Group Auricular Acupuncture for PTSD-Related Insomnia in Veterans: A Randomized Trial

Objectives: This study examined how group auricular acupuncture may influence sleep quality, sleep patterns, and hypnotic medication use associated with PTSD-related insomnia in Operation Enduring Freedom and Operation Iraqi Freedom veterans. Design: This study was a randomized controlled trial with sham acupuncture and wait-list controls. Setting: This study took place at the Washington, DC, Department of Veterans Affairs (VA), Medical Center. Subjects: Thirty-five subjects were randomized to participate in the study, but only 25 subjects completed the study. Interventions: Subjects were randomized to one of three groups: (1) true group auricular acupuncture; (2) sham auricular acupuncture; or (3) wait-list control. Outcome Measures: The primary outcome measure was perceived sleep quality (as measured by Insomnia Severity Index (ISI) questionnaires and Morin Sleep Diaries [MSDs]). Secondary outcome measures were total sleep time (TST), sleep efficiency, sleep latency, naps (as measured by MSD and wrist actigraphs [WAs]), hypnotic medication use, veteran satisfaction, and attrition rates. Results: Subjects in the true auricular acupuncture group had a statistically significant improvement (p=0.0165) in sleep quality as measured by the ISI at time (t)=1 month. This group had a trend toward lower MSD TST at t=2 months (p=0.078), lower WA TST at t=1 month (p=0.0893), and toward higher MSD nap times than the other two groups post-treatment (p=0.0666). No statistically significant association between group assignment and hypnotic medication use and satisfaction scores were noted. Conclusions: Acupuncturists should consider incorporating sleep hygiene education into their clinical practices and/or collaborate with insomnia health care professionals when working with individuals with insomnia. This study also supports the finding that perceived sleep quality and objective WA measurements are not significantly correlated.