BACKGROUND: Due to the quick rhythm of life and work pressure, more and more people suffer from sleep quality problems. In this study, we investigated the effect of electroacupuncture on sleep quality of chronic insomniacs and the safety of electroacupuncture therapy. METHODS: Four courses of electroacupuncture treatment were applied to 47 patients. With pre-treatment and post-treatment self-control statistical method, Pittsburgh sleep quality index (PSQI) scores were used for evaluating sleep quality. Polysomnogram was used for detecting insomniacs' changes in sleep architecture. The safety of electroacupuncture was evaluated by monitoring the self-designed adverse events and side effects during treatment and post-treatment. RESULTS: Electroacupuncture considerably improved insomniacs' sleep quality and social function during the daytime. Electroacupuncture had certain repairing effect on the disruption in sleep architecture. At the same time, electroacupuncture prolonged slow wave sleep (SWS) time and relatively rapid eye movement sleep (REM sleep) time. There was no hangover, addiction or decrements in vigilance during the daytime (incidence rate was 0). However, insomnia rebound rate was about 23% within one month. CONCLUSIONS: These results suggest that electroacupuncture has beneficial effect on sleep quality improvement in the patients with chronic insomnia, which may be associated with repairing sleep architecture, reconstructing sleep continuity, as well as prolonging SWS time and REM sleep time. Electroacupuncture treatment for chronic insomnia is safe. Therefore, electroacupuncture therapy could be a promising avenue of treatment for chronic insomnia.

Emotional Freedom Technique (EFT) as a new therapeutic technique in energy psychology has positive effects on psychological and physiological symptoms, and quality of life. In this research we studied the effect of this treatment on immunological factors. This study tested whether 8-week group sessions of EFT (compared to a wait-list control group) with emphasis on patient's respiratory, psychological and immunological problems in chemically pulmonary injured veterans (N=28) can affect on immunological and psychological factors. Mixed effect linear models indicated that EFT improved mental health (F=79.24, p=0) and health-related quality of life (F=13.89, p=0.001), decreased somatic symptoms (F=5.81, p=0.02), anxiety/insomnia (F=24.03, p<0.001), social dysfunction (F=21.59, p<0.001), frequency and severity of respiratory symptoms (F=20.38, p<0.001), and increased lymphocyte proliferation with nonspecific mitogens Concanavalin A (Con A) (F=14.32, p=0.001) and Phytohemagglutinin (PHA) (F=12.35, p=0.002), and peripheral blood IL-17 (F=9.11, p=0.006). This study provides an initial indication that EFT may be a new therapeutic approach for improving psychological and immunological factors.

OBJECTIVE: To observe the therapeutic effect of suspended moxibustion at Baihui (GV 20) for insomnia. METHODS: 75 cases were divided randomly into two groups, with 40 cases in the treatment group treated by suspended moxibustion over Baihui (GV 20) and 35 cases in the control group treated by oral administration of Estazolam. RESULTS: The difference in therapeutic effect between the two groups was not statistically significant (P > 0.1). CONCLUSION: It was concluded that suspended moxibustion at Baihui (GV 20) is as effective as Estazolam for insomnia.

BACKGROUND: Very little is known about the range of diagnoses, course of treatment and long-term outcome in elderly patients who choose to receive homeopathic medical treatment. We investigated homeopathic practice in an industrialised country under everyday conditions.The aim of the study was to determine the spectrum of diagnoses and treatments, as well as to describe the course of illness over time among older patients who chose to receive homeopathic treatment. METHODS: In this subgroup analysis of a prospective, multicentre cohort study totally including 3981 patients treated by homeopathic physicians in primary care practices in Germany and Switzerland, data was analysed from all patients>70 years consulting the physician for the first time. The main outcome measures were: assessment by patient of the severity of complaints (numeric rating scales) and quality of life (SF-36) and by the physician of the severity of diagnoses (numeric rating scales) at baseline, and after 3, 12, and 24 months. RESULTS: A total of 83 patients were included in the subgroup analysis (41% men, mean age 73.2 +/- (SD) 3.1 years; 59% women, 74.3 +/- 3.8 years).98.6 percent of all diagnoses were chronic with an average duration of 11.5 +/- 11.5 years. 82 percent of the patients were taking medication at baseline.The most frequent diagnoses were hypertension (20.5%, 11.1 +/- 7.5 years) and sleep disturbances (15.7%, 22.1 +/- 25.8 years).The severity of complaints decreased significantly between baseline and 24 months in both patients (from 6.3 (95%CI: 5.7-6.8) to 4.6 (4.0-5.1), p<0.001) and physicians' assessments (from 6.6 (6.0-7.1) to 3.7 (3.2-4.3), p<0.001); quality of life (SF 36) and the number of medicines taken did not significantly change. CONCLUSION: The severity of disease showed marked and sustained improvements under homeopathic treatment, but this did not lead to an improvement of quality of life. Our findings might indicate that homeopathic medical therapy may play a beneficial role in the long-term care of older adults with chronic diseases and studies on comparative effectiveness are needed to evaluate this hypothesis.

