing this with the prescribing clinician.
Likewise, persistent insomnia deserves proper assessment. NICE guidance recommends considering other sleep disorders and addressing underlying causes when insomnia persists.
Acupuncture can potentially sit alongside conventional treatment, CBT-I, lifestyle changes and other appropriate forms of care.
When should insomnia be medically assessed?
Insomnia can have many causes, and sometimes poor sleep is a symptom of another condition.
It is particularly important to seek medical advice if you experience symptoms suggesting another sleep disorder, such as breathing difficulties during sleep or significant daytime sleepiness.
You should also speak to your GP if insomnia is persistent, severely affecting your daily life, or accompanied by significant physical or psychological symptoms.
Acupuncture treatment should complement appropriate medical assessment rather than delay it.
A Chinese medicine approach to better sleep
Sleep is not an isolated process. It is influenced by our physical health, emotional state, daily routine and environment.
Traditional Chinese Medicine offers a way of looking at insomnia as part of the individual’s wider pattern of health. Rather than assuming that everyone with insomnia requires the same treatment, acupuncture treatment is selected according to the person’s symptoms and Chinese medicine diagnosis.
For some people, the most important part of treatment may be reducing stress and regulating Qi. For others, it may involve nourishing Blood or Yin, supporting Qi or addressing another underlying imbalance.
The objective is not simply to make you sleepy. It is to help restore the conditions in which natural, restorative sleep can occur.
If you are struggling with persistent insomnia and would like to discuss whether acupuncture may be appropriate for you, you can arrange a consultation to discuss your symptoms and treatment options.
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