Key messages

• Acupuncture may have similar effects to sham acupuncture in reducing insomnia severity and improving sleep quality. Compared to inactive control, acupuncture appears to be more effective at reducing insomnia severity and enhancing sleep quality. However, we have little confidence in the evidence.

• Compared with cognitive behavioural therapy for insomnia (CBT-I), acupuncture is probably less effective in improving insomnia severity and sleep quality.

Insomnia in people with cancer and how it is treated

Insomnia is a common issue for people with cancer. This lack of sleep can really affect their daily life, making both their body and mind feel worse. Current treatment recommendations for insomnia in cancer patients and survivors include psychological approaches (like CBT-I), medications (such as sleeping pills), and other methods (like physical exercise). While CBT-I (the standard talking therapy for insomnia) is considered the most effective treatment, it is not widely available in many cancer treatment centres due to a shortage of trained practitioners and insurance barriers.

What did we want to find out?

We wanted to know if acupuncture was better than 1) sham or placebo control (a "fake" procedure that mimics real acupuncture), 2) inactive control (no treatment or usual care) and 3) other treatments (e.g. CBT-I) in improving insomnia severity, sleep quality, adverse (unwanted or harmful) events, and sleep diary parameters (e.g. time of sleep onset, wake-up time, total sleep time, sleep efficiency).

What did we do?

We looked for studies that compared acupuncture with other treatments for insomnia in people with cancer. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.

What did we find?

We identified three comparisons and five studies with 402 participants. Most of the participants were female with breast cancer.

Compared to sham acupuncture, acupuncture may have little to no effect on reducing insomnia severity or improving sleep quality, although it may lead to slight improvements in certain sleep diary parameters. However, we are very uncertain about these results. Acupuncture may increase the risk of adverse events, but this result is very uncertain.

Compared to inactive control, acupuncture may be more effective in alleviating insomnia severity, enhancing sleep quality, and improving some sleep diary parameters. It may increase the risk of adverse events. However, we are very uncertain about these results.

In the trial comparing acupuncture with CBT-I, acupuncture is probably less effective in improving insomnia severity, sleep quality, time of sleep onset, or sleep efficiency, although it probably improves total sleep duration. It may have little to no effect on adverse events.

What are the limitations of the evidence?

We have little confidence in most of the findings because the studies were small or results varied widely. It's likely that future research could change our understanding of this topic. More comprehensive studies are needed to provide clearer, more reliable answers.

How up-to-date is this evidence?

This evidence is up-to-date to January 2024.