Tai chi is included in the list of methods against insomnia

A new study from Hong Kong, published in The BMJ, has found: tai chi is as good as cognitive behavioural therapy (CBT) at managing chronic insomnia in middle-aged and older people in the long term.

Why it matters

Chronic insomnia is one of the most common sleep disorders in people after age 50. It is associated with an increased risk of:

• cardiovascular disease,

• depression and anxiety disorders,

• memory and cognitive impairment.

The gold standard of treatment is cognitive behavioural therapy for insomnia (CBT-I). But it has two major downsides:

• few specialists,

• high cost, and limited access.

Tai chi is a gentle mind-body practice common in Chinese culture. There has been previous evidence that it improves sleep, but there has been little direct comparison with CPT-I until now.

How the study was conducted

Researchers recruited 200 Chinese men 50+ years old with confirmed chronic insomnia at a research centre in Hong Kong (2020-2022).

Only those who:

• were able to walk independently,

• did not have a serious chronic condition affecting sleep,

• did not regularly engage in aerobics or mind-body practices,

• had not previously undergone CPT-I,

• or worked shifts.

All were randomly divided into two groups:

1. Tai-Chi group

2. CPT-I group (talk therapy)

Both groups received one hour of sessions twice a week, for a total of 24 group sessions (approximately 3 months).

How the outcome was assessed

We used the Insomnia Severity Index (ISI), a questionnaire that takes into account:

• difficulty falling asleep,

• nocturnal awakenings,

• early rising,

• the impact of insomnia on daily life.

The evaluation was carried out:

• immediately after the 3-month course (month 3),

• and one year after the end of the course (month 15).

The scientists pre-set the criterion of non-inferiority:
a difference of 4 ISI scores or less was considered acceptable to recognise the method as comparable to CPT.

What happened

At the beginning of the study, both groups had moderate severity of insomnia.

After 3 months:

• tai chi: improvement by 6.67 points on the ISI,

• CPT-I: improvement of 11.19 points,

• the difference between the groups was 4.52 points.

At this stage, tai ch i was inferior to KPT-I in terms of effectiveness - just below the given threshold of "no worse than 4 points".

But after 15 months (another year later):

• tai chi: 9.51 point improvement,

• CPT-I: 10.18 points,

• a difference of only 0.68 points.

Over the long term, tai-chi was "as good" as KPT-I in terms of insomnia severity.

Plus both approaches showed:

• comparable improvement in subjective sleep parameters,

• an increase in quality of life,

• positive effects on mental health,

• an increase in physical activity levels.

No side effects were recorded during the sessions.

Limitations and conclusions

The authors note:

• part of the effect of tai chi is probably due to the fact that participants continued to practice it even after the programme had ended,

• it is not yet known whether these results are directly transferable to other countries and cultures.

Nevertheless, the researchers make a fairly confident conclusion:

Tai chi can be considered as an alternative, affordable and long-term method of managing chronic insomnia in middle-aged and older people - especially where access to CBT is limited.