Observation on clinical effect of auricular acupoint sticking plus music therapy for post-stroke insomnia

Cai Xiao-min (蔡晓敏), Zhang Xu-ping (章旭萍), Tang Xing (唐杏)

The Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310005, China

Observation on clinical effect of auricular acupoint sticking plus music therapy for post-stroke insomnia

Cai Xiao-min (蔡晓敏), Zhang Xu-ping (章旭萍), Tang Xing (唐杏)

The Third Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310005, China

Objective:To observe the clinical effect of auricular acupoint sticking plus music therapy for post-stroke insomnia.

Insomnia; Sleep Initiation and Maintenance Disorders; Cerebrovascular Disorders; Stroke; Complications; Auricular Acupoint Sticking; Nursing

Insomnia refers to a syndrome that the patient fails to fall into asleep or maintain sleep at night due to various reasons, characterized by difficulty falling asleep, poor sleeping quality, insufficient sleep duration and early waking. The mild cases are often manifested by difficulty falling asleep, or shallow sleep, intermittent sleep and waking, or unable to return to sleep after waking up. The serious cases are often manifested by sleepless throughout the whole night, accompanied by dizziness, poor memory, palpitations and drowsiness, leading to the physiological suffering and psychological burden to the patients[1]. Cerebral stroke is a commonly and frequently encountered disease in the middleaged and old adults. It has been proven by the study that up to 80% of the patients with cerebral stroke are accompanied by insomnia[2]. Post-stroke insomnia can bring direct negative influence to the repair of the patient’s nervous functions, so as to postpone the restoration of the motor functions, affect the rehabilitation from cerebral stroke and lower the patients’ quality of life[3]. Music therapy is able to treat the somatopsychic diseases by improving the physiological functions of the human body, producing a better clinical effect for insomnia. Auricular acupoint sticking can dredge the meridians to treat insomnia by stimulating the corresponding ear acupoints. In this study, the clinical effects were observed in the treatment of post-stroke insomnia by auricular acupoint sticking plus music therapy. Now, the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

1.1.1 Diagnostic criteria of cerebral stroke

The diagnostic criteria for cerebral stroke were based uponCriteria for Diagnosis and Assessment of Clinical Effects of Stroke Diseasestimulated in 1994 by cooperative team of acute cerebral diseases of State Administration of Traditional Chinese Medicine[4]: main symptoms of hemiplegia, deviation of the mouth, tongue, face and lips, aphasia due to tongue stiffness, numb sensation on one side of the body, and even mental cloudiness, obscure spirit or delirium; acute onset or progressive pathologic situation, and premonitory symptoms of headache, dizziness, numb sensation in the limbs, plus high age and constitutional deficiency, excessive consumption of tobacco and alcohol, greasy and sweet food, internal injury and tiredness, and induced by alcoholic drinking, fatigue, anger and catching cold. The examinations of routine blood, blood pressure, nervous system, cerebrospinal fluid and ocular fundus were often given. Abnormal manifestations were present in cranial CT scan and MRI examination.

1.1.2 Diagnostic criteria of insomnia

The diagnostic criteria of insomnia in Western medicine were based upon the internationally acknowledged SPIEGEL scale[5]. The scores ≥ 12 points could be diagnosed as insomnia.

The diagnostic criteria of insomnia in Chinese medicine were based upon the diagnostic criteria of‘sleeplessness’ in the seventh edition textbook ofInternal Medicine of Traditional Chinese Medicine: difficulty falling asleep and maintaining sleep, decline of sleeping quality, or un-refreshed sleep, and still presence of the above symptoms under the circumstances or environment suitable for sleep; plus complaints of fatigue or general discomfort, poor concentration and poor concentration maintenance or poor memory, and declined ability in learning, work and/or social communication, emotional fluctuation or easy frustration, sleepiness in the daytime, decline of interest and energy, increasing mistakes in work or driving process, stress, headache, dizziness, and other somatic symptoms due to lack of sleep, and at least one type of daytime functional defect in association with the sleep in excessive attention to sleep.

1.2 Inclusion criteria

In conformity with the above diagnostic criteria; duration of cerebral stroke ＞14 d, but ≤180 d; age ranged from 40 to 80 years old; insomnia occurring after cerebral stroke; stroke confirmed by cranial CT scan or MRI examination; and the SPIEGEL score ≥12 points.

1.3 Exclusion criteria

Those not in conformity with the above diagnostic criteria; those unable to give clear expression due to serious conscious disturbance, serious dementia, aphasia and deafness; those administrating relevant sedative and sleeping pills within recent one week; those unable to cooperate with the treatment; those with poor obedience; and those complicated with cardiac failure, respiratory failure and dysfunction of other important organs.

1.4 Statistical methods

The SPSS 17.0 version software was used for statistical analysis. The measurement data were expressed by mean ± standard deviationand analyzed byt-test. The Chi-square test was used for comparison of rate. The grading data were processed by rank sum test. All the tests were two-sided tests.P＜0.05 indicates a statistical significant difference.

