The Therapeutic Effect of Aromatherapy on Insomnia: a Meta-Analysis

Effects of Aromatherapy on Physical and Psychological Symptoms in Cancer Patients: A Systematic Review and Meta-analysis

BACKGROUND

Numerous physical and psychological symptoms experienced by cancer patients seriously affect their normal lives. Many academics and medical professionals have attempted to use aromatherapy in this situation to help cancer patients manage their physical and emotional problems.

OBJECTIVE

To systematically investigate the efficacy of aromatherapy on physical and psychological symptoms in cancer patients.

METHODS

A systematic review and meta-analysis of randomized controlled trials was performed. Four electronic databases were searched. The review process followed a registered priori review protocol and was reported using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Data extraction and quality assessment were performed in parallel.

RESULTS

Twenty-six studies with 2912 subjects were included. Meta-analysis showed that aromatherapy significantly improved sleep quality, fatigue, anxiety, and depression. We performed a subgroup analysis according to the different plant or animal aromatics contained in the oil, which found that lavender oil significantly reduced preoperative anxiety. In addition, aromatherapy massage was superior to inhaled aromatherapy in reducing anxiety. Moreover, cancer patients who used aromatherapy reduced the frequency of vomiting in 24 hours.

CONCLUSIONS

Aromatherapy is a useful treatment for improving sleep quality and reducing symptoms of fatigue, anxiety, and depression in cancer patients, as well as the frequency of vomiting over 24 hours.

IMPLICATIONS FOR PRACTICE

Healthcare providers can use aromatherapy to alleviate psychological and physical symptoms in cancer patients. The use of lavender oil and massage is recommended in clinical settings to improve anxiety symptoms in cancer patients.

Aromatherapy for the prevention of postoperative nausea and vomiting: A systematic review and meta-analysis

Objectives

Postoperative nausea and vomiting (PONV) are common complications following surgical procedures. While drug-based treatments are standard, there is increasing interest in nonpharmacological alternatives, such as aromatherapy, due to potential benefits and minimal side effects. This study aimed to assess the effectiveness of aromatherapy in preventing PONV.

Materials and Methods

A comprehensive systematic review and meta-analysis were conducted using PubMed, Cochrane Library, EMBASE, and CINAHL databases for studies published up to May 2023. The included studies were randomized controlled trials (RCTs) and nonrandomized studies of interventions that examined the impact of aromatherapy on PONV. The risk of bias was assessed, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was employed to evaluate the certainty of the evidence.

Results

Eleven studies were selected for review, with eight RCTs included in the meta-analysis. Aromatherapy effectively reduced postoperative nausea severity (standardized mean difference [SMD]: -0.93, 95% confidence interval [CI]: -1.64 to -0.22; P = 0.010), but the reduction in vomiting episodes was not statistically significant (SMD: -0.81, 95% CI: -1.98-0.37; P = 0.180). Subgroup analysis indicated that ginger essence, lavender, and peppermint oils were particularly effective in managing postoperative nausea. However, due to significant statistical heterogeneity and potential biases in the studies, the results should be interpreted with caution. The certainty of the evidence, as evaluated by the GRADE approach, was low.

Conclusion

Preliminary evidence supports the potential benefit of aromatherapy in reducing the severity of postoperative nausea. However, given the low certainty of current evidence, more rigorous and standardized research is needed. The safety, affordability, and potential benefits to patient comfort make aromatherapy a promising area for further research in postoperative care.

The effect of lavender foot baths on postoperative pain and sleep quality in comparison with foot baths with warm water only-A prospective randomized controlled study

INTRODUCTION

The aim of the study was to investigate the effect of warm water (WW) foot bath with or without lavender oil for pain and sleep quality in the patients who undergone abdominal surgeries.

MATERIALS AND METHOD

This study was designed as a prospective randomized controlled. The three study groups were defined as the control group (n = 44), the WW foot bath group (n = 46), WW foot bath with the lavender group (n = 40). Foot baths were done for 20 min with 40 °C every night for 3 days after surgery. Visual Analogue Scale and Richard-Campbell Sleep Questionnaire were used during data collection.

