Insomnia affects between 10% and 30% of the adult population and represents one of the most frequent reasons for seeking medical acupuncture. Although the overall efficacy of the technique for sleep disorders had already been established in previous reviews, one question remained without clear answer: among the dozens of acupoint stimulation modalities available — body acupuncture, electroacupuncture, moxibustion, auriculotherapy, tuina, and their combinations — which produces the best results? A network meta-analysis published in April 2026 in Frontiers in Psychiatry offers the most comprehensive answer ever systematized on the topic.
The work, coordinated by Ying Wang and colleagues at Changchun University of Traditional Chinese Medicine and Shandong University of Traditional Chinese Medicine, screened 166,561 records in eight scientific databases and six clinical trial registries. After rigorous screening, 95 randomized clinical trials (RCTs) with a total of 7,628 patients were included, comparing 14 distinct types of acupoint stimulation therapies for primary insomnia in adults. The protocol was prospectively registered in PROSPERO (CRD42025640547).
MAIN SUCRA RANKINGS BY OUTCOME
How the Study Was Conducted
The systematic search covered eight English- and Chinese-language databases, with a cutoff date in September 2024. From 166,561 records identified, 95 RCTs met the inclusion criteria — all involving adults with diagnosis of primary insomnia treated with some modality of acupoint stimulation. The analysis included 3,829 patients in intervention groups and 3,799 in control groups, with 91 studies (95.8%) reporting gender data and 85 (89.5%) reporting duration of the clinical condition.
The network meta-analysis methodology allowed simultaneous comparison of all 14 modalities, even when there were no studies of direct comparison between them. The primary outcomes were Total Clinical Response Rate (TER), the Pittsburgh Sleep Quality Index (PSQI), and the magnitude of improvement in PSQI score (ΔPSQI). Six PSQI subcomponents were analyzed separately: subjective sleep quality, sleep latency, sleep duration, sleep efficiency, nighttime disturbances, and daytime dysfunction.
Which Technique Wins in Each Outcome?
For the Total Clinical Response Rate — the most directly clinical outcome, defined as “significant improvement or cure” — 89 RCTs with 7,261 patients reported this data. The combination of body acupuncture + electroacupuncture obtained the highest SUCRA value (0.874), indicating an 87.4% probability of being the best among all modalities analyzed. By contrast, body acupuncture alone ranked among the worst (SUCRA 0.081), suggesting that electroacupuncture adds considerable benefit to the base technique.
For the total PSQI score (sleep quality scale, where lower is better), 62 RCTs with 5,275 patients were included. Here moxibustion combined with tuina emerged as the most effective intervention (SUCRA 0.966), with mean difference of 13.10 points over moxibustion alone (95% CI: 5.16–21.05) and 10.24 points over tuina alone (95% CI: 2.71–17.77). For the magnitude of improvement in PSQI (how much the score dropped from the start of treatment), moxibustion alone led with SUCRA 0.933, surpassing the moxibustion + tuina combination by 12.92 points (95% CI: 3.43–22.41).
In the six PSQI subcomponents, the electroacupuncture + auricular acupressure combination stood out consistently: it led in subjective sleep quality (SUCRA 0.938; MD vs. body acupuncture = 1.72; 95% CI: 0.39–3.06), nighttime disturbances (SUCRA 0.835; MD 0.80; 95% CI: 0.09–1.51), and daytime dysfunction (SUCRA 0.799). For sleep latency, specialized needles led (SUCRA 0.908; MD 1.70 vs. body acupuncture; 95% CI: 0.43–2.98). For sleep efficiency, the combination of body acupuncture + scalp acupuncture obtained the best performance (SUCRA 0.764; MD 0.55; 95% CI: 0.10–0.99).
Frequently Asked Questions
They are complementary outcomes that capture different aspects of treatment response. The Total Clinical Response Rate (TER) is a dichotomous outcome defined by the studies’ own researchers as “significant improvement or cure” — it reflects the overall clinical perspective. The PSQI (Pittsburgh Sleep Quality Index) is a standardized scale from 0 to 21 points that measures seven sleep dimensions; a reduction of 3 or more points is considered clinically significant. The fact that different combinations lead in each outcome indicates that “the best treatment” depends on what is prioritized: rapid clinical response (EA + body acupuncture) or gradual and comprehensive sleep improvement (moxibustion + tuina).
This is precisely the main gap in the study: only 16 of 95 RCTs (16.8%) included follow-up data after the end of treatment. Available data suggest maintenance of effects in the short term, but clinical trials with 3–6-month follow-up are rare in the literature on insomnia and acupuncture. From a clinical standpoint, monthly or bimonthly maintenance sessions are recommended after the initial cycle, especially in patients with chronic insomnia or frequent recurrences.
This meta-analysis did not directly compare acupuncture with pharmacologic hypnotics — control groups were primarily “conventional treatment” or “no treatment.” Available literature suggests that acupuncture may be effective as primary therapy in mild-to-moderate insomnia and as an adjunct for dose reduction in patients on chronic hypnotic use. The decision to substitute or reduce medication should be made by the medical acupuncturist together with the patient, considering insomnia severity, comorbidities, and patient preference. Never discontinue hypnotics abruptly without medical supervision.
Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).
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