Bold claim: Tai chi can be as effective as CBT for long-term relief from chronic insomnia, offering a slower start but a steadier, lasting impact at a lower cost for millions of older adults.
A major clinical trial directly compared tai chi with cognitive behavioral therapy (CBT) for treating chronic insomnia. While tai chi may begin with slower gains, its durable benefits over time make it a compelling option alongside CBT.
Study: Tai chi or cognitive behavioral therapy for treating insomnia in middle aged and older adults: randomized non-inferiority trial. (https://www.bmj.com/content/391/bmj-2025-084320) Image Credit: Dragon Images / Shutterstock.com
Overview of the topic
Insomnia in midlife and older adults is widespread. Chronic insomnia affects up to 22% of people in this group globally, with even higher prevalence in some regions like Hong Kong (30–50%). Persistent sleep problems raise the risk for cardiovascular disease, mental health issues, and cognitive impairments. Financially, insomnia care costs are substantial, estimated at about $150 billion in the United States annually.
CBT has become the standard treatment for insomnia due to strong efficacy and minimal adverse effects. However, CBT’s reach is limited by cost and the need for trained professionals, which means only about 10% of chronic insomnia patients in the developed world receive CBT.
Tai chi presents an affordable, low-impact exercise option that emphasizes mind–body coordination. It is well-suited for older adults, with prior studies suggesting benefits that may persist for up to two years. Yet, before this trial, tai chi had not been directly compared with other forms of physical activity, such as aerobic exercise, for insomnia.
About the trial
The study was conducted at a single site in Hong Kong and enrolled 200 Chinese adults aged 50 and older who met DSM-5 criteria for chronic insomnia.
Participants were randomized to receive one-hour sessions of either CBT or tai chi twice weekly for three months. Insomnia severity was measured using the Insomnia Severity Index (ISI). A predefined non-inferiority margin of four points on the ISI established whether tai chi’s outcomes were not worse than CBT’s. Both intention-to-treat and protocol-based analyses were performed.
Key findings
- At the end of the three-month intervention, the tai chi group experienced an average ISI reduction of 6.67 points, while the CBT group saw a greater reduction of 11.2 points, yielding a between-group difference of 4.53 points. This indicates tai chi was inferior to CBT in the short term.
- By 15 months after starting treatment, ISI reductions were 9.5 points for tai chi and 10.2 points for CBT, a 0.68-point difference favoring CBT by a narrow margin. This suggests comparable efficacy between tai chi and CBT over the longer term, with results consistent across both intention-to-treat and per-protocol analyses.
- Treatment response rates differed notably in the short term: 77% of CBT participants achieved stable relief by three months versus 43% for tai chi. At 15 months, these figures were 73% for CBT and 62% for tai chi. While absolute numbers improved for both groups over time, the relative gap persisted.
- Remission and response rates increased by about 55% in the tai chi group between the end of treatment and month 15, potentially reflecting a delayed effect as improvements in systemic and cellular inflammation unfold over time.
- Long-term engagement differed: about 37% of tai chi participants continued practicing after the study, compared with 16% of CBT participants. Importantly, there were no treatment-related adverse events in either group.
Implications
The findings support tai chi as a viable long-term strategy for managing chronic insomnia in middle-aged and older adults, particularly for those who prefer a low-cost, low-impact option or who may not have access to CBT. Tai chi’s benefits appear to accumulate over time, reinforcing the case for incorporating it into broader sleep-management plans.
Journal reference:
Siu, P. M., Yu, D. J., Yu, A. P., et al. (2025). Tai chi or cognitive behavioral therapy for treating insomnia in middle aged and older adults: randomized non-inferiority trial. The BMJ. DOI: 10.1136/bmj-2025-084320. https://www.bmj.com/content/391/bmj-2025-084320.
If you’re weighing options for insomnia relief, consider not only immediate symptom relief but also long-term maintenance. Tai chi offers a low-cost, accessible path with meaningful benefits that may compound over time.
Discussion prompts: Do you think the slower initial improvement of tai chi is a reasonable trade-off for potentially durable benefits and lower costs? How might this influence your or your loved ones’ approach to treating chronic insomnia? Share your experiences or opinions in the comments.
