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Cited by 3Sleep and related disordersObstructive Sleep Apnea ResearchMindfulness and Compassion Interventions

Comparison of diaphragmatic breathing relaxation training and cognitive-behavioral therapy on sleep quality in the elderly: a randomized clinical trial

Kakuei, AliAkbar, Ravari, Ali, Mirzaei, Tayebeh, Kamiab, Zahra, Bahrami, Roya·2025·Sleep and Breathing
DOI 10.1007/s11325-025-03296-1
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Abstract

Objective To examine the effects of diaphragm breathing relaxation training and cognitive-behavioral therapy on sleep quality in the elderly.Methods In this three-arm randomized clinical trial, 99 older patients with a primary diagnosis of insomnia were randomly divided into two intervention groups (n = 33) and a control group (n = 33). The study design was a parallel group trial with an allocation ratio of 1:1. The CBT-I intervention was done in a group format for four weeks, consisting of two 60-min sessions per week. The diaphragmatic breathing intervention was trained in a group setting session and practiced individually for 30 min every night before sleep. The control group received no information about sleep or relaxation. Participants completed the Pittsburgh Sleep Quality Questionnaire before, four weeks, and eight weeks after the intervention.Results A total of 99 patients were randomized to the CBT-I intervention (n = 33), diaphragmatic breathing intervention (n = 33), or control arm (n = 33), with 74 patients providing final analysis data. Repeated measures ANOVA revealed a significant decrease in sleep quality score (p < 0.001) from pre-test to post-test and one-month follow-ups. The greatest effect of both interventions in reducing the sleep quality score was during the first period of the study (four weeks after the intervention), and there was no significant reduction eight weeks after the intervention.Conclusion Diaphragmatic breathing and CBT-I interventions improved sleep quality indicators among older adults.

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Crossref · 10.1007/s11325-025-03296-1

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  • Relaxation training in CBT-I includes progressive muscle relaxation, diaphragmatic breathing, and guided imagery, all of which reduce physical tension and anxiety that interfere with sleep onset.

    “Relaxation training in CBT-I includes methods such as progressive muscle relaxation, diaphragmatic breathing, and guided imagery, all of which reduce physical tension and anxiety that interfere with sleep onset [65].”

    From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [65]

  • Complementary relaxation techniques (diaphragmatic breathing, progressive muscle relaxation, guided imagery) reduce somatic tension and pre-sleep arousal in individuals with GAD.

    “Complementary relaxation techniques, such as diaphragmatic breathing, progressive muscle relaxation, and guided imagery, further reduce somatic tension and pre-sleep arousal in individuals with GAD [65].”

    From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [65]

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Authors
Kakuei, A., Ravari, A., Mirzaei, T., Kamiab, Z., & Bahrami, R.
Affiliations
Rafsanjan University of Medical Sciences (IR)
Corresponding author
Ravari, Ali
ORCID
Venue
Sleep and Breathing
Publisher
Springer Science and Business Media LLC
Published
2025-03-14
Volume
29
Issue
2
Pages
131-131
ISSN
  • 1520-9512 (ISSN-L)
  • 1522-1709
DOI
10.1007/s11325-025-03296-1
OpenAlex
W4408453051
Cited by
3
References
24
Citations by year
2026: 3
FWCI
3.12
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Sleep And Breathing (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords
diaphragmatic breathing, cognitive behavioral therapy for insomnia, sleep quality, insomnia, older adults, relaxation training, group intervention, Pittsburgh Sleep Quality Index
MeSH terms
Sleep Quality, Aged, Aged, 80 and over, Breathing Exercises, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Relaxation Therapy, Cognitive Behavioral Therapy

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