Telephone-Guided Sleep Restriction for Insomnia: A Randomized Sleep Diary-Controlled Trial
Abstract
Abstract Introduction: Insomnia is common, but access to its first-line treatment, cognitive behavioral therapy for insomnia (CBT-I), is limited. To explore a scalable alternative, we investigated the efficacy of sleep restriction therapy (SRT), a core component of CBT-I, delivered via telephone. Methods: In a randomized controlled trial, 147 adults with insomnia were allocated to 6 weeks of telephone-guided SRT (n = 76) or a sleep diary control group (n = 71). The SRT group received weekly supporting phone calls lasting 10–15 min. At baseline and posttest, we measured insomnia severity (primary outcome), sleep diary measures, anxiety symptoms, depressive symptoms, presleep arousal, sleep-safety behaviors, daytime sleepiness, and dysfunctional sleep-related cognitions (secondary outcomes). The SRT group repeated these measures at 3- and 6-month follow-ups. Results: Telephone-guided SRT showed large between-group effects on insomnia severity at posttest relative to the sleep diary control group (d = 1.52; p < 0.001). Based on intention-to-treat, 36 (47%) participants randomized to SRT achieved clinical improvement, and 23 (30%) achieved insomnia remission. We found medium-to-large between-group effects at posttest (d = 0.53–1.18) for all secondary outcomes except daytime sleepiness and total sleep time. At 3- and 6-month follow-ups, the primary and all secondary outcomes, including daytime sleepiness and total sleep time, improved relative to baseline within the SRT group (d…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 147 participants or records.
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