Cited by 28Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Stimulus control for insomnia: A systematic review and meta‐analysis

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Jansson‐Fröjmark, Markus, Nordenstam, Lisa, Alfonsson, Sven, Bohman, Benjamin, Rozental, Alexander, Norell‐Clarke, Annika·2024·Journal of Sleep Research

Abstract

Summary: Stimulus control (SC) is commonly viewed as an evidence‐based treatment for insomnia, but it has not been evaluated comprehensively with modern review and meta‐analytic techniques. The aim of the current study was thus to perform a systematic review and meta‐analysis of trials that examine the efficacy of stimulus control for insomnia. A systematic search for eligible articles and dissertations was conducted in six online bibliographic databases. The 11 included studies, with the majority published between 1978 and 1998, were randomised controlled and experimental studies in adults, comparing stimulus control for insomnia with passive and active comparators and assessing insomnia symptoms as outcomes. A random effects model was used to determine the standardised mean difference Hedge's g at post‐treatment and follow‐up for three sleep diary measures: the number of awakenings, sleep onset latency, and total sleep time. A test for heterogeneity was conducted, forest plots were produced, the risk of publication bias was estimated, and the study quality was assessed. In the trials identified, stimulus control resulted in small to large improvements on sleep onset latency and total sleep time, relative to passive comparators ( g = 0.38–0.85). Compared with active comparators, the improvements following stimulus control were negligible ( g = 0.06–0.30). Although methodological uncertainties were observed in the included trials, stimulus control appears to be an efficacious treatment for insomnia when compared with passive comparators and with similar effects to active comparators. More robust studies are, however, warranted before stronger conclusions are possible to infer.

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  • Altered default mode network-salience network coupling and limbic-prefrontal hyperconnectivity are implicated during periods of sleep anticipation and rumination.

    “Recent neuroimaging studies also implicate altered default mode network (DMN)-salience network coupling and limbic-prefrontal hyperconnectivity during periods of sleep anticipation and rumination [34,35].”

    From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [35]

    The discussion of stimulus control in the Abstract and §4.3 concerns sleep-related cues and treatment mechanisms, not neural connectivity. Searches for default mode–salience network coupling, limbic–prefrontal hyperconnectivity, neuroimaging, sleep anticipation, and rumination found no passage addressing the attributed claim. Page numbers were not available in our copy. (LLM, conf=0.76)

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Research works printed but not linked: 2

  1. Bootzin, R. R., Epstein, D., & Wood, J. M. (1991). Stimulus control instruc- tions. In P. J. Hauri (Ed.), Case studies in insomnia (pp. 19-28). Springer.
  2. Simon, M., & Duran, M. (1994). Behavioural therapy for sleep onset insom- nia: Dependence of its effectiveness on the severity and duration of the disorder. Medical Science Research, 22(1), 73-76.

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Authors
Jansson‐Fröjmark, M., Nordenstam, L., Alfonsson, S., Bohman, B., Rozental, A., & Norell‐Clarke, A.
Affiliations
  • Karolinska Institutet (SE)
  • Uppsala University (SE)
  • Kristianstad University (SE)
Corresponding author
Jansson‐Fröjmark, Markus
Venue
Journal of Sleep Research
Publisher
Wiley
Published
2023-07-27
Volume
33
Issue
1
Pages
e14002-e14002
ISSN
  • 0962-1105 (ISSN-L)
  • 1365-2869
OpenAlex
W4385295470
Cited by
28
References
55
Citations by year
2026: 10 · 2025: 10 · 2024: 5 · 2023: 3
FWCI
1.18
Type
journal article
Language
en
Open access
Locations
  • Journal of Sleep Research (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Örebro University Library (Örebro University) (submittedVersion, other-oa)
  • KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
  • Digitala vetenskapliga arkivet (Diva) (Karlstad University) (submittedVersion, other-oa)
Funders
Karolinska Institutet
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
stimulus control, insomnia, sleep latency, total sleep time, awakening, sleep hygiene, sleep disorder treatment, treatment efficacy
MeSH terms
Sleep Latency, Adult, Humans, Sleep Initiation and Maintenance Disorders, Randomized Controlled Trials as Topic, Treatment Outcome

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