Integrative Therapy for Insomnia: A Pilot Study to Test an Extended CBT-I Program

Research background and Objectives: Cognitive Behavioral Therapy for Insomnia (CBT-I) is recognized as the preferred non-pharmaceutical treatment for Insomnia. This pilot study aims to test the efficacy of an extended version of CBT-I called Integrative Therapy for Insomnia (IT-I). The traditional CBT-I is complemented with exercises that are expected to enhance relearning to sleep by providing different stimuli, and access options for the retrieval and application of the acquired information, cognition, and skills. Method: The efficacy of the IT-I is measured by comparing the participants’ scores on the Insomnia Severity Index at baseline and post-treatment. In total 29 people, with a wide range of ages, participated in the 8 sessions’ treatment of one hour 45 minutes per session, in mixed groups of age, gender, and primary or comorbid insomnia. Results: Comparing the ISI baseline and post-treatment scores, results show a mean improvement of 7.2 points and a p r = −0.43. Conclusions: The integration of exercises that generate sensory-motor stimuli, and address the mirror neuron system fitting with the Mental Contrasting as a metacognitive strategy seems to facilitate re-learning to sleep in cases of primary insomnia as well as for comorbid insomnia. Further studies will be needed to arrive at more firm conclusions.

A Case of Refractory Insomnia Responding to Modified Electroconvulsive Therapy

A 42-year-old female patient suffered refractory insomnia. A variety of drugs including anti-anxiety, antidepressants, antipsychotics and repetitive transcranial magnetic stimulation (rTMS) have been applied in the treatment with no significant effect, whereas modified electroconvulsive therapy (MECT) can significantly improve the patient’s sleep.

Nursing Based on Syndrome Differentiation Combined with Auricular Plaster Therapy in Alleviating Insomnia

Objective:To observe the effect of auricular point pressing combined with nursing based on syndrome differentiation in the treatment of insomnia patients.Methods:Totally 92 patients with insomnia were randomly divided into the observation groupgiven auricular point pressing combined with nursing care based on syndrome differentiation and the control group treated with auricular point pressing alone.The improvement of Pittsburgh Sleep Quality Index(PSQI),TCM Syndrome Score and nursing satisfaction were compared between the 2 groups.Results:The time effect of PSQI total score and 6 factors in both groups were statistically significant(P<0.05).The time effect,interaction effect and inter-group effect of subjective sleep quality,PSQI total score were statistically significant(P<0.05);the 4 inter-group factors of sleep quality,sleep latency,sleep duration and daytime function were statistically significant(P<0.05).The total score of TCM syndromes in the observation group was lower than that in the control group(P<0.05),and the satisfaction rate in the observation group higher than that in the control group(80.43%vs.60.86%,P<0.05).Conclusion:Auricular point pressing combined withnursing based on syndrome differentiation can effectively improve the sleep quality of insomnia patients,and has significant advantages in improving TCM syndromes,as well as gained higher nursing satisfaction from patients.

INSOMNIA TREATED WITH AURICULAR-PLASTER THERAPY IN 218 CASES

218 cases of insomnia were treated by auricular plaster therapy with seeds of Vaccaria segetalis. The auricular points Heart, Shenmen, Occiput and Brain were selected. The resultsshowed that 136 cases were cured, 76 markedly impr0ved and 6 no effect. The effect of this therapywas significantly better than that of medication (P【0. 01) in comparison with the application of western medicine.

Clinical Observation on the Treatment of Insomnia in Germany with Deficiency of Heart and Spleen by the Ear Bean Therapy

Objective: To observe the effect of insomnia patients with deficiency of heart and spleen in Germany by the therapy of ear points pressing with bean. Methods: A total of 80 cases of insomnia with deficiency of heart and spleen in Germany were divided into the observation group and the control group, with 40 cases in each group. The patients in the control group were treated with oral modified Guipi Decoction(归脾汤), while the patients in the observation group were treated with oral traditional Chinese medicine(TCM) and the therapy of ear points pressing with bean. The efficacy, sleep quality, the TCM syndromes score and the incidence of adverse reactions were compared between the two groups. Results: The effective rate in the observation group was higher than that in the control group, and there was statistical difference between the two group(P<0.05). After treatment, the Pittsburgh sleep quality index scale(PSQI) score, insomnia severity index(ISI) score and the TCM syndromes score in the two groups were decreased sharply(P<0.01), and those scores in the observation group were lower than that in the control group(P<0.05). There was no adverse reaction between the two groups. Conclusion: The therapy of ear points pressing with bean is effective on insomnia in Germany, which is worth further study and promotion.

