Sleep hygiene education as a treatment of insomnia: A systematic review and meta-analysis

Ka Fai Chung, Chit Tat Lee, Wing Fai Yeung, Man Sum Chan, Emily Wing Yue Chung, Wai Ling Lin

Research output: Journal article publicationJournal articleAcademic researchpeer-review

143 Citations (Scopus)


Background. Sleep hygiene education (SHE) is commonly used as a treatment of insomnia in general practice. Whether SHE or cognitive-behavioural therapy for insomnia (CBT-I), a treatment with stronger evidence base, should be provided first remains unclear. Objective. To review the efficacy of SHE for poor sleep or insomnia. Methods. We systematically searched six key electronic databases up until May 2017. Two researchers independently selected relevant publications, extracted data and evaluated methodological quality according to the Cochrane criteria. Results. Twelve of 15 studies compared SHE with CBT-I, three with mindfulness-based therapy, but none with sham or no treatment. General knowledge about sleep, substance use, regular exercise and bedroom arrangement were commonly covered; sleep-wake regularity and avoidance of daytime naps in seven programs, but stress management in only five programs. Major findings include (i) there were significant pre- to post-treatment improvements following SHE, with small to medium effect size; (ii) SHE was significantly less efficacious than CBT-I, with difference in effect size ranging from medium to large; (iii) pre- to post-treatment improvement and SHE-CBT-I difference averaged at 5% and 8% in sleep-diary-derived sleep efficiency, respectively, and two points in Pittsburgh Sleep Quality Index; (iv) only subjective measures were significant and (v) no data on acceptability, adherence, understanding and cost-effectiveness. Conclusions. Although SHE is less effective than CBT-I, unanswered methodological and implementation issues prevent a firm conclusion to be made on whether SHE has a role in a stepped-care model for insomnia in primary care.

Original languageEnglish
Pages (from-to)365-375
Number of pages11
JournalFamily Practice
Issue number4
Publication statusPublished - 1 Jan 2018


  • Cognitive-behavioural therapy
  • Insomnia
  • Meta-analysis
  • Psychological intervention
  • Sleep hygiene education
  • Systematic review

ASJC Scopus subject areas

  • Family Practice


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