If you've reached menopause and just can't sleep like you used to, you might want to learn about a special spot on your body. No, not that one. It's the Sanyinjiao acupoint, or Spleen 6 — a small area just above the ankle on the inside of the leg. New research suggests that for women with menopause-related sleep problems, acupuncture, particularly on that point, may offer relief.
Among the myriad discomforts that afflict menopausal women, sleep problems may not get as much attention as hot flashes. But all manner of sleep disturbances — from waking up at the crack of dawn unable to fall back asleep to full blown insomnia — are pervasive among this demographic.
Researchers report that the prevalence of menopause-related sleep disturbances ranges from 8.4 to 56.6 percent. Estrogen deficiency contributes to the problem; nocturnal hot flashes are also sometimes a factor.
In the new review, a meta-analysis of more than 30 clinical trials involving 2,433 participants published in the journal Obstetrics and Gynecology, researchers in China found a "substantial association" between acupuncture and improved sleep in peri-menopausal and post-menopausal women. Specifically, the researchers say they demonstrated "that the association of reduction in menopause-related sleep disturbance and acupuncture was correlated with changes in serum estradiol levels particularly when the Sanyinjiao acupoint was stimulated." (Estradiol is the estrogen mostly produced from the ovaries, and can also be used to treat peri-menopausal symptoms.)
The researchers theorize that the elevated serum estradiol levels may be the key to why acupuncture could help alleviate the sleep disturbances.
There are caveats: the researchers report an association only between acupuncture and a decrease in sleep disturbances; also, sleep quality assessments were mostly based on patients perceptions; in addition, the researchers report that their analysis only looked at articles in English and Chinese, which might limit the generalizability of the review.
In the paper, researchers conclude with a ringing endorsement:
"...we recommend that acupuncture should be adopted as an alternative or complementary therapy for improving sleep in addition to current conventional therapies [for instance, hormone therapy] in women experiencing menopause-related sleep disturbances.
Individuals who are interested in adopting acupuncture therapy as an alternative therapy to conventional treatments for improving menopause-related sleep disturbances should talk to their acupuncturists about the Sanyinjiao acupoint [Spleen 6, in English, "the junction point of the spleen, liver, and kidney meridians"] as the preferred acupoint to stimulate the secretion of serum estradiol levels."
I asked Dr. Bridget Chin, a medical acupuncturist at Spaulding Rehabilitation Hospital in Boston, what she thought of the study and to quantify the possible benefit. She said that while it's hard to generalize about this kind of meta-analysis, overall there is about a 21 percent reduction in sleep disturbances, and she added, "all but one [of the studies]favor acupuncture, and these were studies quite scrutinized for lack of bias with adequate controls." Here are more comments from Dr. Chin via email:
Here's what she wrote in an email:
In my Medical Acupuncture practice at Spaulding, I routinely treat menopausal insomnia in addition to the hot flashes and anxiety symptoms that occur.
This is an excellent meta-analysis to support the use of acupuncture for menopausal women with sleep disturbances. Previous reviews found promising results, but were unable to conclude this due to limited evidence.
I believe that acupuncture improves sleep disturbance through multiple mechanisms, additionally by improving melatonin secretion.
The fact that they were able to identify a strong correlation of elevated estradiol in the acupuncture groups compared to controls makes sense. Increasing estradiol levels have also improved perimenopausal depression in previous studies.
Most interestingly, they were able to pinpoint a specific acupuncture point, Spleen 6 which correlates with an increase in estradiol levels compared to other points chosen. I routinely use this point for my patients with menopausal symptoms, and I now have some scientific research to support continued use of this point.