CLINICAL OBSERVATION ON TREATMENT OF 61 CASES OF INSOMNIA WITH AURICULAR PLASTER THERAPY

Objective: To observe the therapeutic effect of auricular plaster (otopoint-pressure) therapy in the treatment of insomnia. Methods: In this paper, 61 cases of insomnia patients including 16 males and 45 females were treated with Ershenmen (MA-TF 1), Zhen (MA-AT), Yuanzhong (MA-AT), Nao Dian and E (MA-AT), combined with other otopoints according to symptoms. The otopoint was stuck with a piece of plaster adhered with vaccaria seeds and pressured by the patient him- or her-self. The treatment was given twice a week, with 7 times being a therapeutic course. Results: After 1-2 courses of treatment, 19 (31.15%) cases were cured, 34 (55.74%) had improvement and 8 (13.11%) had no changes, with the total effective rate being 86.9%. Conclusion: Auricular plaster therapy works well in the treatment of insomnia patient.

Contrasting cognitive behavioral therapy for insomnia to analyze sleep theory in Laolao Hengyan

Insomnia is a prominent problem.The current mainstream therapy for insomnia is cognitive behavioral therapy.Traditional Chinese medicine has rich clinical experience in treating insomnia,but we have ignored the contribution of traditional Chinese medicine to behavioral therapy in the past.Completed in the Qing Dynasty in China,Laolao Hengyan is a comprehensive book on the management of the elderly's self-health.The book describes many ways to promote sleep health.This book inherits the traditional Chinese medical treatment concept and reflects traditional Chinese culture.By comparing this book with cognitive behavioral therapy,we find that the Chinese Qing Dynasty literature has documented some cognitive and behavioral aspects of sleep that are consistent with modern medical concepts.Moreover,this method is superior to modern medicine in some aspects,so this is worthy of our in-depth study to complement and enrich modern medical theory.

魏福良教授治疗失眠症经验举隅

文章对魏福良教授治疗失眠症的经验进行了总结。失眠症为中医临床常见病,安徽省名老中医魏福良主任医师认为其诊治需从“五脏藏神”理论着手,诊脉查舌,辨证论治。魏师精研针、灸、药结合之道,用针本神,以脏腑辨证为本,精研刺灸之法,脏腑经络并治,令阴平阳秘;针药同施,内外并治,脏腑气血阴阳调和而神自安。

舒神汤联合穴位拔罐治疗慢性顽固性失眠50例

目的观察舒神汤联合神门、三阴交穴位拔罐治疗慢性顽固性失眠的临床效果。方法选择100例病程6个月以上的慢性顽固性失眠患者。双盲随机分成治疗组与对照组。对照组行常规治疗,采用安眠类西药;治疗组应用舒神汤,联合神门、三阴交穴位拔罐。两组治疗4周,观察治疗效果。结果治疗组治愈率64.0%(32/50)高于对照组的8.0%(4/50),总有效率100.0%(50/50)高于对照组的66.0%(33/50),差异均有统计学意义(P<0.05)。治疗后,治疗组汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评分较治疗前明显降低,且治疗组低于对照组,差异有统计学意义(P<0.05);治疗组匹兹堡睡眠质量指数(PSQI)评分较治疗前明显降低,且治疗组低于对照组,差异有统计学意义(P<0.05);治疗组健康状况调查问卷(SF-36)评分较治疗前明显升高,差异有统计学意义(P<0.05),且治疗组高于对照组,差异有统计学意义(P<0.05)。对照组不良反应总发生率为46.0%(23/50),高于治疗组的2.0%(1/50),差异有统计学意义(P<0.05)。结论舒神汤联合神门、三阴交穴位拔罐治疗慢性顽固性失眠安全性高、有显著效果。

Treating Comorbid Insomnia in Older Adults via Cognitive-Behavioural Treatment, Bright Light and Exercise

