Insomnia in Menopausal Women Treated with Auricular Acupuncture:HRV correlation

(Warning, this post is only for those interested in the tiny niche of acupuncture and HRV.)
Gotta love this study since it correlates HRV with treatment outcomes. Yay! Though there has been quite a bit of research on HRV and acupuncture, there has been precious little looking at whether HRV response correlates with clinical outcomes. In this study they found nLF to go down and nHF to go up in patients who had effective treatment (i.e. less insomnia) and for nLF to go up in the nonresponders. Progress! Some researchers insist that one needs to look only at non-normalized values and that HF is more predictive than LF, but we'll take what we can get.

Menopause. 2011 Jun;18(6):638-45.

The relationship of subjective sleep quality and cardiac autonomic nervous system in postmenopausal women with insomnia under auricular acupressure.

Kung YY, Yang CC, Chiu JH, Kuo TB.

Source

Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan.

Abstract

OBJECTIVE:

The aim of this study is to examine the relationship between the changes in self-reported sleep symptoms and cardiac sympathovagal activity among women with postmenopausal insomnia (PI) who received auricular acupressure (AA) therapy.

METHODS:

A pretest/posttest study design was conducted at Taipei Veterans General Hospital, Taiwan, from August 2008 to July 2009. Forty-five women (mean ± SD age, 56.2 ± 5.4 years) with PI (4.9 ± 3.5 years of insomnia) received an AA therapy course on five auricular points every night before going to sleep for 4 weeks. Heart rate variability (HRV), the Chinese version of the Pittsburgh Sleep Quality Index, and the Menopause Rating Scale were measured before and after AA treatment.

RESULTS:

The total sleep duration and sleep efficiency were increased, and the sleep latency was shortened significantly (P < 0.01) after AA therapy. The total Menopause Rating Scale and somatovegetative subscale scores were reduced significantly (P < 0.05) after the intervention. A greater percentage change in Pittsburgh Sleep Quality Index was moderately correlated with both a lower percentage change in high-frequency power of HRV (r = -0.660, P < 0.001) and a greater percentage change in normalized low-frequency power (nLF) of HRV (r = 0.599, P < 0.001). An elevation of high-frequency power and a reduction of nLF of HRV were observed in the responder group, whereas a raise in nLF of HRV was noted in the nonresponder group.

CONCLUSIONS:

This study suggests that AA intervention leads to more cardiac parasympathetic and less cardiac sympathetic activity, which contributes to the improvement of PI.

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For more information about acupuncture and HRV, please click here.

Follow up on patient with Severe Thoracic Spine Pain

This is the follow up on a patient I posted on earlier here.
When the patient came in for a follow up visit, his pain was at a 5 level (5 out of 10.) He had had another episode of severe spasm the day before requiring Dilaudid. But it had resolved on its own. He thinks that the acupuncture is helping to quell the severe spasms.
I tried doing cupping on his back since it can be helpful when muscle tightness is involved, but it ended up aggravating after about 10 minutes. So the cups came off.
His readings, again, showed a decrease in the stress response( values follow.) The whole idea is to be able to "balance" his system, reduce his stress there by increase his pain threshold. From there we can reduce his medications and get him moving again with a gentle stretching and exercise plan.
His reading for 60 to 360 seconds, and 360 to 660 seconds.
LFR/HFR- .76 and .24
SD1/SD2- .52 and .56 (not much change, granted)
Sample entropy 1.67 and 1.88

(Brief primer: LFR/HFR stands for Low Frequency/High Frequency HRV. If this decreases, it is interpreted to mean that the stress response in decreased. So decrease in LFR/HFR=decreased stress. The other measure SD1/Sd2, is a nonlinear method, if this ratio increases =decreased stress.)
(For more info on my practice, please click here, for information about stress and acupuncture please click here.)

Case Study: PCOS patient, acupuncture and HRV

So PCOS stands for Polycystic Ovarian Syndrome. And HRV stands for Heart Rate Variability, a measure of autonomic balance, or in layman's terms, the stress response or relaxation response.
I wanted to try to illustrate the gist of my research interest. I will start with this particular patient who is in her late 20's and carries a diagnosis of PCOS and even with clomid does not ovulate. So she has been coming to me for acupuncture. I have done some previous posts on PCOS and HRV and the protocols here, here, here.
What these graphs show are some of the treatments I have her following the protocol using 2Hz strong stimulation electroacupuncture. What I would like to see is a decrease in her LFR/HFR ratio during treatment. As you can see the first three graphs from 6.2.2011, 6.20.2011, and 6.27.2011 all show minimal decrease in her LFR/HFR ratio. So I decided to abandon the protocol and do manual acupuncture with more emphasis on traditional treatment with standard TCM (Traditional Chinese Medicine) points. As you can see, she had a better relaxation response with that treatment as reflected in the decrease in her LFR/HFR ratio. Also notice that in the last graph, she also has a lower value of LFR/HFR more between the 1 and 2 range, which is the lower than in the other graphs. (So sorry for the poor quality of the graphs, will try to work on those and repost.)
I called her after analyzing the data to see how she was doing and she said that she had had some spotting, which was new for her. So we will see how she does with time and I'll try to keep you posted. (For more info on my practice, please click here.)

