Sleep Disorders

Understanding Sleep Disorders

Sleep disorders are a group of conditions that disturb normal sleep patterns, and they are among the most common clinical problems. Inadequate or non-restorative sleep can interfere with physical, mental and emotional functioning, safety and quality of life.^[1] Most of the research on complementary care covers insomnia, so much of this page focuses on it.

The International Classification of Sleep Disorders groups them into insomnia, sleep-disordered breathing (including obstructive sleep apnea), disorders of excessive sleepiness (such as narcolepsy), body-clock (circadian) disorders, parasomnias (such as sleepwalking and nightmares) and sleep-related movement disorders (such as restless legs syndrome).^[1]

Common symptoms

Symptoms depend on the type of disorder. Common ones include difficulty falling or staying asleep, waking too early, daytime sleepiness, poor concentration or memory, irritability and waking unrefreshed.^[1]

• Loud snoring, choking or gasping during sleep, which may point to sleep apnea
• An urge to move the legs in the evening, which may point to restless legs syndrome
• Sleepwalking, night terrors or acting out dreams
• Sudden, uncontrollable sleep during the day, which may point to narcolepsy

Causes and risk factors

Causes differ by disorder. Insomnia often accompanies stress, anxiety, depression, pain, other medical conditions, some medicines, caffeine, alcohol and irregular sleep schedules.^{[1, 2]} Sleep apnea is linked to excess weight, alcohol use and the structure of the airway. Narcolepsy is thought to involve a shortage of a brain chemical called hypocretin. Shift work and light exposure can disturb the body clock.

How it is diagnosed and treated conventionally

Diagnosis starts with a clinical interview about your sleep and medical history, plus sleep questionnaires and diaries. An overnight sleep study (polysomnography) is advised when another sleep disorder, such as sleep apnea or periodic limb movement disorder, is suspected, or when insomnia does not respond to treatment.^[3]

For chronic insomnia, cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment, and medicines can be offered for short-term use if it is not enough.^[3] Only CBT-I has shown lasting benefit after treatment stops.^[4] Sleep apnea is usually treated with a CPAP machine or other airway devices, and sometimes surgery. Other disorders have their own treatments.

Why Sleep Disorders calls for a whole-person approach

Sleep problems rarely have a single cause. Stress, mood, pain, other illnesses, medicines and daily habits all affect sleep, and poor sleep affects each of them in turn.^[2]

Care that looks at body, mind and routine together is a reasonable addition to the treatment a physician or sleep specialist provides. It is not a substitute for finding out which sleep disorder you have.

Stress and an overactive alert system

Insomnia is linked to hyperarousal, in which brain circuits for emotion and alertness stay too active at night to allow restful sleep.^[5] This is one reason relaxation and stress-reduction practices are part of standard care for insomnia.

Mood and anxiety

Insomnia is a risk factor for, a companion of, and a symptom of many mental health conditions, including mood and anxiety disorders.^[2] Poor sleep and low mood can feed each other.

Medical conditions and medicines

Pain, breathing problems during sleep, restless legs and some medicines can all disrupt sleep. A sleep study may be needed to separate them, so treating the underlying problem is part of care.^{[1, 3]}

Daily routine

Regular sleep and wake times, limiting caffeine, alcohol and nicotine in the evening, and a comfortable sleep environment are standard advice.^[1] Light therapy and exercise may be useful additions to CBT-I.^[3]

Acupuncture for Sleep Disorders

What the research shows

Most acupuncture research is on insomnia, and it is mixed. A 2021 review of 24 trials included a meta-analysis of 15 trials in which acupuncture improved sleep quality scores more than medicines, with the benefit appearing after about three weeks of treatment. The trials differed widely in design and results varied a lot between them.^[6] The Cochrane review of 33 trials concluded that the evidence was not rigorous enough to support or refute acupuncture for insomnia, citing high risk of bias, small effects and likely publication bias.^[7]

