title: Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Because psychological approaches are likely to produce sustained benefits without the risk for tolerance or adverse effects associated with pharmacologic approaches, cognitive behavioral therapy for insomnia (CBT-i) is now commonly recommended as first-line treatment for chronic insomnia.
  
  
  OBJECTIVE
  To determine the efficacy of CBT-i on diary measures of overnight sleep in adults with chronic insomnia.
  
  
  METHODS
  Searches of MEDLINE, EMBASE, PsycINFO, CINAHL, the Cochrane Library, and PubMed Clinical Queries from inception to 31 March 2015, supplemented with manual screening.
  
  
  METHODS
  Randomized, controlled trials assessing the efficacy of face-to-face, multimodal CBT-i compared with inactive comparators on overnight sleep in adults with chronic insomnia. Studies of insomnia comorbid with medical, sleep, or psychiatric disorders were excluded.
  
  
  METHODS
  Study characteristics, quality, and data were assessed independently by 2 reviewers. Main outcome measures were sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE%).
  
  
  RESULTS
  Among 292 citations and 91 full-text articles reviewed, 20 studies (1162 participants [64% female; mean age, 56 years]) were included. Approaches to CBT-i incorporated at least 3 of the following: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. At the posttreatment time point, SOL improved by 19.03 (95% CI, 14.12 to 23.93) minutes, WASO improved by 26.00 (CI, 15.48 to 36.52) minutes, TST improved by 7.61 (CI, -0.51 to 15.74) minutes, and SE% improved by 9.91% (CI, 8.09% to 11.73%). Changes seemed to be sustained at later time points. No adverse outcomes were reported.
  
  
  CONCLUSIONS
  Narrow inclusion criteria limited applicability to patients with comorbid insomnia and other sleep problems, and accuracy of estimates at later time points was less clear.
  
  
  CONCLUSIONS
  CBT-i is an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes.
  
  
  BACKGROUND
  None. (PROSPERO registration number: CRD42012002863).
authors.forename: James M
authors.initials: JM
authors.lastname: Trauer
authors.forename: Mary Y
authors.initials: MY
authors.lastname: Qian
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Doyle
authors.forename: Shantha M W
authors.initials: SM
authors.lastname: Rajaratnam
authors.forename: David
authors.initials: D
authors.lastname: Cunnington
mesh_terms: D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D006801:Humans; D012064:Relaxation Therapy; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology / Q000628:therapy*; D013997:Time Factors