In short
- CBT-ICognitive behavioral therapy for insomnia. Is the first-line treatment for chronic insomnia and has the strongest evidence by a distance.
- Acupuncture has some supportive evidence and is reasonable as an addition, particularly where pain or stress is keeping you awake.
- Improved sleep is among the most commonly reported effects of a course of acupuncture, even when people came for something else.
- Loud snoring with pauses in breathing points to sleep apnea, which needs a medical assessment, not needles.
What insomnia actually is
Insomnia means difficulty falling asleep, staying asleep, or waking too early, despite adequate opportunity to sleep, and feeling the consequences during the day. It is called chronic when it happens at least three nights a week for three months or more.
Short-term insomnia usually has an obvious trigger and resolves with it. Chronic insomnia tends to become self-sustaining: the bed becomes associated with frustration, effort goes into trying to sleep, and the trying itself keeps you awake. This is precisely why a behavioral approach works so well.
Start with the thing that works best
CBT-I is recommended as the first treatment for chronic insomnia by major sleep medicine bodies, ahead of sleeping medication. It addresses the habits and thought patterns that keep insomnia going, and its benefits persist after treatment ends, which is not generally true of sleeping pills. It is usually delivered over a handful of sessions, and app-based and online programs exist.
If you have chronic insomnia and have not tried CBT-I, that is the higher-value thing to do first. Acupuncture can run alongside it.
Where acupuncture fits
Trials of acupuncture for insomnia generally report improvements in how long people take to fall asleep and how long they stay asleep, though the studies vary in quality and many are small. Reviews tend to describe the evidence as encouraging but not strong.
There is a practical case too. When sleep is being broken by chronic pain, hot flushes, or a high level of baseline tension, treating those directly can improve sleep as a consequence, and those are areas where acupuncture has more to offer.
Acupuncture sits alongside medical care, not in place of it. Keep any treatment your physician has prescribed, and tell your acupuncturist about it.
What a course looks like
Typically one or two sessions a week for four to six weeks, with a review. Practitioners usually ask about your sleep routine as well: caffeine timing, alcohol, screens, nap habits, what time you get up at weekends. Expect to be asked to change some of that; it is part of the treatment, not an aside.
A simple sleep diary makes progress visible: roughly when you went to bed, how long you think you took to fall asleep, how many times you woke, when you got up, and how you felt the next day.
Sleep problems that need a doctor first
- Loud snoring, gasping, or someone witnessing you stop breathing. This suggests sleep apnea and needs testing.
- Overwhelming daytime sleepiness, or falling asleep without intending to.
- Acting out dreams physically, which can be an early sign of a neurological condition.
- Insomnia alongside low mood, loss of interest, or thoughts of self-harm. The mood needs treating.
- An unpleasant urge to move the legs at night, which points to restless legs syndrome.
Questions for a practitioner
- Do you treat insomnia often, and do you ask patients to keep a sleep diary?
- Will you look at what else might be waking me: pain, hot flushes, anxiety?
- How many sessions before we review?
- Have you heard of CBT-I, and would you be happy for me to do both?