It has been increasingly recognized that insomnia is a prevalent problem, which often leads to a reduced quality of life and diminished work productivity. Many insomniacs take pharmacological agents, which can become addictive, and only a minority of patients are treated with effective non-pharmacological therapies. A self-help intervention might offer an inexpensive and more accessible alternative to face-to-face treatment. van Straten and Cuijpers conducted a meta-analysis of randomized controlled studies that examined the effects of self-help interventions for insomnia, as identified through extensive searches of bibliographical databases. The authors examined the effects of self-help on different sleep outcomes, in comparison with both waiting lists controls and face-to-face treatments. Ten studies with a total of 1000 subjects were included. The intervention did significantly improve sleep efficiency, sleep onset latency, wake after sleep onset, and sleep quality. There was no improvement in total sleep time. The sleep improvements were maintained over the longer term. Symptoms of anxiety and depression also decreased after self-help, respectively. Although based on a very limited number of studies, the face-to-face treatments did not show statistically significant superiority to the self-help treatments. The effect sizes associated with self-help treatments might be overestimated due to publication bias.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The effects of self-help treatments are small to moderate. Nevertheless, they might constitute a useful addition to existing treatment options especially when integrated in a stepped care approach.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: From time to time, we all experience insomnia. If you have the problem on a regular basis, it would be worthwhile to seek treatment via non-pharmacological approaches. These techniques, such as relaxation therapy with or without biofeedback, can help you sleep without relying upon expensive pharmacological assistance. You also won’t have to worry about becoming reliant upon the latter.

A van Straten, P Cuijpers. Self-help therapy for insomnia: A meta-analysis. Sleep Medicine Review, October 25, 2008.