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Fam Pract. 2018 Jul 23;35(4):365-375. doi: 10.1093/fampra/cmx122.

Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis.

Author information

1
Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China.
2
Department of Psychiatry, Queen Mary Hospital, Hong Kong SAR, China.
3
School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China.
4
Maternal Mental Health, Waitemata District Health Board, Takapuna, Auckland, New Zealand.
5
Chinese University of Hong Kong, Hong Kong SAR, China.
6
Hong Kong Institute of Integrative Medicine, Chinese University of Hong Kong, Hong Kong SAR, China.

Abstract

Background:

Sleep hygiene education (SHE) is commonly used as a treatment of insomnia in general practice. Whether SHE or cognitive-behavioural therapy for insomnia (CBT-I), a treatment with stronger evidence base, should be provided first remains unclear.

Objective:

To review the efficacy of SHE for poor sleep or insomnia.

Methods:

We systematically searched six key electronic databases up until May 2017. Two researchers independently selected relevant publications, extracted data and evaluated methodological quality according to the Cochrane criteria.

Results:

Twelve of 15 studies compared SHE with CBT-I, three with mindfulness-based therapy, but none with sham or no treatment. General knowledge about sleep, substance use, regular exercise and bedroom arrangement were commonly covered; sleep-wake regularity and avoidance of daytime naps in seven programs, but stress management in only five programs. Major findings include (i) there were significant pre- to post-treatment improvements following SHE, with small to medium effect size; (ii) SHE was significantly less efficacious than CBT-I, with difference in effect size ranging from medium to large; (iii) pre- to post-treatment improvement and SHE-CBT-I difference averaged at 5% and 8% in sleep-diary-derived sleep efficiency, respectively, and two points in Pittsburgh Sleep Quality Index; (iv) only subjective measures were significant and (v) no data on acceptability, adherence, understanding and cost-effectiveness.

Conclusions:

Although SHE is less effective than CBT-I, unanswered methodological and implementation issues prevent a firm conclusion to be made on whether SHE has a role in a stepped-care model for insomnia in primary care.

PMID:
29194467
DOI:
10.1093/fampra/cmx122

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