Is cognitive behavioral therapy for insomnia (CBTi) efficacious for treating insomnia symptoms in shift workers? A systematic review and meta-analysis
Abstract
Shift workers commonly report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBTi) is the first line treatment for insomnia, however efficacy in shift workers is not well understood. This systematic review and meta-analysis evaluates existing trials of CBTi in shift working populations. A systematic literature search was conducted across seven electronic databases (n = 2120). Fifty-two full-text articles were reviewed and of these, nine studies (across ten publications with a total of 363 participants) were deemed suitable for inclusion. Heterogeneity was considerable between studies, with variability in study design, style and delivery of intervention, and follow-up times. Small sample sizes were common and attrition was high. Some studies modified aspects of CBTi for use in shift workers, while others were limited to psycho-education as part of larger intervention studies. Mean differences (MD) pre and post CBTi were modest for both the insomnia severity index (ISI; MD: -3.08, 95% CI: -4.39, -1.76) and the Pittsburgh sleep quality index (PSQI; MD: -2.38, 95% CI: -3.55, -1.21). Neither difference was of a magnitude considered to reflect a clinically significant improvement. Tailored approaches to CBTi are needed for shift workers to improve efficacy, ideally including co-production with workers to ensure interventions meet this population's needs.
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Studies conducted to date using classic CBT-I methods have shown little effect on shift workers.
“As already mentioned above, studies conducted to date using classic CBT-I methods have shown little effect on shift workers.”
From Efficacy study comparing a CBT-I developed for shift workers (CBT-I-S) to standard CBT-I (cognitive behavioural therapy for insomnia) on sleep onset latency, total sleep time, subjective sleep quality, and daytime sleepiness: study protocol for a parallel group randomised controlled trial with online therapy groups of seven sessions each (2024) · cites this paper as [7]
Reynolds et al. conclude that although CBT-I in shift workers reduces symptoms, on average the reduction does not reach clinically significant levels, and they see this as evidence that standard CBT-I is not appropriate for this target group.
“Summarising the results of studies of CBT-I in shift workers, Reynolds et al. [7] conclude that although there is a reduction in symptoms as a result of these interventions, on average this reduction does not reach clinically significant levels. They see this as evidence that the use of standard CBT-I is not appropriate for this target group.”
From Efficacy study comparing a CBT-I developed for shift workers (CBT-I-S) to standard CBT-I (cognitive behavioural therapy for insomnia) on sleep onset latency, total sleep time, subjective sleep quality, and daytime sleepiness: study protocol for a parallel group randomised controlled trial with online therapy groups of seven sessions each (2024) · cites this paper as [7]
CBT-I mainly consists of psychoeducation, cognitive restructuring of dysfunctional assumptions about sleep, sleep hygiene, sleep restriction, stimulus control, and relaxation.
“It mainly consists of psychoeducation, and cognitive restructuring of dysfunctional assumptions about sleep as well as training subjects in sleep hygiene, sleep restriction, stimulus control, and relaxation, [7, 14].”
From Efficacy study comparing a CBT-I developed for shift workers (CBT-I-S) to standard CBT-I (cognitive behavioural therapy for insomnia) on sleep onset latency, total sleep time, subjective sleep quality, and daytime sleepiness: study protocol for a parallel group randomised controlled trial with online therapy groups of seven sessions each (2024) · cites this paper as [7]
Because CBT-I interventions require regular sleep and wake times, they are not suitable for shift workers.
“However, because these interventions require regular sleep and wake times, they are not suitable for shiftworkers [7].”
From Efficacy study comparing a CBT-I developed for shift workers (CBT-I-S) to standard CBT-I (cognitive behavioural therapy for insomnia) on sleep onset latency, total sleep time, subjective sleep quality, and daytime sleepiness: study protocol for a parallel group randomised controlled trial with online therapy groups of seven sessions each (2024) · cites this paper as [7]
The gold standard of insomnia treatment is CBT-I.
“The gold standard of insomnia treatment is CBT-I (cognitive behavioural therapy for insomnia).”
From Efficacy study comparing a CBT-I developed for shift workers (CBT-I-S) to standard CBT-I (cognitive behavioural therapy for insomnia) on sleep onset latency, total sleep time, subjective sleep quality, and daytime sleepiness: study protocol for a parallel group randomised controlled trial with online therapy groups of seven sessions each (2024) · cites this paper as [7]
Reynolds et al. estimate that 20% of all employees are shift workers, of whom 20-40% could suffer from clinically relevant sleep disorders.
“Reynolds et al. [7] estimate the proportion of shift workers at 20% of all employees, of whom 20–40% could suffer from clinically relevant sleep disorders.”
From Efficacy study comparing a CBT-I developed for shift workers (CBT-I-S) to standard CBT-I (cognitive behavioural therapy for insomnia) on sleep onset latency, total sleep time, subjective sleep quality, and daytime sleepiness: study protocol for a parallel group randomised controlled trial with online therapy groups of seven sessions each (2024) · cites this paper as [7]
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Self-citationIndividual and occupational predictors of CBT-I response patterns among shift-working firefighters
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A Personalized Recovery Intervention to Support Sleep Health in Emergency Healthcare Professionals
Schmidt, L. S., Rey, A. E., Valero, B., Schlatter, S., Reynaud, È., Lilot, M., Tazarourte, K., Douplat, M., & Mazza, S. (2026) · Journal of Sleep Research · doi:10.1111/jsr.70464
- Authors
- Reynolds, A. C., Sweetman, A., Crowther, M. E., Paterson, J. L., Scott, H., Lechat, B., Wanstall, S. E., Brown, B. W., Lovato, N., Adams, R. J., & Eastwood, P. R.
- Affiliations
- Flinders University (AU)
- ORCID
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2023-02
- Volume
- 67
- Pages
- 101716
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W4309762012
- Cited by
- 43
- References
- 54
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 11 · 2023: 10
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Murdoch University Research Portal (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy for insomnia, shift work, insomnia, treatment efficacy, Insomnia Severity Index, Pittsburgh Sleep Quality Index, personalized interventions, co-production, psychoeducation
- MeSH terms
- Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy, Treatment Outcome
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