Acupuncture for Sleep Disturbances in Post-Deployment Military Service Members: A Randomized Controlled Trial

Abstract

This RCT and mixed-methods study examined the difference between two groups receiving the following interventions: (1) brief manual standardized stress acupuncture (MSSA) combined with an abbreviated Cognitive Behavioral Therapy (ACBT) versus (2) ACBT alone. Three study aims: Aim (1): Insomnia Severity Index (ISI) and Pittsburg Sleep Quality Index (PSQI) scores were analyzed using descriptive summaries, linear regression, and reliable change index (RCI). Aim (2): Journal entries were analyzed using content analysis. Aim (3): Acupuncture Expectancy Scale (AES) scores were analyzed using paired t-test and RCI. Aim (1): Both groups demonstrated similar improvements in the ISI scores (p = .480). Aim (2): The ACBT/MSSA group reported greater benefits in sleep and in other life areas including mental, physical, and social functioning. Aim (3): The AES showed that 21.6% had a clinically meaningful increase in expectations in the effect of acupuncture for stress (p = .965). The study was registered in ClinicalTrials.gov (NCT04031365) at https://clinicaltrials.gov/ct2/show/NCT04031365 on July 24, 2019.

Keywords

acupuncture sleep disturbances military service members

Get full access to this article

View all access options for this article.

References

Abanes

Hiers

Rhoten

Dietrich

M. S.

Ridner

S. H.

(2019). Feasibility and acceptability of a brief acupuncture intervention for service members with perceived stress. Military Medicine, 185(1–2), e17–e22. https://doi.org/10.1093/milmed/usz132

Allan

N. P.

Conner

K. R.

Pigeon

W. R.

Gros

D. F.

Salami

T. K.

Stecker

(2017). Insomnia and suicidal ideation and behaviors in former and current U.S. service members: Does depression mediate the relations? Psychiatry Research, 252, 296–302. https://doi.org/10.1016/j.psychres.2017.03.009

Amin

M. A.

Parisi

J. A.

Morris

S. G.

Gold

A. R.

(2010). War-related illness symptoms among operation Iraqi freedom/operation enduring freedom returnees. Military Medicine, 175(3), 155–157.

Anderson

S. L.

Vande Griend

J. P.

(2014). Quetiapine for insomnia: A review of the literature. American Journal of Health-System Pharmacy, 71(5), 394–402. https://doi.org/10.2146/ajhp130221

Bastien

C. H.

Morin

C. M.

Ouellet

M. C.

Blais

F. C.

Bouchard

(2004). Cognitive-behavioral therapy for insomnia: Comparison of individual therapy, group therapy, and telephone consultations. Journal of Consulting and Clinical Psychology, 72(4), 653–659. https://doi.org/10.1037/0022-006x.72.4.653

Bastien

C. H.

Vallieres

Morin

C. M.

(2001). Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307.

Bramoweth

A. D.

Germain

(2013). Deployment-related insomnia in military personnel and veterans. Current Psychiatry Reports, 15(10), 401. https://doi.org/10.1007/s11920-013-0401-4

Buysse

D. J.

Reynold

C. F.

Monk

T. H.

Berman

S. R.

Kupfer

D. J.

(1988). The Pittsburg Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.

Christensen

Mendoza

J. L.

(1986). A method of assessing change in a single subject: An alteration of the RC index. Behavior Therapy, 17(3), 305–308. https://doi.org/10.1016/S0005-7894(86)80060-0

10.

Department of Health Nursing Care Quality Assurance Commission. (2017). Medical acupuncture: Scope of practice for advanced registered nurse practitioners. https://www.doh.wa.gov/Portals/1/Documents/6000/NCAO12.pdf

11.

Doghramji

Jangro

W. C.

(2016). Adverse effects of psychotropic medications on sleep. Sleep Medicine Clinics, 11(4), 503–514. https://doi.org/10.1016/j.jsmc.2016.08.001

12.

Engel

C. C.

Cordova

E. H.

Benedek

D. M.

Liu

Gore

K. L.

Goertz

Freed

M. C.

Crawford

Jonas

W. B.

Ursano

R. J.

(2014). Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder. Medical Care, 52(12 Suppl. 5), S57–S64. https://doi.org/10.1097/MLR.0000000000000237

13.

Eshkevari

Egan

Phillips

Tilan

Carney

Azzam

Amri

Mulroney

S. E.

(2012). Acupuncture at ST36 prevents chronic stress-induced increases in neuropeptide Y in rat. Experimental Biology and Medicine (Maywood, N.J.), 237(1), 18–23. https://doi.org/10.1258/ebm.2011.011224

14.

