Insomnia

What is Insomnia?

Insomnia is persistent difficulty falling asleep, staying asleep or sleeping long enough, which leaves you tired or unable to function well during the day. It is common, can be short-lived or long-lasting, and often occurs alongside other medical or mental health conditions.^{[1, 2]}

Common symptoms

The main symptoms are taking a long time to fall asleep, waking often in the night, waking too early and not getting back to sleep, and feeling unrefreshed.^[2] Poor sleep can affect daytime function, mood, concentration and quality of life.^[2]

• Daytime fatigue and low energy
• Irritability or mood changes
• Trouble with focus and memory
• Worry about sleep itself

Causes and risk factors

Insomnia can stand alone or appear with other conditions, and it can raise the risk of developing or worsening other disorders if it is not treated.^[3] Common contributors include stress, anxiety and depression, pain, breathing problems during sleep, restless legs, hormonal change, some medicines, caffeine, alcohol and an irregular sleep schedule.^{[2, 4]}

Research on the brain suggests that people prone to insomnia may have a stress and alert system that stays switched on, which keeps the brain in a state of hyperarousal at night.^[5]

How it is diagnosed and treated conventionally

Insomnia is diagnosed mainly from a clinical interview about your sleep and medical history, often with a sleep diary and questionnaires. A sleep study is used when another sleep disorder, such as sleep apnea, is suspected.^[6]

Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia in adults.^{[3, 6]} When it is not enough, a physician can offer a medicine for short-term use. CBT-I has shown benefits that last after treatment ends, which is not clear for medicines.^[3]

Why Insomnia calls for a whole-person approach

Insomnia rarely has a single cause. Stress, mood, pain, health conditions, medicines and daily habits can all feed into poor sleep, and poor sleep can feed back into each of them.^[4]

Care that looks at body, mind and routine together is therefore a reasonable addition to the standard treatment your physician or sleep specialist provides.

Stress and an overactive alert system

Insomnia is linked to hyperarousal, in which brain circuits for emotion and alertness stay active when they should quiet down for sleep.^[5] This is one reason relaxation, breathing practices and stress reduction are part of standard behavioral treatment.^[6]

Mood and anxiety

Insomnia is a symptom shared across many mental health conditions. It may be a risk factor for mood and anxiety disorders, and it often occurs alongside them.^[4]

Pain, medical conditions and medicines

Other health problems, including pain, sleep apnea and some medicines, can disrupt sleep, so treating the underlying condition is part of care.^{[1, 2]}

Daily routine and sleep habits

Light exposure and exercise may be useful additions to CBT-I.^[6] Regular sleep and wake times and limiting caffeine and alcohol are standard advice.^[2]

Acupuncture for Insomnia

What the research shows

Research suggests acupuncture may improve sleep in some people, but the overall quality of the evidence is mixed. A 2021 review of 24 trials included a meta-analysis of 15 trials that found acupuncture improved sleep quality scores more than medicines, with the benefit appearing after about three weeks of treatment. Results varied widely between trials.^[7]

The Cochrane review of 33 trials concluded that the evidence was not rigorous enough to support or refute acupuncture for insomnia. All trials had a high risk of bias, effects were small, and publication bias was likely.^[8]

Some newer sham-controlled trials are more encouraging. In a trial of 270 people with insomnia and depression in China, electroacupuncture (3 sessions a week for 8 weeks, alongside standard care) improved sleep quality more than sham acupuncture, and the benefit was still present at 32 weeks.^[9] In 138 breast cancer patients with insomnia after chemotherapy, the main sleep score did not differ from sham acupuncture, although some secondary measures such as sleep onset time, anxiety and mood did favor real acupuncture.^[10] A meta-analysis in cancer-related insomnia found acupuncture improved sleep scores compared with a wait-list in breast cancer patients, while real and sham acupuncture were similar.^[11]

A 2024 review concluded that acupuncture is a promising option for primary insomnia, with minimal side effects, but that methodological weaknesses reduce confidence and better trials are needed.^[12]

How acupuncture may work

Researchers propose that acupuncture may act on brain chemical messengers, stress hormone pathways, inflammation and the body's daily rhythm. Animal studies suggest these pathways, so they remain proposed explanations.^[12]

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the body, and sometimes the ear, usually left in place for about 20 to 40 minutes. One trial gave 3 sessions a week for 8 weeks.^[9] We reassess after a short course of visits to see whether sleep is improving.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Insomnia

