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Cited by 89Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesObstructive Sleep Apnea Research

Non-Pharmacological Treatment of Insomnia

Open access
Siebern, Allison T., Suh, Sooyeon, Nowakowski, Sara·2012·Neurotherapeutics
DOI 10.1007/s13311-012-0142-9PMC PMC3480569
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Abstract

Insomnia is one of the most common sleep disorders, which is characterized by nocturnal symptoms of difficulties initiating and/or maintaining sleep, and by daytime symptoms that impair occupational, social, or other areas of functioning. Insomnia disorder can exist alone or in conjunction with comorbid medical and/or psychiatric conditions. The incidence of insomnia is higher in women and can increase during certain junctures of a woman's life (e.g., pregnancy, postpartum, and menopause). This article will focus on an overview of cognitive behavioral therapy for insomnia, evidence of effectiveness for this treatment when insomnia disorder is experienced alone or in parallel with a comorbidity, and a review with promising data on the use of cognitive behavioral therapy for insomnia when present during postpartum and menopause.

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Crossref · 10.1007/s13311-012-0142-9

Cites

128 of 128 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 85 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    General psychotherapy is not an effective intervention for insomnia.

    “It is important to note that general psychotherapy is not an effective intervention for insomnia [15].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] Kopta, 1994, Patterns of symptomatic recovery in psychotherapy, J Consult Clin Psychol source

      Not checked in the free run.

  • Interpretationcitation

    Research demonstrates that in those with insomnia disorder and presence of a comorbid medical or psychiatric condition, CBTI is effective.

    “Nevertheless, research demonstrates that in those with insomnia disorder and presence of a comorbid medical or psychiatric condition, CBTI is effective.”
    Quote in the paperSubstantial claim
  • Premisecitation

    There is insufficient evidence for sleep hygiene to be an option for single therapy.

    “Although there is insufficient evidence for sleep hygiene to be an option for single therapy, it is usually provided in conjunction with other modalities [18,28].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [18] Morgenthaler, 2006, Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report, Sleep source

      Not checked in the free run.

    • cites [28] Stepanski, 2003, Use of sleep hygiene in the treatment of insomnia, Sleep Med Rev source

      Not checked in the free run.

  • Premisecitation

    Poor and insufficient sleep during pregnancy are associated with increased circulating levels of inflammatory markers involved in poor health and adverse pregnancy outcomes, including intrauterine growth restriction and preterm delivery.

    “Poor and insufficient sleep during pregnancy are also associated with increased circulating levels of inflammatory markers involved in poor health [57][58][59][60][61] and adverse pregnancy outcomes, including intrauterine growth restriction and preterm delivery [62][63][64][65][66][67][68].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [57][58][59][60][61]

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    • cites [62][63][64][65][66][67][68]

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  • Premisecitation

    Relaxation is especially effective in helping with sleep initiation.

    “Research suggests that relaxation is especially effective in helping with sleep initiation [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Morin, 1994, Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy, Am J Psychiatry source

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  • May combine two claims. 28
  • Classified as probably not a substantial claim. 13

  • May combine two claims.

    Findingcitation

    In a preliminary study of peri-or postmenopausal women receiving group CBTI, there was a significant reduction from pre-to post-CBTI in Insomnia Severity Index and Beck Depression Inventory, with no significant main effect for group or interaction between time and group.

    “Repeated measures of analysis of variance revealed a significant reduction from pre-to post-CBTI in Insomnia Severity Index (from 20.2±4.4 to 10.3±4.2;p<0.001) and Beck Depression Inventory (from 11.6±7.8 to 6.6±5.4;p<0.001), with no significant main effect for group or interaction between time and group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [131] Nowakowski, 2012, Examination of cognitive behavioral therapy for insomnia in perimenopausal women, Sleep

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  • May combine two claims.

    Premisecitation

    CBTI is a short-term treatment that includes 4 to 8 sessions on average and adopts a multi-component approach, typically including sleep restriction, stimulus control, cognitive therapy, sleep hygiene, and relaxation training.

