Polysomnography and Diary-Measured Sleep Duration and Responsiveness to Cognitive Behavioral Therapy for Insomnia: A Chart-Review

Behav Sleep Med. 2025 Oct 5:1-14. doi: 10.1080/15402002.2025.2569364. Online ahead of print.

ABSTRACT

OBJECTIVES: Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia. However, patients with objective short sleep duration may show a reduced response to CBT-I and require alternative or additional treatment.This study investigated the effect of objective and subjective short sleep duration before treatment on response to CBT-I in patients with chronic insomnia.

METHODS: We analyzed chart-review data from 446 patients with chronic insomnia (66.6% female, age M = 51.6 ± 15.6 years) treated with a 5-6 session CBT-I program in a sleep clinic. Short sleep duration was assessed from single-night polysomnography ( < 6 h:n = 254; ≥6 h:n = 178) and oneweek of sleep diaries ( < 6 h:n = 229; ≥6 h:n = 124). Mixed models tested for differences between sleep duration groups on changes in sleepdiary outcomes and daytime functioning questionnaires at post-treatment and three-month follow-up.

RESULTS: Short objective sleep duration predicted reduced improvements in daytime functioning (p = .019) and depression (p = .04), but no other outcomes. Short subjective sleep duration predicted greater improvement in all sleep diary outcomes (all p < .001). Results were consistent across sensitivity analyses.

CONCLUSIONS: Objective and subjective sleep duration predicted some, mostly small, differences in treatment response to CBT-I in patients with chronic insomnia. That said, patients with short or normal sleep durations benefitted from CBT-I.

PMID:41046545 | DOI:10.1080/15402002.2025.2569364