Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment

Abstract

Introduction:The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations. Methods: The American Academy of Sleep Medicine commissioned a task force of 9 experts in sleep medicine and sleep psychology. A systematic review was conducted to identify randomized controlled trials that addressed behavioral and psychological interventions for the treatment of chronic insomnia disorder in adults. Statistical analyses were performed to determine if the treatments produced clinically significant improvements in a range of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation process was used to evaluate the evidence for making specific treatment recommendations. Results: The literature search identified 1,244 studies; 124 studies met the inclusion criteria, and 89 studies provided data suitable for statistical analyses. Evidence for the following interventions is presented in this review: cognitive-behavioral therapy for insomnia, brief therapies for insomnia, stimulus control, sleep restriction therapy, relaxation training, sleep hygiene, biofeedback, paradoxical intention, intensive sleep retraining, and mindfulness. This review provides a detailed summary of the evidence along with the quality of evidence, the balance of benefits vs harms, patient values and preferences, and resource use considerations.

Sleep Well and Recover Faster with Less Pain—A Narrative Review on Sleep in the Perioperative Period

“…Non-pharmacological management of sleep is the first-line treatment for sleep problems, but not all methods may be feasible within the time available [ 96 ]. The basic rules of sleep hygiene should be gone through in the preoperative visit with the patient.…”

“…In the preoperative evaluation, patients should be advised to maintain the regular circadian sleep–wake rhythm while at the hospital, if possible, and after discharge at home. Non-pharmacological techniques that are likely to improve sleep in both pre- and postoperative settings and which only need short practice include, for example, relaxation techniques, breathing exercises, and listening to music [ 96 , 97 , 98 , 99 ]. The availability of these techniques has significantly increased with the availability of internet-based programs.…”

Sleep-Related Cognitive Processes and the Incidence of Insomnia Over Time: Does Anxiety and Depression Impact the Relationship?

“…Though this has to date only been demonstrated in patients with persistent insomnia, pilot studies have shown that cognitive therapy for insomnia has been associated with a reduction of worry, unhelpful beliefs, somatic arousal, selective attention and monitoring, and safety behaviors after treatment (Harvey et al, 2007 , 2014 ; Sunnhed et al, 2020 ). Regarding pre-sleep arousal, which predicted insomnia, relaxation techniques have been associated with beneficial effects on a number of clinical issues, including insomnia, depression, and anxiety (Jorm et al, 2008 ; Kim and Kim, 2018 ; Edinger et al, 2021 ). Whether patients with anxiety and depression might benefit from relaxation as a prevention intervention regarding insomnia, as a way of killing three birds with one stone, is an unanswered question.…”

Advances in the Treatment of Chronic Insomnia: A Narrative Review of New Nonpharmacologic and Pharmacologic Therapies

“… 9 This is likely due in part by the numerous meta-analyses demonstrating robust clinical improvements across numerous sleep-related outcomes using individual, group, internet-based, and self-help CBT-I. 68 …”