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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“[37]”
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Retracted
Notes
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Dedication
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Copyright Page
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“Ready for Landing”—study protocol for the evaluation of a brief sleep hygiene group intervention for youth with psychiatric disorders
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Influential
Additional file 1 of Prevalence and associated factors of DSM-5 insomnia disorder in the general population of Qatar
Khaled, S. M., Petcu, C. G., Al-Thani, M. A., Al-Hamadi, A. M., Daher‐Nashif, S., Zolezzi, M., & Woodruff, P. W. R. (2021) · Figshare · doi:10.6084/m9.figshare.13787425
Additional file 2 of Promoting sleep health during pregnancy for enhancing women’s health: a longitudinal randomized controlled trial combining biological, physiological and psychological measures, Maternal Outcome after THERapy for Sleep (MOTHERS)
Meneo, D., Baldi, E., Cerolini, S., Curati, S., Bastianini, S., Berteotti, C., Simonazzi, G., Manconi, M., Zoccoli, G., Bartolo, P. D., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26011968
Additional file 1 of Efficacy of a digital cognitive behavioral therapy for insomnia in people with low back pain: a feasibility randomized co-twin and singleton-controlled trial
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Additional file 1 of Promoting sleep health during pregnancy for enhancing women’s health: a longitudinal randomized controlled trial combining biological, physiological and psychological measures, Maternal Outcome after THERapy for Sleep (MOTHERS)
Meneo, D., Baldi, E., Cerolini, S., Curati, S., Bastianini, S., Berteotti, C., Simonazzi, G., Manconi, M., Zoccoli, G., Bartolo, P. D., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26011844
Additional file 3 of Efficacy of a digital cognitive behavioral therapy for insomnia in people with low back pain: a feasibility randomized co-twin and singleton-controlled trial
Ho, K. K., Simić, M., Pinheiro, M. B., Miller, C. B., Ferreira, M. L., Grunstein, R. R., Hopper, J. L., Ordoñana, J. R., & Ferreira, P. H. (2022) · Figshare · doi:10.6084/m9.figshare.20070967
Additional file 2 of Efficacy of a digital cognitive behavioral therapy for insomnia in people with low back pain: a feasibility randomized co-twin and singleton-controlled trial
Ho, K. K., Simić, M., Pinheiro, M. B., Miller, C. B., Ferreira, M. L., Grunstein, R. R., Hopper, J. L., Ordoñana, J. R., & Ferreira, P. H. (2022) · Figshare · doi:10.6084/m9.figshare.20070964
Experience of patients suffering from insomnia with a focus on their perceptions and therapeutic journey
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The Associations of Maladaptive Personality, Self-Regulation, and Sleep Hygiene with Insomnia Severity: A serial Mediation Model
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“32–34 This study has several limitations that should be considered when interpreting the results.”
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“The improvements observed in the PE group may reflect the provision of sleep education and the use of a daily sleep diary (Feingold, 2013; Chung et al., 2017), although nonspecific factors such as attention, expectancy, or general participation effects may also have contributed.”
The role of sleep hygiene in the co-occurrence of GAD and MDD symptoms in an undergraduate sample
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“44 However, sleep hygiene education may offer benefits for MDD. 45 Additionally, research is needed to examine whether sleep hygiene compliance, beyond mere education, can improve sleep quality and reduce GAD and MDD symptoms.”
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Effect of Nursing Behavioral Intervention on Subjective Sleep Quality Among Postpartum Women: A Quasi-Experimental Study
Mohammad, E. E. H., Ali, M. A. M., Khedr, M. A., Alabd, A. M. A., Marzouk, S. A., Alenizi, S. F., Mohamed, A. I., Eltohamy, N. A. E., Mohamed, A. A., Mohamed, B. M., et al. (2026) · Healthcare · doi:10.3390/healthcare14101331
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Sleep hygiene and sleep control mediate the relationship between cognitive fusion and insomnia severity
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“It is associated with small to medium (Chung et al., 2018; Friedrich & Schlarb, 2018) effect size improvements in insomnia symptoms However both subjective and objective improvement in insomnia symptoms is inferior to other non-pharmacological interventions including CBT-I (Ruan et al., 2025).”

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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