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Cited by 620Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesObstructive Sleep Apnea Research

Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review

Open access
Mitchell, Matthew D, Gehrman, Philip, Perlis, Michael, Umscheid, Craig A·2012·BMC Family Practice
DOI 10.1186/1471-2296-13-40PMC PMC3481424
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Abstract

BACKGROUND: Insomnia is common in primary care, can persist after co-morbid conditions are treated, and may require long-term medication treatment. A potential alternative to medications is cognitive behavioral therapy for insomnia (CBT-I). METHODS: In accordance with PRISMA guidelines, we systematically reviewed MEDLINE, EMBASE, the Cochrane Central Register, and PsycINFO for randomized controlled trials (RCTs) comparing CBT-I to any prescription or non-prescription medication in patients with primary or comorbid insomnia. Trials had to report quantitative sleep outcomes (e.g. sleep latency) in order to be included in the analysis. Extracted results included quantitative sleep outcomes, as well as psychological outcomes and adverse effects when available. Evidence base quality was assessed using GRADE. RESULTS: Five studies met criteria for analysis. Low to moderate grade evidence suggests CBT-I has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term, while very low grade evidence suggests benzodiazepines are more effective in the short term. Very low grade evidence supports use of CBT-I to improve psychological outcomes. CONCLUSIONS: CBT-I is effective for treating insomnia when compared with medications, and its effects may be more durable than medications. Primary care providers should consider CBT-I as a first-line treatment option for insomnia.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review found that CBT-I is at least as effective as sleep medications for chronic insomnia and may produce more durable long-term benefits. The evidence base was limited to five RCTs, all in primary insomnia, and was too small and heterogeneous for meta-analysis.

Key findings

  • Five RCTs met inclusion criteria, all in patients with primary insomnia; comparators were zopiclone, zolpidem, temazepam, and triazolam. One trial in comorbid insomnia was excluded because it used nefazodone, now withdrawn.
  • Low- to moderate-grade evidence suggested CBT-I was superior to benzodiazepine and non-benzodiazepine drugs in the long term, while very low-grade evidence suggested benzodiazepines were more effective in the short term. Moderate-grade evidence favored CBT-I over non-benzodiazepines in the short term.
  • Long-term CBT-I generally improved sleep latency by 30–45 minutes, total sleep time by 30–60 minutes, and sleep efficiency by 8–16%; drug effects declined over time. In Morin 1999 at 24 months, CBT-I increased total sleep time by 65.2 minutes and sleep efficiency by 16.4%, versus 11.5 minutes and 2.9% for temazepam, with all temazepam measurements significantly worsening from end of treatment to follow-up.
  • Psychological outcomes favored CBT-I in one trial: at 6 months, State-Trait Anxiety Index scores improved for CBT-I versus zopiclone (state: –5.11 vs. +1.61, p < 0.05; trait: –4.47 vs. +1.97, p < 0.01). Sleep Impairment Index declined 10 points with CBT-I versus 4 with temazepam at 24 months (p = 0.01), and PSQI improved 1.2 points with CBT-I versus worsened 0.8 points with temazepam at 8 months (p < 0.01).

Methods

  • PRISMA-guided systematic review of MEDLINE, EMBASE, Cochrane Central Register, and PsycINFO through September 2011, plus review of published systematic reviews for missed RCTs.
  • Included published RCTs of adults aged 18+ with chronic insomnia per DSM-IV, comparing individual or group CBT-I delivered by a professional to FDA-approved prescription or non-prescription insomnia medications; studies had to report at least one quantitative sleep outcome. Studies with fewer than 10 patients per group, self-help programs, and comparisons of CBT-I components were excluded.
  • Five RCTs were included; evidence was too small and heterogeneous for meta-analysis. Quality was assessed with a nine-point Jadad/Chalmers-based scale, and overall evidence strength was rated using GRADE. Sleep diary and automated measures (polysomnography/actigraphy) were analyzed separately.

