The Clinical Effectiveness of Cognitive Behavioral Therapy for Patients with Insomnia and Depression: A Systematic Review and Meta-Analysis

Table 1

Components of CBT-I.

Component	Description
Cognitive therapy	Cognitive therapy aims to identify and replace dysfunctional beliefs and attitudes about sleep. These dysfunctional beliefs include unrealistic expectations of sleep, such as overestimating the consequences of poor sleep.
Stimulus control	Stimulus control aims at avoiding patients to associate bed with other stimulating activities such as avoiding nonsleep activities in the bedroom; going to bed only when sleepy; and leaving the bedroom when unable to sleep for15−20 min, returning to bed only when sleepy
Sleep restriction	Sleep restriction aims to limit time in bed to match perceived sleep duration in order to increase sleep drive and reduce time awake in bed. Time allowed in bed is initially restricted to the average time perceived as sleep per night and then adjusted to ensure that sleep efficiency remains >85%.
Sleep hygiene	Sleep hygiene relates to environmental factors, physiologic factors, and habits that improve sleep, such as regular sleep scheduling, avoiding long daytime naps, and limiting alcohol, caffeine, and nicotine intake especially before bed.
Relaxation	Any relaxation technique that the patient finds effective can be used to limit cognitive arousal and reduce muscular tension to improve sleep. Specific relaxation techniques include meditation, mindfulness, progressive muscle relaxation, guided imagery, and breathing techniques.