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Cited by 1,094Sleep and related disordersMindfulness and Compassion InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials

Open access
Scott, Alexander J., Webb, Thomas L., Martyn-St James, Marrissa, Rowse, Georgina, Weich, Scott·2021·Sleep Medicine Reviews
DOI 10.1016/j.smrv.2021.101556PMC PMC8651630

Published version of a preprint

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Abstract

The extent to which sleep is causally related to mental health is unclear. One way to test the causal link is to evaluate the extent to which interventions that improve sleep quality also improve mental health. We conducted a meta-analysis of randomised controlled trials that reported the effects of an intervention that improved sleep on composite mental health, as well as on seven specific mental health difficulties. 65 trials comprising 72 interventions and N = 8608 participants were included. Improving sleep led to a significant medium-sized effect on composite mental health (g+ = -0.53), depression (g+ = -0.63), anxiety (g+ = -0.51), and rumination (g+ = -0.49), as well as significant small-to-medium sized effects on stress (g+ = -0.42), and finally small significant effects on positive psychosis symptoms (g+ = -0.26). We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health. Our findings suggest that sleep is causally related to the experience of mental health difficulties. Future research might consider how interventions that improve sleep could be incorporated into mental health services, as well as the mechanisms of action that explain how sleep exerts an effect on mental health.

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of randomised controlled trials found that interventions which successfully improved sleep quality produced significant improvements in subsequent mental health, with a medium-sized effect on composite mental health. The findings support a causal role for sleep in mental health difficulties and suggest sleep as a transdiagnostic treatment target.

Key findings

  • Across 65 trials, 72 interventions, and N = 8608 participants, improving sleep led to a significant medium-sized effect on composite mental health (g+ = −0.53, 95% CI −0.68 to −0.38), depression (g+ = −0.63), anxiety (g+ = −0.51), and rumination (g+ = −0.49), plus smaller effects on stress (g+ = −0.42) and positive psychosis symptoms (g+ = −0.26).
  • A dose–response relationship was found: greater improvements in sleep quality were associated with greater improvements in mental health (B = 0.77, 95% CI 0.52 to 1.02, p < 0.001).
  • Studies with a significant effect on sleep quality showed larger mental health effects (g = −0.53) than those without (g = −0.12; Q = 17.59, p < 0.001); effects were larger at shorter follow-up (<6 months, g+ = −0.60) than longer follow-up (≥6 months, g+ = −0.18; Q = 10.75, p < 0.01), and larger for clinician-delivered (g+ = −0.63) than self-administered interventions (g+ = −0.34; Q = 4.50, p < 0.05).
  • Publication bias was indicated by funnel plot asymmetry (Egger’s regression = −1.09, p < 0.05); trim-and-fill adjustment reduced the composite effect to g+ = −0.35, and Orwin’s fail-safe n was 4101.

Methods

  • Systematic review and meta-analysis of RCTs that tested an intervention designed to improve sleep, produced a statistically significant improvement in sleep quality versus control, and measured mental health at a later follow-up; studies were excluded if the intervention specifically targeted mental health or recruited participants under 18 years.
  • Searches covered MEDLINE, Embase, PsycINFO, and The Cochrane Library, plus reference lists and trial registries, originally in May 2019 and updated in February 2021; PRISMA selection yielded 65 studies and 72 comparisons.
  • Random-effects meta-analysis in R used Hedges g, I² for heterogeneity, moderation/subgroup analyses and meta-regression, Cochrane risk-of-bias assessment, and publication-bias checks including funnel plot, Egger’s test, trim-and-fill, and Orwin’s fail-safe n.

