Acupressure for Insomnia

Insomnia is a significant health problem and is associated with increased mental health
issues: It is estimated that 9% to 15% of the adult population suffers from chronic
insomnia. These estimates are considerably higher in primary care where from 20% to 33%
suffer from chronic insomnia. Insomnia adversely affects psychological, physical and
occupational functioning and places a significant burden on society. Moreover, several
cohort studies have found that people with insomnia have significantly higher absenteeism at
work, report poor self-esteem, less job satisfaction, and less efficiency at work compared
to good sleepers.

Acupressure is a TCM technique based on a philosophy similar to that of acupuncture (the
placement and stimulation of very fine needles into acupuncture points). Acupressure
involves placing physical pressure by fingers, thumb, elbow, or with the aid of various
devices such as pencil erasers on different acupuncture points (acupoints). Depending on the
date of the review and the inclusion criteria, e.g., searched in Chinese language databases,
there are anywhere from 7^12 to 4^68 randomized clinical trials (RCT) of various types of
acupuncture (inclusive of acupressure) for treating insomnia. Regardless of the review the
conclusions are remarkably consistent. Mainly, that the majority of RCTs demonstrated that
acupuncture was significantly more effective than BDZs, sleep hygiene counseling, no
treatment and sham acupuncture for treating insomnia.

The investigators will attempt to prove that self-administered Relaxation Acupressure (RA)
will result in improvements in measures of sleep quality and quantity, compared to
Stimulating Acupressure (SA) and a wait list control (WL). Also, that they will be able to
teach the acupressure points using a web-based application.

Participants will be randomized into 1 of 3 arms; RA, SA, or WL (standard of care). If
randomized into one of the acupressure arms, the participants will view their appropriate
acupressure training lesson online and be tested on their understanding. They will also be
asked to perform their acupoints once per day for a total of 6 weeks.

Inclusion Criteria:

- 18-65 years of age

- Meet DSM-IV criteria for primary insomnia

- Insomnia must also be documented on two weeks of a baseline sleep diary

Exclusion Criteria:

- Diagnosis or high clinical suspicion of a sleep disorder other than insomnia

- Evidence of a unstable Axis I psychiatric disorder

- Evidence of an uncontrolled medical disorder or pain syndrome that affects sleep,
causes daytime sleepiness, or is likely to be causally associated with the insomnia

- Current pharmacological or non-pharmacological insomnia treatment

- Routine overnight shift work

- Previous failed trial of acupuncture or acupressure