    “CBTI is a short-term treatment that includes 4 to 8 sessions on average and adopts a multi-component approach, which typically includes sleep restriction, stimulus control, cognitive therapy, sleep hygiene, and relaxation training [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Smith MT, Nowakowski S, Perlis ML. Primary insomnia: diagnostic issues, treatment, and future directions. In: Perlis, M & Lichstein, K, eds. Treating Sleep Disorders: Principles and Practice of Behavioral Sleep Medicine. Hoboken: John Wiley & Sons, Inc., 2003:214-261.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The American Academy of Sleep Medicine recommends that stimulus therapy, relaxation training, and cognitive behavioral therapy are individually effective therapies in the treatment of insomnia as a standard.

    “The American Academy of Sleep Medicine currently recommends that stimulus therapy, relaxation training, and cognitive behavioral therapy are individually effective therapies in the treatment of insomnia as a standard [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Morgenthaler, 2006, Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report, Sleep source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Randomized controlled trials comparing CBTI with hypnotic medications reveal comparable efficacy immediately after treatment, but longer lasting effects at follow-up compared to medication.

    “Randomized control trials comparing CBTI with hypnotic medications reveal comparable efficacy immediately after treatment, but longer lasting effects at follow-up were compared to medication [33][34][35].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33][34][35]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prevalence estimates of insomnia experienced in the presence of a comorbid psychiatric condition is approximately 28%.

    “Prevalence estimates of insomnia experienced in the presence of a comorbid psychiatric condition is approximately 28 % [39].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Ohayon, 2003, Place of chronic insomnia in the course of depressive and anxiety disorders, J Psychiatr Res source

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  • May combine two claims.

    Interpretationreasoning

    Insomnia may have a reciprocal feedback on the comorbid condition, suggesting a more complex relationship than cause and effect, possibly a shared pathway of development, although the etiology of insomnia remains under investigation.

    “This is suggestive of insomnia having a reciprocal feedback on the comorbid condition that speaks to a more complex relationship than cause (medical/psychiatric condition) and effect (insomnia), but rather a possible shared pathway of development, although the etiology of insomnia remains under investigation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The prevalence of a probable diagnosis of perinatal insomnia ranges from 41 to 58% of perinatal women.

    “The prevalence of a probable diagnosis of perinatal insomnia range from 41 to 58 % of perinatal women [54,71,72].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [54] Mindell, 2000, Sleep disturbances during pregnancy, J Obstet Gynecol Neonatal Nurs source

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    • cites [71] Dorheim, 2009, Sleep and depression in postpartum women: a population-based study, Sleep source

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    • cites [72] Swanson, 2011, Relationships among depression, anxiety, and insomnia symptoms in perinatal women seeking mental health treatment, J Womens Health (Larchmt) source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ohayon examined patients with chronic pain conditions and found 3 times more frequency of insomnia symptoms and more reported daytime impairments due to sleep issues in those with chronic pain in comparison to those with just reported insomnia symptoms.

    “Ohayon [44] examined patients with chronic pain conditions and found 3 times more frequency of insomnia symptoms and more reported daytime impairments due to sleep issues in those with chronic pain in comparison to those with just reported insomnia symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Ohayon, 2005, Relationship between chronic painful physical condition and insomnia, J Psychiatr Res source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In another randomized controlled trial, sleep latency percentage change based on sleep diary revealed pre-to post-treatment effect sizes for CBTI (d=1.17), combined CBTI and medication (d=1.08), and medication (d=0.51); at follow-up, increased sleep latency was seen in the medication and combined groups compared with CBTI only.

    “Sleep latency percentage change based on sleep diary revealed pre-to post-treatment effect sizes for the CBTI group (Cohen's d01.17), combined CBTI and medication group (d 01.08), and medication group (d00.51).At follow-up, increased sleep latency was seen in the medication group and the combined CBTI and medication group, as compared with the CBTI only group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Jacobs, 2004, Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison, Arch Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    For the average participant, the benefit was reduction in main insomnia symptom and a total sleep time increase of approximately 30 minutes, along with significant improvement in perceived sleep quality and satisfaction with sleep.