The Ayurvedic view

Ayurveda describes sleeplessness as Anidra, a condition in which the sleep-supporting qualities of the body are disturbed. In this traditional framework it is most often linked to aggravated Vata, the principle said to govern movement and the nervous system, and sometimes to Pitta from heat and overwork. These are traditional categories used to choose treatment, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Daily routine and diet, such as regular sleep and waking times, a light evening meal and a calming evening routine
• Warm oil massage of the body or scalp
• Shirodhara, a therapy in which warm oil is poured in a steady stream over the forehead; a small case series used oil prepared with brahmi^[14]
• Herbs such as ashwagandha (Withania somnifera), which has been tested for sleep^{[15, 16]}
• Breathing, yoga and meditation practices

Panchakarma procedures are not appropriate during pregnancy, acute illness or frailty, or before a medical cause of the sleep problem has been assessed. Shirodhara and similar oil therapies are not suitable when you are unwell or have a fever.

What the research shows

The evidence for Ayurvedic treatment of insomnia is limited. The strongest data are for ashwagandha extract. A meta-analysis of 5 placebo-controlled trials with 400 participants found a small improvement in sleep, larger in people diagnosed with insomnia, but the authors said more safety data were needed.^[15] A trial of 80 people, half of whom had insomnia, found improved sleep onset and sleep efficiency with ashwagandha root extract compared with placebo over 8 weeks, and the authors called for additional trials.^[16]

For shirodhara, one case series of 10 adults, with no control group, reported improved insomnia scores at the end of 5 daily sessions. The improvement was no longer statistically significant one week later.^[14]

Herbal medicine for Insomnia

Herbs and formulas that have been studied

Chinese herbal formulas that have been studied for insomnia include guipi decoction, chaihu longgu muli decoction, suanzaoren (jujube seed), and Huanglian Wendan decoction.^[17] Ashwagandha, discussed above, is also used in Ayurveda.^[15]

What the research shows

A 2025 network meta-analysis of 186 randomized trials of 13 Chinese herbal interventions found that several improved sleep scores compared with conventional medicines, with the included studies at low to moderate risk of bias.^[17] These findings are not a reason to replace prescribed sleep medicine.

The 2023 European Insomnia Guideline does not recommend herbal products (phytotherapeutics) as a treatment for insomnia.^[6] Herbal medicine is best viewed as an optional addition to CBT-I and medical care.

Safety and herb-drug interactions

Herbs can interact with medicines. Reviews describe interactions such as kava with the sedative alprazolam, and St John's wort with antidepressants, so people taking sedatives or antidepressants need a practitioner's review before using herbs for sleep.^[18] Herbs with calming effects may add to drowsiness from sleep medicines or alcohol.

Ashwagandha supplements have been linked to cases of liver injury, in a small case series usually with jaundice and itching appearing 2 to 12 weeks after starting; liver tests returned to normal within 1 to 5 months in most cases.^[19] Tell us if you have liver disease. In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine describes insomnia through patterns such as a heart and spleen deficiency or heat disturbing the spirit. Researchers studying acupuncture for sleep look at things that loosely parallel this picture: neurotransmitter signaling, the stress hormone axis and the body's circadian rhythm.^[12]

Ayurveda's aggravated Vata describes a restless, overactive nervous system. This resembles the hyperarousal that researchers describe in insomnia.^[5] No study has shown that a dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for insomnia is complementary. Keep your physician or sleep specialist, and do not stop or change prescribed sleep medicines, antidepressants or other medicines without your prescriber, since stopping some sleep medicines suddenly can cause problems. We do not diagnose the cause of insomnia, so sleep trouble that lasts should be medically evaluated for conditions such as sleep apnea, depression or medicine effects.

Please bring your diagnosis, a full list of medicines and supplements, and any sleep study results or notes about CBT-I you have had.

When to seek urgent medical care

Insomnia can sometimes point to a condition that needs prompt attention, such as severe depression or a breathing disorder during sleep.^[6]

• Thoughts of suicide or self-harm; call or text 988 (Suicide and Crisis Lifeline)
• Loud snoring with pauses in breathing, or waking up gasping or choking
• Falling asleep while driving or at risk moments during the day
• Sleeplessness for several days with racing thoughts, a feeling of not needing sleep or confusion
• New insomnia with chest pain, shortness of breath or severe symptoms

If any of these are an emergency, call 911 or go to the nearest emergency department.