Limitations

  • The paper states that relatively few studies examined long-term effects, and longer follow-ups generally showed smaller effects, likely due to diminishing intervention effects on sleep quality over time.
  • The paper states that few primary studies existed for outcomes other than depression and anxiety, limiting inferences for other mental health difficulties, and that most analyses were based on CBT for insomnia; the focus on sleep quality may also have excluded studies of sleep disorders with different improvement definitions.
  • Evident from the text: most included studies were at high (29, 45%) or unclear (26, 40%) risk of bias, with only 10 (15%) at low risk; main analyses showed substantial heterogeneity (I² = 76–82% for composite, depression, and anxiety), and publication bias was present, with trim-and-fill reducing the composite effect.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.smrv.2021.101556

Cites

187 of 187 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 36 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Improving sleep led to a significant medium-sized effect on composite mental health (g+ = −0.53).

    “Improving sleep led to a significant medium-sized effect on composite mental health (g+ = −0.53), depression (g+ = −0.63), anxiety (g+ = −0.51), and rumination (g+ = −0.49), as well as significant small-to-medium sized effects on stress (g+ = −0.42), and finally small significant effects on positive psychosis symptoms (g+ = −0.26).”
    Quote in the paperSubstantial claim
  • Findingown data

    The meta-analysis included 65 trials comprising 72 interventions and N = 8608 participants.

    “65 trials comprising 72 interventions and N = 8608 participants were included.”
    • Also stated in: § Study characteristics · plain
      “The 65 studies provided 72 comparisons between an intervention that successfully improved sleep quality vs. a control group.”
    • Also stated in: § Study characteristics · plain
      “A total of N = 8608 participants took part across the 72 interventions.”
    Quote in the paperNot a substantial claim
  • Findingown data

    After eleven outlying effect sizes were removed, the composite mental health effect was relatively homogeneous (I2 = 20%, Q = 75.24, p = 0.0888).

    “and now relatively homogeneous (I2 = 20%, Q = 75.24, p = 0.0888).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Improving sleep led to a significant medium-sized effect on depression (g+ = −0.63).

    “Improving sleep led to a significant medium-sized effect on composite mental health (g+ = −0.53), depression (g+ = −0.63), anxiety (g+ = −0.51), and rumination (g+ = −0.49), as well as significant small-to-medium sized effects on stress (g+ = −0.42), and finally small significant effects on positive psychosis symptoms (g+ = −0.26).”
    Quote in the paperSubstantial claim
  • Findingown data

    Improving sleep led to a significant medium-sized effect on rumination (g+ = −0.49).

    “Improving sleep led to a significant medium-sized effect on composite mental health (g+ = −0.53), depression (g+ = −0.63), anxiety (g+ = −0.51), and rumination (g+ = −0.49), as well as significant small-to-medium sized effects on stress (g+ = −0.42), and finally small significant effects on positive psychosis symptoms (g+ = −0.26).”
    Quote in the paperSubstantial claim
  • May combine two claims. 18
  • Classified as probably not a substantial claim. 20

  • May combine two claims.

    Findingown data

    Greater improvements in sleep quality led to greater improvements in mental health, indicating a dose-response relationship.

    “We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After eleven outlying effect sizes were removed, the effect of improving sleep on composite mental health outcomes was small-to-medium sized but still statistically significant (g+ = −0.42, 95% CI = −0.49 to −0.34, p < 0.001).

    “After re-running the analysis with eleven outlying effect sizes removed, the effect of improving sleep on composite mental health outcomes was small-to-medium sized but still statistically significant, (g+ = −0.42, 95% CI = −0.49 to −0.34, p < 0.001)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Studies that found significant effects of the intervention on sleep quality reported larger effects on subsequent composite mental health (g = −0.53, 95% CI = −0.68 to −0.38, p < 0.001) than studies that did not find a significant effect on sleep quality (g = −0.12, 95% CI = −0.24 to 0.01, p = 0.0522), a difference that was statistically significant (Q = 17.59, p < 0.001).

