Effects of Connective Tissue Massage in Patients With Chronic Insomnia

This randomized controlled trial will investigate the effects of connective tissuemassage on insomnia severity, objective and subjective sleep outcomes, and stress‐ andautonomic‐related biomarkers in adults with chronic insomnia. Chronic insomnia is acommon sleep disorder characterized by persistent difficulties in initiating ormaintaining sleep and is associated with impaired daytime functioning, reduced cognitiveperformance, and diminished quality of life. Non‐pharmacological interventions mayprovide a safe alternative or complementary approach for individuals with chronicinsomnia.A total of 74 adults diagnosed with chronic insomnia by a neurologist and who have notused sleep medication during the previous four weeks will be enrolled. Participants willbe randomly allocated to either a connective tissue massage group or a control group. Theintervention group will receive 12 sessions of connective tissue massage over a four‐weekperiod, with three sessions per week, in addition to sleep hygiene education. The controlgroup will receive sleep hygiene education alone.Assessments will be performed at baseline and immediately after the four‐weekintervention period. The primary outcome will be the change in insomnia severity,assessed using the Insomnia Severity Index. Secondary outcomes will include objectivesleep parameters recorded by actigraphy over five consecutive days, including total sleeptime, sleep efficiency, sleep onset latency, and wake after sleep onset. Blood biomarkersassociated with hypothalamic‐pituitary‐adrenal axis activity and autonomic regulation,including cortisol, DHEA‐S, alpha‐amylase, and oxytocin, will also be assessed.Subjective sleep quality and sleep hygiene will be evaluated using the Pittsburgh SleepQuality Index and Sleep Hygiene Index, respectively. Adherence to sleep hygienerecommendations will additionally be assessed using sleep diaries.The study aims to determine whether connective tissue massage combined with sleep hygieneeducation is more effective than sleep hygiene education alone in reducing insomniaseverity and improving objective and subjective sleep outcomes and selected physiologicalbiomarkers in adults with chronic insomnia.