IMPORTANCE:Sleep disturbances have been linked to increased morbidity and mortality, yet it is unknown whether improving sleep quality in older adult patients with insomnia alters biomarkers of diabetes and cardiovascular disease risk.

OBJECTIVE:Determine the comparative efficacy of cognitive behavioral therapy (CBT), tai chi chih (TCC), and a sleep seminar control (SS) to reduce multisystem biomarkers of disease risk in older adults with insomnia.

DESIGN:Randomized controlled comparative efficacy trial.

SETTING:Los Angeles community.

PARTICIPANTS:A population-based sample of 109 older adults with chronic and primary insomnia.

INTERVENTION:Random assignment to CBT, TCC, or SS for 2-h group sessions weekly over 4 months with a 16-month evaluation (1 year after follow-up).

MAIN OUTCOME(S) AND MEASURE(S):Multisystem biological risk comprised of 8 biomarkers: high-density lipoprotein, low-density lipoprotein, triglycerides, hemoglobinA1c, glucose, insulin, C-reactive protein, and fibrinogen. Using clinical laboratory cutoffs defined as abnormal, a multisystem risk score was computed representing a sum of the deviation around the cutoffs across the 8 biomarkers. In addition, high risk grouping was classified if subjects exhibited 4 or more biomarkers in the abnormal laboratory range.

RESULTS:An interaction of time-by-treatment-by-high risk group was found (F(4, 197.2)=3.14, p=.02) in which both TCC (p=.04) and CBT (p=.001) showed significantly lower risk scores as compared to SS at 16-months. CBT reduced risk of being in the high risk group at 4-months (odds ratio [OR]=.21 [95% CI, .03-1.47], p<.10) and at 16-months (OR=.06 [95% CI, .005-.669]; p<.01). TCC reduced the risk at 16-months (OR=.10 [95% CI, .008-1.29]; p<.05) but not at 4 months. Of participants who were classified in the high risk category at baseline, improvements in sleep quality, as defined by a clinical severity threshold, reduced the likelihood of being in the high risk group at 16-months, OR=.08 (95% CI, .008-.78); p=.01.

CONCLUSIONS AND RELEVANCE:Participants classified as having high multisystem biological risk at entry and assigned to CBT or TCC show improvements in risk scores after one year follow-up. Given that these clinical biomarkers are associated with cardiovascular, metabolic, and inflammatory disease risk, improving sleep quality has the potential to reduce the risk of chronic disease in older adults with insomnia.

STUDY OBJECTIVES: To determine the efficacy of a novel behavioral intervention, Tai Chi Chih, to promote sleep quality in older adults with moderate sleep complaints. DESIGN: Randomized controlled trial with 16 weeks of teaching followed by practice and assessment 9 weeks later. The main outcome measure was sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI). SETTING: General community at 2 sites in the US between 2001 and 2005. PARTICIPANTS: Volunteer sample of 112 healthy older adults, aged 59 to 86 years. Intervention: Random allocation to Tai Chi Chih or health education for 25 weeks. RESULTS: Among adults with moderate sleep complaints, as defined by PSQI global score of 5 or greater, subjects in the Tai Chi Chih condition were more likely to achieve a treatment response, as defined by PSQI less than 5, compared to those in health education (P < 0.05). Subjects in the Tai Chi Chih condition with poor sleep quality also showed significant improvements in PSQI global score (P < 0.001) as well as in the sleep parameters of rated sleep quality (P < 0.05), habitual sleep efficiency (P < 0.05), sleep duration (P < 0.01), and sleep disturbance (P < 0.01). CONCLUSIONS: Tai Chi Chih can be considered a useful nonpharmacologic approach to improve sleep quality in older adults with moderate complaints and, thereby, has the potential to ameliorate sleep complaints possibly before syndromal insomnia develops. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov Identifier: NCT00118885.