    “For the average participant, the benefit was reduction in main insomnia symptom (i.e., time to get to sleep or time awake in the middle of the night) and a total sleep time increase of approximately 30 minutes, along with significant improvement in the patient's perceived sleep quality and satisfaction with sleep [31].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Morin, 1999, Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review, Sleep source

      Not checked in the free run.

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    Premisecitation

    Longitudinal studies suggest that insomnia increases the risk of developing a psychiatric condition, and that treatment of the psychiatric condition does not necessarily resolve disturbed sleep.

    “Longitudinal studies suggest that insomnia increases the risk of developing a psychiatric condition [6,40,41]; these studies also suggest that the treatment of the psychiatric condition does not necessarily resolve disturbed sleep [42,43].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [6] Ford, 1989, Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?, JAMA source

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    • cites [40] Breslau, 1996, Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults, Biol Psychiatry source

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    • cites [41] Schramm, 1995, Mental comorbidity of chronic insomnia in general practice attenders using DSM-III-R, Acta Psychiatr Scand source

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    • cites [42] Nierenberg, 1999, Residual symptoms in depressed patients who respond acutely to fluoxetine, J Clin Psychiatry source

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    • cites [43] Manber, 2003, The effects of psychotherapy, nefazodone, and their combination on subjective assessment of disturbed sleep in chronic depression, Sleep source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A meta-analysis of 23 studies by Irwin et al. found significant effect sizes for behavioral treatment for sleep latency (-0.52 adult vs -0.051 older adult), improvement in wakefulness after sleep onset (-0.57 adult vs -0.73 older adult), and sleep quality (0.89 adult vs 0.60 older adult).

    “Consistent with previous findings [29,37,38], significant effect sizes were found for the behavioral treatment for sleep latency (-0.52 adult group vs -0.051 older adult group), improvement in wakefulness after sleep onset (-0.57adult group vs -0.73 older adult group), and sleep quality (0.89 adult group vs 0.60 older adult group).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Irwin, 2006, Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age, Health Psychol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Lichstein et al. found that those with medical or psychiatric comorbidities responding to CBTI produced significant post-treatment gains: reduction in sleep latency by 35%, reduction in frequency of awakenings by 14%, a 30% reduction in time awake after sleep onset, and a 14% increase in total sleep duration.

    “These findings are consistent with a previous study that revealed those with medical or psychiatric comorbidities responding to CBTI by Lichstein et al. [48], which produced significant post-treatment gains as follows: reduction in sleep latency by 35 %, reduction in frequency of awakenings by 14 %, a 30 % reduction in the amount of time awake after sleep onset, and a 14 % increase in total sleep”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] Lichstein, 2000, Psychological treatment of secondary insomnia, Psychol Aging source

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  • Classified as probably not a substantial claim.

    Premisereasoning

    The National Institutes of Health consensus and the American Academy of Sleep Medicine Practice parameters recommend that CBTI be considered standard treatment for insomnia based on strong empirical support of effectiveness.

    “The National Institutes of Health consensus and the American Academy of Sleep Medicine Practice parameters recommend that CBTI be considered standard treatment for insomnia based on strong empirical support of effectiveness.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The Morawetz study highlights the complex relationship between depression and insomnia and challenges the previously held assumption that treating depression will resolve insomnia.

    “This study highlights the complex relationship between depression and insomnia, and challenges the previously held assumption that treating depression will resolve insomnia.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Complaints of sleep disturbance are common during pregnancy, generally commencing with the onset of pregnancy, and increasing in frequency and duration as the pregnancy progresses due to pregnancy-related anatomic, physiologic, and hormonal changes.

    “Complaints of sleep disturbance are common during pregnancy, generally commencing with the onset of pregnancy, and increasing in frequency and duration as the pregnancy progresses due to pregnancy-related anatomic, physiologic, and hormonal changes [54][55][56].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54][55][56]

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  • May combine two claims.

