A recent survey on sleep disorders in the general population indicated rates of 56% in the US, 31%
in Western Europe and 23% in Japan. About 50% of subjects with sleep disorders had never taken any steps to resolve them and the majority of respondents had not spoken to a physician about the problem.29 The implications of insomnia are a reduced quality of life, decreased productivity and increased absenteeism.30,31 These patients experience significantly more limited activity than those without insomnia and are a greater burden on health services: overall, annual costs attributable to insomnia in the US have been estimated between $92.5 billion and $107.5 billion.32,33
As particularly the elderly are affected by sleep disorders, accurate screening and appropriate therapy could improve general health and well-being provided pharmacotherapy is used cautiously and conservatively.34 It is therefore possible for a physician to be asked to treat such disorders with non-conventional methods such as acupuncture. With auricular diagnosis the therapist may identify some recurrent areas of the ear which can be included in the treatment for improving the patient's quality of sleep. According to DSMIV, primary insomnia must be distinguished from mental disorders that include it as an essential or associated factor, such as depressive disorders.
Sleep disorders can manifest in several ways, ranging from insomnia to sleepiness and from disrupted sleep to lack of restful sleep. Measuring sleep disorders is an area of active research and several patient-reported outcome instruments exist for measuring various aspects of sleep dysfunction. In the systematic review by Devine and colleagues, four essential physical domains were included: (i) sleep initiation; (ii) sleep maintenance; (iii) sleep adequacy; and (iv) sleepiness during the daytime.35
For my research, among the instruments measuring these domains, I selected an adapted version of the Basic Nordic Sleep Questionnaire
(BNSQ) used in Scandinavian sleep surveys.
I preferred this questionnaire to, for example, the Pittsburgh Sleep Quality Index (PSQI), because the BNSQ allows the patient to record sleep disorders over the previous 3 months while the PSQI is limited to the previous month.
Of the 11 items proposed by BNSQ, seven concern the first three domains listed above and four measure the various aspects of sleepiness during the daytime; the total scoring ranges from 0 to 44.
I examined 153 consecutive patients from my general practice with an average age of 45.6 years using the BNSQ; 16.1% of them were taking more or less regular medication with benzodiazepines or non-benzodiazepines for inducing sleep.
Since insomnia diminishes the quality of life and interferes with general health, I first made a regression line as with the GHQ and found a moderate positive association between the number of tender points and the BNSQ scoring (Fig. 5.19). Afterwards I attempted to identify those auricular areas that more often seemed to be associated with a poor quality of sleep. Since the literature did not report a cut-off line for scoring better and worse sleepers, I chose an arbitrary level of <21 for the first group and >22 for the second. The comparison between the mean number of points per sector with paired sample t-test showed a significantly higher concentration of points on sectors 1, 2, 5 and 8 for the worse sleepers (Table 5.3).
As regards the identified clusters of points, we can appreciate the importance of the anterior ear lobe (sector 1), the forehead area (sector 2) and the significance of the cluster on the posterior part of the antitragus, extending from the anthelix-antitragus incisure toward the end of the scaphoid groove (sector 8). The central pivot area (sector 5), possibly related to mood disorders, cyclothymic personality and fear traits, also appears to be associated with sleep disorders (Fig. 5.20).
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