Self-help therapy for insomnia: A meta-analysis

Insomnia is a prevalent problem which often leads to a reduced quality of life and diminished work productivity. 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. We conducted a meta-analysis of randomized controlled studies examining the effects of self-help interventions for insomnia, identified through extensive searches of bibliographical databases. We 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 improve sleep efficiency (d = 0.42; p < 0.05), sleep onset latency (d = 0.29; p < 0.05), wake after sleep onset (d = 0.44; p < 0.05) and sleep quality (d = 0.33; p < 0.05) but not total sleep time (d = 0.02; p > 0.05). The sleep improvements were maintained over the longer term. Symptoms of anxiety and depression also decreased after self-help (d = 0.28; p < 0.05 and d = 0.51; p < 0.05, 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. 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.