Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis

Abstract

Insomnia is a major public health problem considering its high prevalence, impact on daily life, co-morbidity with other disorders and societal costs. Cognitive behavioral treatment for insomnia (CBTI) is currently considered to be the preferred treatment. However, no meta-analysis exists of all studies using at least one component of CBTI for insomnia, which also uses modern techniques to pool data and to analyze subgroups of patients. We included 87 randomized controlled trials, comparing 118 treatments (3724 patients) to non-treated controls (2579 patients). Overall, the interventions had significant effects on: insomnia severity index (g = 0.98), sleep efficiency (g = 0.71), Pittsburgh sleep quality index (g = 0.65), wake after sleep onset (g = 0.63) and sleep onset latency (SOL; g = 0.57), number of awakenings (g = 0.29) and sleep quality (g = 0.40). The smallest effect was on total sleep time (g = 0.16). Face-to-face treatments of at least four sessions seem to be more effective than self-help interventions or face-to-face interventions with fewer sessions. Otherwise the results seem to be quite robust (similar for patients with or without comorbid disease, younger or older patients, using or not using sleep medication). We conclude that CBTI, either its components or the full package, is effective in the treatment of insomnia.

EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis

“…Outside the field of rheumatic diseases, meta-analyses support the effectiveness of behavioural, including self-help, interventions on sleep outcomes 41 42. Face-to-face treatments of at least four sessions seem to be more effective than self-help interventions 43. In meta-analyses, small but significant effects of sleep interventions on pain have been observed in people with varied chronic medical conditions 44 45…”

Sleep Disorders Among People With Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study

“…57 CBTi is the recommended preferred treatment for insomnia; 58 a meta-analysis of 87 randomized controlled trials found CBTi to be useful in patients with and without comorbid disease. 59 Specifically in CM, a small pilot study, not included in the meta-analysis, showed that in women, behavioral sleep modification resulted in reduced headache frequency and reversion to EM. 60 Similarly, in individuals with CM, behavioral treatment of comorbid insomnia yielded reductions in headache frequency.…”

The SENSE Study: Treatment Mechanisms of a Cognitive Behavioral and Mindfulness-Based Group Sleep Improvement Intervention for At-Risk Adolescents

“…Cognitive behavioral therapy for insomnia (CBT-I) is recommended as a first-line treatment for adult insomnia 23 , based on evidence from multiple systematic reviews and meta-analyses that the intervention improves sleep and mental health in adults, with small to medium effect sizes. [24][25][26][27] However, only nine trials have evaluated the efficacy of cognitive behavioral sleep interventions among adolescents. Two were randomized controlled trials (RCTs) 28,29 , one was a prospective RCT 30 , and six were uncontrolled feasibility trials.…”

“…As with adults, improvements tended to be stronger for wakefulness in bed variables compared to sleep duration variables and self-reported sleep variables compared to objective sleep variables. [24][25][26] However, the trials were limited in several ways, including small sample sizes [31][32][33][34][35][36] , lack of control groups [31][32][33][34][35][36] , wait-list control groups 28,29 , high attrition rates 29,32 , lack of follow-ups 31,34 , short follow-ups 28,35,36 , and/or reliance of self-reported measures of sleep. 29,33,34 The SENSE study is an RCT investigating whether a 7-week, cognitive behavioral, and mindfulness-based group sleep intervention can prevent the emergence of major depressive disorder (MDD) at 2-year follow-up among a group of adolescents (aged 12-17 years) who were experiencing elevated levels of sleep problems and anxiety symptoms.…”