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

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.

Negative impact of COVID-19 pandemic on sleep quantitative parameters, quality, and circadian alignment: Implications for health and psychological well-being

“…This calls for targeted interventions for improving sleep parameters, and prevention of associated psychological consequences. Available interventions for improving sleep health are stress management and relaxation practice, stimulus control, sleep hygiene, and exercise (Murawski et al, 2018[ 28 ]). These interventions are feasible for home practicing during the COVID-19 crisis when treatment-seeking is not possible.…”

“…The PSQI is a widely used 19-item self-report questionnaire for measuring sleep disturbances and healthy sleep (Buysse et al, 1989[ 10 ]; Backhaus et al, 2002[ 4 ]; Murawski et al, 2018[ 28 ]). It includes seven clinically derived domains of sleep difficulties, including sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction.…”

Right care, first time: a highly personalised and measurement‐based care model to manage youth mental health

“…Cognitive behaviour therapy or behavioural regulation therapy focusing on sleep–wake behaviour and resynchronisation of circadian rhythms are two key first line treatments which aim to encourage behaviour that boosts circadian synchrony . These therapies encourage a range of behaviours including appropriate timing of meals, engagement in physical activity, adequate exposure to light (particularly morning light), minimisation of intake of caffeine, alcohol and other substances during the evening, and timing of sleep onset and offset …”

Metabolic health and lifestyle medicine should be a cornerstone of future pandemic preparedness

“…[78][79][80][81][82] Lifestyle medicine also has significant scope to improve sleep quantity and quality, both of which are associated with immune function and overall mortality. [83][84][85][86] Initiatives such as group consultations and social prescribing can even help to tackle loneliness and social isolation, which are associated with both altered inflammatory processes and increased mortality. [87][88][89] The majority of lifestyle medicine interventions can also be implemented and tracked using simple telemedicine and digital health solutions.…”