The efficacy of intensive sleep retraining for insomnia: A systematic review and research agenda

Abstract

SummaryIntensive sleep retraining (ISR) is a brief behavioural treatment for sleep onset insomnia, administered in just a single overnight treatment session. This systematic review evaluates existing trials about the efficacy of intensive sleep retraining for treating insomnia, to inform whether there is enough evidence to recommend its use for clinical practice. A systematic literature search was conducted across three databases, yielding 108 results. Of these studies, three were deemed suitable for inclusion in this review. The included studies consistently reported significant reductions in insomnia symptoms following intensive sleep retraining, particularly decreases in sleep diary‐derived sleep latency and increases in total sleep time. Based on these inconclusive but promising findings, a research agenda is proffered to test intensive sleep retraining as a treatment for insomnia. Large randomised controlled trials are needed to elucidate the potential benefits of intensive sleep retraining for different populations with insomnia, as are mechanistic trials to test which components underlie its seemingly therapeutic effects. Since more practical modalities of intensive sleep retraining administration have been developed, such trials are more feasible to conduct now than ever before.

Assessment and management of sleep disorders in shift workers: Challenges and considerations for general practice

“…38 This might be, in part, a consequence of the challenges shift work schedules pose for complying with behavioural aspects of CBT-i, and it is presently unclear whether techniques such as intensive sleep retraining for insomnia are appropriate for shift workers. 39 Bedtime restriction is a mainstay of CBT-i and might be challenging for shift workers to implement in the context of rosters, particularly because recent prior sleep history is important for waking function, and might be used by organisations in formal fatigue risk management systems. Some aspects of stimulus control therapy in CBT-i, particularly related to only being in bed when sleepy, might be more appropriate for shift workers than, for example, setting regular morning rise times (potentially impossible for rotating rosters).…”

The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023

“…Intensive sleep retraining is a newer form of behavioural treatment, requiring PSG monitoring. Scott et al (2023) summarise promising evidence for this new type of training; however, at present data are still too scarce to provide a recommendation.…”