    “Studies that found significant effects of the intervention on sleep quality reported larger effects on subsequent composite mental health, (g = −0.53, 95% CI = −0.68 to −0.38, p < 0.001), than studies that did not find a significant effect of the intervention on sleep quality, (g = −0.12, 95% CI = −0.24 to 0.01, p = 0.0522)”
    • Also stated in: § Moderators of the effect of improving sleep quality on composite mental health outcomes · plain
      “a difference that was statistically significant, (Q = 17.59, p < 0.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    There was no difference in the effect of improving sleep quality on mental health between those with clinically defined mental health difficulties and those with non-clinical experiences, or between those recruited from clinical versus community settings, with both groups receiving significant benefits of improved sleep on mental health.

    “we found no difference in the effect of improving sleep quality on mental health between those with clinically defined mental health difficulties and those with non-clinical experiences or between those recruited from clinical vs. community settings, with both groups receiving significant benefits of improved sleep on mental health.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Studies reporting the effect of the intervention at shorter follow-ups reported larger improvements in sleep quality (g = −1.03, 95% CI = −1.27 to −0.78, p < 0.001) than those reporting longer follow-ups (g = −0.44, 95% CI = −0.62 to −0.27, p < 0.001), a difference that was statistically significant (Q = 14.38, p < 0.001).

    “Studies reporting the effect of the intervention at shorter follow-ups reported larger improvements in sleep quality, (g = −1.03, 95% CI = −1.27 to −0.78, p < 0.001), than those reporting longer follow-ups (g = −0.44, 95% CI = −0.62 to −0.27, p < 0.001), a difference that was statistically significant, (Q = 14.38, p < 0.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The stress effect had moderate levels of heterogeneity (I2 = 55%, Q = 11.05, p = 0.05) and no outlying effect sizes.

    “There were moderate levels of heterogeneity (I2 = 55%, Q = 11.05, p = 0.05), but there were no outlying effect sizes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Duval and Tweedie's trim and fill procedure imputed ten studies, resulting in a statistically significant, small-to-medium sized adjusted effect of improving sleep on composite mental health outcomes (g+ = −0.35, 95% CI = −0.55 to −0.16, p < 0.001).

    “Ten studies were imputed resulting in a statistically significant, small-to-medium sized adjusted effect of improving sleep on composite mental health outcomes (g+ = −0.35, 95% CI = −0.55 to −0.16, p < 0.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The effect of improving sleep quality on composite mental health was medium-sized and statistically significant, regardless of the presence of physical and/or mental health comorbidities.

    “The effect of improving sleep quality on composite mental health was medium-sized and statistically significant, regardless of the presence of physical and/or mental health comorbidities.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The suicidal ideation effect had low levels of heterogeneity (I2 = 20%, Q = 1.25, p = 0.263) and no outlying effect sizes.

    “There were low levels of heterogeneity (I2 = 20%, Q = 1.25, p = 0.263) and no outlying effect sizes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Ten studies (15%) were judged as having low risk of bias, 29 studies (45%) as high risk of bias, and 26 studies (40%) as unclear.

    “Ten studies (15%) were judged as having low risk of bias, 29 studies (45%) were judged as high risk of bias, and 26 studies (40%) were judged as unclear.”
    Quote in the paperNot a substantial claim

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

    Findingreasoning

    Most of the analyses are based on CBT interventions for insomnia.

    “most of the analyses are based on CBT interventions for insomnia.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    To date there has been no or limited attempts to investigate variables that influence or moderate the impact of interventions that improve sleep on mental health.

    “Finally, to date there has been no or limited attempts to investigate variables that influence – or moderate – the impact of interventions that improve sleep on mental health.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Poor sleep contributes to the onset, recurrence, and maintenance of mental health difficulties.

    “such that poor sleep contributes to the onset, recurrence, and maintenance of mental health difficulties [[13]∗, [14], [15]∗, [16], [17]].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [[13]∗, [14], [15]∗, [16], [17]]

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    Effects at the first post-intervention time point are limited to the short-term where they are likely to be strongest.

    “2) effects are limited to the short-term where they are likely to be strongest.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    At the first post-intervention time point, there is no temporal lag between the measurement of sleep and measurement of mental health.

