Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+years of age
Abstract
Meta-analyses support the effectiveness of behavioral interventions for the treatment of insomnia, although few have systematically evaluated the relative efficacy of different treatment modalities or the relation of old age to sleep outcomes. In this meta-analysis of randomized controlled trials (k = 23), moderate to large effects of behavioral treatments on subjective sleep outcomes were found. Evaluation of the moderating effects of behavioral intervention type (i.e., cognitive-behavioral treatment, relaxation, behavioral only) revealed similar effects for the 3 treatment modalities. Both middle-aged adults and persons older than 55 years of age showed similar robust improvements in sleep quality, sleep latency, and wakening after sleep onset. A research agenda is recommended to examine the mechanisms of action of behavioral treatments on sleep with increased attention to the high prevalence of insomnia in older individuals.
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The effect sizes for improvements in sleep duration and subjective sleep quality in this study were similar to or greater than those reported for cognitive behavioral intervention and other physical activity studies.
“The effect size for the improvements in sleep duration and subjective sleep quality in this study were similar or even greater than that reported for cognitive behavioral intervention and other physical activity studies [18, 30, 36-38].”
From Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia (2010) · cites this paper as [38]
Cognitive Behavioral Therapy for Insomnia does not carry the risks of prescription hypnotic medications and is therefore preferable for reasons beyond demonstrated efficacy, efficacy relative to medications, and effectiveness.
“The recommended first-line treatment, Cognitive Behavioral Therapy for Insomnia (CBTI) does not carry these risks and is therefore preferable for reasons beyond demonstrated efficacy(244-248), efficacy relative to medications(249-253), and effectiveness(254).”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [246]
In a previous meta-analytic review, relaxation, cognitive-behavioral, and strictly behavioral interventions all demonstrated robust effects on sleep quality and symptoms of insomnia among middle-aged and older adults.
“This conclusion is consistent with the results of a previous meta-analytic review, in which relaxation, cognitive-behavioral, and strictly behavioral interventions all demonstrated robust effects on sleep quality and symptoms of insomnia among middle-aged and older adults; however, cognitive behavioral techniques were needed to improve sleep efficiency (Irwin et al., 2006).”
From Insomnia treatment in the context of alcohol use disorder: A systematic review and meta-analysis (2017) · cites this paper as Irwin et al., 2006
In a previous meta-analytic review, cognitive behavioral techniques were needed to improve sleep efficiency among middle-aged and older adults.
“This conclusion is consistent with the results of a previous meta-analytic review, in which relaxation, cognitive-behavioral, and strictly behavioral interventions all demonstrated robust effects on sleep quality and symptoms of insomnia among middle-aged and older adults; however, cognitive behavioral techniques were needed to improve sleep efficiency (Irwin et al., 2006).”
From Insomnia treatment in the context of alcohol use disorder: A systematic review and meta-analysis (2017) · cites this paper as Irwin et al., 2006
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).”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [36]
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).”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [36]
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.”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [36]
CBTI has been shown to be efficacious for the treatment of chronic insomnia in older adults.
“CBTI has also been shown to be efficacious for the treatment of chronic insomnia in older adults [33,36].”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [36]
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- Authors
- Irwin, M. R., Cole, J. C., & Nicassio, P. M.
- Affiliations
- University of California, Los Angeles (US)
- ORCID
- Irwin, Michael R.
- Venue
- Health Psychology
- Published
- 2006
- Volume
- 25
- Issue
- 1
- Pages
- 3-14
- ISSN
- 0278-6133 (ISSN-L)
- 1930-7810
- OpenAlex
- W2106043734
- Cited by
- 537
- References
- 80
- Citations by year
- 2026: 5 · 2025: 16 · 2024: 14 · 2023: 27 · 2022: 23 · 2021: 20 · 2020: 21 · 2019: 37 · 2018: 31 · 2017: 34 · 2016: 35 · 2015: 42 · 2014: 35 · 2013: 32 · 2012: 36
- FWCI
- 3.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (AA13239, R01AA013239)
- National Institute on Aging (AG 18367, R01AG018367, AR/AG41867)
- National Institute of Mental Health (MH-55253, R01MH055253, T32MH019925, T32 MH 19925)
- National Institute on Drug Abuse (R01DA016541, DA 16541)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR049840, 1 R01 AR 49840-01)
- National Center for Research Resources ((M01 RR00865), M01RR000865)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- insomnia, behavioral interventions, cognitive behavioral therapy, relaxation training, middle-aged adults, older adults, sleep quality, sleep latency, wake after sleep onset, aging and sleep
- MeSH terms
- Behavior Therapy, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Randomized Controlled Trials as Topic, Treatment Outcome
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