Limitations

  • Stated: all included trials focused on primary insomnia and may not represent the majority of patients with comorbid medical or psychiatric disorders; only one comorbid-insomnia trial was found and was excluded because the drug was withdrawn. No trials compared CBT-I with antihistamines or antidepressants, adverse-event reporting was limited, long-term data versus non-benzodiazepines were sparse, short-term CBT-I versus benzodiazepine data were inconsistent, and double-blinding was not possible.
  • Stated: the evidence base was too small and heterogeneous for meta-analysis, and three of five included studies were in older adults.
  • Evident from the text: only five RCTs were available, outcome measures and demographic composition were diverse, and the review could not draw conclusions about relative safety.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1471-2296-13-40

Cites

55 of 55 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 46 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Only one trial compared CBT-I to drug therapy in patients with comorbid insomnia.

    “Only one trial compared CBT-I to drug therapy in patients with comorbid insomnia [34]: the drug used was nefazodone (now withdrawn from the market), so the study was excluded from further analysis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Thase ME, Rush AJ, Manber R, Kornstein SG, Klein DN, Markowitz JC, Ninan PT, Friedman ES, Dunner DL, Schatzberg AF, Borian FE, Trivedi MH, Keller MB: Differential effects of nefazodone and cognitive behavioral analysis system of psychotherapy on insomnia associated with chronic forms of major depression. J Clin Psychiatry. 2002, 63: 493-500. 10.4088/JCP.v63n0605. source

      Not checked in the free run.

  • Findingown data

    Very low grade evidence supports use of CBT-I to improve psychological outcomes.

    “Very low grade evidence supports use of CBT-I to improve psychological outcomes.”
    Quote in the paperSubstantial claim
  • Findingown data

    Very low grade evidence suggests benzodiazepines are more effective than CBT-I in the short term.

    “very low grade evidence suggests benzodiazepines are more effective in the short term”
    Quote in the paperSubstantial claim
  • Findingown data

    Low to moderate grade evidence suggests CBT-I has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term.

    “Low to moderate grade evidence suggests CBT-I has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term”
    Quote in the paperSubstantial claim
  • Findingown data

    Five studies met criteria for analysis.

    “Five studies met criteria for analysis.”
    • Also stated in: § Results · plain
      “Our search found a total of five RCTs that met the inclusion criteria and compared CBT-I to medications.”
    Quote in the paperSubstantial claim
  • May combine two claims. 12
  • Classified as probably not a substantial claim. 14
  • The quote only partly states this claim. 2

  • May combine two claims.

    Findingcitation

    In Wu et al., after 8 months the Pittsburgh Sleep Quality Index improved by 1.2 points with CBT-I and worsened by 0.8 points with temazepam (p < 0.01).

    “Wu et al [32] surveyed patients using the Pittsburgh Sleep Quality Index: after 8 months this measure improved an average of 1.2 points in patients treated with CBT-I, while it worsened 0.8 points in patients given tamezepam (p < 0.01).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Wu R, Bao J, Zhang C, Deng J, Long C: Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. Psychother Psychosom. 2006, 75: 220-228. 10.1159/000092892. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Some studies reported intermediate time points as well, which were consistent with the initial and final results.

    “Some studies reported intermediate time points as well, which were consistent with the initial and final results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Three of the five included studies were in older adults.

    “In terms of demographic composition, three of the five studies we included were in older adults.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The included studies were diverse in sleep-related outcome measures (subjective versus objective) and demographic composition.

    “The studies also were diverse in terms of sleep-related outcome measures (subjective versus objective) and demographic composition.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    All trials asked patients to complete sleep diaries.

    “All trials asked patients to complete sleep diaries.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Short-term, CBT-I improves sleep outcomes more than non-benzodiazepines, with moderate GRADE evidence.

    “CBT-I vs. non-benzodiazepines | Short term | Improved more with CBT-I”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [26] Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O'Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer TT, Varonen H, Vist GE, Williams JW, Zaza S, GRADE Working Group: Grading quality of evidence and strength of recommendations. BMJ. 2004, 328: 1490-1497. source

      Not checked in the free run.