Telomeres and Cardiovascular Disease Risk Factore

Dusted off this oldie also. By the same group looking at cardiovascular health and telomeres and stress. (This post is an offshoot of this earlier post.)
*1: *Psychoneuroendocrinology. 2006 Apr;31(3):277-87. Epub 2005 Nov
17.

Cell aging in relation to stress arousal and cardiovascular
disease risk factors.


UCSF Department of Psychiatry, San Francisco, CA, USA.
epele@healthpsych.ucsf.edu

We previously reported that psychological stress is linked to and
possibly accelerates cellular aging, as reflected by lower PBMC
telomerase and shortened telomeres. Psychological stress is a major
risk factor for cardiovascular disease (CVD), with multiple
behavioral and physiological mediators. Telomere shortness has been
associated with CVD, but the relationship between low telomerase
activity, a potential precursor to telomere shortening, and CVD risk
factors has not been examined in humans. Here we examine whether
telomere length and telomerase in leukocytes are associated with
physiological signs of stress arousal and CVD risk factors in 62
healthy women. Low telomerase activity in leukocytes was associated
with exaggerated autonomic reactivity to acute mental stress and
elevated nocturnal epinephrine. Further, low telomerase activity was
associated with the major risk factors for CVD -smoking, poor lipid
profile, high systolic blood pressure, high fasting glucose, greater
abdominal adiposity-as well as to a composite Metabolic Syndrome
variable. Telomere length was related only to elevated stress
hormones (catecholamines and cortisol). Thus, we propose that low
leukocyte telomerase constitutes an early marker of CVD risk,
possibly preceding shortened telomeres, that results in part from
chronic stress arousal. Possible cellular mechanisms by which low
telomerase may link stress and traditional risk factors to CVD are
discussed. These findings may implicate telomerase as a novel and
important mediator of the effects of psychological stress on
physical health and disease.

Original Proceedings of National Academy of Sciences study on telomeres and stress

A bit of background from this earlier post, I had this in the deep freeze of my computer. This was the landmark study showing increased aging in mothers of handicapped children versus mothers of non-handicapped children.
Department of Psychiatry, University of California, 3333 California
Street, Suite 465, San Francisco, CA 94143, USA. elissa@itsa.ucsf.edu

Numerous studies demonstrate links between chronic stress and
indices of poor health, including risk factors for cardiovascular
disease and poorer immune function. Nevertheless, the exact
mechanisms of how stress gets "under the skin" remain elusive. We
investigated the hypothesis that stress impacts health by modulating
the rate of cellular aging. Here we provide evidence that
psychological stress--both perceived stress and chronicity of
stress--is significantly associated with higher oxidative stress,
lower telomerase activity, and shorter telomere length, which are
known determinants of cell senescence and longevity, in peripheral
blood mononuclear cells from healthy premenopausal women. Women with
the highest levels of perceived stress have telomeres shorter on
average by the equivalent of at least one decade of additional aging
compared to low stress women. These findings have implications for
understanding how, at the cellular level, stress may promote earlier
onset of age-related diseases.

Toll From Stress: Links to Parkinson's and other Diseases

From Scientific American Mind,( www.ScientificAmerican.com/mind) an article about brain disorders result from a complex interaction between our genes and the environments to which we are exposed. A set of recent studies has just uncovered an important environmental instigator of neurodegenerative disease: stress. It goes on to say that stress has been shown to have an adverse effects on numerous psychological condition The idea that stress may figure into neurodegenerative disease, is relatively new. The research was done on rats and monkeys, but the implications for human disease are pretty clear.
Their Fast Facts:
1. A recent wave of research has unveiled an important environmental player in the genesis of neurodegenerative disease: Stress
2. Pairs of identical twins developed Alzheimer's disease in concert only 40% of the time, showing that factors other than genetics must contribute to the disorder.
3. Stress seems to impede the ability of certain brain cells to recover from insults, triggering aor aggravating the symptoms of disorders such as Parkinson's.

We know from the work of Dr. Elizabeth Blackburn that telomeres show increased cellular aging in patient populations with increased stress, so it is not too surprising that Alzheimer's would be influenced by increased stress levels also.
As readers of this blog know, stress is my particular area of interest especially using acupuncture as a mitigator of the stress response. (I have a page on my website here.)
Be Smart! Relax! And get your acupuncture! (As well as exercise, meditation etc..._
(For information about my practice, please click here.)

The Stress Response (Autonomic Balance) and Acupuncture

A recent study from Columbia looks at a topic that is near and dear to me, i.e. autonomic balance, or the stress response, and acupuncture. In my own study (see my website) I found that there was more likely to be a decreased stress response during acupuncture treatment sessions in patients who benefited from acupuncture. Those patients who did not "get better" with acupuncture were less likely to see a decrease in their stress response. This study was performed on healthy volunteers, so, of course they couldn't draw any correlation with efficacy or outcomes. But I'm thrilled that the correlation of Heart Rate Variability (HRV) with acupuncture is being explored in various centers.

