How Do You Treat Insomnia in Your Practice?

Abstract

Insomnia is a common problem among women with gynecological cancers. There are several factors that contribute to this condition. During chemotherapy, neuropathic and musculoskeletal pain from taxanes and postoperative discomfort contribute to insomnia. High-dose steroids, which are used to prevent nausea and taxane allergic reactions, increase wakefulness and restlessness. After active therapy is completed, women experience anxiety and insomnia because of fear of recurrence. Many women become dependent on lorazepam, which is used as an adjunct to antiemetic therapy, for sleep.

Acupuncture can be helpful to reduce stress, anxiety, and improve sleep patterns. The following points are helpful: HT 7 (Shenmen); PC 6 (Neiguan); GB 21 (Jianjing); Anmian (Extra Point midway between GB 20 [Fengchi] and J 17 [Yifeng]); Yintang (“Hall of Impression” [M-HN 3] an Extra Point midway between the medial ends of the eyebrows); and GV20 (Baihui).

With the patient in a supine position, bilateral HT 7, PC 6, Yintang, and GV 20 are needled. The needles are left in place for 20 minutes. The needles are removed and then the patient is repositioned in a supine position. Needles for bilateral Anmian and GB 21 are placed. Radiant heat with an infrared heating lamp on the back is added. The needles are left in place for 20 minutes. After the needles have been removed, cupping along the Gallbladder and Bladder Meridians in areas of musculofascial contraction is performed for 10 minutes.

Previous acupuncture studies have reported benefit for insomnia. Acupuncture was associated with a significant nocturnal increase in endogenous melatonin secretion, which is known to be important for sleep.¹ A 2009 Cochrane review suggested that acupuncture may improve the quality of sleep.² The number of acupoints selected ranged from 4 to 15. The number of acupuncture sessions ranged from 2 to 30. The most frequently used acupoints were: Shenmen on hands (HT 7); Shenmen on ears; Baihui (GV 20); and Neiguan (PC 6).²

References

Spence

, Kayumov

, Chen

et al. Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report. J Neuropsychiatry Clin Neurosci, 2004; 16,1:19–28.

Cheuk

, Yeung

, Chung

, Wong

. Acupuncture for insomnia [review] Cochrane Database Syst Rev, 2007; 3CD005472.