Behavioral interventions as treatment for insomnia - A scoping review of randomized controlled trials.

OBJECTIVE: To map behavioral interventions evaluated as a potential treatment for insomnia in previous randomized controlled trials (RCTs) through a scoping review. METHODS: A bibliographic search was performed to gather RCTs evaluating behavioral interventions for insomnia, either diagnosed according to standardized criteria or limited to moderate to severe symptoms. Behavioral interventions included should be: 1. Focused on modifying behaviors that affect sleep, 2. Self-implementable, 3. Suitable for home implementation, and 4. Not depending on or using cognitive/emotional processes. Behavioral interventions were categorized as "increasing/engaging", "reducing/avoiding", and "adjusting/modifying" behaviors. RESULTS: Forty-nine RCTs were included, with an average of 1.8 RCTs per year and peak publication record in 2015 and 2023 (k = 6 each). Adjusting/modifying behavior interventions were the most frequent (k = 32, 65.3 %), followed by increasing/engaging behaviors (k = 18, 36.7 %). Among individual interventions, multi-component behavioral therapy with sleep restriction was the most common (k = 17, 34.7 %), followed by sleep restriction alone (k = 9, 18.4 %), yoga and tai chi (k = 6, 12.2 %) and physical exercise (k = 6, 12.2 %). Another nine interventions were listed, with one to four RCTs each. CONCLUSION: Despite the ubiquity of advice to practice good sleep hygiene to improve sleep quality, these findings highlight the need for high-quality randomised trials examining which behavioural interventions lead to improved sleep, as many currently being recommended do not have an adequate evidence base.