Abstract： Objective： To observe the clinical efficacy of bioholographic auricular point therapy combined with acupuncture in treating chronic insomnia. Methods：A total of 96 patients with chronic insomnia admitted to The First Affiliated Hospital of Henan University of Chinese Medicine from January 2023 to June 2024 were divided into the control group and the observation group，with 48 cases each，using the random number table method. The control group received Estazolam Tablets，while the observation group received bioholographic auricular point therapy combined with acupuncture. Both groups were treated for four weeks. Clinical efficacy was evaluated. Pittsburgh Sleep Quality Index （PSQI）， Hamilton Anxiety Scale （HAMA）， Hamilton Depression Scale-17 （HAMD-17）， Flinders Fatigue Scale （FFS）， and SF-36 quality of life scores were compared before and after treatment. Polysomnography （PSG） parameters were recorded. Serum neurotransmitter levels （5-HT， β-EP， NSE， BDNF） were measured. Results： The total effective rate was 91.67%（ 44/48） in the observation group，higher than that of 72.92%（ 35/48） in the control group （P＜0.05）. After treatment，PSQI dimension scores decreased in both groups （P＜0.05），with lower scores in the observation group （P＜0.05）. SF-36 scores increased while HAMA，HAMD-17 and FFS scores decreased in both groups （P＜0.05）；the SF-36 score in the observation group was higher than that in the control group，and the scores of HAMA， HAMD-17 and FFS were lower （P＜0.05）. After treatment， total sleep time （TST） and sleep efficiency（ SE） increased，while wake after sleep onset（ WASO） and sleep latency（ SL） shortened in both groups（ P＜ 0.05）；the TST and SE levels in the observation group were higher than those in the control group，while WASO and SL were shorter（P＜0.05）. After treatment， REM， N2 and N3 percentages increased while N1 percentage decreased in both groups （P＜0.05）， the REM， N2 and N3 percentages in the observation group were higher than those in the control group，and N1 percentage was lower （P＜0.05）. After treatment，5-HT and β-EP levels increased while NSE and BDNF levels decreased in both groups（ P＜0.05），and 5-HT and β-EP levels in the observation group were higher than those in the control group，and NSE and BDNF levels were lower （P＜0.05）. The incidence of adverse reactions was 2.08% （1/48） in the observation group， lower than that of 14.58% （7/48） in the control group （P＜0.05）. Conclusion：Bioholographic auricular point combined with acupuncture significantly improves sleep quality in chronic insomnia by modulating sleep-related neurotransmitters.