Insomnia

Insomnia trials of acupuncture mostly measure sleep the way patients report it, on questionnaires such as the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI), and a few also measure it with a wrist-worn motion sensor called an actigraph. Cochrane’s 2012 review by Daniel Cheuk and colleagues at the University of Hong Kong concluded that the trials then available could neither support nor refute acupuncture for insomnia. Many trials have been published since, and Cochrane has begun a new review. The later evidence reports better questionnaire scores with acupuncture than with sham acupuncture, but it also shows that sham itself moves those scores, and that measured sleep moves less than reported sleep. Sham acupuncture is a control procedure made to resemble acupuncture, such as a blunt needle that touches the skin and retracts; Sham acupuncture covers the kinds in use.

The 2012 Cochrane review

The review searched to October 2011 and included 33 randomised trials with 2,293 participants aged 15 to 98. Some had conditions that contribute to poor sleep, including stroke, end-stage kidney disease, perimenopause, pregnancy and psychiatric illness. The trials tested needle acupuncture, electroacupuncture, acupressure and magnetic acupressure against sham, no treatment, or the same other treatment given without acupuncture; the review left out trials comparing acupuncture with a different treatment.

• Acupressure against no treatment (2 trials, 280 people) and against sham (2 trials, 112 people): more people reported better sleep quality with acupressure. When the authors assumed that people who dropped out had done badly, the benefit became inconclusive.
• Acupuncture added to another treatment, against that treatment alone (13 trials, 883 people): acupuncture might marginally increase the share of people whose sleep quality improved. In a subgroup analysis only needle acupuncture, not electroacupuncture, showed a benefit.

Every trial was at high risk of bias, and they differed in how they defined insomnia, whom they enrolled, which points they used and how often. Effects were generally small with wide confidence intervals, and the authors judged publication bias, the tendency for positive trials to be published and negative ones not, to be likely. Adverse effects were rarely reported, and those reported were minor. Nothing ever fails sets out how publication bias shows up across this literature.

Cochrane’s replacement is under way. Its protocol, published in July 2025 by Ang and colleagues at the Korea Institute of Oriental Medicine, states that whether the evidence is rigorous enough for a definitive conclusion remains uncertain. It plans to test whether the number of sessions, the type of acupuncture and the kind of control change the size of the effect.

Later reviews against sham

A 2025 meta-analysis by Yu and colleagues pooled 10 trials with 757 people with chronic insomnia disorder that compared acupuncture with sham, searching eight databases to March 2025.

Its trial sequential analysis, a test of whether the pooled sample is large enough to treat a result as settled, found the sample too small for definitive conclusions. The authors concluded that acupuncture improved subjective sleep quality against sham, and that its effect on objectively measured sleep was uncertain.

A 2026 review by Chi and colleagues pooled the sham groups of 15 insomnia trials with 609 participants and found that their PSQI scores and sleep efficiency improved from baseline. The improvement was largest with gentle stimulation at sites that are not acupuncture points, and with courses of 13 to 20 sessions. The authors note that most of these trials were single-blind, which can bias the result. Reading an acupuncture trial explains why the choice of control changes what a trial can find.

Against sleeping drugs, a 2021 meta-analysis by Kim and colleagues in South Korea pooled 15 trials with 1,475 participants. PSQI scores were better with acupuncture overall, with no significant difference in the first two weeks and a difference from the third week on. The trials disagreed widely with one another (I² 89%, where higher values mean more inconsistency).

Two sham-controlled trials

A 2017 trial at the Shanghai Municipal Hospital of Traditional Chinese Medicine randomised 72 people with primary insomnia, meaning insomnia not explained by another condition, to acupuncture or sham three times a week for four weeks. ISI scores improved more with acupuncture at two and four weeks of treatment and at two and four weeks afterwards, as did actigraph sleep efficiency and total sleep time. The trial was single-blind.

A 2022 trial at three Shanghai hospitals enrolled 270 people with both insomnia and depression. All had standard psychiatric care; one group added electroacupuncture, one sham acupuncture and one nothing more, three sessions a week for eight weeks. At week 8 the PSQI score was 3.6 points better with electroacupuncture than with sham and 5.1 points better than with standard care alone, and the difference lasted to week 32. Actigraph total sleep time rose by 29 minutes within the electroacupuncture group, and the number of awakenings did not differ between groups. No serious adverse events were reported. The needled points were GV20 (Baihui), GV24 (Shenting), XH03 (Yintang, which the trial writes as GV29), XH16 (Anmian), HT07 (Shenmen), PC06 (Neiguan) and SP06 (Sanyinjiao), with current running between GV20 and Yintang. Reading a point code explains why the same point carries two codes.

What guidelines say

The European Sleep Research Society’s 2017 European insomnia guideline recommended cognitive behavioural therapy for insomnia (CBT-I), a structured course that changes sleep habits and the thoughts around sleep, as first-line treatment for chronic insomnia in adults. It recommended against complementary and alternative treatments, naming homeopathy and acupuncture, as a weak recommendation on very low-quality evidence. The 2023 update keeps CBT-I first-line and makes no recommendation on acupuncture either way. Acupuncture appears in it only in a table of meta-analyses, as one of three treatments that a 2021 review of people over 60 found better than a waiting list. Clinical guidelines compares other guideline bodies.

What the reviews could not settle

The gap between reported and measured sleep is unresolved: the sham-controlled evidence shows better reported sleep, while measured total sleep time did not differ significantly from sham in the pooled data. Sham groups improve too, by amounts that depend on how the sham is done, so the size of any specific effect depends on the control chosen. The trials are small, several enrol people whose insomnia comes with another condition, and the Cochrane review that would replace the 2012 one has not yet reported. None of the reviews on this page compared acupuncture directly with CBT-I, the treatment the European guideline puts first.

AcuiQ’s insomnia page, with the related chronic insomnia and primary insomnia pages, lists the protocols individual studies prescribed, each with its citation. Depression and Anxiety cover two conditions that appear alongside insomnia in some of these trials.