Nurse-administered acupressure reduces PSQI scores by MD -7.61 in menopausal insomnia

This is a meta-analysis of randomized controlled trials evaluating non-pharmacological interventions for insomnia in women after natural menopause. The analysis synthesized data from a total population of 1648 women. The interventions reviewed included cognitive behavioral therapy, exercise, acupuncture, acupressure (both self-administered and nurse-administered), and integrated interventions. The primary outcome was the change in PSQI and ISI scores, with the main results reported for PSQI scores.

For the primary outcome, cognitive behavioral therapy resulted in a mean difference (MD) of -3.38 in PSQI scores (95% CI -4.15 to -2.62). Exercise led to an MD of -1.17 (95% CI -1.88 to -0.47). Acupuncture showed an MD of -6.25 (95% CI -7.64 to -4.87). Self-administered acupressure resulted in an MD of -2.26 (95% CI -3.10 to -1.43). Nurse-administered acupressure had the largest effect, with an MD of -7.61 (95% CI -8.30 to -6.93). Integrated interventions yielded an MD of -2.89 (95% CI -3.67 to -2.12). All results indicated a significant reduction in PSQI scores.

The review did not report data for secondary outcomes, such as ISI scores, in the provided input. Safety and tolerability findings were not reported; adverse events, serious adverse events, and discontinuations were all listed as not reported. The analysis did not include a comparator group, as it focused on the effects of the various non-pharmacological interventions.

These results compare to prior landmark studies in the therapeutic area of insomnia management, which have generally supported cognitive behavioral therapy as a first-line non-pharmacological treatment. The current meta-analysis extends this evidence to menopausal women, highlighting the potential of acupressure, particularly nurse-administered, as a highly effective option. However, the lack of direct comparisons to pharmacological therapies or hormone therapy in this analysis limits direct cross-study comparisons.

Key methodological limitations include the absence of reported follow-up periods, which affects the assessment of long-term efficacy. The analysis is based on a meta-analysis of randomized controlled trials, but specific study settings and potential biases were not detailed in the input. The population was restricted to women after natural menopause, which may limit generalizability to other populations with insomnia.

For clinical practice, these findings suggest that non-pharmacological interventions are preferred options for managing insomnia related to natural menopause. They may be particularly beneficial for patients who refuse to use hypnotic medications or hormone therapy, or who have contraindications to these treatments. Clinicians can consider offering nurse-administered acupressure, given its large effect size, as part of a comprehensive management plan.

Unanswered questions remain, including the long-term durability of these effects, direct comparisons with pharmacological interventions, and the optimal sequencing or combination of these non-pharmacological approaches. Future research should address these gaps to refine clinical guidelines for insomnia in menopausal women.