Background: Insomnia occurs frequently in older adults. The underlying factors for the disorder are physiological changes of the sleep-wake cycle, comorbid diseases and drug treatment. Cognitive behavioural therapy (CBT I) combined with light therapy and physical activity can be effective in the treatment of comorbid insomnia in older adults. Methods: Sixty-three (63) insomnia patients (47 female, 16 male) with an average age of 66.6 years participated in the program. Before and after the treatment, the participants completed questionnaires to assess their sleep quality (PSQI), day-time sleepiness (ESS), mood (BDI) and well-being (WHO-5-Index). In addition, they kept sleep diaries for six weeks. Results: Pre-post comparisons revealed a significant improvement in sleep latency and sleep quality, as well as a significant reduction of day-time sleepiness. In patients with both insomnia and depression, all depression scores improved slightly but significantly. Conclusions: Non-pharmacological combination treatment using CBT I, light therapy and physical activity seemed to be effective in older adults with comorbid insomnia and improve additionaly depressive symptoms.

Cognitive Behavioral Therapy as the Basis for Preventive Intervention in a Sleep Health Program: A Quasi-Experimental Study of E-Mail Newsletters to College Students

Several reports suggest that college students often have atypical sleep patterns and experience poor sleep quality. We examined the effect of a cognitive behavioral therapy (CBT) based intervention program to improve sleep quality and overall mental health among college students. The intervention was delivered in the form of e-mail newsletters. Fifty-three students participated in the intervention group, and another 50 students participated in the control group. The intervention group received a lecture on sleep hygiene;once-weekly e-mail newsletters on sleep health topics (sleep hygiene, stimulus control, sleep restriction, sleep titration, and relapse prevention) and were asked to maintain a four-week sleep diary. The Pittsburgh Sleep Quality Index (PSQI), a measure of sleep quality, and the Kessler 6, a measure of psychological distress, were administered before the lecture (as the baseline measurement) and again 16 weeks later (follow-up measurement). PSQI and K6 scores were reduced in the intervention group compared with the control group. A CBT-based sleep health program utilizing e-mail newsletters may work to improve sleep quality and mental health. This program may represent a cost effective way for Japanese students to receive treatment for poor sleep and may also serve to prevent psychiatric problems.

Meta-analysis of ear acupoint therapy to treat sleep disorders in hemodialysis patients

Background:To evaluate the therapeutic effect of auricular therapy on sleep disorders in hemodialysis patients using meta-analysis methods,and to provide evidence-based support for clinical practice.Methods:PubMed,Embase,Cochrane Library,Chinese Biomedical Literature Database,China Journal Full-text Database,Chinese Science and Technology Journal Full-text Database,and Wanfang Resource Database were searched up to February 2023.Randomized controlled trials of auricular therapy for sleep disorders in hemodialysis patients were collected and included in the study.Meta-analysis was performed using RevMan 5.3 software.Results:587 patients from 7 randomized controlled trial studies were included.The auricular therapy group had better sleep conditions than the conventional care group,as evaluated by the Pittsburgh Sleep Quality Index,in terms of total Pittsburgh Sleep Quality Index score(mean difference(MD)=–5.11,95%confidence interval(CI)(–5.25,–4.96),P<0.00001),subjective sleep quality(MD=–0.64,95%CI(–0.72,–0.56),P<0.00001),falling asleep time(MD=–0.37,95%CI(–0.49,–0.26),P<0.00001),sleep time(MD=–0.38,95%CI(0.44,–0.32),P<0.00001),sleep efficiency(MD=–0.15,95%CI(–0.23,–0.07),P<0.0001),sleep disturbances(MD=–0.18,95%CI(–0.28,–0.09),P=0.0002),daytime dysfunction(MD=–0.89,95%CI(–1.18,–0.6),P<0.00001),and hypnotic medication(MD=–0.22,95%CI(–0.4,–0.03),P=0.02).Conclusion:Auricular therapy is an effective method for improving sleep quality in hemodialysis patients,providing evidence-based support for clinical practice.