    • cites [27] Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schunemann HJ, GRADE Working Group: Going from evidence to recommendations. BMJ. 2008, 336: 1049-1051. 10.1136/bmj.39493.646875.AE. source

      Not checked in the free run.

    • cites [28] Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ, GRADE Working Group: What is “quality of evidence” and why is it important to clinicians?. BMJ. 2008, 336: 995-998. 10.1136/bmj.39490.551019.BE. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Reported sleep measures included sleep latency, total sleep time, and total time spent awake during the night.

    “Reported sleep measures included sleep latency, TST, and total time spent awake during the night.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Trends toward improved results with CBT-I were observed on the Penn State Worry Questionnaire and Worry Domains Questionnaire, but differences were not statistically significant.

    “Trends towards improved results with CBT-I were observed in the Penn State Worry Questionnaire and the Worry Domains Questionnaire, but the differences between groups were not statistically significant.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Omvik S, Sivertsen B, Pallesen S, Bjorvatn B, Havik OE, Nordhus IH: Daytime functioning in older patients suffering from chronic insomnia: treatment outcome in a randomized controlled trial comparing CBT with zopiclone. Behav Res Ther. 2008, 46: 623-641. 10.1016/j.brat.2008.02.013. source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Short-term, CBT-I improves sleep outcomes less than benzodiazepines, with very low GRADE evidence.

    “CBT-I vs. benzodiazepines | Short term | Improved less with CBT-I”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [26] Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O'Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer TT, Varonen H, Vist GE, Williams JW, Zaza S, GRADE Working Group: Grading quality of evidence and strength of recommendations. BMJ. 2004, 328: 1490-1497. source

      Not checked in the free run.

    • cites [27] Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schunemann HJ, GRADE Working Group: Going from evidence to recommendations. BMJ. 2008, 336: 1049-1051. 10.1136/bmj.39493.646875.AE. source

      Not checked in the free run.

    • cites [28] Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ, GRADE Working Group: What is “quality of evidence” and why is it important to clinicians?. BMJ. 2008, 336: 995-998. 10.1136/bmj.39490.551019.BE. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The overall quality of the evidence base for each comparison was rated using the GRADE approach.

    “The overall quality of the evidence base for each comparison was rated using the GRADE approach [26-28].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [26] Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O'Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer TT, Varonen H, Vist GE, Williams JW, Zaza S, GRADE Working Group: Grading quality of evidence and strength of recommendations. BMJ. 2004, 328: 1490-1497. source

      Not checked in the free run.

    • cites [27] Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schunemann HJ, GRADE Working Group: Going from evidence to recommendations. BMJ. 2008, 336: 1049-1051. 10.1136/bmj.39493.646875.AE. source

      Not checked in the free run.

    • cites [28] Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ, GRADE Working Group: What is “quality of evidence” and why is it important to clinicians?. BMJ. 2008, 336: 995-998. 10.1136/bmj.39490.551019.BE. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Measures from patients' sleep diaries and measures from automated means were analyzed separately because of known unreliability in patients' perceptions of sleep.

    “Measures from patients’ sleep diaries and measures from automated means (polysomnography and actigraphy) were analyzed separately because of known unreliability in patients’ perceptions of sleep.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: There can be substantial differences between automated measures of sleep time and patients' self-reports on sleep diaries.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Assessment of RCT quality was done using a nine-point scale based on scales by Jadad and Chalmers.

    “Assessment of RCT quality was done using a nine-point scale (Additional file 1: Table S6) based on scales by Jadad [24] and Chalmers [25].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [24] Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ: Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials. 1996, 17: 1-12. 10.1016/0197-2456(95)00134-4. source

      Not checked in the free run.

    • cites [25] Chalmers TC, Smith H, Blackburn B, Silverman B, Schroeder B, Reitman D, Ambroz A: A method for assessing the quality of a randomized control trial. Control Clin Trials. 1981, 2: 31-49. 10.1016/0197-2456(81)90056-8. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisereasoning

    The new systematic review does not tell us whether CBT-I is as effective as sleep medications.

