Tai chi proves as effective as CBT for long-term insomnia relief

By Dr. Liji Thomas, MDReviewed by Benedette Cuffari, M.Sc.Dec 3 2025

A major clinical trial reveals that while tai chi starts slower than CBT, its steady and lasting impact on sleep makes it a powerful, low-cost option for millions of older adults struggling with chronic insomnia.

Study: Tai chi or cognitive behavioral therapy for treating insomnia in middle aged and older adults: randomized non-inferiority trial. Image Credit: Dragon Images / Shutterstock.com

A recent study published in The BMJ compares the efficacy of Tai chi with cognitive behavioral therapy (CBT) for the treatment of chronic insomnia.

Tai chi is an ancient martial art involving mind-body coordination in exercise. Originating in China, Tai chi is widely practiced throughout the world, with over four million practitioners in the United States of America alone. 

How is insomnia treated?

Chronic insomnia affects up to 22 % of middle-aged and older adults globally, with 30 to 50 % of adults affected in Hong Kong. People with chronic insomnia are at a greater risk of cardiovascular disease, mental illness, and impaired cognition. Chronic insomnia is also a financial burden, as its treatment costs amount to $150 billion USD each year in the U.S. alone.

CBT is the standard treatment for insomnia because of its effectiveness and lack of adverse effects. However, CBT is often expensive and requires trained personnel, thereby limiting its wider accessibility and availability to reach only about 10 % of chronic insomnia patients receiving CBT in the developed world.

Tai chi is an inexpensive form of exercise that requires minimal physical effort, making it ideal for older adults. Furthermore, previous studies suggest that Tai chi is beneficial for managing insomnia, with potential benefits persisting for up to 24 months.

To date, the efficacy of Tai chi in managing chronic insomnia has not been compared with that of aerobic exercise or other forms of physical activity.

About the study

The current study was conducted at a single research site in Hong Kong, involving 200 participants. All study participants were Chinese adults 50 years of age and older who suffered from chronic insomnia based on Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) criteria.

Study participants were randomized to receive one-hour sessions of either CBT or Tai chi twice a week for three months, after which the severity of their insomnia was assessed based on the Insomnia Severity Index (ISI). A pre-defined non-inferiority margin of four points on the ISI was established to reflect that patient outcomes with Tai chi were not worse than those associated with CBT. Intention-to-treat and protocol-based analyses were subsequently performed.

Participants randomized to CBT or tai chi sessions

At the end of the study period, the Tai chi group reported a reduction in insomnia severity by an average of 6.67 points, compared to 11.2 points with CBT, resulting in a difference of 4.53 points. These findings demonstrate that Tai chi was inferior to CBT for improving insomnia symptoms.  

At 15 months after treatment initiation, corresponding reductions in insomnia severity were 9.5 and 10.2 for Tai chi and CBT, respectively, which reflects a 0.68-point difference between groups that suggests comparable efficacy between Tai chi and CBT at this time point. These results were consistent across intention-to-treat and per-protocol analyses, though not identical.

About 83 % of CBT participants achieved stable relief from their chronic insomnia by the end of the three-month study intervention period, as compared to 56 % of Tai chi participants. Similar efficacies of 63 % and 77 % were observed at 15 months after treatment initiation, respectively. This is a crucial finding, as prior research indicates a relapse rate as high as 38 %, which emphasizes the importance of long-term efficacy of any treatment.

Treatment response rates in the CBT and Tai chi groups were 77 % and 43 %, respectively, at three months, whereas response rates of 73 % and 62 % were reported at month 15, respectively. The difference between groups did not significantly change over time, although absolute values increased in both groups. 

Both remission and response rates increased by 55 % in the Tai chi group at month 15, compared to immediately after treatment. This delay in treatment response may be attributed to the slower effects on systemic and cellular inflammation caused by insomnia relief over the next year. About 37 % of Tai chi participants continued to practice this form of exercise after the end of the study, as compared to 16 % of CBT participants. No treatment-related adverse events were reported in either group

This finding supports the use of Tai chi as an alternative approach for the long-term management of chronic insomnia in middle aged and older adults.