Tai chi noninferior to CBT-I for long-term management of insomnia

Tai chi practice is noninferior to cognitive behavioural therapy for insomnia (CBT-I) in sustaining beneficial improvements at month 15 among middle-aged and older adults with chronic insomnia, researchers from the School of Public Health at the University of Hong Kong (HKU) found.

The randomized noninferiority trial included 200 Chinese participants aged ≥50 years with chronic insomnia diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 5^th edition. Participants were from a single research site in Hong Kong and were recruited from the local community between May 2020 and July 2022. They were randomized 1:1 to receive tai chi or CBT-I, the gold-standard treatment for chronic insomnia. Tai chi and CBT-I interventions, which consisted of twice-weekly 1-hour sessions, were delivered in group format at the School of Public Health, HKU, over 3 months (total, 24 sessions). Attendance was recorded by the instructors as a measure of treatment adherence. Outcomes were assessed at baseline, after the intervention (month 3), and at 12 month follow-up (month 15). [BMJ 2025;391:e084320]

At month 3, Insomnia Severity Index (ISI) score in the tai chi group showed a reduction from baseline of 6.67 (95 percent confidence interval [CI], 5.61–7.73) vs 11.19 (95 percent CI, 10.06–12.32) in the CBT-I group, resulting in a between-group difference of 4.52 (-∞ to 5.81). At month 15, the reductions were 9.51 (95 percent CI, 8.47–10.54) and 10.18 (95 percent CI, 8.97–11.40), respectively, with a between-group difference of 0.68 (95 percent CI, -∞ to 2.00). Compared with CBT-I, tai chi was deemed inferior at month 3 because the upper confidence limit exceeded the noninferiority margin, while it was considered noninferior at month 15 because the upper confidence limit fell within the noninferiority margin.

These results differ slightly from those of an earlier study in patients who had undergone successful treatment for breast cancer and had insomnia. The study found that tai chi was noninferior to CBT-I at both 3-month and 12-month postintervention follow-up. Authors of the current study attributed the difference in results to differences in clinical characteristics (such as increased levels of depression, anxiety and fatigue) and insomnia profiles between patients with a history of breast cancer and participants in the current study. [J Clin Oncol 2017;35:2656-2665; Sleep Med Rev 2006;10:419-429]

In Hong Kong, 30–50 percent of middle-aged and older adults report having insomnia problems, with old age being a main predictor. Chronic insomnia in middle-aged and older adults has been associated with increased risk of cardiovascular diseases, mental disorders, and cognitive impairment, which prospectively increases hospital admission and mortality rates, as well as financial burden on the healthcare and socioeconomic systems. [Sleep Res 2011;20:117-126; Lancet 2012;379:1129-1141]

 “While CBT-I delivers rapid relief, tai chi offers sustained, long-term improvement without the barriers of cost or therapist availability,” said Professor Parco Ming-Fai Siu, leader of the research team. “For many middle-aged and older adults struggling with chronic insomnia, access to CBT-I often means long waits and high expenses.”

“Our research provides strong evidence that tai chi can serve as a practical alternative — providing a lifestyle-based intervention that improves sleep while promoting overall physical and mental well-being. This is more than just good news for insomnia sufferers. Instead of relying solely on clinical referrals, patients can integrate lifestyle-based interventions into insomnia care. This empowers individuals to take control of their health,” noted Siu.