A systematic review and meta-analysis of cognitive and behavioral interventions to improve sleep health in adults without sleep disorders

Summary & key facts

Researchers looked at studies testing talking-and-behavior programs to help adults who sleep poorly but do not have a diagnosed sleep disorder. They searched thousands of papers and included 11 studies. Overall, these programs produced a medium-sized improvement in sleep quality. The benefit varied depending on how poor people’s sleep was at the start. Common parts of the programs were stress management or relaxation, rules about bedtime habits, practical sleep rules, and exercise. The evidence is promising but comes from a small number of studies with some differences between them, so results are not certain for everyone.

Key facts:

• The review searched many scientific databases and screened about 18,000 records, then read about 600 full papers before including 11 studies that fit the rules.
• Seven of the included studies used the same standard questionnaire to measure overall sleep quality.
• When the results were combined, the interventions had a medium effect on improving sleep quality compared with control groups.
• The statistical summary showed some uncertainty: the range of likely effects went from a fairly small benefit to a stronger benefit, which means the size of the benefit varied across studies.
• How well people slept before starting the program was the only factor that significantly changed how much they benefited, which means initial sleep status mattered.
• The most common parts of the programs were stress management and relaxation, changing cues and routines around bed (called stimulus control), basic sleep rules (sleep hygiene), and exercise.
• The review only included adults aged about 18 to 64 and only papers in English, so the findings do not automatically apply to older adults or non-English studies.
• Because there were only 11 studies and they used different methods, the authors said the evidence is promising but still limited and should be interpreted cautiously.

Abstract

Many adults without a diagnosed sleep disorder report poor sleep health, which is defined by dissatisfactory levels of sleep duration, sleep quality, or the timing of sleep. No previous review has summarized and described interventions targeting poor sleep health in this population. This meta-analysis aimed to quantify the efficacy of behavioral and cognitive sleep interventions in adults with poor sleep health, who do not have a sleep disorder. Electronic databases (Medline, Embase, PsycInfo, Cinahl) were searched with restrictions for age (18-64 y) and English language full-text, resulting in 18,009 records being screened and 592 full-texts being assessed. Eleven studies met inclusion criteria, seven of which reported a measure of overall sleep health (Pittsburgh sleep quality index [PSQI]). Following appraisal for risk of bias, extracted data were meta-analyzed using random-effects models. Meta-analyses showed interventions had a medium effect on sleep quality (Hedge's g = -0.54, [95% confidence interval (CI)] -0.90 to -0.19, p < 0.01). Baseline sleep health was the only significant effect moderator (p = 0.01). The most frequently used intervention components were stress management and relaxation practice, stimulus control, sleep hygiene, and exercise. Interventions targeting cognitive and behavioral self-regulation improve sleep quality in adults without clinical sleep disorder.

Topics

Restless Legs Syndrome Research Sleep and related disorders Sleep and Wakefulness Research

Categories

Experimental and Cognitive Psychology Psychology Social Sciences

Tags

Clinical psychology Cognition Computer science Environmental health Insomnia Internal medicine Medicine Meta-analysis Operating system Physical therapy Pittsburgh Sleep Quality Index Population Psychiatry Psychological intervention Sleep (system call) Sleep disorder Sleep hygiene Sleep onset Sleep onset latency Sleep quality

Conditions & symptoms

Sleep disorder Poor sleep