RESULTS

A total of 130 patients, mean age 55.99 ±  ± 13.05 years, 66 male (51 %), 103 of whom underwent abdominal surgery, were included in the study. When the patients during the postoperative three days were evaluated, decreased pain score and increased sleep quality both the WW and WW foot bath with lavender groups (p < 0.001). Noise-related sleep quality was detected to be lesser in the control group patients on the 3rd day (p < 0.001).

CONCLUSION

WW foot bath with or without lavender oil is an uncomplicated, economical, and effective complementary therapy to reduce postoperative pain and improve sleep quality. WW foot baths with essential oils are optionally available in clinics and can be used according to patients' preferences.

Rosemary (Rosmarinus officinalis L.) hydrosol based on serotonergic synapse for insomnia

ETHNOPHARMACOLOGICAL RELEVANCE

Rosemary (Rosmarinus officinalis L.) has been widely used as a traditional remedy for insomnia, depression and anxiety in China and Western countries. Modern pharmacological studies have shown that rosemary has important applications in neurological disorders. However, the mechanism of action of rosemary hydrosol in the treatment of insomnia is not known.

AIMS OF THE STUDY

Insomnia is closely linked to anxiety and depression, and its pathogenesis is related to biology, psychology, and sociology. Rosemary is a natural plant that has been used to treat insomnia and depression and has good biological activity, but its material basis and mechanism for the treatment of insomnia are not clear. Here, we report on the role of aqueous extracts of rosemary in the treatment of insomnia.

MATERIALS AND METHODS

The study was based on network pharmacology, using a combination of RNA-sequencing, "quantity-effect" weighting coefficients, and pharmacodynamic experiments. DL-4-chlorophenylalanine (PCPA) was intraperitoneally injected into SD rats to replicate the insomnia model with a blank, model, diazepam, and rosemary hydrosol low-, medium-, and high-dose groups were set up for the experiment. The key pathways in the treatment of insomnia with rosemary hydrosol were analyzed by molecular docking, open field assay, ELISA, western-Blot, Rt-PCR, and immunohistochemical assay.

RESULTS

Rosemary hydrosol was analyzed by GC-MS to identify 19 components. 1579 differential genes were obtained by RNA-Seq analysis, 533 targets for rosemary hydrosol and 2705 targets for insomnia, and 29 key targets were obtained by intersection. The KEGG results were ranked by "quantity-effect" weighting coefficients, resulting in serotonergic synapse was the key pathway for the treatment of insomnia with rosemary hydrosol. Molecular docking results showed that 1,7,7-trimethylbicyclo[2.2.1] heptan-2-one, 3-methyl-4-isopropylphenol, caryophyllene, and citronellol of rosemary hydrosol acted synergistically to achieve a therapeutic effect on insomnia. Caryophyllene acts on the HTR1A target by upregulating 5-HT1AR, leading to increased 5-HT release, and upregulation of ADCY5, cAMP, PKA and GABAA at serotonergic synapses; citronellol upregulated ADCY5 and 1,7,7-trimethylbicyclo[2.2.1] heptan-2-one, and 3-methyl-4-isopropylphenol up-regulated GABAA to improve insomnia symptoms. In open-field experiments, ELISA kits (5-HT, GABA, and DA), Western-blotting, Rt-PCR and immunohistochemical assay experiments, insomnia rats in the low-, medium- and high-dose groups of rosemary hydrosol showed different degrees of improvement compared with the model group.

CONCLUSIONS

It was shown that rosemary hydrosol may exert its therapeutic effects on insomnia through serotonergic synapses by combining RNA-Seq, "quantity-effect" weighting coefficients network pharmacology and pharmacodynamic experiments. We have provided a preliminary theoretical study for the development of rosemary hydrosol additive into a beverage for the treatment of insomnia, but it needs to be studied in depth. This study was conducted in rats and the results have limitations and may not apply to humans.

Pain and sleep after open-heart surgery-inhalation peppermint essence: double-blind randomized clinical trial

OBJECTIVE

The aim of this study was to determine the effect of inhaling peppermint essence on pain relief and sleep quality after open-heart surgery.