"The Acute Effects of Acupuncture Upon Autonomic Balance in Healthy Subjects. The Acute Effects of Acupuncture Upon Autonomic Balance in Healthy Subjects. Carpenter RJ, Dillard J, Zion AS, Gates GJ, Bartels MN, Downey JA, De Meersman RE. Department of Rehabilitation Medicine, College of Physicians and Surgeons of Columbia University and Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA.Am J Chin Med. 2010;38(5):839-847. Abstract

"Restoration of the sympathovagal (S/V) balance, involving a lowering of sympathetic and/or an augmentation of vagal modulation or a combination of both is associated with improvements in cardiovascular morbidity and mortality. To determine whether acupuncture exerts a favorable influence upon resting blood pressure and sympathovagal balance, a single-blind cross-over investigation was used to study the acute effects of acupuncture on S/V balance in normal healthy subjects. The ANOVA revealed a significant lowering of the sympathovagal balance (LF:HF) during rest for the acupuncture treatment from pre (4 +/- 2 nu) to post (2.2 +/- 1.8 nu)(p < style="font-weight: bold;">These findings are of importance since acupuncture treatments are non-pharmacological and have no known detrimental side-effects. This investigation employed healthy volunteers, yet acupuncture has been found to have more potent effects in animal models of hypertension and or in the presence of an autonomic imbalance ." (emphasis mine)

I have successfully treated patients for high blood pressure with acupuncture. I wish I was set up to be able to have HRV readings on all patients, especially those with high blood pressure or other autonomic disturbances. That is something that I'm working towards in my practice.
For other posts on autonomic balance and acupuncture:
http://ksparrowmd.blogspot.com/2010/04/heart-rate-variability-and-acupuncture.html
http://ksparrowmd.blogspot.com/2009/10/acupuncture-autonomic-nervous-system.html
http://ksparrowmd.blogspot.com/2009/10/heart-rate-variability-tens-and-body.html

Acupuncture and Stress, in Rats?

This is a study looking at biochemical markers of stress in rats using a very common acupuncture point Pericardium 6. (Pericardium 6 is the point often used for motion sickness or nausea in pregnancy.)
They gave the animals mild stressors for 8 weeks and compared acupuncture at Pericardium 6 to Triple Heater 5 (another common point on the other side of the arm.)
Their conclusion was
"The present results demonstrated that acupuncture was effective in restoring CMS-related biochemical and behavioral impairments such as anxiety and anhedonia and that acupuncture point was more effective than non-acupuncture point. These results suggest that acupuncture has a therapeutic effect on chronic stress-related diseases such as depression and anxiety.
The effects of acupuncture stimulation at PC6 (Neiguan) on chronic mild stress-induced biochemical and behavioral responses."
Neurosci Lett. 2009 May 7.
Division of Brain Disease, Center for Biomedical Science, National Institute of Health, Seoul, 122-701 Republic of Korea.

Kim H, Park HJ, Han SM, Hahm DH, Lee HJ, Kim KS, Shim I.

Animal Studies Corroborrate My HRV Studies

This blog entry is hardly of broad interest, but it pertains to the studies that I've done.
My own research has looked at the effect of acupuncture on the autonomic nervous system, or stress response. ( Analysis of Heart Rate Variability in Acupuncture Practice: Can It Improve Outcomes?MEDICAL ACUPUNCTUREVolume 19, Number 1, 2007Kristen Sparrow, MD) What I found is that in patients who responded (i.e. got better) from acupuncture, had a decrease in their stress response during treatment. This was corroborated in an article published last year by Baecker.(Acupuncture in Migraine :Investigation of Autonomic Effects Clin J Pain Volume 24, Number 2, February 2008)

I am quite interested in this recent article because it was performed on rats and showed that electroacupuncture applied at Stomach 36 but not Bladder 21 resulted in a decrease in the stress response in restrained rats.

There are so many variables in the clinic setting that it is difficult to have confidence in the results at times. This animal study confirms my findings and that just might be meaningful.
Excerpts of the study follow.
(For more information about my practice, please click here.)

Electroacupuncture Improves Imbalance of Autonomic Function under Restraint Stress in Conscious Rats.
Am J Chin Med. 2009;37(1):45-55
Imai K, Ariga H, Takahashi T.
Department of Surgery, Duke University, Durham, North Carolina 27710, USA
Acupuncture may modulate the imbalance of the autonomic nervous system. It is well known that restraint stress delays gastric emptying via inhibiting parasympathetic activity and/or stimulating sympathetic activity in rats.
EA at ST-36 significantly reduced the elevated heart rate and LF, compared to that of control group. EA at ST-36 also significantly increased HF component after finishing the stress loading. In contrast, EA at BL-21 had no significant effect on the heart rate, LF and HF. It is suggested that EA at ST-36 stimulates parasympathetic activity and inhibits sympathetic activity under the restraint stress in rats.