Cognitive behavioral therapy vs. Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial.
Level 2 - randomized trial
Individual randomized controlled comparative efficacy trial
PubMed 25142571 · doi:10.5665/sleep.4008
What was done
Randomized controlled comparative efficacy trial of 123 older adults in the Los Angeles community with chronic and primary insomnia. Participants were randomly assigned to cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), or a sleep seminar education control (SS) for 2-hour weekly group sessions over 4 months, with follow-up at 7 and 16 months. Outcomes measured were clinician-ascertained insomnia diagnosis, patient-reported outcomes (sleep quality, fatigue, depressive symptoms), polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels.
What was found
CBT led to significantly greater remission of clinical insomnia compared to TCC and SS (P < 0.01), as well as greater and more sustained improvements in sleep quality, sleep parameters, fatigue, and depressive symptoms (all P < 0.01). Compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (OR 0.26, 95% CI 0.07-0.97, P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC improved sleep quality, fatigue, and depressive symptoms compared to SS (all P < 0.05), but not insomnia remission. PSG measures did not change in any group.
Why it matters
Behavioral treatment of late-life insomnia achieves sustained clinical remission and reduces systemic inflammatory risk markers relevant to cardiovascular disease and diabetes.
Limits
The sample size was modest (n = 123) and drawn from a single community. Objective polysomnography measures did not change despite clinical and self-reported improvements. Specific baseline CRP levels, attrition rates, and demographic details are not provided in the abstract.
Cited by
- supports A randomized study comparing CBT-I, tai chi, and a sleep seminar showed that CBT-I led to the largest reductions in hs-CRP and improvements in sleep lasting up to 16 months.