    “1) there is no temporal lag between the measurement of sleep and measurement of mental health (a key tenet of causal inference);”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Poor sleep is associated with post-traumatic stress.

    “For example, poor sleep has also been associated with post-traumatic stress [25], eating disorders [26], and psychosis spectrum experiences such as delusions and hallucinations [23,27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Harvey, 2003, Sleep and posttraumatic stress disorder: a review, Clin Psychol Rev source

      Not checked in the free run.

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

    Premisecitation

    The association between sleep and mental health is well documented.

    “The association between sleep and mental health is well documented [9,13,[18], [19], [20], [21], [22], [23]∗].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9,13,[18], [19], [20], [21], [22], [23]∗]

      Not checked in the free run.

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

    Study design and conductcitation

    Risk of bias was assessed using the risk of bias assessment criteria developed by the Cochrane Collaboration.

    “Risk of bias was assessed using the risk of bias assessment criteria developed by the Cochrane Collaboration [60].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] Higgins, 2011, Chapter 8: assessing risk of bias in included studies

      Not checked in the free run.

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

    Study design and conductcitation

    Publication bias was assessed via visual inspection of a funnel plot and Egger's test.

    “Publication bias was assessed via visual inspection of a funnel plot and Egger's test [70].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] Egger, 1997, Bias in meta-analysis detected by a simple, graphical test, BMJ source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Specific sleep disorders, such as sleep apnoea, circadian rhythm disruption, restless leg syndrome, excessive daytime sleepiness and narcolepsy, sleepwalking, and nightmares, are all more prevalent in those experiencing mental health difficulties.

    “Studies have also found that specific sleep disorders, such as sleep apnoea [28], circadian rhythm disruption [29], restless leg syndrome [30], excessive daytime sleepiness and narcolepsy [31,32], sleepwalking [33], and nightmares [34] are all more prevalent in those experiencing mental health difficulties.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [28] Sharafkhaneh, 2005, Association of psychiatric disorders and sleep apnea in a large cohort, Sleep source

      Not checked in the free run.

    • cites [29] Wulff, 2010, Sleep and circadian rhythm disruption in psychiatric and neurodegenerative disease, Nat Rev Neurosci source

      Not checked in the free run.

    • cites [30] Picchietti, 2005, Restless legs syndrome, periodic limb movements in sleep, and depression, Sleep

      Not checked in the free run.

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

    Premisecitation

    Poor sleep is associated with eating disorders.

    “For example, poor sleep has also been associated with post-traumatic stress [25], eating disorders [26], and psychosis spectrum experiences such as delusions and hallucinations [23,27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Lauer, 2004, Sleep in eating disorders, Sleep Med Rev source

      Not checked in the free run.

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

    Study design and conductcitation

    The review followed PRISMA guidelines when selecting studies.

    “We followed PRISMA guidelines [53] when selecting studies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, BMJ source

      Not checked in the free run.

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

    Study design and conductown data

    Records were screened by two members of the review team, and a sub-sample of 10% of each reviewer's records were second checked by the other reviewer, with almost perfect agreement between the reviewers.

    “Records were screened by two members of the review team, and a sub-sample of 10% of each reviewer's records were second checked by the other reviewer, with almost perfect agreement between the reviewers (kappa = 1.00 and 0.99).”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    Orwin's formula was used to determine the fail-safe n.

    “Additionally, Orwin's formula [71] was used to determine the fail-safe n.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [71] Orwin, 1983, A fail-safe N for effect size in meta-analysis, J Educ Stat

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The focus of previous reviews has been limited to depression and anxiety only, and typically limited to CBTi interventions.

    “Third, the focus of previous reviews has been limited to depression and anxiety only, and typically limited to CBTi interventions.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    A sensitivity analysis examining the effect of outliers for each outcome was conducted by rerunning the analysis with any outlying effect sizes removed.