METHODS

In a double-blind randomised clinical trial carried out in Iran in 2020, 64 cardiac patients were selected by convenience sampling and randomly allocated to aromatherapy (n=32) and placebo (n=32) groups. The aromatherapy and control groups received inhaled aromatherapy using peppermint essence and distilled water, respectively. Data gathering tools were the Numeric Pain Rating Scale and St Mary's Hospital Sleep Questionnaire. Data were analysed using an independent t-test, χ2 test, Mann-Whitney U test and generalised estimating equation analysis.

RESULTS

The mean severity of pain in the aromatherapy and placebo groups was 3.22±0.88 and 4.56±0.90, respectively, which was a statistically significant difference (p=0.0001). The mean sleep scores after the intervention on day 1 were 20.10±4.90 and 25.76±6.36 in the aromatherapy and placebo groups, respectively, and 18.63±5.56 and 22.62±5.69, respectively, on day 2. The difference between the two groups was statistically significantly different after the intervention in terms of sleep quality (p<0.05).

CONCLUSION

Aromatherapy attenuated pain and improved sleep quality after open-heart surgery. Peppermint essence aromatherapy is therefore recommended after surgery.

The Effects of Inhalational Lavender Essential Oil Aromatherapy on Sleep Quality in Hemodialysis Patients: A Before-and-After-Intervention Trial

One of the most essential physical prerequisites for human survival is sleep. Patients undergoing hemodialysis often experience a lack of sleep, and it is one of the decisive variables in dialysis patients' quality of life. The objective of this study was to assess the effects of inhaling lavender essential oil on sleep quality in hemodialysis patients. A total of 30 patients were enrolled in the before-and-after intervention trial, which took place in a tertiary care hospital's dialysis unit. The study participants were selected using the purposive sampling technique and they received lavender oil inhalation therapy. The sleep quality was measured using the Pittsburgh Sleep Quality Index. The mean age of the participants was 55.11 (SD = 8.45) years. The mean posttherapy Pittsburgh Global Sleep Quality Index score was 8.8 ± 1.89 compared with the pretherapy score of 14.73 ± 1.53. Patients undergoing hemodialysis experienced a substantial improvement in sleep quality ( P < .05). Aromatherapy using lavender oil is effective in enhancing sleep quality in hemodialysis patients.

2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association

Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P - Patient, problem, or population; I - Intervention; C - Comparison, control, or comparator; O - Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.

Efficacy of non-pharmacological interventions on improving sleep quality in depressed patients: A systematic review and network meta-analysis

OBJECTIVE

Depression and sleep are closely related and tend to affect each other. To improve the sleep quality in depressed patients and the depression severity, there is an urgent need to find safer and more effective treatments - non-pharmacological interventions. This network meta-analysis aimed to investigate the effects of non-pharmacological interventions on improving sleep quality of patients with depression.

METHODS

All published literature were searched from four databases (Pubmed, Embase, Cochrane, Web of Science) as of November 2022. The risk of bias of the included studies was assessed using the Cochrane Systematic Review Manual 2.0 bias risk assessment tool. The primary outcome was sleep quality and, the secondary outcome was depression severity.

RESULTS

This study included 26 randomized controlled trials, involving 11 interventions and 3748 depressed patients. Cognitive-behavioral therapy (CBT) (SMD: 2.80; 95% CI: 1.63,3.96), aromatherapy (SMD: 3.95; 95% CI: 0.71,7.19), and acupuncture (SMD:3.49; 95% CI: 0.88,6.10) statistically and significantly improved sleep quality, compared to education only. CBT and acupuncture both were significantly more effective than education in depression severity. The cluster analysis showed that acupuncture, exercise, and cognitive-behavioral therapy were considered to be more effective non-pharmacological interventions.

CONCLUSION

Non-pharmacological interventions are promising in the daily care of depressed patients. In future research, we should value the need for psychological and social aspects of psychiatric care and make better use of nonpharmacological interventions through the biopsychosocial model. (PROSPERO registration number: CRD42023402316).

