Sleep Problems? What do you treat first ? Mind or body?

Here’s abstract on a study  I found last week. This is a great example of mind-body integration. Perhaps most of us know that constant worrying , suppressing negative emotions , being in toxic relationships and stressful work situations keep us a wake at night. But how many of us accept that  thoughts and feelings affect the body at a cellular level? It is more widely accepted now that inflammation is associated with depression. Research has found a correlation between elevated inflammatory markers and patients with depression. We don’t know whether inflammation can cause depression and it is unlikely it would in all cases because depression is a difficult concept to pin down and some argue against the validity of mental illness because it ignores the body.

​In this study on treatments for insomnia the adults were divided into 3 groups. One group undertook cognitive-behavioural therapy (CBT) for insomnia. Another group were taught tai chi chih (TCC) and the third group attended a regular sleep seminar education. Inflammation markers were measured before commencement of interventions and then at follow-up periods.

What is interesting is CBT and TCC are completely different in almost every way. CBT is a mind based therapy. TCC is a form of exercise which consists of series of movements completed in a sequence. People often see TCC as a form of mediation. CBT is self-reflective and self-analytical. TCC shifts our focus out of ourselves and into our body in which we feel each movement. Two very different methods and  both seemed to reduce inflammatory levels.

Firstly this is good news because it shows there is  more than one way to help with your sleep problem, well in this case insomnia associated inflammation. Secondly it shows that the body and mind are one.  It would have been useful if this study had measure the sleep improvements instead of just inflammatory markers.

Background

Sleep disturbance is associated with activation of systemic and cellular inflammation, as well as proinflammatory transcriptional profiles in circulating leukocytes. Whether treatments that target insomnia-related complaints might reverse these markers of inflammation in older adults with insomnia is not known.
MethodsIn this randomized trial, 123 older adults with insomnia were randomly assigned to cognitive-behavioral therapy for insomnia (CBT-I), tai chi chih (TCC), or sleep seminar education active control condition for 2-hour sessions weekly over 4 months with follow-up at 7 and 16 months. We measured C-reactive protein (CRP) at baseline and months 4 and 16; toll-like receptor-4 activated monocyte production of proinflammatory cytokines at baseline and months 2, 4, 7, and 16; and genome-wide transcriptional profiling at baseline and month 4.

Results
As compared with sleep seminar education active control condition, CBT-I reduced levels of CRP (months 4 and 16, ps < .05), monocyte production of proinflammatory cytokines (month 2 only, p < .05), and proinflammatory gene expression (month 4, p < .01). TCC marginally reduced CRP (month 4, p = .06) and significantly reduced monocyte production of proinflammatory cytokines (months 2, 4, 7, and 16; all ps < .05) and proinflammatory gene expression (month 4, p < .001). In CBT-I and TCC, TELiS promoter-based bioinformatics analyses indicated reduced activity of nuclear factor-κB and AP-1.

Conclusions
Among older adults with insomnia, CBT-I reduced systemic inflammation, TCC reduced cellular inflammatory responses, and both treatments reduced expression of genes encoding proinflammatory mediators. The findings provide an evidence-based molecular framework to understand the potential salutary effects of insomnia treatment on inflammation, with implications for inflammatory disease risk.

 

Source

Irwin, Michael R., et al. “Cognitive behavioral therapy vs. Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial.” Sleep 37.9 (2014): 1543.


Acupuncture shows beneficial effect for insomnia

The exact physiological or biochemical mechanisms by which acupuncture might improve sleep are not completely understood. However, many studies have demonstrated that acupuncture can cause multiple biological responses (Ulett 1998). A review article has summarised how the nervous system, neurotransmitters and endogenous substances could respond to needling stimulation and electroacupuncture, thereby mediating pain relief and other therapeutics (Ma 2004). Acupuncture causes stimulation of the opiodergic neurons in rats resulting in increased concentrations of beta-endorphin which might have a sleep promoting effect (Cheng 2009). Acupuncture is also found to increase melatonin secretion, which is associated with improvement in sleep (Spence 2004). Stimulation of certain acupoints is found to increase nitric oxide in the brain and the blood, which is associated with sleep improvement clinically (Li 2003). Acupuncture can also cause up-regulation of an important inhibitory neurotransmitter, gamma-aminobutyric acid (GABA) that may promote sleep (Fu 2009). Acupuncture also results in modulation of the autonomic nervous system, affecting both sympathetic and parasympathetic activities, which may be associated with its sleep-promoting effect (Huang 2011).

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005472.pub3/full

Acupuncture for Treatment of Insomnia: A Systematic Review of Randomized Controlled Trials

Background: Acupuncture is commonly used in treating insomnia in China, and clinical studies have shown that acupuncture may have a beneficial effect on insomnia compared with Western medication.

Methods: We included randomized controlled trials on acupuncture for insomnia. We searched PubMed, the Cochrane Library (2008 Issue 3), China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wan Fang Database. All searches ended in December 2008. Two authors extracted data and assessed the trials’ quality independently. RevMan 5.0.17 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI).

Results: Forty-six (46) randomized trials involving 3811 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding, and intention-to-treat analysis. Meta-analyses showed a beneficial effect of acupuncture compared with no treatment (MD −3.28, 95% CI −6.10 to −0.46, p = 0.02; 4 trials) and real acupressure compared with sham acupressure (MD −2.94, 95% CI −5.77 to −0.11, p = 0.04; 2 trials) on total scores of Pittsburgh Sleep Quality Index. Acupuncture was superior to medications regarding the number of patients with total sleep duration increased for >3 hours (RR 1.53, 95% CI 1.24–1.88, p < 0.0001). However, there was no difference between acupuncture and medications in average sleep duration (MD −0.06, 95% CI −0.30–0.18,p = 0.63). Acupuncture plus medications showed better effect than medications alone on total sleep duration (MD 1.09, 95% CI 0.56–1.61, p < 0.0001). Similarly, acupuncture plus herbs was significantly better than herbs alone on increase of sleep rates (RR 1.67, 95% CI 1.12–2.50, p = 0.01). There were no serious adverse effects with related to acupuncture treatment in the included trials.

Conclusions: Acupuncture appears to be effective in treatment of insomnia. However, further large, rigorous designed trials are warranted.

http://online.liebertpub.com/doi/abs/10.1089/acm.2009.0041