    “We conducted a sensitivity analysis examining the effect of outliers for each outcome by rerunning the analysis with any outlying effect sizes removed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    To the authors' knowledge, the review is the first to adopt this approach in the field of sleep and mental health.

    “To our knowledge, the review is the first to adopt this approach in the field of sleep and mental health”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The review was specifically designed to test the causal association between sleep and mental health (i.e., RCTs only, successful sleep improvement required, temporal lag between measures etc.).

    “the review was specifically designed to test the causal association between sleep and mental health (i.e., RCTs only, successful sleep improvement required, temporal lag between measures etc.).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Taken together, the findings suggest that improving sleep leads to better mental health, providing strong evidence that sleep plays a causal role in the experience of mental health difficulties.

    “Taken together, the findings suggest that improving sleep leads to better mental health, therefore providing strong evidence that sleep plays a causal role in the experience of mental health difficulties.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Improving sleep might be one tool that can be used in combination with others to limit the risk of transition to more severe mental health difficulties.

    “therefore improving sleep might be one tool that can be used in combination with others to limit the risk of transition.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The review provides an analysis of possible moderators of the effect of improving sleep on mental health, identifying several key moderators of the effect.

    “we provide an analysis of possible moderators of the effect of improving sleep on mental health, identifying several key moderators of the effect.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The review provides a comprehensive and up-to-date search of RCTs examining the effect of improving sleep on a variety of subsequent mental health outcomes.

    “it provides a comprehensive and up-to-date search of RCTs examining the effect of improving sleep on a variety of subsequent mental health outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Premisenone given

    The timing of sleep is particularly important in circadian rhythm disorders and daytime sleepiness is a key outcome in sleep apnoea research.

    “the timing of sleep is particularly important in circadian rhythm disorders and daytime sleepiness is a key outcome in sleep apnoea research.”
    Quote in the paperNot a substantial claim

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

    Interpretationreasoning

    The focus on sleep quality may have precluded some studies that do not focus on insomnia from inclusion.

    “it may be that our focus on sleep quality precluded some studies that do not focus on insomnia from inclusion.”
    Quote in the paperNot a substantial claim

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

    Premisereasoning

    Different sleep disorders have different conceptualisations of improvement that might not include sleep quality.

    “different sleep disorders have different conceptualisations of improvement that might not include sleep quality.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Studies with longer follow-ups generally found smaller effects (although still statistically significant), most likely due to the diminishing effects of interventions on sleep quality over time.

    “Those that did report longer follow-ups generally found smaller effects (although still statistically significant), most likely due to the diminishing effects of interventions on sleep quality over time [91].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [91] van der Zweerde, 2019, Cognitive behavioral therapy for insomnia: a meta-analysis of long-term effects in controlled studies, Sleep Med Rev source

      Not checked in the free run.

36 of 36

  • The paper relies on this without support.

    The interventions that successfully improved sleep quality did not improve mental health through mechanisms other than improved sleep.

    “To better isolate the effect of improved sleep on mental health, we excluded interventions that included specific elements targeting mental health (e.g., CBT elements for depression).”
1 of 1

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?

  • Improvements in all lifestyle domains targeted are associated with improvements in the QOL mental component summary measure.

    “This is aligned with evidence showing that improvements in all lifestyle domains that we targeted is associated with improvements in the QOL mental component summary measure [5, 6, 70, 81, 82].”

    From Personalized machine learning guided intervention for optimizing lifestyle behaviors in depression: a pilot study (2026) · cites this paper as [82]

    The Results section, Table 3 (page unavailable), reports improved composite mental health following interventions that improved sleep quality. The paper does not establish this association for all targeted lifestyle domains or for the specific QOL mental component summary measure; its composite mental-health outcome is a different measure. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • Improvements in sleep, diet and exercise are linked to improvements in depression symptoms.

    “This finding aligns with the strong foundation in the literature that improvements in sleep, diet and exercise are linked to improvements in depression symptoms [82, 99, 100].”

