Acupuncture for insomnia management: An international evidence-based guideline that integrates multidisciplinary consensus and regional adaptability

Insomnia poses significant challenges to public health systems. Acupuncture, a widely used traditional therapy around the world, has shown promise in improving sleep outcomes, but clinical practice remains inconsistent. This guideline aims to provide evidence-based recommendations for acupuncture practice in insomnia management while addressing implementation across diverse healthcare settings. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted, encompassing studies published before January 2025. Evidence certainty was assessed using the GRADE approach, and recommendations were formulated through a modified Delphi process involving a multidisciplinary panel of 26 experts from 11 countries that comprehensively considered patient preferences, cost-effectiveness, and regional accessibility. Based on moderate-to low-certainty evidence, it is conditionally suggested that electroacupuncture or manual acupuncture may be considered for patients with chronic insomnia particularly in institutions where it is available. Notably, electroacupuncture is conditionally suggested for patients with comorbid insomnia or for patients with poor sleep quality. To standardize clinical application, expert consensus established a core set of acupoints, including Baihui (DU20), Sanyinjiao (SP6), Sishencong (EX-HN1), and Anmian (EX-HN-54), and a treatment protocol involving needle retention for 30 min after obtaining "de qi", administered three times per week for at least four weeks.