Cognitive Behavioral Therapy vs. Tai Chi for Late Life Insomnia and Inflammatory Risk: A Randomized Controlled Comparative Efficacy Trial

TLDR

To compare the efficacy of cognitive behavioral therapy, Tai Chi Chih, and sleep seminar education on insomnia and related outcomes in older adults. The randomized controlled trial enrolled 123 older adults with chronic insomnia, assigning them to 4‑month weekly 2‑hour group sessions of CBT, TCC, or SS, and measured insomnia diagnosis, sleep quality, fatigue, depressive symptoms, polysomnography, and high‑sensitivity C‑reactive protein at baseline, 7‑month, and 16‑month follow‑ups. CBT achieved superior and sustained remission of insomnia, greater improvements in sleep quality, fatigue, and depressive symptoms, and a lower risk of elevated CRP at 16 months compared with TCC and SS, while TCC improved some symptoms but not insomnia remission and PSG measures remained unchanged.

Abstract

To investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia.Randomized controlled, comparative efficacy trial.Los Angeles community.123 older adults with chronic and primary insomnia.Random assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with follow-up at 7 and 16 months.Insomnia diagnosis, patient-reported outcomes, polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels.CBT performed better than TCC and SS in remission of clinical insomnia as ascertained by a clinician (P < 0.01), and also showed greater and more sustained improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than TCC and SS (all P values < 0.01). As compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (odds ratio [OR], 0.26 [95% CI, 0.07-0.97] P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC was associated with improvements in sleep quality, fatigue, and depressive symptoms as compared to SS (all P's < 0.05), but not insomnia remission. PSG measures did not change.Treatment of late-life insomnia is better achieved and sustained by cognitive behavioral therapies. Insomnia treatment and remission reduces a marker of inflammatory risk, which has implications for cardiovascular morbidity and diabetes observed with sleep disturbance in epidemiologic surveys.