Meg Seymour, PhD and Nina Zeldes, PhD, National Center for Health Research
Most cancer patients experience insomnia, which is defined as having trouble falling and/or staying asleep. Most cancer patients with insomnia are prescribed sleep-aid medications as treatment, which can have unpleasant side effects, such as memory problems and health risks. In fact, studies show that people who take sleep medication more often are more likely to develop many types of cancer (You can read this article for more information). Fortunately, in 2019, cancer researchers at Memorial Sloan Kettering found that there are safer and possibly more effective treatments for cancer patients’ insomnia: acupuncture, as well as a type of therapy specifically developed for treating insomnia, called Cognitive Behavioral Therapy for Insomnia (CBT-I).
Acupuncture is a traditional Chinese treatment where a trained acupuncturist places special needles into the skin at specific points at the body, which are associated with different aspects of health. There are certain places on the body that acupuncturists place needles in order to treat sleep problems, as well as pain.
CBT-I is a type of therapy that uses several different approaches to treat insomnia. It uses methods such as “cognitive restructuring,” which trains patients to reduce anxious thoughts in ways that make it easier to fall asleep. Another strategy is “sleep restriction,” in which patients primarily stay in bed for sleeping, not for watching TV, reading, or other activities. The goal is to associate being in bed with sleeping, not thinking about issues that can interfere with sleeping.
Comparing acupuncture and therapy as insomnia treatments
Acupuncture and cognitive behavioral therapy had previously been proven effective for insomnia. For example, CBT-I had previously been shown to reduce insomnia among cancer survivors, and acupuncture has been found to be effective for insomnia patients without cancer. The goal of the 2019 study was to compare these two treatments for insomnia among cancer survivors, to determine which was more effective.
The study compared the two treatments in 160 cancer survivors whose insomnia was severe enough that they were diagnosed with insomnia. Participants were randomly assigned to receive either 10 sessions of acupuncture treatment over 8 weeks, or 7 sessions of CBT-I over the course of 8 weeks. The researchers measured the severity of the participants’ insomnia, as well as other symptoms such as pain and anxiety. Participants’ symptoms were measured before they began treatment, right after completing the 8 weeks of treatment, and every four weeks up to 20 weeks after they finished the treatment. Measuring symptoms at these different times compared how effective the treatments were in both the short-term and the long-term.
Which treatment was most effective?
The researchers found that both treatments were effective at reducing insomnia, and they also helped patients reduce their use of sleep aids, even at 20 weeks after finishing treatment. About 25% of patients were using at least one prescription sleep aid at the beginning of the study, but only 17% used the medication 20 weeks after treatment. CBT-I was slightly more effective than acupuncture at reducing insomnia symptoms and improving overall sleep quality, as well as reducing the amount of time it took to fall asleep and reducing the number of times participants woke up in the night.
Twenty weeks after completing treatment with CBT-I, participants fell asleep an average of 24 minutes faster, and those who received acupuncture fell asleep an average of 11 minutes faster than before they started treatment. That might not seem like much benefit, but it is comparable to the small benefit of sleeping pills. After treatment, both groups stayed asleep for longer at night. However, those who received acupuncture stayed asleep even longer than those who received CBT-I. Right after completing treatment, participants who had acupuncture treatment slept for an average of 62 more minutes a night, 27 more minutes than those who were treated with CBT-I. After 20 weeks, those who received acupuncture still slept 51 minutes more than before treatment, which was 5 and a half minutes more than those treated with CBT-I. That is much more additional sleep than is typical of sleeping pills.
However, this difference in the effectiveness of the two treatments was only true for men. The two treatments were equally effective at reducing overall insomnia severity in women. The researchers also found that CBT-I was only more effective among White participants, highly educated participants, and those with lower pain levels. Otherwise, the two treatments were equally effective.
In addition to evaluating insomnia severity, the researchers also measured participants’ fatigue, anxiety, depression, and overall quality of life as measured by mental and physical health. The two treatments were equally effective at improving those symptoms.
The bottom line
Both acupuncture and CBT-I helped reduce insomnia symptoms in cancer survivors, but CBT-I was more effective for men, Whites, highly educated participants, and those with lower pain levels. The researchers concluded that CBT-I should be used as the first line of treatment for cancer-related insomnia, but pointed out that patients might find it difficult to find CBT-I treatment. Unfortunately, there are few trained CBT-I therapists, but acupuncture is a good alternative. In addition, acupuncture was more effective for the treatment of short-term pain than CBT-I.
Despite the shortage of well-trained CBT-I therapists, the availability of online therapy can help those who are interested get access to this treatment. For more information on online therapy, you can read this article.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
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