OBJECTIVE:In 2002 we suggested a new hypothesis of migraine. This hypothesis implies that migraine is a consequence of a loss of neurohormonal and metabolic integrity. The goal of this clinical analysis is to present the evaluation of the effect of a multimodal treatment program in migraine management.

MATERIAL AND METHODS:We evaluated 30 patients ages 16-66 with migraine who were treated with a multimodal treatment program. All patients received a complex program which included: hormonorestorative therapy (HT) with bio-identical hormones; correction of balance between sympathetic and parasympathetic systems and simultaneously calcium/magnesium balance;"resetting"the pineal gland; improvement of intestinal absorption through restoration of normal intestinal flora, and a cleanse from parasitic infestation (if necessary). Serum levels of total cholesterol (TC), pregnenolone, dehydroepiandrosterone sulfate (DHEAS), progesterone, total estrogen, and total testosterone were determined,

RESULTS:All patients responded to this regimen. We do not have patients who still have migraine after they started to use this program. Laboratory finding prior to HT showed the significant deficiency in production of all basic steroid hormones (progesterone and pregnenolone production declined the most). Concurrent symptoms such as fibromyalgia, insomnia, depression, gastrointestinal disorders, and fatigue had disappeared. Total cholesterol completely normalized in 22 (91.7%) patients. No adverse effects or complications related to this program were registered.

CONCLUSIONS:Our findings support the hypothesis that migraine is a consequence of a loss of neurohormonal and metabolic integrity, and that migraine can be managed by a multimodal approach.

Sleep duration and sleep quality are important predictors of risk for cardiovascular disease (CVD). One potential link between sleep health and CVD is through lifestyle factors such as diet. To clarify the association between diet and sleep, we assessed the associations of sleep duration and insomnia symptoms with current Mediterranean-style diet (aMed), and with historical changes in aMed score.Actigraphy-measured sleep duration and self-reported insomnia symptoms categorized as insomnia with short sleep (<6 h/night), insomnia without short sleep, no insomnia with short sleep and no insomnia or short sleep, were obtained from 2068 individuals who also had dietary intake data. A 10-point aMed score, derived from a self-report food frequency questionnaire, was collected concurrently with the sleep assessment, and 10 y before.Compared to individuals who currently reported a low aMed score, those with a moderate-high aMed score were more likely to sleep 6-7 h/night vs.<6 h/night (p<0.01) and less likely to report insomnia symptoms occurring with short sleep (vs. no insomnia or short sleep alone) (p<0.05). An increase in aMed score over the preceding 10 y was not associated with sleep duration or insomnia symptoms. However, compared to those with decreasing aMed score, individuals with an unchanging score reported fewer insomnia symptoms (p≤0.01).These results suggest that a Mediterranean-style diet is associated with adequate sleep duration, less insomnia symptoms, and less likely to have insomnia accompanied by short sleep. Further research should identify possible mediators through which diet may promote adequate sleep duration and reduce the risk of insomnia.

