. 2020 Feb 3;7(3):250–266. doi: 10.1002/mdc3.12899

Table 3.

Studies examining nonpharmacologic interventions for insomnia in PD

Study	Design	Demographic + PD Staging	Intervention	Treatment Duration	Insomnia/Sleep Assessments	Main Findings
Rios Romenets et al., 201357	Randomized clinical trial	N = 18, 78% men; age 66 ± 12 years; H&Y: 1–3	CBT‐I + daily BLT (n = 6) vs. doxepin 10 mg (n = 6) vs. placebo (red light; n = 6)	6 weeks	PDSS, PSQI, ISI, SCOPA‐S, sleep diary	CBT‐I/BLT significantly reduced the ISI relative to placebo (−7.8 ± 3.8 vs. −2.0 ± 3.9; P = 0.03). No other significant improvements in sleep noted
Patel et al., 201767	Randomized clinical trial	N = 28, 57% men; age 64 ± 8 years; H&Y: NR	Online CBT‐I (n = 14) vs. sleep hygiene control group (n = 14)	6 weeks	ISI	Among completers, ISI reduction was significantly better in CBT‐I than the control group (ISI: −7.9 vs. −3.5, P = 0.03)
Videnovic et al., 201768	Randomized clinical trial	N = 31, 42% men; age 62 ± 10 years; H&Y: 2.0 ± 0.4	1‐hour BLT (10 K lux; n = 16) or dim light (placebo; n = 15) in am and evening	2 weeks	Sleep diaries, PSQI, PDSS	Group‐by‐time interactions noted with the BLT group improving more in SD DIS and number of awakenings, PSQI, and PDSS than the placebo group
Martino et al., 201869	Retrospective longitudinal	N = 140, 65% men; age 66 ± 10 years; H&Y: NR	Daily 1‐hour BLT (3–4K lux) 1 hour before usual bedtime	4 months–15 years	Investigator‐derived insomnia Likert scale: B, 1, 2, 4, 6 minutes and Q 6 minutes	Main effects for insomnia improvement with BLT were noted during the 5‐year period. Rapid improvement occurred in the first month of BLT, continued to improve in year 1, and then plateaued
Nascimento et al., 201473	Prospective cohort	N = 42, 50% men; age 67 years; H&Y: 1.7	Multimodal 1‐hour exercise sessions 3x/wk (n = 23) vs. control group (n = 19)	6 months	MSQ	Group‐by‐ time interaction noted with exercise group modestly improving on MSQ while control group worsened
Frazzitta et al., 201570	Retrospective	N = 138, 44% men; age 69 ± 7 years; H&Y: 2.6 ± 0.5	Multidisciplinary exercise 3 1‐hour sessions/d 5x/wk (n = 89) vs. control group (n = 49)	28 days	PDSS	Group‐by‐time interaction noted with PDSS scores improving in exercise group (107 ± 27 to 118 ± 20; P < 0.001) while they slightly worsened in the control group (113.3 ± 14.8 vs. 112.8 ± 14.8; P = 0.03)
Silva‐Batista et al., 201771	Randomized clinical trial	N = 22, 73% men; age 65 ± 9 years; H&Y: 2.5 ± 0.5	Resistance training 1‐hour sessions 2x/wk (n = 11) vs. control group (n = 11)	12 weeks	PSQI	Group‐by‐time interaction noted with PSQI sleep quality, sleep disturbance, and daytime dysfunction scores improving in resistance training group while no changes were observed in the control group. No improvements noted in SOL, sleep duration, or sleep efficiency
Xiao and Zhuang, 201675	Randomized clinical trial	N = 96, 70% men; age 68 ± 9 years; H&Y: 2.2 ± 0.2	Qigong minimum of 4x/wk + 30‐minute walking/d (n = 48) vs. control condition (30‐minute walking/d; n = 48)	6 months	PDSS‐2	Group‐by‐time interactions noted with Qigong group improving in PDSS‐2 total score (29 ± 13 to 15 ± 11; P = 0.04) and all its subscales while no significant changes were noted in controls
Yang et al., 201776	Randomized clinical trial	N = 36, 56% men; age 63 ± 5; H&Y: 1–3	Tai Chi group‐based sessions (n = 19) vs. Tai Chi individual sessions (n = 17); session 3x/wk in both conditions	13 weeks	PDSS	Both Tai Chi groups showed significant improvements of PDSS total score over time (group: 97 ± 16 to 108 ± 16; individual: 97 ± 20 to 105 ± 20; both changes P < .001)

Study

Design

Demographic + PD Staging

Intervention

Treatment Duration

Insomnia/Sleep Assessments

Main Findings

Rios Romenets et al., 201357

Randomized clinical trial

N = 18,

78% men;

age 66 ± 12 years;