Eshkevari

Mulroney

S. E.

Egan

Lao

(2015). Effects of acupuncture, RU-486 on the hypothalamic-pituitary-adrenal axis in chronically stressed adult male rats. Endocrinology, 156(10), 3649–3660. https://doi.org/10.1210/en.2015-1018

15.

Everitt

Baldwin

D. S.

Stuart

Lipinska

Mayers

Malizia

A. L.

Manson

C. C.

Wilson

(2018). Antidepressants for insomnia in adults. The Cochrane Database of Systematic Reviews, 5(5), CD010753. https://doi.org/10.1002/14651858.CD010753.pub2

16.

Garner

B. K.

Hopkinson

S. G.

Ketz

A. K.

Landis

C. A.

Trego

L. L.

(2018). Auricular acupuncture for chronic pain and insomnia: A randomized clinical trial. Medical Acupuncture, 30(5), 262–272. https://doi.org/10.1089/acu.2018.1294

17.

Germain

(2013). Sleep disturbances as the hallmark of PTSD: Where are we now? The American Journal of Psychiatry, 170(4), 372–382. https://doi.org/10.1176/appi.ajp.2012.12040432

18.

Good

C. H.

Brager

A. J.

Capaldi

V. F.

Mysliwiec

(2020). Sleep in the United States military. Neuropsychopharmacology, 45(1), 176–191. https://doi.org/10.1038/s41386-019-0431-7

19.

Graneheim

U. H.

Lundman

(2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105–112. https://doi.org/10.1016/j.nedt.2003.10.001

20.

Hansen

L. P.

Kinskey

Koffel

Polusny

Ferguson

Schmer-Galunder

Erbes

C. R.

(2018). Sleep patterns and problems among army national guard soldiers. Military Medicine, 183(11–12), e396–e401. https://doi.org/10.1093/milmed/usy107

21.

Heinzelmann

Lee

Rak

Livingston

Barr

Baxter

Scattergood-Keepper

Mysliwiec

Gill

(2014). Sleep restoration is associated with reduced plasma C-reactive protein and depression symptoms in military personnel with sleep disturbance after deployment. Sleep Medicine, 15(12), 1565–1570. https://doi.org/10.1016/j.sleep.2014.08.004

22.

Jacobson

N. S.

Follette

W. C.

Revenstorf

(1984). Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behavior Therapy, 15, 336–352.

23.

Jacobson

N. S.

Truax

(1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19.

24.

King

C. H.

Moore

Spence

D. L.

(2016). Exploring self-reported benefits of auricular acupuncture among veterans with posttraumatic stress disorder. Journal of Holistic Nursing, 34(3), 291–299.

25.

King

H. C.

Spence

D. L.

Hickey

A. H.

Sargent

Elesh

Connelly

C. D.

(2015). Auricular acupuncture for sleep disturbance in veterans with post-traumatic stress disorder: A feasibility study. Military Medicine, 180(5), 582–590. https://doi.org/10.7205/MILMED-D-14-00451

26.

Koffel

Polusny

M. A.

Arbisi

P. A.

Erbes

C. R.

(2013). Pre-deployment daytime and nighttime sleep complaints as predictors of post-deployment PTSD and depression in National Guard troops. Journal of Anxiety Disorders, 27(5), 512–519. https://doi.org/10.1016/j.janxdis.2013.07.003

27.

Langarizadeh

Tabatabaei

M. S.

Tavakol

Naghipour

Rostami

Moghbeli

(2017). Telemental health care, an effective alternative to conventional mental care: A systematic review. Acta Informatica Medica: AIM: Journal of the Society for Medical Informatics of Bosnia & Herzegovina: casopis Drustva za medicinsku informatiku BiH, 25(4), 240–246. https://doi.org/10.5455/aim.2017.25.240-246

28.

Lian

Chen

Hammes

Kolster

(2011). Pictorial Atlas of Acupuncture: An Illustrated Manual of Acupuncture Points. h. f. ullmann.

29.

Lincoln

M. L.

Moore

R. S.

Ames

G. M.

(2018). Sleep disturbances after deployment: National guard soldiers’ experiences and strategies. Sleep Health, 4(4), 377–383. https://doi.org/10.1016/j.sleh.2018.05.005

30.

Lippa

S. M.

Fonda

J. R.

Fortier

C. B.

Amick

M. A.

Kenna

Milberg

W. P.

McGlinchey

R. E.

(2015). Deployment-related psychiatric and behavioral conditions and their association with functional disability in OEF/OIF/OND veterans. Journal of Traumatic Stress, 28(1), 25–33. https://doi.org/10.1002/jts.21979

31.

Mao

J. J.

Armstrong

Farrar

J. T.

Bowman

M. A.

(2007). Acupuncture expectancy scale: Development and preliminary validation in China. Explore (New York, N.Y.), 3(4), 372–377. https://doi.org/10.1016/j.explore.2006.12.003

32.