TIP睡眠调控技术联合耳穴磁疗对乳腺癌患者围手术期睡眠质量的影响

目的观察低阻抗意念导入疗法(thought induction psychotherapy,TIP)睡眠调控技术联合耳穴磁疗对乳腺癌患者围术期睡眠质量、情绪状态和恢复质量的影响。方法将60例行乳腺癌手术的心肾不交证型失眠患者随机分为研究组和对照组,每组30例。对照组接受围手术期常规护理和耳穴磁疗,研究组在对照组基础上辅助TIP睡眠调控技术,每天1次,从术前1 d开始治疗至术后3 d。观察两组术前和术后3 d的匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)、中医证候积分、临床疗效、焦虑自评量表(self-rating anxiety scale,SAS)评分和抑郁自评量表(self-rating depression scale,SDS)评分,以及15项恢复质量评分(quality of recovery-15,QoR-15)。结果治疗后,两组患者的PSQI各因子评分,SAS、SDS评分,中医证候积分均低于治疗前(P<0.05),且研究组睡眠质量、入睡时间、睡眠效率、睡眠障碍及日间功能障碍评分,SAS、SDS评分,中医证候积分下降幅度显著大于对照组(P<0.05)。治疗后,研究组总有效率为93.3%,明显高于对照组的66.7%。与对照组比较,研究组术后1、3 d QoR-15评分升高(P<0.05);与术前1 d比较,研究组术后1 d、3 d QoR-15评分降低(P<0.05);与术后1 d比较,研究组术后3 d QoR-15评分升高(P<0.05)。结论TIP睡眠调控技术联合耳穴磁疗可以减轻乳腺癌患者围手术期睡眠障碍,降低焦虑和抑郁水平,有助于提高患者的睡眠质量和术后恢复质量。

Integration of Chinese herbal medicines and exercise for insomnia:a systematic review and meta-analysis

Background:As a disease,insomnia is often ignored by the general public.Insomnia,which not directly fatal,may be equivalent to chronic suicide if it is not paid attention to.However,there are many theories on how to treat insomnia,and researchers have been searching for a cure.Chinese herbal medicine(CHM)and exercise therapy(ET)are relatively effective,and have been used since ancient times to treat insomnia.This study aimed to examine the effect of CHM combined with ET(CHM-ET)on patients with insomnia.Methods:We searched eight electronic databases including PubMed,Web of Science,EMBASE,the Cochrane Library,the China National Knowledge Infrastructure(CNKI),the China Biology Medicine disc(CBMdisc),the China Science and Technology Journal Database(VIP),the Wanfang Database to find randomized controlled trials(RCTs)evaluating CHM-ET in the treatment of insomnia patients up to September 13,2022.Two researchers read and screened the publications to extract data.We used the pittsburgh sleep quality index(PSQI)as the evaluation indicators for each study,and the other was the total effective rate(TER).The Cochrane risk-of-bias assessment tool was used to assess the risk of bias of the included literature.The level of evidence for this result was assessed by GARDE method.The meta-analysis was performed using STATA 14 software and RevMan 5.3.The research method was registered with PROSPERO(CRD42022350926).Results:We included fourteen randomized controlled trials,which including a total of 1,126 participants.Compared with the control group,the experimental group showed significantly improvements in sleep effect as reflected by the reduced PSQI score[mean difference(MD)=-2.47,95%confidence interval(CI)(-3.15,-1.78),I^(2)=92%]with low quality of evidence,and increased TER[risk ratio(RR)=1.23,95%CI(1.14,1.33),I^(2)=40%]with moderate quality of evidence.Compared with hypnotic drugs,CHM-ET significantly reduced the PSQI score[mean difference(MD)=-3.18,95%CI(-5.48,-0.89),I^(2)=73%]with low quality of evidence.The PSQI of CHM-ET significantly decreased compared with single CHM[mean difference(MD)=-3.04,95%CI(-5.84,-0.25),I^(2)=98%]with low quality of evidence,and ET[mean difference(MD)=-2.44,95%CI(-2.87,-2.02),I^(2)=0%]with moderate quality of evidence.No serious adverse reactions were observed.Conclusion:This review suggested that CHM-ET may be an effective treatment for insomnia.However,given the limited quality of the studies and methodologies included in the trials,further rigorous randomized controlled trials are needed for more accurate results.

