Evidence-Based Reviews

Cognitive-behavioral therapy for insomnia: A review of 8 studies

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  • CBT-I was effective for insomnia regardless of circadian preference.
  • A smaller reduction in depression scores was noted in participants with greater evening preference.
  • Depression outcomes were better among participants with evening preference if they were assigned to CBT-I vs control therapy.
  • The control therapy (sleep education) was particularly ineffective in reducing depression symptoms in participants with evening preference.


  • Individuals with MDD and insomnia and an evening preference are at an increased risk for poor response to antidepressants alone.
  • Outcomes for both depression and insomnia improve if CBT-I is combined with antidepressants.
  • Offering sleep education alone is not sufficient.

5. Drake CL, Kalmbach DA, Arnedt JT, et al. Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. Sleep. 2019;42(2):zsy217. doi: 10.1093/sleep/zsy217.

Postmenopausal women with sleep disturbances experience higher medical and psychiatric comorbidities, and have higher alcohol consumption and stress levels than postmenopausal women with good sleep. Nonpharmacologic insomnia treatments with durable effects are imperative for postmenopausal women because they are safer than pharmacologic approaches. Although CBT-I is the recommended first-line treatment for chronic insomnia, its application in menopause-related insomnia is limited. Drake et al13 evaluated the efficacy of CBT-I in menopause-related insomnia compared with sleep restriction therapy (SRT) and sleep hygiene education (SHE).

Study design

  • This RCT was conducted at a health system with 6 hospitals in Michigan.
  • Postmenopausal women who met DSM-5 criteria for chronic insomnia disorder (n = 150) were randomized into 1 of 3 groups: SHE, SRT, or CBT-I.
  • Primary outcome measures were ISI scores and sleep diaries that documented multiple sleep parameters, including sleep onset latency, wake time after sleep onset, number of awakenings in the middle of the night, time in bed, total sleep time, and sleep efficiency. These were measured at baseline, after completion of treatment, and 6 months after treatment.

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