    “But this review does not tell us whether CBT-I is as effective as sleep medications.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Okajima I, Komada Y, Inoue Y: A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep Biol Rhythms. 2011, 9: 24-34. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Inclusion criteria were defined in advance of data abstraction using the PICO framework.

    “Inclusion criteria were defined in advance of data abstraction using the PICO framework below [22].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Richardson WS, Wilson MC, Nishikawa J, Hayward RS: The well-built clinical question: A key to evidence-based decisions. ACP J Club. 1995, 3: A12-A13. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A new systematic review meta-analyzed evidence from 14 randomized trials comparing CBT-I to control groups and found that CBT-I had a medium to large effect in reducing insomnia, with effects maintained after treatment.

    “A new systematic review [21] meta-analyzes evidence from 14 randomized trials comparing groups of patients given CBT-I to control groups.”
    • Also stated in: § Background · plain
      “The meta-analysis found that CBT-I had a medium to large effect in reducing insomnia, and that the effects were maintained even after conclusion of the treatment period.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Okajima I, Komada Y, Inoue Y: A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep Biol Rhythms. 2011, 9: 24-34. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data synthesis methods followed the practice of the Cochrane Collaboration.

    “Data synthesis methods followed the practice of the Cochrane Collaboration.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The AHRQ Evidence-based Practice review addressed whether CBT-I is as effective as sleep medications, but it was published in 2005 and lacks evidence published since September 2004.

    “The AHRQ Evidence-based Practice review [20] addressed that question, but it was published in 2005 and lacks evidence published since September 2004.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen TP, Witmans M: Manifestations and Management of Chronic Insomnia in Adults. Evidence Report/ Technology Assessment No. 125. AHRQ Publication No. 05-E021-2. 2005, Rockville: Agency for Healthcare Research and Quality

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Insomnia often persists following resolution of 'primary' conditions and generally does not spontaneously resolve over time if left untreated.

    “There is now evidence to suggest that insomnia often persists following resolution of these ‘primary’ conditions, and that it generally does not spontaneously resolve over time if left untreated [5].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Morin CM, Belanger L, LeBlanc M, Ivers H, Savard J, Espie CA, Merette C, Baillargeon L, Gregoire JP: The natural history of insomnia: a population-based 3-year longitudinal study. Arch Intern Med. 2009, 169: 447-453. 10.1001/archinternmed.2008.610. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two research analysts reviewed the full text of each retrieved article to determine whether it met the stated inclusion criteria, and disagreements were resolved by a third reviewer.

    “Two research analysts (MDM, BL) reviewed full text of each retrieved article to determine whether it met the stated inclusion criteria. Disagreements were resolved by a third reviewer (PG).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All studies in this field suffer an unavoidable risk of bias because double-blinding is not possible.

    “Lastly, all studies in this field suffer an unavoidable risk of bias because double-blinding is not possible.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    CBT-I may have advantages over medications, most notably more durable treatment gains that reduce or eliminate the need for long-term pharmacologic treatment.

    “Second, CBT-I may have advantages when compared to medications, most notably more durable treatment gains that reduce or eliminate the need for long-term pharmacologic treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Many providers may not be aware of CBT-I or know how to refer patients for treatment.

    “Despite the evidence supporting the effectiveness of CBT-I, many providers may not be aware of its existence or know how to refer patients for treatment [39].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Wetzler RG, Winslow DH: New solutions for treating chronic insomnia: an introduction to behavioral sleep medicine. J Ky Med Assoc. 2006, 104: 502-512.

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    CBT-I is an effective treatment for insomnia that can produce durable results in a relatively brief number of visits.

    “CBT-I is an effective treatment for insomnia that can produce durable results in a relatively brief number of visits.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationown data

    Inconsistencies in short-term data comparing CBT-I to benzodiazepines need to be resolved.