    Premisecitation

    The 23 studies' treatment components revealed robust effect sizes: sleep latency (-0.38 for CBT vs -0.60 for relaxation, 0.59 for BT only), wakefulness after sleep onset (-0.75 for CBT, -0.35 for relaxation, and -0.82 for BT), and sleep quality (0.53 for relaxation, 0.91 for BT only).

    “The treatment components revealed robust effect sizes: sleep latency (-0.38 for CBT vs -.0.60 for relaxation, 0.59 for BT only), wakefulness after sleep onset (-0.75 for CBT, -0.35 for relaxation, and -0.82 for BT), and sleep quality (0.53 for relaxation, 0.91 for BT only).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Irwin, 2006, Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age, Health Psychol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The 2006 review revealed sleep improvements sustained in time in primary insomnia and in the presence of medical/psychiatric comorbidities, and 9 treatment studies in older adults indicated facilitation of discontinuation of hypnotic medication after chronic use.

    “In addition to revealing sleep improvements sustained in time in primary insomnia and in the presence of medical/psychiatric comorbidities, 9 treatment studies in older adults also indicated facilitation of discontinuation of hypnotic medication after chronic use [32].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Morin, 2006, Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004), Sleep source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Stimulus control and sleep restriction are considered first-line interventions, and sleep hygiene, cognitive therapy, and relaxation training are considered adjunctive interventions.

    “Stimulus control and sleep restriction have been considered first-line interventions and sleep hygiene, cognitive therapy, and relaxation training have been considered adjunctive interventions [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Smith MT, Nowakowski S, Perlis ML. Primary insomnia: diagnostic issues, treatment, and future directions. In: Perlis, M & Lichstein, K, eds. Treating Sleep Disorders: Principles and Practice of Behavioral Sleep Medicine. Hoboken: John Wiley & Sons, Inc., 2003:214-261.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Morawetz found that more than 80% of those with and without depression significantly improved post-treatment, and those with depression also experienced improvement in depressive symptoms as measured by the Beck Depression Inventory, despite no specific depression treatment.

    “A study by Morawetz [50] found that more than 80 % of those with and without depression significantly improved post-treatment, and interestingly those with depression also experienced improvement in their depressive symptoms as measured by the Beck Depression Inventory, despite no specific depression treatment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] Morawetz, 2003, Insomnia and depression: which comes first?, Sleep Res Online

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The meta-analysis reveals moderate-to-large effect sizes for treatment modalities, and for both adult and older age groups in subjective sleep outcomes of latency to sleep, wakefulness after sleep onset and sleep quality.

    “The meta-analysis reveals moderate-to-large effect sizes for treatment modalities, and for both adult and older age groups in subjective sleep outcomes of latency to sleep, wakefulness after sleep onset and sleep quality.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Irwin, 2006, Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age, Health Psychol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Longitudinal studies have documented that the first 6 months postpartum are associated with a substantial increase in time awake after sleep onset and a decrease in sleep efficiency compared to the last trimester of pregnancy.

    “Longitudinal studies have documented that the first 6 months postpartum are associated with a substantial increase in time awake after sleep onset and a decrease in sleep efficiency compared to the last trimester of pregnancy [54,[73][74][75].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54,[73][74][75]

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  • May combine two claims.

    Premisecitation

    Of those who were depressed and had significant improvement in sleep post-treatment, 57% were no longer depressed and 13% had a 40% reduction in depressive symptoms, compared to depressed participants without significant sleep improvement, none of whom had elimination or significant reduction in depression at post-treatment.

    “Of those who were depressed and had significant improvement in sleep post-treatment, 57 % were no longer depressed and 13 % of participants had a 40 % reduction in depressive symptoms post-treatment compared to those who were depressed and did not have a significant improvement in sleep, none of these participants had elimination or significant reduction in depression at post-treatment [50].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [50] Morawetz, 2003, Insomnia and depression: which comes first?, Sleep Res Online

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Insomnia rates range from 16 to 33% for those with comorbid medical conditions, such as diabetes mellitus, heart disease, and chronic back pain, and the rates range as high as 88% for those with insomnia symptoms and chronic pain.

