Writing Sample: Article

Alternative Treatment of Insomnia in Perimenopausal Women

October 2008

Can a non-pharmaceutical, minimally invasive treatment help women get a good night sleep? If so, why are so few scientists studying it?


If you are in your mid-thirties and perimenopausal, insomnia is probably proving to be a greater tyrant than intermittent hot flashes, mood swings, and the hourly cycling of hormones. The absence of recuperative sleep can be traumatic. Insomnia negatively impacts a person’s effectiveness at work, limits the ability to focus, and interferes family relationships. According to an article on insomnia appearing in the Archives of Internal Medicine in June 2006 by Dr. Maurice M. Ohayon, women are not only increasingly affected by insomnia as they age, but their lives are altered by this condition.


Treatment for insomnia often calls for medication (either over-the-counter or prescription) or lifestyle changes (avoiding alcohol and caffeine, regular exercise, and a nocturnal routine). One option that has not been widely studied, but shows promise of being effective, is acupuncture. Paired with conventional medicine and self-care techniques, acupuncture offers women experiencing symptoms of hormonal change before entering menopause an option for regaining productive sleep with minimal or no side-effects.


Lisa White, L.Ac. is a licensed acupuncturist who works with Natural Health Solutions, a Roswell, Georgia clinic that offers alternative medical services such as chiropractic, herbal medicine, and homeopathy in addition to acupuncture. White stated that her area of practice has an immediate impact on the problem of sleeplessness. “Most patients report improved sleep after the first visit,” she offered.


In addition to treating pain and allergy symptoms, White’s practice focuses on women’s health issues including gynecological concerns. Perimenopause is one of the conditions that falls under the acupunturist’s specialty. The symptoms of perimenopause mirror those of full-blown menopause (anxiety, depression, sleep disturbance, hot flashes, irregular menstrual cycles, changes in vaginal lubrication and elasticity), but occur in women in their forties and as well as some in their early to mid-thirties. While all of the symptoms that make up perimenopause can be irritating and inconvenient (picture being in bumper to bumper traffic when accosted by a raging hot flash), chronic insomnia has the potential to increase days missed at work and harm a woman’s ability to manage a busy home life.


According to White, “acupuncture treatment would be based on the individual’s patterns that are the reasons for the insomnia. “ White’s approach to treating the perimenopausal woman falls in line with her “head-to-toe” holistic approach. “Not all people have insomnia for the same reason, therefore, treatment is specific.” This suggests that not every perimenopausal woman is dealing with insomnia that has a hormonal base. A comprehensive evaluation makes it easier to pinpoint the cause of sleeplessness. Acupuncture, in turn, should make the disorder easier to eliminate.


The specific benefit that acupuncture provides to patients suffering from insomnia or any condition, while affirmed by practitioners like White, is not very clear to other medical professionals. A study on the use of acupuncture to treat insomnia in pregnant women appeared in Acupuncture in Medicine in 2005. While the results of the study showed that insomnia decreased by 50% in nine of the 17 women in the study group, the authors admit that few studies have been conducted on the effectiveness of acupuncture on insomnia.


The deficient research in the area of acupuncture in general is lagging behind the actual practice of this treatment. In a 2002 National Survey, 8.2 million adults in the United States admitted to undergoing acupuncture.


When asked why there are so few studies centered on her specialty, White is curt: “There is no money to be made by anyone in particular.”


Many of the acupuncture studies accessed for this article focused on patients in other countries such as Australia, Korea, and especially China. Studies on acupuncture, insomnia, and perimenopausal women were even harder to find. In some articles, the effect of acupuncture is buried under statistics about hot flashes and other symptoms associated with menopause. Maybe perimenopausal studies are as unprofitable as acupuncture research.


Ohayon’s article in the Archives of Internal Medicine discussed the association between hot flashes and insomnia. The study found that 81.3% of the women participants who reported severe hot flashes also complained of sleep disturbance (problems initiating and maintaining sleep; not feeling rested after awakening). These results paired with those of an unpublished case featured in a 2007 article in the BMC Contemporary and Alternative Medicine Journal in which acupuncture is credited for the reduction of hot flashes by 77% suggests a correlation between this alternative medicine and insomnia-suffering women experiencing symptoms of hormonal changes.


An article that directly examined the effectiveness of acupuncture in the treatment of insomnia appeared in Medical Acupuncture in 2002. The article cited a study showing that “100% of patients treated for insomnia [with acupuncture] obtained benefit without reoccurrence within 18 months of follow-up.”


While there is some evidence that acupuncture can positively impact sleep disorders, the American Academy of Sleep Medicine has reported that 25% of people suffering from insomnia use over-the-counter medications. These medications may be used several times a week. Other forms of self-medication for insomnia include herbal supplements such as melatonin and valerian. Prescription drugs range from barbiturates to antidepressants. There is the possibility of negative side effects in the use of any of these substances, including daytime drowsiness.
Side effects make the use of pharmaceuticals a less than attractive approach to coping with insomnia. With the trend towards organic foods and natural products, the modern perimenopausal woman may seek an alternative that will ease her symptoms and promote her general health.


When asked, White whimsically listed the “side effects” associated with acupuncture. “Feelings of well being, more energy, less pain, regular menstrual cycles, improved sleep.” Playfully she added, “Oh, you mean adverse side effects? Usually none.”


White does admit that some people may bruise from the needles, but they won’t have to drag themselves into work the day after an acupuncture treatment.


Limited research aside, the woman searching for relief from many of her perimenopausal symptoms including insomnia could benefit from the services of a licensed practitioner. White suggests choosing an acupuncturist who is also commissioned by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).


White’s last tip supports patient research by encouraging those seeking acupuncture treatment to make sure the potential practitioner “[has] some experience treating the problems the prospective patient is having.”