AIM: The aim of this paper is to report an investigation of the effects of soft music on sleep quality in older community-dwelling men and women in Taiwan. BACKGROUND: Sleep is a complex rhythmic state that may be affected by the ageing process. Few studies have focused on the effects of music, a non-pharmacological method of improving the quality of sleep in older adults. METHOD: A randomized controlled trial was used with a two-group repeated measures design. Sixty people aged 60-83 years with difficulty in sleeping were recruited through community leaders and screened using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale. Those reporting depression, cognitive impairment, medical or environmental problems that might interfere with sleep; and those who used sleeping medications, meditation, or caffeine at bedtime were excluded. Participants listened to their choice among six 45-minute sedative music tapes at bedtime for 3 weeks. There were five types of Western and one of Chinese music. Sleep quality was measured with the PSQI before the study and at three weekly post-tests. Groups were comparable on demographic variables, anxiety, depressive symptoms, physical activity, bedtime routine, herbal tea use, napping, pain, and pretest overall sleep quality. RESULTS: Music resulted in significantly better sleep quality in the experimental group, as well as significantly better components of sleep quality: better perceived sleep quality, longer sleep duration, greater sleep efficiency, shorter sleep latency, less sleep disturbance and less daytime dysfunction (P = 0.04-0.001). Sleep improved weekly, indicating a cumulative dose effect. CONCLUSION: The findings provide evidence for the use of soothing music as an empirically-based intervention for sleep in older people.

AIM: This paper is a report of a study to investigate the effects of music on sleep quality in young participants with poor sleep. BACKGROUND: Sleep disorders may result in fatigue, tiredness, depression and problems in daytime functioning. Music can reduce sympathetic nervous system activity, decrease anxiety, blood pressure, heart and respiratory rate and may have positive effects on sleep via muscle relaxation and distraction from thoughts. Control groups have not been used in most previous studies. METHODS: We used a three-group repeated measures design. Ninety-four students (aged between 19 and 28 years) with sleep complaints were studied in 2006. Participants listened for 45 minutes either to relaxing classical music (Group 1) or an audiobook (Group 2) at bedtime for 3 weeks. The control group (Group 3) received no intervention. Sleep quality was measured using the Pittsburg Sleep Quality Index before the study and weekly during the intervention. Depressive symptoms in experimental group participants were measured using the Beck Depression Inventory. RESULTS: Repeated measures anova revealed a main effect of TIME (P < 0.0001) and an interaction between TIME and GROUPS (P < 0.0001). Post hoc tests with Bonferroni correction showed that music statistically significantly improved sleep quality (P < 0.0001). Sleep quality did not improve statistically significantly in the audiobook and the control group. Depressive symptoms decreased statistically significantly in the music group (P < 0.0001), but not in the group listening to audiobooks. CONCLUSION: Relaxing classical music is an effective intervention in reducing sleeping problems. Nurses could use this safe, cheap and easy to learn method to treat insomnia.

OBJECTIVE: To observe characteristics of acupuncture in improvement of sleep quality in the patient of insomnia. METHODS: Forty-six cases of primary insomnia were randomly divided into an observation group (n = 24) and a control group (n = 22). The observation group were treated by the needling method for regulating mental activity, with Baihui (GV 20), Shenting (GV 24), Shenmen (HT 7) selected as main points; the control group were treated with oral administration of Estazolam. The therapeutic effects and scores of Pittsburgh Sleep Quality Index Scale before and after treatment were compared between the two groups. RESULTS: The total effective rate was 83.3% in the observation group and 72.7% in the control group, the observation group being better than the control group (P < 0.05). Estazolam was better than acupuncture treatment in prolonging sleeping time, and the acupuncture treatment was better than the control group in the improvement of somnipathy and the increase of daytime functional state (P < 0.05). CONCLUSION: Acupuncture treatment has advantages of improving somnipathy and increasing daytime functional state.

OBJECTIVE: To observe characteristics of acupuncture in improvement of sleep quality in the patient of insomnia. METHODS: Forty-six cases of primary insomnia were randomly divided into an observation group (n = 24) and a control group (n = 22). The observation group were treated by the needling method for regulating mental activity, with Baihui (GV 20), Shenting (GV 24), Shenmen (HT 7) selected as main points; the control group were treated with oral administration of Estazolam. The therapeutic effects and scores of Pittsburgh Sleep Quality Index Scale before and after treatment were compared between the two groups. RESULTS: The total effective rate was 83.3% in the observation group and 72.7% in the control group, the observation group being better than the control group (P < 0.05). Estazolam was better than acupuncture treatment in prolonging sleeping time, and the acupuncture treatment was better than the control group in the improvement of somnipathy and the increase of daytime functional state (P < 0.05). CONCLUSION: Acupuncture treatment has advantages of improving somnipathy and increasing daytime functional state.