Mao

J. J.

Xie

S. X.

Bowman

M. A.

(2010). Uncovering the expectancy effect. Alternative Therapy Health Medicine, 16(6), 23–27.

33.

Matsangas

Shattuck

N. L.

Saitzyk

(2020). Sleep-related practices, behaviors, and sleep-related difficulties in deployed active-duty service members performing security duties. Behavioral Sleep Medicine, 18(2), 262–274. https://doi.org/10.1080/15402002.2019.1578771

34.

Morin

C. M.

(2017). Insomnia severity index. https://mapi-trust.org/questionnaires/isi/

35.

Pace-Schott

E. F.

Germain

Milad

M. R.

(2015). Sleep and REM sleep disturbance in the pathophysiology of PTSD: The role of extinction memory. Biology of Mood & Anxiety Disorders, 5, 3. https://doi.org/10.1186/s13587-015-0018-9

36.

Perlis

M. L.

Jungquist

Smith

M. T.

Posner

(2006). Cognitive behavioral treatment of insomnia: A session-by-session guide (Vol. 1). Springer Science & Business Media.

37.

Rice

V. J. B.

Schroeder

P. J.

(2019). Self-reported sleep, anxiety, and cognitive performance in a sample of U.S. military active duty and veterans. Military Medicine, 184(Suppl 1), 488–497. https://doi.org/10.1093/milmed/usy323

38.

Sedgwick

Greenwood

(2015). Understanding the Hawthorne effect. BMJ, 351, h4672. https://doi.org/10.1136/bmj.h4672

39.

Seelig

A. D.

Jacobson

I. G.

Smith

Hooper

T. I.

Boyko

E. J.

Gackstetter

G. D.

Gehrman

Macera

C. A.

Smith

T. C.

; Millennium Cohort Study Team. (2010). Sleep patterns before, during, and after deployment to Iraq and Afghanistan. Sleep, 33(12), 1615–1622.

40.

Short

N. A.

Allan

N. P.

Oglesby

M. E.

Moradi

Schmidt

N. B.

Stecker

(2019). Prospective associations between insomnia symptoms and alcohol use problems among former and current military service personnel. Drug and Alcohol Dependence, 199, 35–41. https://doi.org/10.1016/j.drugalcdep.2019.02.018

41.

Stocker

R. P.

Paul

B. T.

Mammen

Khan

Cieply

M. A.

Germain

(2016). Effects of blast exposure on subjective and objective sleep measures in combat veterans with and without PTSD. Journal of Clinical Sleep Medicine, 12(1), 49–56. https://doi.org/10.5664/jcsm.5392

42.

Ulmer

C. S.

Bosworth

H. B.

Germain

Lindquist

Olsen

Brancu

Beckham

J. C.

(2015). Associations between sleep difficulties and risk factors for cardiovascular disease in veterans and active duty military personnel of the Iraq and Afghanistan conflicts. Journal of Behavioral Medicine, 38(3), 544–555. https://doi.org/10.1007/s10865-015-9627-4

43.

Vaismoradi

Turunen

Bondas

(2013). Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & Health Sciences, 15(3), 398–405. https://doi.org/https://doi.org/10.1111/nhs.12048

44.

Wagley

J. N.

Rybarczyk

Nay

W. T.

Danish

Lund

H. G.

(2013). Effectiveness of abbreviated CBT for insomnia in psychiatric outpatients: sleep and depression outcomes. Journal of Clinical Psychology, 69(10), 1043–1055. https://doi.org/10.1002/jclp.21927

45.

Walling

(2006). Therapeutic modulation of the psychoneuroimmune system by medical acupuncture creates enhanced feelings of well-being. Journal of the American Academy of Nurse Practitioners, 18(4), 135–143. https://doi.org/10.1111/j.1745-7599.2006.00115.x

46.

Weathers

F. W.

Litz

B. T.

Keane

T. M.

Palmieri

P. A.

Marx

B. P.

Schnurr

P. P.

(2013). The PTSD checklist for DSM-5 (PCL-5). https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp

47.

White

Cummings

Filshie

(2008). An introduction to western medical acupuncture. Elsevier.

48.

Wortmann

J. H.

Jordan

A. H.

Weathers

F. W.

Resick

P. A.

Dondanville

K. A.

Hall-Clark

Foa

E. B

Young-McCaughan

Yarvis

J. S.

Hembree

E. A.

Mintz

Peterson

A. L.

Litz

B. T.

(2016). Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychological Assessment, 28(11), 1392–1403. https://doi.org/10.1037/pas0000260

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB

0.03 MB

0.02 MB

0.22 MB

0.10 MB