Network Meta-Analysis Ranks Best Non-Drug Sleep Interventions for Older Adults
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TL;DR
CBT-I ranks #1 (PSQI -4.8), combined aerobic+resistance exercise #2 (-3.9), and MBSR #3 (-3.5) for improving sleep in adults 60+, based on 89 RCTs with 7,236 participants.
Background
With over 50% of older adults reporting sleep problems, non-pharmacological interventions are increasingly preferred over sleep medications due to side effect concerns. However, the relative effectiveness of different interventions has been unclear — until now.
Key Findings
The University of Melbourne-led network meta-analysis included 89 RCTs with 7,236 participants aged 60+.
| Rank | Intervention | PSQI Improvement | Evidence Quality |
|---|---|---|---|
| 1 | CBT-I | -4.8 | High |
| 2 | Aerobic + Resistance Exercise | -3.9 | Moderate-High |
| 3 | MBSR | -3.5 | Moderate |
| 4 | Yoga | -3.2 | Moderate |
| 5 | Tai Chi | -2.9 | Moderate |
| 6 | Aerobic Exercise (alone) | -2.7 | Moderate-High |
Differential Effects
- Sleep onset: CBT-I > Mindfulness > Yoga > Aerobic
- Sleep maintenance: Combined Exercise > CBT-I > Tai Chi
- Deep sleep: Aerobic > Yoga > Tai Chi > CBT-I
Clinical Implications
- CBT-I as first-line for all insomnia types in older adults
- Afternoon exercise (4-6 PM) promotes 18% more deep sleep than morning
- Combined interventions yield 1.8× the effect of single approaches
References
Frequently Asked Questions
Many digital CBT-I programs (Sleepio, CBT-I Coach) show similar effectiveness. Exercise and mindfulness are excellent alternatives available to most people.