Cited by 313Sleep and related disordersObstructive Sleep Apnea ResearchAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis

Chung, Ka-Fai, Lee, Chit-Tat, Yeung, Wing-Fai, Chan, Man-Sum, Chung, Emily Wing-Yue, Lin, Wai-Ling·2018·Family Practice

DOI 10.1093/fampra/cmx122

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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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“Access to CBT-I is also limited due to a lack of therapists, stigmatization, high costs, and lack of awareness [20,23,24].”
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“…and most people initially seek help from their PCP. Pharmacological agents are most commonly offered but the most common non-pharmacological intervention is SHE (14), which is considered only minimally effective, with effect sizes no larger than those found for psychological placebo (33).”
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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
ORCID: Chung, Ka-Fai
Yeung, Wing-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
DOI: 10.1093/fampra/cmx122
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 (medical) › 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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Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis

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