CoChat
Sign Up
Cited by 309Sleep and related disordersObstructive Sleep Apnea ResearchPsychotherapy Techniques and Applications

Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment

Open access
Edinger, Jack D., Arnedt, J. Todd, Bertisch, Suzanne M., Carney, Colleen E., Harrington, John J., Lichstein, Kenneth L., Sateia, Michael J., Troxel, Wendy M. +4 more·2021·Journal of Clinical Sleep Medicine
DOI 10.5664/jcsm.8988PMC PMC7853211
Open this paper in CoChat — free accountOpen PDF

Abstract

Introduction The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations. Methods The American Academy of Sleep Medicine commissioned a task force of 9 experts in sleep medicine and sleep psychology. A systematic review was conducted to identify randomized controlled trials that addressed behavioral and psychological interventions for the treatment of chronic insomnia disorder in adults. Statistical analyses were performed to determine if the treatments produced clinically significant improvements in a range of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation process was used to evaluate the evidence for making specific treatment recommendations. Results The literature search identified 1,244 studies; 124 studies met the inclusion criteria, and 89 studies provided data suitable for statistical analyses. Evidence for the following interventions is presented in this review: cognitive-behavioral therapy for insomnia, brief therapies for insomnia, stimulus control, sleep restriction therapy, relaxation training, sleep hygiene, biofeedback, paradoxical intention, intensive sleep retraining, and mindfulness. This review provides a detailed summary of the evidence along with the quality of evidence, the balance of benefits vs harms, patient values and preferences, and resource use considerations.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.5664/jcsm.8988

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

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?

Self-check

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

The self-check needs the paper’s full text.

The citation lists haven’t been fetched yet

References 201 · Cited by 309

Part of this paper’s reference list could not be split into single entries.

