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Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review

Matthew D Mitchell1*, Philip Gehrman23, Michael Perlis23 and Craig A Umscheid1456

Author Affiliations

1 Center for Evidence-based Practice, University of Pennsylvania Health System, 3535 Market St. Mezzanine Suite 50, Philadelphia, PA 19104, USA

2 Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Suite 670, Philadelphia, PA 19104, USA

3 Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, 3624 Market St., Philadelphia, PA 19104, USA

4 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Blockley Hall, 423 Guardian Dr., Philadelphia, PA 19104, USA

5 Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St., Philadelphia, PA 19104, USA

6 Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104, USA

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BMC Family Practice 2012, 13:40  doi:10.1186/1471-2296-13-40

Published: 25 May 2012



Insomnia is common in primary care, can persist after co-morbid conditions are treated, and may require long-term medication treatment. A potential alternative to medications is cognitive behavioral therapy for insomnia (CBT-I).


In accordance with PRISMA guidelines, we systematically reviewed MEDLINE, EMBASE, the Cochrane Central Register, and PsycINFO for randomized controlled trials (RCTs) comparing CBT-I to any prescription or non-prescription medication in patients with primary or comorbid insomnia. Trials had to report quantitative sleep outcomes (e.g. sleep latency) in order to be included in the analysis. Extracted results included quantitative sleep outcomes, as well as psychological outcomes and adverse effects when available. Evidence base quality was assessed using GRADE.


Five studies met criteria for analysis. Low to moderate grade evidence suggests CBT-I has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term, while very low grade evidence suggests benzodiazepines are more effective in the short term. Very low grade evidence supports use of CBT-I to improve psychological outcomes.


CBT-I is effective for treating insomnia when compared with medications, and its effects may be more durable than medications. Primary care providers should consider CBT-I as a first-line treatment option for insomnia.

Insomnia; Sleep; Behavior therapy; Cognitive therapy; Hypnotics and sedatives