Behavioral interventions as treatment for insomnia - A scoping review of randomized controlled trials

To map behavioral interventions evaluated as a potential treatment for insomnia in previous randomized controlled trials (RCTs) through a scoping review.

A bibliographic search was performed to gather RCTs evaluating behavioral interventions for insomnia, either diagnosed according to standardized criteria or limited to moderate to severe symptoms. Behavioral interventions included should be: 1. Focused on modifying behaviors that affect sleep, 2. Self-implementable, 3. Suitable for home implementation, and 4. Not depending on or using cognitive/emotional processes. Behavioral interventions were categorized as "increasing/engaging", "reducing/avoiding", and "adjusting/modifying" behaviors.

Forty-nine RCTs were included, with an average of 1.8 RCTs per year and peak publication record in 2015 and 2023 (k = 6 each). Adjusting/modifying behavior interventions were the most frequent (k = 32, 65.3 %), followed by increasing/engaging behaviors (k = 18, 36.7 %). Among individual interventions, multi-component behavioral therapy with sleep restriction was the most common (k = 17, 34.7 %), followed by sleep restriction alone (k = 9, 18.4 %), yoga and tai chi (k = 6, 12.2 %) and physical exercise (k = 6, 12.2 %). Another nine interventions were listed, with one to four RCTs each.

Despite the ubiquity of advice to practice good sleep hygiene to improve sleep quality, these findings highlight the need for high-quality randomised trials examining which behavioural interventions lead to improved sleep, as many currently being recommended do not have an adequate evidence base.