Research works printed but not linked: 52

  1. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(2):307-349.
  2. Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, R össler W. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep. 2008; 31(4):473-480.
  3. Morin CM, LeBlanc M, Daley M, Gregoire JP, Mérette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med. 2006;7(2):123-130.
  4. Walsh JK, Coulouvrat C, Hajak G, et al. Nighttime insomnia symptoms and perceived health in the America Insomnia Survey (AIS). Sleep. 2011;34(8): 997-1011.
  5. Deguchi Y, Iwasaki S, Ishimoto H, et al. Relationships between temperaments, occupational stress, and insomnia among Japanese workers. PLoS One. 2017; 12(4):e0175346.
  6. Li L, Wu C, Gan Y, Qu X, Lu Z. Insomnia and the risk of depression: a meta- analysis of prospective cohort studies. BMC Psychiatry. 2016;16(1):375.
  7. Vargas I, Perlis ML, Grandner M, et al. Insomnia symptoms and suicide-related ideation in U.S. Army service members. Behav Sleep Med. 2020;18(6):820-836.
  8. Ozminkowski RJ, Wang S, Walsh JK. The direct and indirect costs of untreated insomnia in adults in the United States. Sleep. 2007;30(3):263-273.
  9. Kessler RC, Berglund PA, Coulouvrat C, et al. Insomnia and the performance of US workers: results from the America insomnia survey. Sleep. 2011;34(9): 1161-1171.
  10. Daley M, Morin CM, LeBlanc M, Grégoire JP, Savard J. The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Sleep. 2009;32(1):55-64.
  11. Lane JM, Jones SE, Dashti HS, et al. Biological and clinical insights from genetics of insomnia symptoms. Nat Genet. 2019;51(3):387-393.
  12. Soehner AM, Kaplan KA, Harvey AG. Prevalence and clinical correlates of co- occurring insomnia and hypersomnia symptoms in depression. J Affect Disord. 2014;167:93-97.
  13. Ellis J, Hampson SE, Cropley M. The role of dysfunctional beliefs and attitudes in late-life insomnia. J Psychosom Res. 2007;62(1):81-84.
  14. Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest. 2015;147(4):1179-1192.
  15. Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM. Recommendations for a standard research assessment of insomnia. Sleep. 2006;29(9):1155-1173.
  16. Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34(5):601-608.
  17. Smith MT, McCrae CS, Cheung J, et al. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2018;14(7):1209-1230.
  18. Morin CM, Vallières A, Ivers H. Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16). Sleep. 2007;30(11):1547-1554.
  19. Smith MT, McCrae CS, Cheung J, et al. Use of actigraphy for the evaluation of sleep disorders and circadian rhythm sleep-wake disorders: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2018; 14(7):1231-1237.
  20. Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125-133.
  21. Mansfield D, Grima NA, Bei B. Insomnia management. Aust J Gen Pract. 2019; 48(4):198-202.
  22. National Institutes of Health. NIH State-of-the-Science Conference Statement on manifestations and management of chronic insomnia in adults. NIH Consens State Sci Statements. 2005;22(2):1-30.
  23. Cheong MJ, Lee GE, Kang HW, et al. Clinical effects of mindfulness meditation and cognitive behavioral therapy standardized for insomnia: a protocol for a systematic review and meta-analysis. Medicine (Baltimore). 2018;97(51): e13499.
  24. Ho FY, Chung KF, Yeung WF, et al. Self-help cognitive-behavioral therapy for insomnia: a meta-analysis of randomized controlled trials. Sleep Med Rev. 2015; 19:17-28.
  25. Ye YY, Chen NK, Chen J, et al. Internet-based cognitive-behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials. BMJ Open. 2016;6(11):e010707.
  26. Chesson AL Jr, Anderson WM, Littner M, et al. Practice parameters for the nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 1999;22(8):1128-1133.
  27. Morgenthaler TI, Deriy L, Heald JL, Thomas SM. The evolution of the AASM clinical practice guidelines: another step forward. J Clin Sleep Med. 2016;12(1): 129-135.
  28. Alessi C, Martin JL, Fiorentino L, et al. Cognitive behavioral therapy for insomnia in older veterans using nonclinician sleep coaches: randomized controlled trial. J Am Geriatr Soc. 2016;64(9):1830-1838.
  29. Arnedt JT, Cuddihy L, Swanson LM, Pickett S, Aikens J, Chervin RD. Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. Sleep. 2013;36(3):353-362.
  30. Currie SR, Clark S, Hodgins DC, El-Guebaly N. Randomized controlled trial of brief cognitive-behavioural interventions for insomnia in recovering alcoholics. Addiction. 2004;99(9):1121-1132.
  31. Edinger JD, Olsen MK, Stechuchak KM, et al. Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized clinical trial. Sleep. 2009;32(4):499-510.
  32. Edinger JD, Wohlgemuth WK, Radtke RA, Coffman CJ, Carney CE. Dose- response effects of cognitive-behavioral insomnia therapy: a randomized clinical trial. Sleep. 2007;30(2):203-212.
  33. Ellis JG, Cushing T, Germain A. Treating acute insomnia: a randomized controlled trial of a "single-shot" of cognitive behavioral therapy for insomnia. Sleep. 2015;38(6):971-978.
  34. Espie CA, MacMahon KM, Kelly HL, et al. Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice. Sleep. 2007;30(5):574-584.
  35. Harvey AG, Soehner AM, Kaplan KA, et al. Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: a pilot randomized controlled trial. J Consult Clin Psychol. 2015;83(3):564-577.
  36. Ho FY, Chung KF, Yeung WF, Ng TH, Cheng SK. Weekly brief phone support in self-help cognitive behavioral therapy for insomnia disorder: relevance to adherence and efficacy. Behav Res Ther. 2014;63:147-156.
  37. Hou Y, Hu P, Liang Y, Mo Z. Effects of cognitive behavioral therapy on insomnia of maintenance hemodialysis patients. Cell Biochem Biophys. 2014;69(3): 531-537.
  38. Irwin MR, Olmstead R, Carrillo C, et al. Cognitive behavioral therapy vs. Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial. Sleep. 2014;37(9):1543-1552.
  39. Jansson-Fröjmark M, Linton SJ, Flink IK, Granberg S, Danermark B, Norell- Clarke A. Cognitive-behavioral therapy for insomnia co-morbid with hearing impairment: a randomized controlled trial. J Clin Psychol Med Settings. 2012; 19(2):224-234.
  40. Jernelöv S, Lekander M, Blom K, et al. Efficacy of a behavioral self-help treatment with or without therapist guidance for co-morbid and primary insomnia-a randomized controlled trial. BMC Psychiatry. 2012;12(1):5.
  41. Lancee J, Eisma MC, van Straten A, Kamphuis JH. Sleep-related safety behaviors and dysfunctional beliefs mediate the efficacy of online CBT for insomnia: a randomized controlled trial. Cogn Behav Ther. 2015;44(5):406-422.
  42. Lancee J, van den Bout J, van Straten A, Spoormaker VI. Internet-delivered or mailed self-help treatment for insomnia? A randomized waiting-list controlled trial. Behav Res Ther. 2012;50(1):22-29.
  43. Lancee J, van Straten A, Morina N, Kaldo V, Kamphuis JH. Guided online or face-to-face cognitive behavioral treatment for insomnia: a randomized wait-list controlled trial. Sleep. 2016;39(1):183-191.
  44. Lovato N, Lack L, Wright H, Kennaway DJ. Evaluation of a brief treatment program of cognitive behavior therapy for insomnia in older adults. Sleep. 2014; 37(1):117-126.
  45. Morin CM, Beaulieu-Bonneau S, LeBlanc M, Savard J. Self-help treatment for insomnia: a randomized controlled trial. Sleep. 2005;28(10):1319-1327.
  46. Morin CM, Kowatch RA, Barry T, Walton E. Cognitive-behavior therapy for late- life insomnia. J Consult Clin Psychol. 1993;61(1):137-146.
  47. Rybarczyk B, Lopez M, Benson R, Alsten C, Stepanski E. Efficacy of two behavioral treatment programs for comorbid geriatric insomnia. Psychol Aging. 2002;17(2):288-298.
  48. Rybarczyk B, Lopez M, Schelble K, Stepanski E. Home-based video CBT for comorbid geriatric insomnia: a pilot study using secondary data analyses. Behav Sleep Med. 2005;3(3):158-175.
  49. Sandlund C, Hetta J, Nilsson GH, Ekstedt M, Westman J. Improving insomnia in primary care patients: a randomized controlled trial of nurse-led group treatment. Int J Nurs Stud. 2017;72:30-41.
  50. Savard J, Simard S, Ivers H, Morin CM. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. J Clin Oncol. 2005;23(25):6083-6096.
  51. Smith MT, Finan PH, Buenaver LF, et al. Cognitive-behavioral therapy for insomnia in knee osteoarthritis: a randomized, double-blind, active placebo- controlled clinical trial. Arthritis Rheumatol. 2015;67(5):1221-1233.
  52. Ström L, Pettersson R, Andersson G. Internet-based treatment for insomnia: a controlled evaluation. J Consult Clin Psychol. 2004;72(1):113-120.