疏肝健脾汤联合刮痧治疗亚健康失眠临床观察

目的 观察疏肝健脾汤联合刮痧治疗亚健康失眠的临床效果。方法 将90例亚健康失眠患者随机分为治疗组和对照组,每组45例。治疗组采用疏肝健脾汤联合刮痧治疗,对照组口服艾司唑仑片。2组均连续治疗3周,观察2组患者的临床疗效。结果 治疗组总有效率92.86%(39/42)高于对照组的78.57%(33/42),差异有显著统计学意义(P<0.01)。治疗后,治疗组匹兹堡睡眠质量指数(PSQI)及中医证候积分均明显低于对照组(P<0.01)。结论 疏肝健脾汤联合刮痧治疗可有效改善亚健康失眠患者的失眠状态,提高其生活质量,值得临床进一步推广。

皮内针联合子午流注五音疗法用于心脾两虚型不寐临床观察

目的探讨皮内针联合子午流注五音疗法对心脾两虚不寐症患者的临床效果。方法选择天水市中医医院脾胃病科2021年5月—2021年10月入住的心脾两虚型不寐患者100例,根据随机数字表法分为对照组、观察组,各50例。对照组给予皮内针干预,观察组在对照组基础上加用子午流注五音疗法干预,2周后比较两组总有效率、匹兹堡睡眠质量指数(PSQI)得分。结果观察组总有效率为94.00%(47/50),高于对照组的74.00%(37/50),差异有统计学意义(P<0.05);干预后,两组PSQI得分较干预前均下降,且观察组低于对照组,差异有统计学意义(P<0.01)。结论皮内针联合子午流注五音疗法能有效改善心脾两虚型不寐患者的睡眠质量,值得临床推广应用。

龙胆汤联合足浴治疗脑卒中后失眠临床观察

目的研究龙胆汤内服联合足浴在脑卒中后失眠老年患者中的临床疗效。方法选取66例脑卒中后失眠患者,随机分为对照组和观察组,每组33例。对照组采用艾司唑仑片口服治疗,观察组采用龙胆汤内服联合足浴治疗。疗程均为4周,比较2组患者的临床疗效。结果治疗后观察组总有效率为93.94%(31/33),明显高于对照组的66.67%(22/33),差异有统计学意义(P<0.01)。结论采用龙胆汤内服联合足浴治疗脑卒中后失眠,可有效改善患者睡眠质量,且无明显不良反应,值得临床推广。

ACUPUNCTURE TREATMENT FOR 100 CASES WITH INSOMNIA OF THE TYPE OF THE HEART AND SPLEEN DEFICIENCY

cases of insomnia of the type of heart and spleen deficiency were treated by acupuncture.Results indicated that 95 cases were cured,accounting for 95%;3 cases were markedly effective,accounting for 3% and the 2 cases were ineffective,accounting for 2%,the total effective rate was 98%.

耳部刮痧配合正念疗法对晚期肺癌患者肿瘤相关性失眠的临床疗效

[目的]探讨耳部刮痧配合正念疗法对住院的晚期肺癌患者睡眠障碍的影响。[方法]选取2023年1月—2024年1月在天津中医药大学第一附属医院诊治的具有睡眠障碍的肺癌晚期患者128例,随机分为安宁疗护组、耳部刮痧组、正念疗法组、联合组4组,每组32例。分别采取安宁疗护护理、安宁疗护+耳部刮痧、安宁疗护+正念疗法、安宁疗护+耳部刮痧+正念疗法干预。4组患者在第0周和第4周周末测量匹兹堡睡眠质量指数(PSQI)量表、生活质量测定量表(EORTC QLQC-30),并比较临床疗效有效率。[结果]干预4周后4组患者PSQI评分均下降(P<0.05),且EORTC QLQ-C30评分升高(P<0.05),且耳穴刮痧组PSQI评分低于正念疗法组(P<0.05),正念疗法组EORTC QLQ-C30评分高于耳穴刮痧组;联合组改善效果最佳,PSQI评分低于其他3组(P<0.05),且EORTC QLQ-C30评分高于其他3组(P<0.05),且联合组有效率显著高于耳部刮痧组与正念疗法组。[结论]耳部刮痧配合正念疗法能有效改善晚期肺癌患者肿瘤相关性失眠症状,从身、心两方面提高患者整体生活质量。