Fatigue is a common, often debilitating, side effect of cancer chemotherapy. Pharmacologic vitamin C has been used as an alternative treatment for the disease itself but its effects on fatigue have not often been documented. Here we report on the case of a woman with recurrent breast cancer, undergoing weekly chemotherapy, with lethargy as a major symptom. Vitamin C (50 g/session) was administered twice weekly and quality of life and multidimensional fatigue symptomology questionnaires were undertaken. Dramatic decreases in fatigue and insomnia were observed, as well as increased cognitive functioning. There were no adverse side effects of i.v. vitamin C.

Background: Insomnia has become a threat to public health, and acupuncture has shown an advantage in treatment of insomnia with good efficacy and few side effects. Objective: To observe the therapeutic effects of scalp penetration acupuncture for insomnia. Design, setting, participants and interventions: A total of 70 insomnia cases meeting inclusion criteria from Department of Acupuncture and Moxibustion, General Hospital of People's Liberation Army were randomly divided into routine acupuncture group and scalp penetration acupuncture group. There were 32 cases in the scalp penetration acupuncture group, and 34 cases in the routine acupuncture group, for four cases lost to follow-up. The insomnia patients were all treated for four weeks. Main outcome measures: The therapeutic effects, cumulative scores of Pittsburgh Sleep Quality Index (PSQI) and contents of sleep architecture were compared before and after treatment in the two groups. Results: The total response rate of 90.6% in the scalp penetration acupuncture group was higher than 73.5% in the routine acupuncture group (P<0.05), and the improvements of PSQI cumulative scores in sleep quality, sleep time and sleep efficiency in the scalp penetration acupuncture group were superior to those in the routine acupuncture group (P<0.05, P<0.01). The total sleep time and deep sleep time of sleep architecture in the scalp penetration acupuncture group significantly increased as compared with those in the routine acupuncture group (P<0.01). Conclusion: The therapeutic effects of scalp penetration acupuncture are better than those of routine acupuncture, especially for improving sleep quality, sleep time and sleep efficiency.

Background: Insomnia has become a threat to public health, and acupuncture has shown an advantage in treatment of insomnia with good efficacy and few side effects. Objective: To observe the therapeutic effects of scalp penetration acupuncture for insomnia. Design, setting, participants and interventions: A total of 70 insomnia cases meeting inclusion criteria from Department of Acupuncture and Moxibustion, General Hospital of People's Liberation Army were randomly divided into routine acupuncture group and scalp penetration acupuncture group. There were 32 cases in the scalp penetration acupuncture group, and 34 cases in the routine acupuncture group, for four cases lost to follow-up. The insomnia patients were all treated for four weeks. Main outcome measures: The therapeutic effects, cumulative scores of Pittsburgh Sleep Quality Index (PSQI) and contents of sleep architecture were compared before and after treatment in the two groups. Results: The total response rate of 90.6% in the scalp penetration acupuncture group was higher than 73.5% in the routine acupuncture group (P<0.05), and the improvements of PSQI cumulative scores in sleep quality, sleep time and sleep efficiency in the scalp penetration acupuncture group were superior to those in the routine acupuncture group (P<0.05, P<0.01). The total sleep time and deep sleep time of sleep architecture in the scalp penetration acupuncture group significantly increased as compared with those in the routine acupuncture group (P<0.01). Conclusion: The therapeutic effects of scalp penetration acupuncture are better than those of routine acupuncture, especially for improving sleep quality, sleep time and sleep efficiency.