1.5 General data

Totally, 154 cases with post-stroke insomnia were recruited from the Acupuncture Clinic, Rehabilitation Clinic and Cerebral Diseases Clinic of our hospital between January 2013 and August 2014. The above patients were randomly divided into an observation group and a control group by the random digital table, 77 cases in each group. The differences in gender, average age, duration of cerebral stroke and SPIEGEL score were not statistically significant (P＞0.05), indicating that the two groups were comparable (Table 1) .

Table 1. Comparison of general data between the two groups (case)

2 Treatment Methods

2.1 Observation group

2.1.1 Auricular acupoint sticking

Acupoints: Shenmen (TF4), Sympathia (AH6a), Heart (CO15), Liver (CO12), Kidney (CO10) and Central Rim (AT2,3,4i)

Method: After routine disinfection of the auricular skin, the herbal seeds ofWang Bu Liu Xing(Semen Vaccariae) were glued with medical plaster on the acupoints of the unilateral ear and pressed for three times per day, for 30-60 s each time. The herbal seeds were replaced once every day, alternatively in the two ears. Ten sessions made one course. A two-day rest was given between the courses. Totally, three courses were given.

2.1.2 Music therapy

Music therapy was applied based upon auricular acupoint sticking. After a quiet and comfortable environment was selected, one of therapeutic music of traditional Five Elements tones (including Gong tone, Shang tone, Jue tone, Zhi tone, and Yu tone) was chosen in accordance with different traditional Chinese medicine patterns of body constitutions and insomnia condition[6].

Operation: The music of Gong tone (belonging to the Earth of Five Elements) for the patients with deficiency of the heart and spleen, such as the representative music ofEr Quan Ying Yue(Moonlight on Second Spring) andYou Yi Di Jiu Tian Chang(Auld Lang Syne). The music of Shang tone (belonging to the Metal of Five Elements) for the patients with internal disturbance of phlegm and heat, such as the representative music of Yang Chun Bai Xue(White Snow in Sunny Spring) andHuang He Da He Chang(Yellow River Cantata). The music of Jue tone (belonging to the Wood of Five Elements) for the patients with liver qi stagnation turning into fire, such as the representative music ofCao Mu Qing Qing(Everlasting Green Trees and Grass) andLü Ye Ying Chun(Green Leaves Greeting the Spring). The music of Zhi tone (belonging to the Fire of Five Elements) for the patients with qi deficiency of the heart and gallbladder, such as the representative music ofHua Hao Yue Yuan(Blooming Flowers and Full Moon) andBai Niao Chao Feng(All Birds Paying Homage to the Phoenix). The music of Yu tone (belonging to the Water of Five Elements) for the patients with fire hyperactivity due to yin deficiency, such as the representative music ofLiang Zhu(The Butterfly Lovers) andZhao-jun Yuan(Zhao-jun’s Blame). The music was played once every day, for 30 min each time. Ten sessions made one course. A two-day rest was given between two courses. Totally, three courses were given.

2.2 Control group

The patients in the control group were only treated with auricular acupoint sticking as given to the observation group, with the same acupoints and method.

3 Therapeutic Effects

3.1 Criteria of therapeutic effects

In reference to the therapeutic effects criteria of insomnia in theRevised Draft on Criteria of Therapeutic Effects of Mental Illness[1].

Cure: After treatment, the duration of sleep restored to normal level or over 6 h, with sound sleep and full of energy after waking up.

Remarkable effect: Sleep was obviously improved and the duration of sleep was increased by over 3 h.

Effect: The duration of sleep was increased than before treatment, but the duration of sleep was increased by less than 3 h.

Failure: No improvement after treatment.

3.2 Therapeutic results

3.2.1 Comparison of clinical effects between the two groups after treatment

At the end of treatment, the total effective rate was 98.7% in the observation group and 89.6% in the control group, with a statistically significant difference between the two groups (P＜0.05), indicating that the total effective rate was better in the observation group than that in the control group (Table 2).

Table 2. Comparison of clinical effects between the two groups (case)

3.2.2 Comparison of clinical effects between the two groups three months after treatment

In the follow-up (three months after the end of the treatment), the total effective rate was 90.9% in the observation group and 80.5% in the control group, with a statistically significant difference between the two groups (P＜0.05), indicating that there were certain long-term effects in the two groups, and the auricular acupoint sticking plus music therapy was better than auricular acupoint sticking alone in the therapeutic effects (Table 3).