Authors
Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., Sateia, M. J., Troxel, W. M., Zhou, E. S., Kazmi, U., Heald, J. L., & Martin, J. L.
Affiliations
  • National Jewish Health (US)
  • University of Michigan (US)
  • Brigham and Women's Hospital (US)
  • Toronto Metropolitan University (CA)
  • University of Nebraska Medical Center (US)
  • University of Alabama (US)
  • Dartmouth College (US)
  • RAND Corporation (US)
  • Boston Children's Hospital (US)
  • American Academy of Sleep Medicine (US)
  • University of California, Los Angeles (US)
ORCID
Venue
Journal of Clinical Sleep Medicine
Publisher
Springer Science and Business Media LLC
Published
2021-02
Volume
17
Issue
2
Pages
263-298
ISSN
  • 1550-9389 (ISSN-L)
  • 1550-9397
DOI
10.5664/jcsm.8988
PMC
PMC7853211
OpenAlex
W3102513748
Cited by
309
References
201
Citations by year
2026: 49 · 2025: 73 · 2024: 52 · 2023: 66 · 2022: 45 · 2021: 23 · 2020: 1
FWCI
4.91
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Sleep Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
chronic insomnia, behavioral sleep interventions, psychological intervention, cognitive behavioral therapy for insomnia, stimulus control, sleep restriction therapy, relaxation training, sleep hygiene, biofeedback, paradoxical intention, mindfulness, adults
MeSH terms
Academies and Institutes, GRADE Approach, Adult, Humans, Sleep Initiation and Maintenance Disorders, Sleep, United States, Cognitive Behavioral Therapy

About these checks

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.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review