We thank Dr. Ganguly for his comments about our article.1 We agree that the jury is still out regarding whether acupuncture may play a role in the treatment of insomnia. As we have pointed out in our review of this literature (following up on the Cochrane review and including studies not published in English),2 rigorously controlled randomized clinical trials (RCTs) will be needed to sort out the many issues involved.
Specifically regarding Dr. Ganguly's comments on insomnia secondary to chronic pain, it certainly was not our intention to reach firm conclusions about the utility of acupuncture in any forms of secondary insomnia. In fact, our patients had multiple comorbidities, including not only pain but also anxiety, posttraumatic stress disorder, and/or depression. One patient also had traumatic brain injury. Thus, we would not be so quick to conclude that the use of acupuncture for insomnia should be limited to secondary to chronic pain, or to dismiss its potential relevance for other forms of secondary insomnia, or even primary insomnia. Only well-designed RCTs targeting different populations will answer such questions.
In the literature review accompanying our Case Series,1 we hypothesized that, regardless of the patient population under study, acupuncture's effects might be mediated by autonomic activity modulation. We believe that understanding of the mechanisms whereby acupuncture may affect sleep would enhance understanding of its possible effects in any population, as well as having implications for current models of insomnia. Our current research efforts pursue such issues.
This was not an industry supported study. The author has indicated no financial conflicts of interest.