    “Insomnia rates range from 16 to 33 % for those with comorbid medical conditions, such as diabetes mellitus, heart disease, and chronic back pain [14,45], and the rates range as high as 88 % for those with insomnia symptoms and chronic pain [46].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [14] Sridhar, 1994, Prevalence of sleep disturbances in diabetes mellitus, Diabetes Res Clin Pract source

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    • cites [45] Katz, 1998, Clinical correlates of insomnia in patients with chronic illness, Arch Intern Med source

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    • cites [46] Smith, 2000, Sleep quality and presleep arousal in chronic pain, J Behav Med source

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  • May combine two claims.

    Premisecitation

    Stimulus control has received the most empirical support and is identified as an effective and recommended therapy in the treatment of insomnia.

    “Although there is no particular order that has been specified in which these modalities are delivered, stimulus control has received the most empirical support and is identified as an “effective and recommended therapy in the treatment of insomnia” [17,18].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [17] Chesson, 1999, Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine, Sleep source

      Not checked in the free run.

    • cites [18] Morgenthaler, 2006, Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report, Sleep source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Self-reported nocturnal flashes correlate with subjective poor sleep quality, but the association is less clear when objective sleep measures are used.

    “Although self-reported nocturnal flashes correlate with subjective poor sleep quality, such association is less clear when objective sleep measures are used [96,105,106].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [96] Young, 2003, Objective and subjective sleep quality in premenopausal, perimenopausal, and postmenopausal women in the Wisconsin Sleep Cohort Study, Sleep source

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    • cites [105] Shaver, 1988, Sleep patterns and stability in perimenopausal women, Sleep source

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    • cites [106] Ensrud, 2009, Frequency and severity of hot flashes and sleep disturbance in postmenopausal women with hot flashes, Menopause source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Hot flashes occur in 60 to 80 % of women during the menopausal transition and persist for 4 to 5 years on average.

    “it is generally believed that hot flashes occur in 60 to 80 % of women during the menopausal transition [102] and persist for 4 to 5 years on average [103,104].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [102] Gold, 2000, Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age, Am J Epidemiol source

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    • cites [103] Politi, 2008, Revisiting the duration of vasomotor symptoms of menopause: a meta-analysis, J Gen Intern Med source

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    • cites [104] Col, 2009, Duration of vasomotor symptoms in middle-aged women: a longitudinal study, Menopause source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The prevalence of insomnia, defined as disturbed sleep associated with distress or impairment, is estimated at 38 to 60 % in peri-and postmenopausal women.

    “The prevalence of insomnia, defined as disturbed sleep associated with distress or impairment, is estimated at 38 to 60 % in peri-and postmenopausal women [92][93][94].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [92][93][94]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Troubled sleep was reported by 54 to 58 % of women between 40 and 60 years of age in the Ohio Midlife Women's study.

    “Troubled sleep was reported by 54 to 58 % of women between 40 and 60 years of age in the Ohio Midlife Women's study [95].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [95] Glazer, 2002, The Ohio Midlife Women's Study, Health Care Women Int source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Difficulty sleeping is reported by 38 % of women between 40 and 55 years of age, with higher levels among late perimenopausal (45.4 %) and surgical post-menopausal (47.6 %) women in the Study of Women's Health Across the Nation (SWAN).

    “The Study of Women's Health Across the Nation (SWAN) has shown that difficulty sleeping is reported by 38 % of women between 40 and 55 years of age, with higher levels among late perimenopausal (45.4 %) and surgical post-menopausal (47.6 %) women [92].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [92] Kravitz, 2003, Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition, Menopause

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The most common menopausal sleep complaint is difficulty falling asleep, but significant increases in self-reported night-time awakenings and daytime drowsiness have also been described, even after controlling for confounding variables such as age and depression.