Table 3. Comparison of clinical effect three months after treatment between the two groups (case)

4 Discussion

It is believed in modern medical study that insomnia is caused by decreased secretion of melatonin in the pineal gland of the brain. It is indicated in the theory of sleeping medicine that one of the reasons of insomnia is circadian rhythm disorder of the sympathetic nervous system, and the elevated excitability enhancement of the sympathetic nerve in the whole day, leading to sleep: waking rhythm disorder[7]. It is believed in traditional Chinese medicine that the main reasons of insomnia include emotional depression, over-thinking, fatigue, fear and fright, excessive sexual activity, constitutional deficiency due to long-term illness and improper food intake. Among them, over-thinking and fatigue are most common. Insomnia is associated with the heart, liver, gallbladder, spleen, stomach and kidney. The pathological mechanism is mainly related to dysfunction in yin, yang, qi and blood, and to yang preponderance and yin decline, yang failing to enter yin, and disharmony between yin and yang.

At present, the patients with insomnia in the recovery phase of cerebral stroke are mostly treated by giving hypnotic drugs of diazepam agents. The immediate and short-term clinical effects are affirmative in this type of medications. But, the drug dependence, drug resistance and insomnia recurrence limit the long-term administration of this type of medications. The medical mode of modern society has changed from biomedical model to biologicalpsychological-social medical model. People pay more and more attention to the self psychological status and social survival quality. Therefore, it is significant to find out a therapeutic plan with long-term affirmative effect and free of dependence for insomnia.

Auricular acupoint sticking is physiotherapy of non-invasion and non-adverse reaction and is one of the common effective methods for insomnia[8]. The motional nursing of Chinese medicine is an important component of the holistic rehabilitative nursing in the recovery phase of cerebral stroke. It has been proven by many studies that the emotional nursing in Chinese medicine is remarkably effective for insomnia induced by chronic disease[9]: the emotional nursing in Chinese medicine can remarkably alleviate anxiety and sleeping disorder in the patients with cerebral stroke[10]. The emotional nursing is beneficial to the improvement of sleep and the patients’ quality of life with post-stroke depression[11]. Music therapy is an important component of the emotional nursing in Chinese medicine and is one of the effective methods for insomnia[12]. It has been proven by our previous studies that when Jingming (BL 1) is An-pressed and Rou-kneaded under the musical background, the sleeping quality, sleep latency, duration of sleep, sleeping efficacy, sleeping disorder, and daytime functional disturbance are obviously improved than before interference[13].

Based upon numerous literature reference and basic theory[14-16], in this study by the effective integration of the auricular acupoint sticking and music therapy for clinical study of insomnia in the patients during the recovery phase of cerebral stroke, we found out the integrative therapy of the two therapeutic methods for insomnia is better than the auricular acupoint sticking alone in the immediate and long-term effects and needs to popularizing.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Acknowledgments

This work was supported by Project of Zhejiang Provincial Administration of Traditional Chinese Medicine (浙江省中医药管理局项目, No. 2013ZA070).

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Received: 25 January 2015/Accepted: 27 February 2015

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Translator:Huang Guo-qi (黄国琪)

耳穴贴压结合音乐疗法对脑卒中后失眠的疗效观察

目的：观察耳穴贴压结合音乐疗法对脑卒中失眠的疗效。方法：将 154例脑卒中后失眠患者按照随机数表法分为对照组及观察组, 每组各 77例。对照组接受耳穴贴压治疗, 观察组在耳穴贴压的基础上结合音乐移情护理。比较两组患者疗程结束时及治疗结束3个月后的临床疗效。结果：治疗结束时, 观察组总有效率为98.7%,显著高于对照组的89.6%, 两组差异具有统计学意义(P＜0.05); 治疗结束3个月后, 观察组总有效率为90.9%, 显著高于对照组的80.5%, 两组差异具有统计学意义(P＜0.05)。结论：耳穴贴压结合音乐疗法治疗脑卒中后失眠临床疗效肯定, 为制定脑卒中后失眠患者最佳护理康复干预方案提供了新思路。

失眠症; 入睡和睡眠障碍; 脑血管意外; 中风; 并发症; 耳穴贴压; 护理

R245.9 【

】A

Author: Cai Xiao-min, senior nurse.

E-mail: hzhs2013@163.com

Methods:A total of 154 cases with post-stroke insomnia were randomly divided into a control group and an observation group by the random digital table, 77 cases in each group. The control group was treated by auricular acupoint sticking, while the observation group was treated by auricular acupoint sticking plus music therapy, to compare the clinical effects at the end of the treatment and three months after the treatment between the two groups.

Results:At the end of treatment, the total effective rate was 98.7% in the observation group, remarkably higher than 89.6% in the control group, with a statistically significant difference between the two groups (P＜0.05). Three months after the end of the treatment, the total effective rate was 90.9% in the observation group, remarkably higher than 80.5% in the control group, with a statistically significant difference between the two groups (P＜0.05).

Conclusion:Auricular acupoint sticking plus music therapy was affirmative in the clinical effects for post-stroke insomnia, providing a new idea to design a best nursing and rehabilitative plan for the patients with post-stroke insomnia.