Some newer trials are more encouraging. In a sham-controlled trial of 270 people in China with insomnia and depression, 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.^[8] An umbrella review of 15 reviews found that acupuncture improved sleep quality and insomnia severity, but results on objectively measured sleep were inconclusive and study quality was low.^[9]

For obstructive sleep apnea, a meta-analysis of nine trials (584 participants) reported fewer breathing interruptions per hour and less sleepiness with acupuncture, but the quality of evidence was low to very low, the sleepiness result did not hold up in a sensitivity analysis, and the authors called for better trials.^[10] Acupuncture is not a replacement for CPAP or other sleep apnea treatment.

For restless legs syndrome, a Cochrane review found only two small trials and insufficient evidence to judge acupuncture.^[11] A later meta-analysis of 18 studies reported better symptom scores with acupuncture, but it was low in quality and called for sham-controlled trials.^[12]

How acupuncture may work

How acupuncture might improve sleep is not settled, and we do not cite a mechanism as established. Reviews found benefits mainly on self-reported sleep, while effects on objectively measured sleep were inconclusive.^[9]

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. Trials have given sessions several times a week for several weeks.^[8] 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 Sleep Disorders

The Ayurvedic view

Ayurveda describes sleeplessness as Anidra, and treats sleep (Nidra) as one of the supports of health. In this traditional framework, poor sleep 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]
• Breathing 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 sleep problems is limited and concerns insomnia. The strongest data are for ashwagandha extract. A meta-analysis of five placebo-controlled trials with 400 participants found a small but significant improvement in sleep, larger in people diagnosed with insomnia. The authors said more safety data were needed.^[15]

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

No Ayurvedic studies for sleep apnea, restless legs syndrome or narcolepsy were found.

Herbal medicine for Sleep Disorders

Herbs and formulas that have been studied

Chinese herbal formulas studied for insomnia include guipi decoction, chaihu longgu muli decoction, suanzaoren (jujube seed) and Huanglian Wendan decoction.^[16] Valerian is a Western herb widely used for sleep.^[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 low to moderate risk of bias. Most trials were done in China, so the results may not apply everywhere.^[16]

For valerian, an umbrella review of eight systematic reviews found a good safety profile but no evidence of efficacy for insomnia on objective measures, and the studies were of low quality.^[17] The 2023 European Insomnia Guideline does not recommend herbal products (phytotherapeutics) as a treatment for insomnia.^[3] Herbal medicine is therefore best viewed as an optional addition to CBT-I and medical care.

Safety and herb-drug interactions

Herbs can interact with medicines. Reviews describe kava causing a semicomatose state with the sedative alprazolam and St John's wort causing serotonin syndrome with antidepressants, so people taking sedatives or antidepressants need a practitioner's review before using herbs for sleep.^[18] The same review describes bleeding when ginkgo or danshen was combined with warfarin.^[18]

Ashwagandha supplements have been linked to rare cases of liver injury with jaundice and itching beginning 2 to 12 weeks after starting; liver tests normalized within 1 to 5 months in most of the cases described.^[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 poor sleep through patterns such as heart and spleen deficiency or heat disturbing the spirit. Researchers studying sleep look at things that loosely parallel this picture, such as arousal systems, stress responses and emotional regulation.^{[2, 5]}

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 or a TCM pattern corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for sleep disorders is complementary. Keep your physician or sleep specialist, and do not stop or change prescribed sleep medicines, antidepressants, CPAP use or other treatments without your prescriber. We do not diagnose the type of sleep disorder, so sleep trouble that lasts should be medically evaluated for conditions such as sleep apnea, restless legs syndrome, 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

Sleep problems can sometimes point to a condition that needs prompt attention, such as severe depression or a breathing disorder during sleep.^[3]

• 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 other risky moments during the day
• Several nights of almost no sleep with racing thoughts, a feeling of not needing sleep, or confusion
• New sleep trouble with chest pain or shortness of breath

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