    “The most common menopausal sleep complaint is difficulty falling asleep, but significant increases in selfreported night-time awakenings and daytime drowsiness have also been described, even after controlling for confounding variables, such as age and depression [92,[95][96][97][98][99][100][101].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [92,[95][96][97][98][99][100][101]

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Sleep disturbance was identified as a core symptom of menopause in the 2005 National Institutes of Health State-of-the-Science Conference panel report on menopause-related symptoms.

    “In the 2005 National Institutes of Health Stateof-the-Science Conference panel report on menopauserelated symptoms, sleep disturbance was identified as a core symptom of menopause [91].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [91] National Institutes of Health, 2005, National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms, Ann Intern Med

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Compared to women who did not receive the sleep intervention, those who underwent CBTI had lower average daily cigarettes smoked and a higher percentage of cigarette-free days.

    “compared to women who did not receive the sleep intervention, those who did undergo CBTI had lower average daily cigarettes smoked and a higher percentage of cigarette-free days [86].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [86] Stone, 2011, Effects of a behavioral sleep intervention on postpartum sleep, Sleep

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Two recent pilot studies provide evidence for the efficacy of CBTI during the postpartum period and both demonstrate that the benefits of CBTI extend beyond improvement in sleep to other domains.

    “Two recent pilot studies provide evidence for the efficacy of CBTI during the postpartum period and both demonstrate that the benefits of CBTI extend beyond improvement in sleep to other domains.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Sleep disturbance during the postpartum period and its effects on maternal role functioning and mother-infant interactions are not well understood.
    • Rests on an assumption: Interventions to improve maternal sleep and fatigue in the postpartum are limited.

  • Classified as probably not a substantial claim.

    Premisereasoning

    The National Institutes of Health Consensus and the American Academy of Sleep Medicine parameters recommend CBTI as a standard treatment for insomnia.

    “Strong empirical support has led the National Institutes of Health Consensus and the American Academy of Sleep Medicine parameters to recommend CBTI as a standard treatment for insomnia.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    CBTI is an effective non-pharmacological treatment for primary insomnia and insomnia comorbid with a medical and/or psychiatric condition.

    “CBTI is an effective non-pharmacological treatment for primary insomnia and insomnia comorbid with a medical and/or psychiatric condition.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Long-term use of zolpidem and eszopiclone is associated with concerns of tolerance, abuse, dependence, and rebound insomnia after discontinuation.
36 of 36

  • The paper relies on this without support.

    No randomized controlled trials have tested CBTI during pregnancy.

    “However, to our knowledge, no randomized controlled trials have tested CBTI during pregnancy.”

  • The paper relies on this without support.

    Sleep disturbance during the postpartum period and its effects on maternal role functioning and mother-infant interactions are not well understood.

    “Sleep disturbance during the postpartum period and its effects on maternal role functioning and mother-infant interactions are not well understood.”

  • The paper relies on this without support.

    Interventions to improve maternal sleep and fatigue in the postpartum are limited.

    “Interventions to improve maternal sleep and fatigue in the postpartum are limited, perhaps because of the universal nature of the experience and the belief that disturbed sleep is an unavoidable part of motherhood.”

  • The paper relies on this without support.

    Insomnia disorder tends to occur more frequently in women, particularly during times of hormonal fluctuation.

    “Although insomnia disorder is widespread in the general population, it tends to occur more frequently in women, particularly during times of hormonal fluctuation (with the onset of menses, during pregnancy, postpartum period, and with peri-and post-menopause).”

  • The paper relies on this without support.

    Women experience greater subjective complaints of insufficient or nonrestorative sleep, as well as increased need for sleep compared to men.

    “Research has shown that women experience greater subjective complaints of insufficient or nonrestorative sleep, as well as increased need for sleep compared to men.”

  • The paper relies on this without support.

    Female reproductive hormones, specifically estrogen and progesterone, influence sleep and circadian rhythms through their secondary actions in the central nervous system.

    “Female reproductive hormones, specifically estrogen and progesterone, not only regulate reproductive tissue function during the menstrual cycle, but also, through their secondary actions in the central nervous system, influence sleep and circadian rhythms.”

  • The paper relies on this without support.

