In general, insomnia consists of a complaint of disturbed sleep, Which presents as difficulty in sleep initiation or maintenance, and/or Early awakenings. Insomnia also includes the presence of daytime Impairments to normal functioning as result of sleep insufficiency. These impairments are generally manifested as fatigue, irritability, a Decrease in memory and concentration, and malaise. Given a lack of Standardization for the term insomnia, and the infrequency of sleep Problem assessment during patient histories, insomnia is often Undiagnosed or untreated.

Classifications of insomnia based on etiology include primary and Secondary insomnia. Primary insomnia is not caused by known Physical or mental conditions. It is, however, characterized by Consistent symptoms, a defined clinical course, and is responsive to Treatment, Secondary insomnia (also referred to as comorbid insomnia) Is a result of other medical and psychiatric illnesses, medications, or Other sleep disorders. When classifying insomnia based on duration,2 Forms are generally considered. Acute insomnia (also know as Transient insomnia) is typically the result of specific environmental or Social events such as the death of a family member, working on a differential shift schedule, travel, or additional noise. Acute insomnia is typically managed by treating the episode directly; or in cased where insomnia is expected to occur (eg, travel, varying work schedule), it can be treated prophylactically. The second type of insomnia based on durations is chronic insomnia. Chronic insomnia does not have specific diagnostic criteria but generally lasts for more than 1 month, ranges from 1 to 6 months in duration, occurs 3 or more times per week, and results in some degree of daytime dysfunction. Chronic insomnia is often correlated with other intrinsic sleep discorders, primary insomnia, or other chronic medical conditions interfering with a patient’s sleep pattern. Treatment for chronic insomnia typically requires a thorough examination of underlying conditions or disorders. According to the 2003 sleep in America Poll conducted by the National Sleep Foundation, approximately one half (48%) of surveyed Adults 55 to 84 years of age reported experiencing 1 or more symptoms Of insomnia at least a few nights per week. Prevalence estimates Reported in published studies for chronic insomnia range from 10% to 20%. The wide variation in estimates of insomnia reported in the Literature is related to the lack of definition and consistency in Diagnostic criteria for the disorder. The elderly population is frequently Affected by insomnia and should be of particular concern to managed Care providers and payers.

Insomnia treatment should reflect the etiology of the patient’s Insomnia. Primary insomnia generally responds well to pharmacologic Therapy, while secondary insomnia may be treated with pharmacologic And or psychologic treatments. Treatment should be geared toward the Specific component of insomnia that is most problematic for the patient (ie, sleep onset, sleep maintenance, sleep quality, or next-day function- Ing). Pharamacologic options can be grouped into 4 main categories; Benzodiazepines, nonbenzodiazepines, melatonin receptor agonists, And over-the-counter(OTC) medications. Currently, 5 benzodiaaepines Are approved for use in the United States for the short-term treatment of Insomnia. However, use of these agents in certain populations, most Notably the elderly and patients with a potential for abuse or addiction, Is a concern. Moreover, medicare part D does not cover the use of Benzodiazepines. The nonbenzodiazepine agents provide an alternative To benzodiazepines in the treatment of insomnia. However, a majority Of the nonbenzodiazepine agents have a mechanism of action similar to The benzodiazepines in that both bind to a γ-aminobutyric acid receptor. The exception to this mechanism is ramelteon, which is a selective Agonist for the melatonin MT1/MT2 receptors. Ramelteon has a Reported advantage of no abuse potenstial compared with the Benzodiazepines which are classified as C-IV controlled substances. Several OTC preparations are also available for insomnia treatment. These medications consist largely of antihistamines that are marketed As sleep aids because of their sedative side effects. These Nonprescription agents have the advantage of being relatively Inexpensive but are often associated with next-day sedation, Anticholinergic side effects(dry mouth, blurred vision), and tolerance. Psychologic treatments for insomnia are also a consideration, Particularly for patient suffering from secondary insomnia. Psychologic approaches to treatment include congnitive therapy, Cognitive behavioral therapy, relaxation techniques, sleep restriction, And stimulus control.

As a natural therapy, ILILT often used to treat insomnia. Wang (2006) have treated 50 patients with insomnia with LGAL at 3mW for 60 min each time, which was done once a day and 10~14 days each session for 1~2 sessions, and found the sympton improvement of 41 (82.0%), 4 (8.0%) and 5 (10.0%) patients were significant, mild and none,respectively.Xu et al.(2001) have treated 38 patients with insomnia with LHNL at 3.5~4.5mW for 30 min each time, which was done once a day and ten days each session for two sessions, and found serum melatonin increase.Xu et al.(2002a) further treated 128 patients with insomnia with LHNL at 3.5~ 4.5mW for 30 min each time, which was done noce a day for ten days,and found the polysomnogram was improved.It has been found that acupuncture induced sleep rehabilitation was mainly mediated by du meridian.ILILT induced sleep rehabilitation might be mediated by nasal du meridiann according to MIH.

ILILT can be integrated with laser acupuncture (LA) and the skin-contact electric acupuncture of low frequency pulse.Chen YM et al, (2004) randomly divided 90 patients with insomnia into two groups, 40 in herb-only group, 50 in ILILT+LA+herb group. ILILT+LA+drugs group was treated with intranasal LHNL for 60 min each time and with LHNL on the acupoints such as neiguan (PC 6) and shenmen (HT7) (Fig.6) and so on for 20 min each time each acupoint, respectively, which was done once a day and seven days each session for 1~2 sessions.The LHNL works at power smaller than 5mW.It has been found the symptoms were improved after trearment in these two groups, but ILILT+LA+herb group was more pronounced than herb-only group.In the herb-only group,the symptom improvement of 16(40.0%),15 (37.5%) and 9(22.5%) patients were significant, mild and none, respectively.In the ILILT+LA+herb group, the symptom improvement of 39(78.0%),10 (20.0%) and 1 (2.0%) patients were significant, mild and none, respectively.