Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis
Abstract
Background: Sleep hygiene education (SHE) is commonly used as a treatment of insomnia in general practice. Whether SHE or cognitive-behavioural therapy for insomnia (CBT-I), a treatment with stronger evidence base, should be provided first remains unclear. Objective: To review the efficacy of SHE for poor sleep or insomnia. Methods: We systematically searched six key electronic databases up until May 2017. Two researchers independently selected relevant publications, extracted data and evaluated methodological quality according to the Cochrane criteria. Results: Twelve of 15 studies compared SHE with CBT-I, three with mindfulness-based therapy, but none with sham or no treatment. General knowledge about sleep, substance use, regular exercise and bedroom arrangement were commonly covered; sleep-wake regularity and avoidance of daytime naps in seven programs, but stress management in only five programs. Major findings include (i) there were significant pre- to post-treatment improvements following SHE, with small to medium effect size; (ii) SHE was significantly less efficacious than CBT-I, with difference in effect size ranging from medium to large; (iii) pre- to post-treatment improvement and SHE-CBT-I difference averaged at 5% and 8% in sleep-diary-derived sleep efficiency, respectively, and two points in Pittsburgh Sleep Quality Index; (iv) only subjective measures were significant and (v) no data on acceptability, adherence, understanding and cost-effectiveness. Conclusions: Although SHE is less effective than CBT-I, unanswered methodological and implementation issues prevent a firm conclusion to be made on whether SHE has a role in a stepped-care model for insomnia in primary care.
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The short sleep hygiene consultation did not qualify as a sleep hygiene education program.
“Thus, it didn't qualify as a sleep hygiene education program although their context, length, administration method may vary (50).”
From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [50]
A strength in using such methods as comparators is the low efficacy compared to other interventions.
“A strength in using such methods as comparators is the low efficacy compared to other interventions (50, 51).”
From Total Sleep Deprivation Followed by Bright Light Therapy as Rapid Relief for Depression: A Pragmatic Randomized Controlled Trial (2021) · cites this paper as [50]
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- Authors
- Chung, K.-F., Lee, C.-T., Yeung, W.-F., Chan, M.-S., Chung, E. W.-Y., & Lin, W.-L.
- Affiliations
- University of Hong Kong (HK)
- Queen Mary Hospital (CN)
- Hong Kong Polytechnic University (HK)
- Waitemata District Health Board (NZ)
- Chinese University of Hong Kong (HK)
- Corresponding author
- Chung, Ka-Fai
- Venue
- Family Practice
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-11-29
- Volume
- 35
- Issue
- 4
- Pages
- 365-375
- ISSN
- 0263-2136 (ISSN-L)
- 1460-2229
- OpenAlex
- W2770032452
- Cited by
- 313
- References
- 43
- Citations by year
- 2026: 31 · 2025: 50 · 2024: 50 · 2023: 54 · 2022: 56 · 2021: 37 · 2020: 22 · 2019: 6 · 2018: 6
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Family Practice (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- PolyU Institutional Research Archive (Hong Kong Polytechnic University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- sleep hygiene education, insomnia, cognitive behavioral therapy for insomnia, mindfulness-based interventions, sleep efficiency, sleep quality, stepped care, primary care, treatment efficacy comparison
- MeSH terms
- Sleep Hygiene, Humans, Sleep Initiation and Maintenance Disorders, Cognitive Behavioral Therapy, Mindfulness
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