Time-Dependent Analysis of Human Neurophysiological Activities during an Ecological Olfactory Experience

It has been demonstrated that odors could affect humans at the psychophysiological level. Significant research has been done on odor perception and physiological mechanisms; however, this research was mainly performed in highly controlled conditions in order to highlight the perceptive phenomena and the correlated physiological responses in the time frame of milliseconds. The present study explored how human physiological activity evolves in response to different odor conditions during an ecological olfactory experience on a broader time scale (from 1 to 90 s). Two odors, vanilla and menthol, together with a control condition (blank) were employed as stimuli. Electroencephalographic (EEG) activity in four frequency bands of interest, theta, alpha, low beta, and high beta, and the electrodermal activity (EDA) of the skin conductance level and response (SCL and SCR) were investigated at five time points taken during: (i) the first ten seconds of exposure (short-term analysis) and (ii) throughout the entire exposure to each odor (90 s, long-term analysis). The results revealed significant interactions between the odor conditions and the time periods in the short-term analysis for the overall frontal activity in the theta (p = 0.03), alpha (p = 0.005), and low beta (p = 0.0067) bands, the frontal midline activity in the alpha (p = 0.015) and low beta (p = 0.02) bands, and the SCR component (p = 0.024). For the long-term effects, instead, only one EEG parameter, frontal alpha asymmetry, was significantly sensitive to the considered dimensions (p = 0.037). In conclusion, the present research determined the physiological response to different odor conditions, also demonstrating the sensitivity of the employed parameters in characterizing the dynamic of such response during the time. As an exploratory study, this work points out the relevance of considering the effects of continuous exposure instead of short stimulation when evaluating the human olfactory experience, providing insights for future studies in the field.

The effect of cognitive-behavioral counseling with or without Citrus aurantium essential oil on sleep quality in pregnant women: a randomized controlled trial

Sleep disorder is very common during pregnancy. Non-pharmacological treatments are a priority to improve the sleep pattern. This study aimed to determine the effect of cognitive-behavioral counseling with or without Citrus aurantium essential oil on sleep quality (primary outcome) and anxiety and quality of life (secondary outcomes). This randomized controlled trial was performed on 75 pregnant women in Tabriz, Iran. Participants were randomly assigned to the intervention and control groups. The first intervention group received 8 sessions of cognitive-behavioral counseling and aromatherapy with Citrus aurantium essential oil 15-20 min before bedtime. The second intervention group received cognitive-behavioral counseling and aromatherapy with placebo and the control group received only routine prenatal care. Pittsburgh Sleep Quality Index, Pregnancy-Specific Quality of life Questionnaire, and Pregnancy-Specific Anxiety Scale were completed before and after intervention. After the intervention based on ANCOVA test and by adjusting the baseline score, the mean score of anxiety in the intervention group 1 (AMD: - 4.54; 95% CI - 6.79 to - 2.28) and intervention group 2 (AMD: - 3.30; 95% CI - 5.60 to - 0.97) was significantly lower than the control group. Also, the mean score of quality of life in intervention group 1 (AMD: 2.55; 95% CI 0.45-4.65) and intervention group 2 (AMD: 2.72; 95% CI 0.60-4.83) was significantly higher than the control group, but there was no statistically significant difference between the study groups in terms of sleep quality (P > 0.05). Also, there was no statistically significant difference between the two intervention groups after the intervention in terms of anxiety (P = 0.379) and quality of life (P = 0.996). Cognitive-behavioral counseling reduced anxiety and improved quality of life. However, further trials are required to reach a definitive conclusion. Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N63. Date of registration: 4/10/2020. URL: https://en.irct.ir/user/trial/54986/view; Date of first registration: 18/10/2020.

Citrus Essential Oils in Aromatherapy: Therapeutic Effects and Mechanisms

Citrus is one of the main fruit crops cultivated in tropical and subtropical regions worldwide. Approximately half (40-47%) of the fruit mass is inedible and discarded as waste after processing, which causes pollution to the environment. Essential oils (EOs) are aromatic compounds found in significant quantities in oil sacs or oil glands present in the leaves, flowers, and fruit peels (mainly the flavedo part). Citrus EO is a complex mixture of ~400 compounds and has been found to be useful in aromatic infusions for personal health care, perfumes, pharmaceuticals, color enhancers in foods and beverages, and aromatherapy. The citrus EOs possess a pleasant scent, and impart relaxing, calming, mood-uplifting, and cheer-enhancing effects. In aromatherapy, it is applied either in message oils or in diffusion sprays for homes and vehicle sittings. The diffusion creates a fresh feeling and enhances relaxation from stress and anxiety and helps uplifting mood and boosting emotional and physical energy. This review presents a comprehensive outlook on the composition, properties, characterization, and mechanism of action of the citrus EOs in various health-related issues, with a focus on its antioxidant properties.

