Traditional Chinese medicine therapies for insomnia: An umbrella review and evidence map.

BACKGROUND

An increasing number of systematic reviews and meta-analyses (SR/MAs) suggests traditional Chinese medicine therapies are effective for insomnia. We aimed to synthesize and evaluate the methodological quality of these studies through an umbrella review with an evidence map for improving evidence quality.

METHODS

We searched 10 databases from inception to March 20, 2025, that investigated the effects of TCM therapies on sleep-related subjective or objective outcomes for insomnia. We assessed the methodological quality of included SR/MAs using A Measurement Tool to Assess systematic Reviews (AMSTAR 2) tool, evaluated the certainty of evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool, and visually presented the results as an evidence map.

RESULTS

Thirty-six SR/MAs included in this umbrella review described 3 TCM non-pharmacotherapies (i.e., acupuncture, Tuina massage, and Chinese exercises), and Chinese herbal medicine (CHM). The AMSTAR 2 results showed that 20 SR/MAs had high or moderate methodological quality, while the remaining studies were of low or critically low methodological quality. The evidence map showed high-quality SR/MAs supported the effect of acupuncture, Tuina massage, Chinese exercises, and CHM on overall sleep quality, while acupuncture, Tuina massage, and Chinese exercises could also improve anxiety and depression. Moreover, acupuncture and Tuina massage might improve objective outcomes such as polysomnography parameters and 5-hydroxytryptamine level.

CONCLUSIONS

Acupuncture, Tuina massage, and Chinese exercises are effective in improving overall sleep quality and emotional outcomes and have potential effects on objective sleep parameters. There is sufficient evidence that several CHM formulas could improve sleep quality. However, the methodological quality of SR/MAs needs further improvement.

PROTOCOL REGISTRATION

PROSPERO, CRD42022347769.