    Insomnia can occur during menopause independent of nocturnal flashes.

    “Indeed, insomnia can occur during menopause independent of nocturnal flashes.”

  • The paper relies on this without support.

    Long-term use of zolpidem and eszopiclone is associated with concerns of tolerance, abuse, dependence, and rebound insomnia after discontinuation.

    “long-term use is associated with concerns of tolerance, abuse, dependence, and rebound insomnia after discontinuation.”

  • The paper relies on this without support.

    When hot flashes occur during the night, they frequently awaken women from sleep, although not every nocturnal flash is associated with an awakening.

    “When hot flashes occur during the night, they frequently awaken women from sleep, although not every nocturnal flash is associated with an awakening.”

  • The paper relies on this without support.

    Women with nocturnal flashes may also experience awakenings that are unrelated to a vasomotor event.

    “Women with nocturnal flashes may also experience awakenings that are unrelated to a vasomotor event.”
10 of 10

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The use of psychological and behavioral therapies such as cognitive behavioral therapy or combined treatment with drug intervention to treat chronic insomnia has been strongly advocated in medical practice.

    “The use of psychological and behavioral therapies such as cognitive behavioral therapy or combined treatment with drug intervention to treat chronic insomnia has been strongly advocated in medical practice.1,47”

    From Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population (2018) · cites this paper as [47]

    The “Cognitive Behavioral Therapy for Insomnia: Evidence of Effectiveness” section (page unavailable) says NIH and sleep-medicine practice parameters recommend CBTI as a standard treatment. It discusses trials of CBTI combined with medication, but does not say combined treatment is strongly advocated; it reports that CBTI alone maintained improvements better at follow-up. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Older adults' sleep-latency effect conflicts with the summary

    Minor

    The reported sleep-latency effect size for older adults is −0.051, which is not moderate to large. The later summary describes the effects for both age groups, including sleep latency, as moderate to large.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 6

  1. Smith MT, Nowakowski S, Perlis ML. Primary insomnia: diagnostic issues, treatment, and future directions. In: Perlis, M & Lichstein, K, eds. Treating Sleep Disorders: Principles and Practice of Behavioral Sleep Medicine. Hoboken: John Wiley & Sons, Inc., 2003:214-261.
  2. Chang, 2011, Sleep duration during pregnancy and maternal and fetal outcomes: a pilot study using actigraphy, Sleep, 34, A317
  3. Doering, 2011, Sleep quality and depression symptoms in disadvantaged postpartum women, Sleep, 34, A319
  4. Stone, 2011, Effects of a behavioral sleep intervention on postpartum sleep, Sleep, 34, A320
  5. National Institutes of Health, 2005, National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms, Ann Intern Med, 142, 1003
  6. Nowakowski, 2012, Examination of cognitive behavioral therapy for insomnia in perimenopausal women, Sleep, 35, A243

Cited by

Sorted by citations

Related

Authors
Siebern, A. T., Suh, S., & Nowakowski, S.
Affiliations
Stanford Medicine (US)
Corresponding author
Siebern, Allison T.
ORCID
Venue
Neurotherapeutics
Publisher
Elsevier BV
Published
2012-10
Volume
9
Issue
4
Pages
717-727
ISSN
1878-7479 (ISSN-L)
DOI
10.1007/s13311-012-0142-9
PMC
PMC3480569
OpenAlex
W2018420318
Cited by
88
References
126
Citations by year
2026: 5 · 2025: 10 · 2024: 6 · 2023: 6 · 2022: 6 · 2021: 8 · 2020: 11 · 2019: 5 · 2018: 10 · 2017: 2 · 2016: 5 · 2015: 2 · 2014: 6 · 2013: 5 · 2012: 1
FWCI
0.66
Type
journal article
Language
en
Open access
Licence
Locations
  • Neurotherapeutics (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Nursing Research (K23NR014008)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Keywords
insomnia, cognitive behavioral therapy for insomnia, non-pharmacological treatment, sleep disorders, comorbidities, menopause, pregnancy, women's sleep
MeSH terms
Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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