Self-administered acupressure has potential as a low-cost alternative treatment for insomnia. To evaluate the short-term effects of self-administered acupressure for alleviating insomnia, a pilot randomized controlled trial was conducted. Thirty-one subjects (mean age: 53.2 years; 77.4% female) with insomnia disorder were recruited from a community. The participants were randomized to receive two lessons on either self-administered acupressure or sleep hygiene education. The subjects in the self-administered acupressure group (n = 15) were taught to practise self-administered acupressure daily for 4 weeks. The subjects in the comparison group (n = 16) were advised to follow sleep hygiene education. The primary outcome was the Insomnia Severity Index (ISI). Other measures included a sleep diary, Hospital Anxiety and Depression Scale and Short-form Six-Dimension. The subjects in the self-administered acupressure group had a significantly lower ISI score than the subjects in the sleep hygiene education group at week 8 (effect size = 0.56, P = 0.03). However, this observed group difference did not reach a statistically significant level after Bonferroni correction. With regard to the secondary outcomes, moderate between-group effect sizes were observed in sleep onset latency and wake after sleep onset based on the sleep diary, although the differences were not significant. The adherence to self-administered acupressure practice was satisfactory, with 92.3% of the subjects who completed the lessons still practising acupressure at week 8. In conclusion, self-administered acupressure taught in a short training course may be a feasible approach to improve insomnia. Further fully powered confirmatory trials are warranted.

OBJECTIVES: To determine the effectiveness of tai chi on self-rated sleep quality and daytime sleepiness in older adults reporting moderate sleep complaints. DESIGN: Randomized, controlled trial with allocation to tai chi or exercise control. SETTING: General community. PARTICIPANTS: One hundred eighteen women and men aged 60 to 92. INTERVENTION: Participants were randomized into tai chi or low-impact exercise and participated in a 60-minute session, three times per week, for 24 consecutive weeks. MEASUREMENTS: Primary outcome measures were the seven subscales of the Pittsburgh Sleep Quality Index (PSQI), PSQI global score, and Epworth Sleepiness Scale (ESS). Secondary outcome measures were physical performance (single leg stand, timed chair rise, 50-foot speed walk) and 12-item short form (SF-12) physical and mental summary scores. RESULTS: Tai chi participants reported significant improvements in five of the PSQI subscale scores (sleep quality, sleep-onset latency, sleep duration, sleep efficiency, sleep disturbances) (P<.01), PSQI global score (P=.001), and ESS scores (P=.002) in comparison with the low-impact exercise participants. Tai chi participants reported sleep-onset latency of about 18 minutes less per night (95% confidence interval (CI)=-28.64 to -7.12) and sleep duration of about 48 minutes more per night (95% CI=14.71-82.41) than low-impact exercise participants. Tai chi participants also showed better scores in secondary outcome measures than low-impact exercise participants. Both groups reported improvements in SF-12 mental summary scores. CONCLUSION: Older adults with moderate sleep complaints can improve self-rated sleep quality through a 6-month, low- to moderate-intensity tai chi program. Tai chi appears to be effective as a nonpharmacological approach to sleep enhancement for sleep-disturbed elderly individuals.

OBJECTIVES:Diurnal cortisol secretion levels were measured and circadian cortisol profiles were evaluated in a pilot study conducted to test the hypothesis that grounding the human body to earth during sleep will result in quantifiable changes in cortisol. It was also hypothesized that grounding the human body would result in changes in sleep, pain, and stress (anxiety, depression, irritability), as measured by subjective reporting.

SUBJECTS AND INTERVENTIONS:Twelve (12) subjects with complaints of sleep dysfunction, pain, and stress were grounded to earth during sleep for 8 weeks in their own beds using a conductive mattress pad. Saliva tests were administered to establish pregrounding baseline cortisol levels. Levels were obtained at 4-hour intervals for a 24-hour period to determine the circadian cortisol profile. Cortisol testing was repeated at week 6. Subjective symptoms of sleep dysfunction, pain, and stress were reported daily throughout the 8-week test period.

RESULTS:Measurable improvements in diurnal cortisol profiles were observed, with cortisol levels significantly reduced during night-time sleep. Subjects' 24-hour circadian cortisol profiles showed a trend toward normalization. Subjectively reported symptoms, including sleep dysfunction, pain, and stress, were reduced or eliminated in nearly all subjects.

CONCLUSIONS:Results indicate that grounding the human body to earth ("earthing") during sleep reduces night-time levels of cortisol and resynchronizes cortisol hormone secretion more in alignment with the natural 24-hour circadian rhythm profile. Changes were most apparent in females. Furthermore, subjective reporting indicates that grounding the human body to earth during sleep improves sleep and reduces pain and stress.