Is relaxation effective for treating insomnia amongst persons older than 55 years of age, as compared to no treatment?
Date of publication of the systematic review: January 2006
Design
Systematic review of 23 randomized controlled trials (RCTs).
Participants
Participants with primary insomnia. Number, exact age range and gender proportion of the participants were not reported by the reviewer.
Intervention
Relaxation-based therapy including progressive relaxation such as biofeedback and hypnosis. However, details about the intervention were not reported by the reviewers.
Comparator
Comparison: Relaxation versus control group which received no treatment.
Major Outcomes
Outcome 1: Sleep latency measured at the end of treatment;
Outcome 2: Total sleep time (TST) measured at the end of treatment;
Outcome 3: Wakening after sleep onset (WASO) measured at the end of treatment.
Settings
The reviewer did not state whether the included trials were conducted in inpatient or outpatient settings.
Comparison    Relaxation versus no treatment
Main Results
Compared to no treatment, relaxation showed a significant effect on improving sleep latency (mean effect size (ESM): -0.60, 95% CI: -0.88 to -0.33) and WASO (ESM: -0.35, 95% CI: -0.66 to -0.03). However, relaxation did not show significant effect on the improvement of TST (ESM: 0.07, 95% CI: -0.28 to 0.41).
Comparison: Relaxation versus control group receiving no treatments in persons older than 55 years of age
Outcomes No. of studies (Total no. of participants) Effect sizes /No. of participants Heterogeneity test (I2) ESM (95% CI) Overall quality of evidence*
Intervention Comparator
1 8 (not reported) Not reported Not reported Not reported -0.60 (-0.88 to −0.33) Moderate
2 4 (not reported) Not reported Not reported Not reported -0.07 (-0.28 to 0.41) Low
3 6 (not reported) Not reported Not reported Not reported -0.35 (-0.66 to -0.03) Moderate
Keys: ESM = mean effect size; CI = confidence interval.
Comparison    Relaxation versus no treatment
Main Results
Compared to no treatment, relaxation showed a significant effect on improving sleep latency (mean effect size (ESM): -0.60, 95% CI: -0.88 to -0.33) and WASO (ESM: -0.35, 95% CI: -0.66 to -0.03). However, relaxation did not show significant effect on the improvement of TST (ESM: 0.07, 95% CI: -0.28 to 0.41).
Comparison: Relaxation versus control group receiving no treatments in persons older than 55 years of age
Outcomes 1 2 3
No. of studies (Total no. of participants) 8 (not reported) 4 (not reported) 6 (not reported)
Effect sizes /No. of participants Intervention Not reported Not reported Not reported
Comparator Not reported Not reported Not reported
ESM (95% CI) -0.60 (-0.88 to −0.33) -0.07 (-0.28 to 0.41) -0.35 (-0.66 to -0.03)
Overall quality of evidence* Moderate Low Moderate
Keys: ESM = mean effect size; CI = confidence interval.
Conclusion
Benefits
Compared to no treatment, relaxation significantly improved sleep latency and WASO amongst persons older than 55 years of age. However, compared to no treatment, relaxation did not demonstrate beneficial effects on TST. For outcomes 1 and 3, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. For outcome 2, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse effect was reported by the reviewers.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/16448292
The synopsis is based on the following article:
Irwin MR, Cole JC, Nicassio PM. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol. 2006 Jan;25(1):3-14.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.