Acupuncture for Sleep Disturbances in Post-Deployment Military Service Members

Abstract

Sleep disturbance is a hallmark symptom and maintainer of posttraumatic stress disorder (PTSD). Yet, it remains resistant to treatment. This RCT and mixed-methods study examined a brief manual standardized stress acupuncture (MSSA) (i.e., four weekly sessions) combined with an abbreviated Cognitive Behavioral Therapy (ACBT) (i.e., 60-minute group psychotherapy and 30-minute phone follow-up) versus ACBT alone among 70 post-deployment service members. This study had two aims: Aim 1a) To assess the effectiveness of treatments using the Insomnia Severity Index (ISI) and Pittsburg Sleep Quality Index (PSQI). Both groups demonstrated similar improvements in the ISI scores using descriptive summaries, linear regression, and reliable change index (RCI) (p= .480). The ACBT/MSSA versus ACBT alone, respectively, showed a reliable decrease in the PSQI total score (60% vs. 46%, p = .241) and greater improvement in the Sleep Quality, Duration, Efficiency, and Use of Sleep Medication components. Aim 1b) To describe the perceived benefit of treatments using journal log entries. The ACBT/MSSA group reported greater benefits in sleep and in other life areas including mental, physical, and social functioning using thematic content analysis. Aim 2) To explore the influence of expectation on the effectiveness of acupuncture on stress using the Acupuncture Expectancy Scale (AES) in the acupuncture group. The AES showed that 21.6% had a clinically meaningful increase in expectations in the effect of acupuncture for stress using the Wilcoxon Signed Ranks test and RCI (p = .965). This study had two secondary outcomes: 1) Vital Signs (VS) measures (blood pressure, heart rate, and pain) in the acupuncture group. No statistically significant changes in VS using descriptive statistical summaries (p > 0.05). 2) Posttraumatic stress symptoms using the PTSD checklist (PCL-5). The ACBT/MSSA group showed a clinically meaningful decrease using descriptive summaries, linear regression, and RCI (30% versus 18%, p = .801) and clinically meaningful decreases in all the four symptom clusters of PTSD. These results suggest that ACBT/MSSA may be useful in improving sleep disturbances and other life areas in service members. Future studies using objective measures of sleep functioning and acupuncture dosing are needed.