    “Data on long-term outcomes of CBT-I compared to non-benzodiazepines is still sparse, and inconsistencies in the data comparing CBT-I to benzodiazepines in the short term need to be resolved.”
    Quote in the paperSubstantial claim
24 of 24

  • The paper relies on this without support.

    Medications are usually not curative, leading to long-term treatment over many years despite a lack of safety and efficacy data for their long-term use beyond 1–2 years.

    “Perhaps the most important disadvantage is that medications are usually not curative, leading to long-term treatment over many years despite a lack of safety and efficacy data for their long-term use beyond 1–2 years.”

  • The paper relies on this without support.

    CBT-I has fewer known side effects than medication.

    “Treating insomnia with CBT-I, as opposed to medication, has a number of potential advantages, including fewer known side effects”

  • The paper relies on this without support.

    There can be substantial differences between automated measures of sleep time and patients' self-reports on sleep diaries.

    “There can also be substantial differences between automated measures of sleep time and patients’ self-reports on sleep diaries.”

  • The paper relies on this without support.

    Insomnia RCTs generally find larger effects of treatment on subjective measures such as questionnaires than on objective measures of actigraphy and polysomnography.

    “In terms of outcome measures, insomnia RCTs generally find larger effects of treatment on subjective measures such as questionnaires than on objective measures of actigraphy and polysomnography.”

  • The paper relies on this without support.

    The diagnosis of insomnia relies on patient report and not on a diagnostic laboratory test.

    “the diagnosis of insomnia relies on patient report and not on a diagnostic laboratory test.”

  • The paper relies on this without support.

    Many patients presenting with insomnia to primary care practices will have secondary or co-morbid insomnia.

    “many patients presenting with insomnia to primary care practices will have secondary or co-morbid insomnia”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • 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 [248]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Wu trial assigned conflicting reference numbers

    Minor

    Wu 2006 is cited as reference [32] in Table 1 but as [31] in Table 3. Reference [31] is the Morin trial.

  • Questionnaire results attributed to the wrong drug

    Minor

    The text says both studies with follow-up sleep questionnaires compared CBT-I with zopiclone, but its descriptions of Morin's and Wu's results identify temazepam as the comparator.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. NIH state-of-the-science conference statement on manifestations and management of chronic insomnia in adults. NIH Consens Sci Statements. 2005, 22: 1-30.

Cited by

Sorted by citations

Related

Authors
Mitchell, M. D., Gehrman, P., Perlis, M., & Umscheid, C. A.
Affiliations
  • University of Pennsylvania Health System (US)
  • University of Pennsylvania (US)
Corresponding author
Mitchell, Matthew D
ORCID
Venue
BMC Family Practice
Publisher
Springer Science and Business Media LLC
Published
2012-05-25
Volume
13
Issue
1
Pages
40-40
ISSN
1471-2296 (ISSN-L)
DOI
10.1186/1471-2296-13-40
PMC
PMC3481424
OpenAlex
W2026032799
Semantic Scholar
21aa68d115e33399322c96f824a3fa2bf6eeab3e
Cited by
617
References
55
Citations by year
2026: 33 · 2025: 59 · 2024: 43 · 2023: 55 · 2022: 59 · 2021: 101 · 2020: 45 · 2019: 43 · 2018: 38 · 2017: 32 · 2016: 33 · 2015: 30 · 2014: 32 · 2013: 9 · 2012: 5
FWCI
3.56
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Family Practice (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • University of Pennsylvania
  • Perelman School of Medicine, University of Pennsylvania
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
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Keywords
cognitive behavioral therapy for insomnia, insomnia, benzodiazepines, non-benzodiazepine hypnotics, sleep medication, sleep latency, psychological outcomes, adverse effects, comorbid insomnia, primary care, long-term treatment effectiveness
MeSH terms
Humans, Sleep Initiation and Maintenance Disorders, Quality of Life, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Evidence-Based Medicine, Comparative Effectiveness Research

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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