Insomnia is a common sleep disorder characterised by difficulty falling asleep, difficulty staying asleep, early waking, or feeling unrefreshed despite adequate opportunity for sleep (American Academy of Sleep Medicine, 2014). It can affect individuals of any age and has a meaningful impact on quality of life, mood, and daily functioning (Riemann et al., 2017).
Insomnia is typically classified based on duration. Short-term (acute) insomnia lasts less than three months, while chronic insomnia persists for three months or longer with regular symptoms (American Academy of Sleep Medicine, 2014). In practice, many presentations exist along a continuum rather than as strict categories.
Epidemiological studies suggest that up to one-third of adults experience insomnia symptoms, with approximately 10% meeting criteria for chronic insomnia (Riemann et al., 2017). Women, older adults, and individuals with coexisting medical or psychological conditions are more likely to be affected (Riemann et al., 2017).
Why insomnia happens
The mechanisms underlying insomnia are complex and are not explained by a single cause.
Current models describe insomnia as a state of hyperarousal, where the nervous system remains relatively active when it should be transitioning into sleep (Riemann et al., 2010). This may involve increased cognitive activity, altered stress responses, and dysregulation of neurochemical systems involved in sleep–wake control.
Common contributing factors include stress, anxiety, depression, pain, irregular sleep schedules, stimulant use, and medical conditions (American Academy of Sleep Medicine, 2014; Riemann et al., 2017). Rather than a single trigger, insomnia is often maintained by an interaction of biological, psychological, and behavioural factors.
Common symptoms
People with insomnia may experience difficulty initiating sleep, frequent awakenings, early morning waking, or non-restorative sleep (American Academy of Sleep Medicine, 2014). These sleep disturbances are often accompanied by daytime consequences such as fatigue, irritability, impaired concentration, and reduced performance (Riemann et al., 2017).
Chronic insomnia is associated with broader impacts, including reduced quality of life and increased risk of mental health conditions (Riemann et al., 2017).
Why assessment matters
Assessment of insomnia focuses on identifying contributing and maintaining factors, rather than sleep symptoms alone.
A clinical evaluation typically includes sleep history, lifestyle factors, psychological stress, medical history, and medication use (American Academy of Sleep Medicine, 2014). Investigations are not routinely required unless another condition is suspected.
It is also important to recognise features that may indicate alternative or coexisting conditions. Symptoms such as loud snoring, witnessed apnoea, waking with choking, significant daytime sleepiness, or prominent mood symptoms may suggest disorders such as obstructive sleep apnoea or depression (American Academy of Sleep Medicine, 2014).
Evidence-based management
Management of insomnia generally involves a combination of non-pharmacological and, in some cases, pharmacological approaches.
Cognitive behavioural therapy for insomnia (CBT-I) is widely recommended as first-line treatment due to strong evidence supporting its effectiveness in improving sleep outcomes (Riemann et al., 2017). CBT-I addresses sleep behaviours, cognitive patterns, and conditioned arousal.
Other non-pharmacological strategies include sleep hygiene education, relaxation techniques, and mindfulness-based approaches (American Academy of Sleep Medicine, 2014).
Medications may be used selectively, particularly for short-term symptom management, but are typically not considered first-line long-term solutions (Riemann et al., 2017).
Can acupuncture help insomnia?
Acupuncture is a traditional Chinese medicine therapy that involves the insertion of fine needles into specific points on the body. It is sometimes considered as a complementary approach for insomnia, particularly when symptoms are associated with stress, anxiety, or somatic tension.
A Cochrane review by Cheuk et al. (2015) found that acupuncture may improve sleep quality compared with no treatment, but concluded that the evidence was limited by methodological concerns and variability between studies.
Similarly, a systematic review by Cao et al. (2009) reported improvements in sleep outcomes with acupuncture compared with medication or no treatment, while also highlighting limitations in study quality.
More recent research includes randomised controlled trials such as Wang et al. (2019), which found improvements in sleep quality with acupuncture compared with sham acupuncture, although placebo effects could not be excluded.
Comparative studies suggest that acupuncture may produce improvements similar to other interventions in some populations. For example, Li et al. (2020) reported that both acupuncture and CBT-I improved sleep outcomes, with differences between treatments not consistently large.
A systematic review and meta-analysis by Liu et al. (2017) found that acupuncture may improve sleep quality and reduce associated symptoms such as anxiety, although heterogeneity across studies remained a limitation.
Overall, current evidence suggests that acupuncture may improve sleep quality in some individuals, but findings are not uniform and further high-quality trials are needed.
Where acupuncture may fit in practice
In practice, acupuncture is typically considered as part of a broader management approach rather than a standalone treatment.
It may be relevant when insomnia is associated with stress, anxiety, muscular tension, or when individuals prefer non-pharmacological options. Some patients may also use acupuncture alongside conventional treatments.
It is important that underlying causes of insomnia, such as sleep-disordered breathing, mood disorders, or chronic medical conditions, are appropriately assessed and managed (American Academy of Sleep Medicine, 2014).
Practical steps to support sleep
Lifestyle and behavioural factors play an important role in sleep quality.
Factors that may worsen insomnia include irregular sleep schedules, excessive screen exposure before bedtime, caffeine, alcohol, nicotine, and high stress levels (American Academy of Sleep Medicine, 2014).
Supportive strategies include maintaining consistent sleep–wake times, creating a suitable sleep environment, reducing stimulation before bedtime, and incorporating relaxation techniques (Riemann et al., 2017).
Important notice
This information is provided for general educational purposes only and does not replace individual medical advice, diagnosis, or treatment. Outcomes may vary between individuals. If you have concerns about your sleep, please consult a qualified healthcare professional.
References
American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.).
Cheuk, D. K., Yeung, W. F., Chung, K. F., Wong, V., & Chan, K. H. (2015). Acupuncture for insomnia. Cochrane Database of Systematic Reviews, (9), CD005472.
Cao, H., Pan, X., Li, H., & Liu, J. (2009). Acupuncture for insomnia: A systematic review. Journal of Alternative and Complementary Medicine, 15(11), 1171–1186.
Li, P., Teng, X., Cheng, L., & Liu, Y. (2020). Acupuncture versus CBT-I for insomnia. Journal of Alternative and Complementary Medicine, 26(5), 418–425.
Liu, B., Yang, H., Li, C., Li, Q., & Wang, X. (2017). Acupuncture versus medication for insomnia: A systematic review. Journal of Alternative and Complementary Medicine, 23(11), 857–866.
Riemann, D., Baglioni, C., Bassetti, C., et al. (2017). European guideline for insomnia. Journal of Sleep Research, 26(6), 675–700.
Riemann, D., Spiegelhalder, K., Feige, B., et al. (2010). The hyperarousal model of insomnia. Sleep Medicine Reviews, 14(1), 19–31.
Wang, Y., Wang, H., Wang, S., & Zhang, Z. (2019). Acupuncture vs sham for insomnia. Journal of Alternative and Complementary Medicine, 25(7), 789–796.