Acupuncture and Cognitive Behavioral Therapy Can Help Cancer Survivors With Insomnia

Jun Mao, Chief of MSK's Integrative Medicine Service, delivers acupuncture

Dr. Mao says the treatment results are enduring. "Survivors don’t need ongoing CBT-I or acupuncture to treat insomnia," he says.

A study led by Memorial Sloan Kettering researchers showed that acupuncture and cognitive behavioral therapy were effective ways for cancer survivors to reduce insomnia. Though cognitive behavioral therapy was found to be better than acupuncture and should be used when available, both options had long-lasting benefits for sleep problems.

“Up to 60% of cancer survivors have some form of insomnia, but it is often underdiagnosed and undertreated,” says Jun Mao, Chief of the Integrative Medicine Service at MSK. Dr. Mao was the senior author on the study that was published in the Journal of the National Cancer Institute. “Now, people have more choices to manage their insomnia. We need to raise awareness that there are good non-drug options for this condition.”

Up to 60% of cancer survivors have some form of insomnia, but it is often underdiagnosed and undertreated.
Jun J. Mao Chief, Integrative Medicine Service

A Need for Relief

Dr. Mao set out to compare the two treatments because he knows insomnia is a frequent concern.

“People often say that cancer impacts sleep,” he says. “It’s hard for people to fall asleep, they wake up multiple times, and they feel very tired during the day. They’re looking for things that are not drugs to help them improve their sleep and quality of life.”

Medications are available to help people with insomnia, but Dr. Mao cautions that they don’t work over a long period and shouldn’t be taken long term because of side effects.

Comparing Two Insomnia Treatments among Cancer Survivors

Study participants, who were on average about 61 years old and about six years post-treatment, were seen over an 8-week period. Overall, 80 received traditional Chinese acupuncture designed to treat insomnia, with an additional focus on pain, fatigue, and stress, and 80 received insomnia-specific cognitive behavioral therapy (CBT-I). It was the largest randomized trial of acupuncture for insomnia conducted in cancer survivors, according to Dr. Mao.

CBT-I has two key components: sleep restriction and stimulus control. Sleep restriction limits the amount of time a person is in bed so that they can have higher quality and more efficient sleep. The result is that when they are in bed, they are deeply sleeping rather than tossing and turning. Stimulus control helps people stop doing anything that can make sleep difficult. This may include checking a smartphone or tablet before bedtime, reading a book, or watching TV in bed. Over time, the bed becomes a place only for sleep, not all kinds of activities.

Alarm clock in foreground with person (out of focus) in bed in the background.
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Before and after the treatment period, people reported the severity of their insomnia on a 28-point index. Dr. Mao and his colleagues saw that overall, CBT-I reduced insomnia by 11 points (from about 19 on the scale to 8) compared with acupuncture, which decreased it by approximately 8 points (from 18 to 10). Since both proved successful, Dr. Mao says that giving people options for managing their insomnia is beneficial.

This trial was the first head-to-head comparison of acupuncture and CBT-I for insomnia.

“Some people are very proactive about improving their sleep habits and prefer CBT-I, but there are quite a few who prefer acupuncture as a more passive or relaxing approach,” he says. “Cancer survivors have so much going on with their lives. It’s not like one size fits all.”

Both treatments improved fatigue, anxiety, and depression, but acupuncture was more effective than CBT-I for pain. For survivors who experience both insomnia and pain, according to Dr. Mao, acupuncture may be the better option.

Both groups maintained the benefit for up to 20 weeks and had improved quality of life.

“Our trial showed that the effects are stable,” Dr. Mao says. “The beauty of CBT-I and acupuncture is that the effects endured without any additional sessions. Survivors don’t need ongoing CBT-I or acupuncture to treat insomnia.”

Looking Ahead: Increased Insomnia Awareness and Combining Therapies

People with insomnia don’t have to suffer in silence: They can work with their doctor to come up with a treatment plan that’s right for them.

“A lot of times, people don’t tell their doctors about their sleep issues,” Dr. Mao says. “And doctors are not knowledgeable enough about ways of treating insomnia that don’t involve medication.”

For MSK patients, both acupuncture and CBT-I are available through the Integrative Medicine Service. Dr. Mao hopes to make both services available to people beyond MSK and is exploring the idea of combining the two therapies for even better outcomes.

Editor’s note: An earlier version of this article was published on May 16, 2018. It was updated with new information on April 9, 2019.