Inhalation Aromatherapy via Brain-Targeted Nasal Delivery: Natural Volatiles or Essential Oils on Mood Disorders

Mood disorders, also often referred to as affective disorders, are a group of psychiatric illnesses that severely impact mood and its related functions. The high medical expenditures have placed a significant financial burden on patients and their families. Aromatherapy is an alternative and complementary treatment that utilizes essential oils (EOs) or volatile oils (VOs) to achieve major therapeutic goals. In general, EOs are volatile chemicals that enter the body primarily through skin absorption and/or nasal inhalation. In addition, they can work through oral administration. Inhalation aromatherapy has shown unique advantages for treating mood disorders, especially depression, anxiety and mental disorders such as sleep disorder, which have been validated over the last decade through clinical and animal studies. Accumulating evidence has shown that EOs or VOs can bypass the blood-brain barrier to target brain tissue through the nasal-brain pathway. Subsequently, they act on the cerebral cortex, thalamus, and limbic system in the brain to improve symptoms of anxiety, depression and improve sleep quality. Here, we review the natural aromatic plants’ volatiles or essential oils used commonly as adjuncts to manage mood disorders and illustrate the mechanisms of inhalation aromatherapy, and mainly summarized the application of transnasal inhalation aromatherapy in depression, anxiety, and sleep disorders. We conclude that aromatherapy does not cause side-effects, which is vastly different from commonly used psychotropic drugs. Inhalation aromatherapy via brain-targeted nasal delivery offers potentially efficacious treatment for mental disorders and merits further study.

Effectiveness of Aromatherapy on Ameliorating Fatigue in Adults: A Meta-Analysis

Background

Fatigue is a common symptom in adults that may cause physical and psychological problems and reduce quality of life. Aromatherapy could possibly provide relief for those suffering from fatigue. Here, we evaluated the effect of aromatherapy on fatigue in adults.

Methods

We searched the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature, SinoMed, Wanfang, and Chinese Scientific Journal Database databases for randomized controlled trials of aromatherapy treatment for fatigue in adults from their inception to June 2021. Two reviewers searched independently, extracted the characteristics of the studies, and assessed the risk of bias using the Cochrane risk-of-bias tool and Stata v. 14.0.

Results

Nineteen studies were included in this systematic review. Aromatherapy had a significant effect on fatigue (standardized mean difference −0.64, 95% confidence interval−1.14, −0.15, I² 94.4%, P < 0.001). Subgroup analysis according to aromatic type, substance, frequency, treatment duration, intervention, outcomes measurement, and population type showed that aromatherapy had a significantly greater effect in the intervention group, compared to the control group. Funnel plots and Egger's test indicated no significant publication bias.

Conclusion

Our results suggest that aromatherapy ameliorates fatigue in adults who suffer from chronic diseases. A rigorous intervention program and larger randomized controlled trials are needed.

The Effect of Copaiba Oil Odor on Anxiety Relief in Adults under Mental Workload: A Randomized Controlled Trial

Background

Aromatherapy has been proved to be effective in alleviating anxiety in practices and research. Recently, copaiba oil (CPO) is popular in the market and is recommended for anxiety relief in aromatherapy practice. However, relevant scientific research is still lacking.

Methods

A randomized controlled trial was designed to evaluate the anxiety-relieving effect of CPO inhalation in 22 adults. Jojoba oil was used as the control treatment. N-back and mental arithmetic tasks were used as stress stimulation. CPO or control intervention was carried out after the n-back training phase. The State-Trait Anxiety Inventory (STAI), EEG activities, physiological indexes including heart rate (HR), blood pressure (BP), blood oxygen saturation, and salivary cortisol were assessed in different phases of the experimental process.

Results

There was no significant difference in the change of HR and BP between the CPO and control groups before odor intervention. The S-AI scores of the CPO treated participants decreased after the n-back and mental arithmetic tests and were significantly lower than those of the participants who received control treatments. The HR and salivary cortisol of participants who received CPO intervention significantly decreased during the n-back and mental arithmetic tests. Furthermore, a remarkable decrease of beta wave activity was observed in the left midfrontal region (F3) when the participant received the CPO intervention.