H&Y: 1–3

CBT‐I + daily BLT (n = 6) vs. doxepin 10 mg (n = 6) vs. placebo (red light; n = 6)

6 weeks

PDSS, PSQI, ISI, SCOPA‐S, sleep diary

CBT‐I/BLT significantly reduced the ISI relative to placebo (−7.8 ± 3.8 vs. −2.0 ± 3.9; P = 0.03). No other significant improvements in sleep noted

Patel et al., 201767

Randomized clinical trial

N = 28,

57% men;

age 64 ± 8 years;

H&Y: NR

Online CBT‐I (n = 14) vs. sleep hygiene control group (n = 14)

6 weeks

ISI

Among completers, ISI reduction was significantly better in CBT‐I than the control group (ISI: −7.9 vs. −3.5, P = 0.03)

Videnovic et al., 201768

Randomized clinical trial

N = 31,

42% men;

age 62 ± 10 years;

H&Y: 2.0 ± 0.4

1‐hour BLT (10 K lux; n = 16) or dim light (placebo; n = 15) in am and evening

2 weeks

Sleep diaries, PSQI, PDSS

Group‐by‐time interactions noted with the BLT group improving more in SD DIS and number of awakenings, PSQI, and PDSS than the placebo group

Martino et al., 201869

Retrospective longitudinal

N = 140,

65% men;

age 66 ± 10 years;

H&Y: NR

Daily 1‐hour BLT (3–4K lux) 1 hour before usual bedtime

4 months–15 years

Investigator‐derived insomnia Likert scale:

B, 1, 2, 4, 6 minutes and Q 6 minutes

Main effects for insomnia improvement with BLT were noted during the 5‐year period. Rapid improvement occurred in the first month of BLT, continued to improve in year 1, and then plateaued

Nascimento et al., 201473

Prospective cohort

N = 42,

50% men;

age 67 years;

H&Y: 1.7

Multimodal 1‐hour exercise sessions 3x/wk (n = 23) vs. control group (n = 19)

6 months

MSQ

Group‐by‐ time interaction noted with exercise group modestly improving on MSQ while control group worsened

Frazzitta et al., 201570

Retrospective

N = 138,

44% men;

age 69 ± 7 years;

H&Y: 2.6 ± 0.5

Multidisciplinary exercise 3 1‐hour sessions/d 5x/wk (n = 89) vs. control group (n = 49)

28 days

PDSS

Group‐by‐time interaction noted with PDSS scores improving in exercise group (107 ± 27 to 118 ± 20; P < 0.001) while they slightly worsened in the control group (113.3 ± 14.8 vs. 112.8 ± 14.8; P = 0.03)

Silva‐Batista et al., 201771

Randomized clinical trial

N = 22,

73% men;

age 65 ± 9 years;

H&Y: 2.5 ± 0.5

Resistance training 1‐hour sessions 2x/wk (n = 11) vs. control group (n = 11)

12 weeks

PSQI

Group‐by‐time interaction noted with PSQI sleep quality, sleep disturbance, and daytime dysfunction scores improving in resistance training group while no changes were observed in the control group. No improvements noted in SOL, sleep duration, or sleep efficiency

Xiao and Zhuang, 201675

Randomized clinical trial

N = 96,

70% men;

age 68 ± 9 years;

H&Y: 2.2 ± 0.2

Qigong minimum of 4x/wk + 30‐minute walking/d (n = 48) vs. control condition (30‐minute walking/d; n = 48)

6 months

PDSS‐2

Group‐by‐time interactions noted with Qigong group improving in PDSS‐2 total score (29 ± 13 to 15 ± 11; P = 0.04) and all its subscales while no significant changes were noted in controls

Yang et al., 201776

Randomized clinical trial

N = 36,

56% men;

age 63 ± 5;

H&Y: 1–3

Tai Chi group‐based sessions (n = 19) vs. Tai Chi individual sessions (n = 17); session 3x/wk in both conditions

13 weeks

PDSS

Both Tai Chi groups showed significant improvements of PDSS total score over time (group: 97 ± 16 to 108 ± 16; individual: 97 ± 20 to 105 ± 20; both changes P < .001)

PD, Parkinson's disease; H&Y, Hoehn & Yahr; NR, not reported; CBT‐I, Cognitive Behavioral Therapy for Insomnia; BLT, bright light therapy; wk, week; PSQI, Pittsburgh Sleep Quality Index; PDSS, Parkinson's Disease Sleep Scale; ISI, Insomnia Severity Index; MSQ, Mini‐Sleep Questionnaire; SD, sleep diary; DIS, difficulty initiating sleep; SOL, sleep onset latency; PDSS‐2, Parkinson's disease sleep scale 2.