Comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combination for the treatment of adult insomnia: A systematic review and network meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials
PubMed 36027795 · doi:10.1016/j.smrv.2022.101687
What was done
Systematic review and network meta-analysis of randomized controlled trials searching MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and ClinicalTrials.gov. The review included trials directly comparing psychotherapy, pharmacotherapy, or combination treatments for adult insomnia against each other or monotherapies (23 RCTs included; 18 evaluated cognitive behavior therapy for insomnia [CBT-I]).
What was found
The abstract reports directional outcomes without quantitative effect sizes, confidence intervals, or p-values. At post-treatment, CBT-I monotherapy showed higher subjective sleep efficiency (SE), lower subjective wake time after sleep onset (WASO), and lower Insomnia Severity Index (ISI) scores compared to pharmacotherapy. Compared with combined CBT-I plus pharmacotherapy, pharmacotherapy monotherapy resulted in lower subjective SE, higher subjective sleep latency (SL), higher polysomnography-measured SL, higher subjective WASO, and higher ISI scores.
Why it matters
This review synthesizes head-to-head and combination trials of the primary clinical modalities for adult insomnia, supporting guidelines that favor CBT-I alone or in combination over medication monotherapy.
Limits
The abstract does not report numerical effect sizes, confidence intervals, or total participant sample size. Specific pharmacotherapy classes, CBT-I delivery formats, and acceptability metrics mentioned in the objective were omitted from the abstract findings, and long-term durability beyond post-treatment was not described.
Cited by
- supports Cognitive behavioral therapy for insomnia (CBT-I) is as effective as sleeping pills in the short term and more efficacious in the long term, with sustained sleep benefits after therapy concludes.