Conclusion

The study's findings supported that the CPO odor showed beneficial effects on alleviating anxiety based on several indicators in subjective, physiological, and EEG measurements.

Salvia officinalis L. Essential Oil: Characterization, Antioxidant Properties, and the Effects of Aromatherapy in Adult Patients

The purpose of this study is to reveal the chemical and biochemical characteristics and the potential aromatherapy applications of the essential oil (EO) of Salvia officinalis (common sage) within a hospital environment. The chemical composition was determined by gas chromatography with mass spectrometry and ATR-FTIR spectroscopy. Three types of sage EOs were included in this study: two commercial oils and one oil obtained by in-house hydrodistillation. Based on the findings, these EOs were included in different chemotypes. The first two samples were similar to the most common chemotype (α-thujone > camphor > 1,8-cineole > β-thujone), while the in-house sage EO revealed a high content of 1,8-cineole, borneol, α-thujone, similar to the Dalmatian type. The latter sample was selected to be evaluated for its antioxidant and medical effects, as borneol, a bicyclic monoterpene, is known as a substance with anesthetic and analgesic effects in traditional Asian medicine. The study suggests that the antioxidant capacity of the sage EO is modest (33.61% and 84.50% inhibition was determined by DPPH and ABTS assays, respectively), but also that the inhalation of sage EO with high borneol content by hospitalized patients could improve these patients’ satisfaction.

Visualizing Research Trends and Identifying Hotspots of Traditional Chinese Medicine (TCM) Nursing Technology for Insomnia: A 18-Years Bibliometric Analysis of Web of Science Core Collection

Objective

To explore the research hotspot and frontier direction of TCM nursing of insomnia and provide reference for the follow-up study of the optimal scheme of TCM nursing of insomnia.

Background

Insomnia is a common sleep-wake disorder, affects 6–10% of adults and was associated with independent higher risks of cardiovascular disease and diabetes. TCM Nursing Techniques of insomnia has a long history and has shown a definite impact. However, it's still lack of analysis in the field of the most commonly used and effective techniques, as well as the co-morbidities associated with insomnia. Therefore, the database was searched and analyzed to find effective TCM Nursing Techniques for insomnia and related diseases related to insomnia.

Method

Randomized controlled trials on the intervention of TCM Nursing Techniques in insomnia were retrieved from Web of Science Core Collection and imported into CiteSpace 5.6.R5 visualization software. The works of literature were co-cited by keywords authors and institutions for visual analysis, and the co-morbidities associated with insomnia of TCM Nursing Techniques in literature was extracted manually. The symptoms of co-morbidities associated with insomnia were imported into Cytoscape 3.9.0 software and clustered by CytoHubba.

Result

As of October 20, 2021, the literature published in the last 20 years from Web of Science Core Collection was screened, and the publication period of the included literature was from 2004 to 2021. From 2016 to now, the total number of articles has been increasing. A total of 146 articles were included, and the highest production year was 2020. There is little cooperation between states, institutions, and authors. China (including Hong Kong and Taiwan) and Hong Kong Polytech University are leading countries and institutions in this area. MYUNGHAENG HUR is the most cited author, and J ALTERN COMPLEM MED is the most cited journal. According to cluster analysis and keyword frequency, auricular therapy, aromatherapy, and acupressure are the three most commonly used techniques. While the top five co-morbidities are fatigue, anxiety, depression, pain and hemodialysis. The three frontier topics and the main research directions are sleep quality, comorbid insomnia and clinical trial design.

Conclusion

We found that acupressure, aromatherapy, and auricular acupoint therapy are the most commonly used nursing methods of TCM to intervene in insomnia. However, these studies have limitations such as small sample size, lack of objectivity in evaluating sleep quality, and high heterogeneity of intervention measures, which are not conducive to forming TCM clinical nursing guidelines. Therefore, it is necessary to adopt objectified sleep quality evaluation methods, select suitable acupoints according to TCM theories, and design multi-center large-sample clinical trials based on the safety principle of randomized blind control. This study provides an in-depth perspective for insomnia research on TCM Nursing Techniques and includes information for follow-up research on TCM Nursing Techniques of insomnia.