Effectiveness of Acupuncture and Acupressure for Improving the Sleep Quality of Menopausal Women: A Meta-Analysis

Menopause represents a significant natural transition in a woman's life, accompanied by various challenging symptoms, with sleep disturbances being particularly prevalent and disruptive to quality of life. This systematic meta-analysis investigated the efficacy of acupuncture and acupressure as complementary treatments for improving sleep quality in menopausal women, filling an important gap in the scientific literature on nonpharmacologic therapies for this population. The investigators conducted a comprehensive search across multiple databases, including Scopus, MEDLINE/PubMed, Cochrane CENTRAL, ProQuest, Google Scholar, and Iranian databases, with no date restrictions, through July 2024. Randomized controlled trials comparing acupuncture or acupressure with placebo in menopausal women with sleep disturbances were included.

The methodology rigorously followed PRISMA guidelines for systematic reviews and meta-analyses, ensuring transparency and reproducibility of findings. Of the 6,003 articles initially identified, 14 high-quality studies were included in the final analysis, totaling 843 participants. The results demonstrated significant efficacy of both interventions: eight studies with 499 participants showed that acupressure significantly improved sleep quality (mean difference = -2.33; 95% CI = -3.27 to -1.38), while six studies with 344 participants showed that acupuncture also produced substantial improvement (mean difference = -3.47; 95% CI = -5.06 to -1.88). Most studies used the Pittsburgh Sleep Quality Index (PSQI) as the primary outcome measure, providing a consistent basis for comparison between interventions.

In the acupressure analysis, diverse techniques were observed: six studies focused on auriculotherapy using Vaccaria seeds or magnetic pressure on specific ear points related to sleep, while two studies applied manual pressure to specific body points. Treatments ranged from 2 to 8 weeks, with varied application frequency, from daily use to three times per week. Regarding acupuncture, five of the six studies were conducted in China and one in the United States, using traditional needling, electroacupuncture, or auricular acupuncture at specific points selected according to traditional Chinese medicine principles for regulating sleep and balancing vital energy (Qi). The proposed mechanism of action for both therapies involves the regulation of neurotransmitters such as serotonin and melatonin, in addition to endorphin release through stimulation of specific points.

Acupuncture, as a regulatory system of the central nervous system, modulates the release of serotonin, dopamine, norepinephrine, and beta-endorphins, potentially relieving neuropsychiatric symptoms including sleep disturbances. Acupressure, through sustained pressure on acupoints, stimulates endorphin release and may help balance bodily energy according to traditional Chinese medicine. Importantly, despite the promising results, there was high heterogeneity between studies (I² > 94% for both interventions), attributed to methodological differences, intervention duration, populations studied, and follow-up periods. Leave-one-out sensitivity analysis showed that removing any single study did not significantly alter the overall heterogeneity, suggesting robustness of findings.

Subgroup analysis for acupressure revealed no statistically significant differences between body acupressure and auriculotherapy, indicating similar efficacy for both approaches. Risk-of-bias assessment showed important limitations, particularly in blinding of participants and assessors, which is expected given the nature of the interventions. Despite these limitations, Egger's and Begg's tests detected no significant publication bias, strengthening the reliability of the results. The clinical implications of these findings are substantial, especially considering that approximately 59% of middle-aged American women report symptoms of insomnia at least a few nights a week, and that female life expectancy has increased significantly, with women spending approximately one third of their lives in postmenopause.

Both therapies offer safe and effective alternatives to pharmacologic treatments, which are often associated with adverse effects. Acupressure has additional advantages by being noninvasive, inexpensive, and easily implementable, and it can be taught for home self-application. This study is the first to compare the effects of acupuncture and acupressure specifically on the sleep quality of menopausal women, providing robust evidence for clinical practice. The findings support the integration of these complementary therapies into holistic approaches for managing sleep disturbances in menopause, contributing to improved quality of life for this population.

Future research should focus on standardizing treatment protocols and conducting studies with larger samples to confirm and refine these promising results.