Acupuncture to Treat Sleep Disorders in Postmenopausal Women: A Systematic Review
Bezerra et al. · Evidence-Based Complementary and Alternative Medicine · 2015
Evidence Level
MODERATEOBJECTIVE
Systematically evaluate the effects of acupuncture on sleep disorders in postmenopausal women
WHO
Postmenopausal women with sleep-related complaints
DURATION
9 to 36 acupuncture sessions
POINTS
Varied protocols including systemic and auricular points based on TCM
🔬 Study Design
Randomized clinical trials
n=8
body or auricular acupuncture
Cohort studies
n=1
auriculotherapy
Case reports
n=3
personalized acupuncture
📊 Results in numbers
Studies with improvement
Positive clinical trials
STRICTA compliance
Low risk of bias
Percentage highlights
📊 Outcome Comparison
Efficacy by study type
This study analyzed research on acupuncture for sleep problems in postmenopausal women. Most studies showed sleep improvements, but more well-designed research is still needed to confirm whether acupuncture truly works for this condition.
Article summary
Plain-language narrative summary
This systematic review investigated the therapeutic effects of acupuncture on sleep disorders in postmenopausal women, analyzing 12 studies selected from 89 articles initially identified. The postmenopausal period is characterized by significant hormonal changes that frequently result in sleep disorders, especially insomnia, which affects 25% to 60% of these women. The methodology included a systematic search of the PubMed/Medline and Scopus databases, with assessment using Cochrane tools and STRICTA guidelines. The selected studies included eight randomized clinical trials, one cohort study, and three case reports, with considerable methodological heterogeneity in the acupuncture protocols.
Results showed that 75% of studies (9 of 12) demonstrated improvements in sleep-related complaints after treatment with acupuncture. Among the randomized clinical trials, 62.5% presented positive results. Risk of bias assessment showed low risk in most criteria, except for blinding of participants. STRICTA guideline compliance averaged 62.1%.
The protocols varied widely regarding type of acupuncture (body, auricular, or mixed), number of sessions (9-36), duration of treatment, and points used, reflecting the individualized approach of Traditional Chinese Medicine. Most studies used subjective sleep assessments, with only one employing polysomnography. Limitations include the small number of studies, high methodological heterogeneity, and lack of standardization in intervention protocols. Despite the promising results, the evidence is still insufficient to establish acupuncture as a standard treatment for postmenopausal sleep disorders.
The authors emphasize that this is not due to inefficacy of the technique, but to the limitation of available evidence. No adverse effects were reported in the analyzed studies, suggesting safety of the intervention. The review concludes that, although the results are encouraging, more methodologically rigorous, multicenter studies with larger samples are needed to confirm the efficacy of acupuncture in this specific population.
Strengths
- 1Rigorous methodology using standard tools
- 2Comprehensive analysis of different study types
- 3Detailed assessment according to STRICTA guidelines
- 4Absence of reported adverse effects
Limitations
- 1Limited number of available studies
- 2High methodological heterogeneity
- 3Most studies with sleep as a secondary outcome
- 4Inability to perform meta-analysis
Expert Commentary
Prof. Dr. Hong Jin Pai
PhD in Sciences, University of São Paulo
▸ Clinical Relevance
Postmenopausal sleep disorders constitute one of the most frequent and underestimated problems we encounter in practice. Insomnia, sleep fragmentation, and early awakening affect between 25% and 60% of women in this phase, according to the data underlying this review, and the conventional pharmacological arsenal carries tolerability and dependence limitations that make prolonged use unfeasible in a substantial portion of patients. Acupuncture, by acting on autonomic modulation, the HPA axis, and serotonergic regulation, offers a biologically plausible therapeutic pathway and, as demonstrated by the 75% of studies with positive outcomes in this review, a clinically tangible one. The safety profile is particularly relevant: no adverse effects were reported. For the physician who follows the woman through climacteric, this consolidates acupuncture — body or auricular — as a legitimate integrative option, especially when the patient refuses or does not tolerate hormone therapy or hypnotics.
▸ Notable Findings
The most expressive finding of the review is that 75% of the analyzed studies — regardless of design — documented objective or subjective improvement in sleep complaints. Even restricting the analysis only to randomized clinical trials, 62.5% presented positive results, which maintains the coherence of the favorable signal even under more stringent methodological criteria. Assessment using STRICTA guidelines, with average compliance of 62.1%, reveals that a substantial part of the protocols already adequately describes treatment individualization — a central factor in Traditional Chinese Medicine and frequently neglected in previous acupuncture reviews. The breadth of protocols — from 9 to 36 sessions, with variations among body, auricular, and combined acupuncture — far from indicating inconsistency, reflects the real clinical heterogeneity of postmenopausal patients and the therapeutic flexibility that distinguishes this approach.
▸ From My Experience
In my practice at the HC-FMUSP Pain Center, I have followed postmenopausal women with sleep disorders for decades, and the pattern I observe is quite consistent with the positive signal of this review. The initial response — reduction in latency and improvement in subjective quality — usually appears between the third and fifth session, especially when we associate systemic acupuncture with auricular points such as Shen Men and Kidney. The profile that responds best is the patient with maintenance insomnia and concurrent nocturnal hot flashes, since acupuncture appears to act on both axes simultaneously. I habitually conduct 12 to 16 sessions for consolidation, with monthly maintenance thereafter. I frequently combine with structured sleep hygiene and, when there is a significant anxious component, I intersperse with relaxation techniques. I do not indicate acupuncture in isolation when there is suspicion of untreated obstructive sleep apnea — the physician must rule out structural causes first.
Full original article
Read the full scientific study
Evidence-Based Complementary and Alternative Medicine · 2015
DOI: 10.1155/2015/563236
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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