Advanced SearchSearch Tips
Effects of Non-pharmacological Interventions on Primary Insomnia in Adults Aged 55 and Above: A Meta-analysis
facebook(new window)  Pirnt(new window) E-mail(new window) Excel Download
  • Journal title : Korean Journal of Adult Nursing
  • Volume 28, Issue 1,  2016, pp.13-29
  • Publisher : Korean Society of Adult Nursing
  • DOI : 10.7475/kjan.2016.28.1.13
 Title & Authors
Effects of Non-pharmacological Interventions on Primary Insomnia in Adults Aged 55 and Above: A Meta-analysis
Kim, Ji Hyun; Oh, Pok Ja;
  PDF(new window)
Purpose: This study was performed to evaluate the effects of non-pharmacological interventions on sleep disturbance amongst adults aged 55 and above. Methods: PubMed, Cochrane Library, EMBASE, CINAHL and several Korean databases were searched. The main search strategy combined terms including non-pharmacological interventions and presence of insomnia. Non-pharmacological interventions included cognitive behavioral therapy, auricular acupuncture, aromatherapy, and emotional freedom techniques. Methodological quality was assessed using Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non randomized studies. Data were analyzed by the RevMan 5.3 program of Cochrane Library. Results: Sixteen clinical trials met the inclusion criteria with a total of 962 participants. Non-pharmacological interventions was conducted for a mean of 5.5 weeks, 7.7 sessions, and an average of 70 minutes per session. The effects of non-pharmacological interventions on sleep quality (ES=-1.18), sleep efficiency (ES=-1.14), sleep onset latency (ES=-0.88), awakening time after sleep onset (ES=-0.87), and sleep belief (ES=-0.71) were significant, and their effect sizes were ranged from moderate to large. However, the effects on total sleep time and insomnia severity were not significant. Conclusion: The findings of the current study suggest that non-pharmacological interventions have a positive impact on attitudes and beliefs about sleep, sleep quality, sleep duration, and sleep efficiency. Therefore, the findings of the study provide an evidence to incorporate various non-pharmacological interventions into nursing practice to improve both sleep quality and quantity in patients with insomnia.
Sleep initiation and maintenance disorders;Intervention studies;Aged;Meta-analysis;
 Cited by
Kwon KH, Suh SR, Suh BD. Sleep patterns and factors influencing sleep in institutionalized elders and elders living at home. Journal of Korean Gerontological Nursing. 2010;12: 131-41.

Basta M, Chrousos GP, Vela-Bueno A, Vgontzas AN. Chronic insomnia and stress system. Sleep Medicine Clinics. 2007;2: 279-91. crossref(new window)

Jun SS, Ha SJ. Sleep disorder experience in older patients with depression. Journal of Korean Academy of Nursing. 2014;44 (3):270-9. crossref(new window)

Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. British Medical Journal. 2005;331 (11):69-75. crossref(new window)

Stepanski EJ. Hypnotics should not be considered for the initial treatment of chronic insomnia. Con. Journal of Clinical Sleep Medicine. 2005;1(2):125-8.

Espie CA. Insomnia: conceptual issues in the development, persistence, and treatment of sleep disorder in adult. The Annual Review of Clinical Psychology. 2002;53:214-43. crossref(new window)

Koo YJ, Koh HJ. Analysis of intervention research about sleep of the elderly in Korea. Keimyung Journal of Nursing Science. 2009;13(1):63-71.

Jaffe S, Patterson DR. Treating sleep problems in patients with burn injuries: practical considerations. Journal of Burn Care & Rehabilitation. 2004;25(3):294-305. crossref(new window)

Wang MY, Wang SY, Tsai PS. Cognitive behavioural therapy for primary insomnia: a systematic review. Journal of Advanced Nursing. 2005;50(5):553-64. crossref(new window)

De Niet GJ, Tiemens BG, Kloos MW, Hutschemaekers GJ. Review of systematic reviews about the efficacy of non-pharmacological interventions to improve sleep quality in insomnia. International Journal of Evidence-Based Healthcare. 2009;7(4):233-42. crossref(new window)

Montgomery P, Dennis JA. Cognitive behavioural interventions for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews. 2003;1 CD003161. crossref(new window)

Okajima I, Komada Y, Inoue Y. A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep and Biological Rhythms. 2011; 9(1):24-34. crossref(new window)

Cheng SK, Dizon J. Computerised cognitive behavioural therapy for insomnia: a systematic review and meta-analysis. Psychotherapy and Psychosomatics. 2012; 81(4):206-16. crossref(new window)

Kim SY, Park JE, Seo HJ, Seo HS, Song HJ, Shin CM, et al. NECA's guidance for undertaking systematic reviews and meta-analyses for intervention. Seoul: National Evidencebased Healthcare Collaborating Agency. 2011.

Higgins JP, Green S. (Eds). Cochrane handbook for systematic reviews of interventions, version 5.1.0. [updated March 2011]. The Cochrane Collaboration, Available from:

Cohen, J. Statistical power analysis for the behavioral sciences, 2nd ed. Hillsdale, NJ, Lawrence Erlbaum Associates. 1998.

Lee J. Meta-analysis, Journal of Korean Endocrine Society. 2008;23(6):361-78. crossref(new window)

Oh SS. Meta-analysis: theory and practice. Seoul, Konkuk University Press. 2002.

Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep. 2006; 29(11):1398-414.

Smith MT, Perlis ML, Park A, Smith MS, Pennington J, Giles DE, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. The American Journal of Psychiatry. 2002;159:5-11. crossref(new window)

Harvey L, Inglis SJ, Espie CA. Insomnias' reported use of CBT components and relationship to long-term clinical outcome. Behaviour Research and Therapy. 2002;40:75-83. crossref(new window)

Vincent N, Lionberg C. Treatment preference and patient satisfaction in chronic insomnia. Sleep. 2001:24:411-7.

Oh PJ, Jang ES. Effects of psychosocial interventions on cortisol and immune parameters in patients with cancer: a metaanalysis, Journal of Korean Academy of Nursing. 2014:44(4): 446-57. crossref(new window)

Goedendrop MM, Gielissen MF, Verhagen CA, Bleijenberg G. Psychosocial interventions for reducing fatigue during cancer treatment in adults. The Cochrane Database of Systematic Reviews. 2009;1 CD006953. crossref(new window)

Morin CM, Culbert JP, Schwartz SM. Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. The American Journal of Psychiatry. 1994;151(8):1172-80. crossref(new window)

Sok SH, Kim KB. Effects of auricular acupuncture on insomnia in Korean elderly. Journal of Korean Academy of Nursing. 2005;35(6):1014-24.

Kamel NS, Gammack JK. Insomnia in the elderly: cause, approach, and treatment. The American Journal of Medicine. 2006;119(6):463-9. crossref(new window)

Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine. 2008; 4:487-504.

Kwon KH. The development of measurement tool of sleep quality of the elderly [dissertation]. Daegu, Kyungpook National University. 2009:1-75.

Morin CM, Blais F, Savard J. Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia? Behaviour Research and Therapy. 2002;40:741-52. crossref(new window)