    From Personalized machine learning guided intervention for optimizing lifestyle behaviors in depression: a pilot study (2026) · cites this paper as [82]

  • ACT promotes acceptance and value-consistent action, reducing the struggle that sustains insomnia-related arousal.

    “Rather than suppressing distressing cognitions, ACT promotes acceptance and value-consistent action, thereby reducing the struggle that sustains insomnia-related arousal [78].”

    From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [78]

    The Results section reports effects of improving sleep quality on outcomes including rumination, but does not describe acceptance and commitment therapy (ACT). Searches for ACT, acceptance, value-consistent action, and insomnia-related arousal found no passage explaining the mechanism attributed to ACT. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • ACT extends the principles of mindfulness by emphasizing psychological flexibility, the capacity to tolerate aversive internal experiences without engaging in maladaptive control efforts.

    “ACT extends the principles of mindfulness by emphasizing psychological flexibility -one's capacity to tolerate aversive internal experiences, such as anxiety or wakefulness, without engaging in maladaptive control efforts [78].”

    From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [78]

    The Method > Outcomes and prioritization table lists mindfulness as a comparator in sleep-intervention trials, but does not describe ACT or its principles; no page number is available for that passage. Searches for acceptance and commitment therapy, psychological flexibility, and aversive internal experiences found no passage in our copy addressing the claim. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • A recent meta-analysis concluded that sleep improvement after different non-pharmacological treatments for insomnia is causally related to improvements in mental health.

    “A recent meta-analysis concluded that sleep improvement after different non-pharmacological treatments for insomnia is causally related to improvements in mental health [19].”

    From Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis (2022) · cites this paper as [19]

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.

  • Sleep-restriction intervention count differs

    Minor

    The intervention summary reports two sleep-restriction-only comparisons, but Table 4 lists one.

  • Significant-sleep-effect moderator Q differs

    Minor

    The moderator comparison is reported as Q = 17.59 in the text but Q = 17.69 in Table 4.

  • Anxiety pooled results differ between Table 3 and the text

    Minor

    Table 3 reports an anxiety effect of −0.51 and Q of 186.92; the anxiety results paragraph reports −0.50 and Q of 187.02.

  • Anxiety comparison count differs between the text and Table 3

    Minor

    The study characteristics report 33 comparisons measuring anxiety, whereas Table 3 reports 35 anxiety comparisons.

4 of 4

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7 of the 194 references couldn’t be matched to a known paper.

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Related

Authors
Scott, A. J., Webb, T. L., Martyn-St James, M., Rowse, G., & Weich, S.
Affiliations
  • Keele University (GB)
  • University of Sheffield (GB)
Corresponding author
Scott, Alexander J.
ORCID
Venue
Sleep Medicine Reviews
Publisher
Elsevier BV
Published
2021-12
Volume
60
Pages
101556
ISSN
1087-0792 (ISSN-L)
DOI
10.1016/j.smrv.2021.101556
PMC
PMC8651630
OpenAlex
W3203364067
Cited by
1,094
References
194
Citations by year
2026: 226 · 2025: 349 · 2024: 275 · 2023: 190 · 2022: 51 · 2021: 3
FWCI
21.13
Type
journal article
Language
en
Open access
Licence
Locations
  • Sleep Medicine Reviews (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Keele Research Repository (Keele University) (submittedVersion, cc-by)
  • PsyArXiv (OSF Preprints) (submittedVersion, cc-by)
  • PsyArXiv (OSF Preprints) (submittedVersion)
Funders
  • Research for Patient Benefit Programme (PB-PG- 0817-20027)
  • National Institute for Health Research
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
sleep quality, mental health, sleep interventions, depression, anxiety, rumination, stress, psychotic symptoms, dose-response relationship
MeSH terms
Sleep Quality, Anxiety, Humans, Mental Health, Psychotic Disorders, Sleep, Randomized Controlled Trials as Topic

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 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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.

What counts as a claim ›How we measure confidence ›How we check this ›

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