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Sleep Med Rev. 2015 Oct;23:20-7. doi: 10.1016/j.smrv.2014.11.002. Epub 2014 Nov 18.

Behavioral economics strategies for promoting adherence to sleep interventions.

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Nationwide Children's Hospital, The Ohio State University Department of Pediatrics, 700 Children's Drive, JWest 4th Floor, Columbus, OH 43205, USA. Electronic address:


Cognitive-behavioral treatment for insomnia and continuous positive airway pressure therapy for obstructive sleep apnea are among the most efficacious sleep interventions. Unfortunately, adherence levels are disappointingly low for these interventions. Behavioral economics offers a promising framework for promoting adherence, often through relatively brief and straightforward strategies. The assumptions, goals, and key strategies of behavioral economics will be introduced. These strategies include providing social norms information, changing defaults, using the compromise effect, utilizing commitment devices, and establishing lottery-based systems. Then, this review will highlight specific behavioral economic approaches to promote patient adherence for three major sleep interventions: 1) behavioral treatment for pediatric insomnia, 2) cognitive-behavioral treatment for adult insomnia, and 3) continuous positive airway pressure for obstructive sleep apnea. Next, behavioral economic strategies will be discussed as ways to improve health care provider adherence to clinical practice guidelines regarding appropriate prescribing of hypnotics and ordering sleep-promoting practices for hospitalized inpatients. Finally, possible concerns that readers may have about behavioral economics strategies, including their efficacy, feasibility, and sustainability, will be addressed.


Behavioral economics; Cognitive behavioral therapy; Continuous positive airway pressure; Sleep

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