Cognitive Behavioral Therapy vs. Tai Chi for Late Life Insomnia and Inflammatory Risk: A Randomized Controlled Comparative Efficacy Trial
Open accessAbstract
STUDY OBJECTIVES: To investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia. DESIGN: Randomized controlled, comparative efficacy trial. SETTING: Los Angeles community. PATIENTS: 123 older adults with chronic and primary insomnia. INTERVENTIONS: Random assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with follow-up at 7 and 16 months. MEASUREMENTS: Insomnia diagnosis, patient-reported outcomes, polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels. RESULTS: CBT performed better than TCC and SS in remission of clinical insomnia as ascertained by a clinician (P < 0.01), and also showed greater and more sustained improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than TCC and SS (all P values < 0.01). As compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (odds ratio [OR], 0.26 [95% CI, 0.07-0.97] P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC was associated with improvements in sleep quality, fatigue, and depressive symptoms as compared to SS (all P's < 0.05), but not insomnia remission. PSG measures did not change. CONCLUSIONS: Treatment of late-life insomnia is better achieved and sustained by cognitive behavioral therapies. Insomnia treatment and remission reduces a marker of inflammatory risk, which has implications for cardiovascular morbidity and diabetes observed with sleep disturbance in epidemiologic surveys.
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.
Integrity signals
Registry
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.
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?
A recent meta-analytic review concluded that sleep disturbances show a stronger association with inflammatory upregulation (CRP and IL-6) than short sleep duration.
“A recent meta-analytic review concluded that sleep disturbances show a stronger association with inflammatory upregulation (i.e., CRP and IL-6) than short sleep duration”
From The Sleep-Immune Crosstalk in Health and Disease (2019) · cites this paper as [259]
Inflammatory markers can be reduced when sleep problems are adequately treated.
“Initial findings demonstrate that these inflammatory markers can be reduced when sleep problems are adequately treated.”
From Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations (2025) · cites this paper as [79]
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 69 · Cited by 303
Research works printed but not linked: 12
- Morin CM, Vallieres A, Guay B, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA 2009;301:2005-15.
- Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia:update of the recent evidence (1998-2004). Sleep 2006;29:1398-414.
- Irwin MR, Wang M, Ribeiro D, et al. Sleep loss activates cellular inflammatory signaling. Biol Psychiatry 2008;64:538-40.
- Irwin MR, Wang M, Campomayor CO, Collado-Hidalgo A, Cole S. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med 2006;166:1756-62.
- Keefe FJ, Caldwell DS. Cognitive behavioral control of arthritis pain. Med Clin North Am 1997;81:277-90.
- Nofzinger EA, Buysse DJ, Germain A, Price JC, Miewald JM, Kupfer DJ. Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry 2004;161:2126-8.
- Morin CM, Rodrigue S, Ivers H. Role of stress, arousal, and coping skills in primary insomnia. Psychosom Med 2003;65:259-67.
- Bonnet MH, Arand DL. Hyperarousal and insomnia. Sleep Med Rev 1997;1:97-108.
- Nicassio P, Greenberg MA. The effectiveness of cognitive-behavioral and psychoeducational interventions in the management of arthritis. I. In: Weisman MH, Weinblatt M, Louie J, eds. Treatment of Rheumatic Diseases. Orlando: William Saunders, 2001:147-61.
- Smets E, Garssen B, Bonke B, De Haes JC. The multi-dimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 1995;39:315-25.
- Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-5.
- Rush AJ, Gullion CM, Basco MR, Jarrett RB, Trivedi MH. The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychol Med 1996;26:477-86.
- Authors
- Irwin, M. R., Olmstead, R., Carrillo, C., Sadeghi, N., Breen, E. C., Witarama, T., Yokomizo, M., Lavretsky, H., Carroll, J. E., Motivala, S. J., Bootzin, R., & Nicassio, P.
- Affiliations
- University of California, Los Angeles (US)
- University of Arizona (US)
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-09-01
- Volume
- 37
- Issue
- 9
- Pages
- 1543-1552
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC4153053
- OpenAlex
- W1973787487
- Cited by
- 303
- References
- 69
- Citations by year
- 2026: 23 · 2025: 29 · 2024: 27 · 2023: 28 · 2022: 26 · 2021: 31 · 2020: 29 · 2019: 25 · 2018: 26 · 2017: 16 · 2016: 19 · 2015: 17 · 2014: 6 · 2013: 1
- FWCI
- 26.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (P30AG028748)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- cognitive behavioral therapy, older adults, C-reactive protein, inflammation, sleep quality, fatigue, depressive symptoms, insomnia remission, cardiovascular risk
- MeSH terms
- Aged, Aged, 80 and over, C-Reactive Protein, Depression, Fatigue, Female, Humans, Inflammation, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Patient Education as Topic, Risk, Sleep, Los Angeles, Cognitive Behavioral Therapy, Treatment Outcome, Polysomnography, Tai Ji
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
