Non-pharmacological interventions aimed at promoting sleep and treating sleep disorders in children and adolescents

Reading time approx. 14 minutes Published: September 24, 2025 Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: September 24, 2025 Report no: ut202513 Registration no: SBU 2025/471

Question

What systematic reviews have been published regarding non-pharmacological interventions, excluding cognitive behavioral therapy, on sleep in children and adolescents with or without sleep disorders?

PICO

Population: Children and young people (0–18 years) with or without sleep disorders
Intervention: Non-pharmacological interventions, such as sleep hygiene advice and other self-care
Comparison: Another intervention, or no intervention
Outcome: All outcomes related to sleep such as sleep duration, sleep quality, awakening, and time to fall asleep.

Method

A systematic literature search was performed using the following databases: Medline, Scopus, PsycInfo.
Two authors independently assessed the abstracts of all identified studies.
Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

Three relevant systematic reviews with low to moderate risk of bias were identified [1-3]. The results and conclusions are presented in Table 1. In nine relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [4-12].

Table 1 Systematic reviews with low/moderate risk of bias.
Included studies	Population, Intervention, Control	Outcome and Results
Feng et al, 2024 [1] The overflow effects of movement behaviour change interventions for children and adolescents: a systematic review and meta-analysis of randomised controlled trials
102 studies in systematic review; 60 studies included in meta-analysis Relevant studies: 7 of 87 studies on physical activity measured sleep duration as non-targeted behaviour 3 of 8 studies on screen time measured sleep	Population: 45 998 children under 18 years Relevant studies: 10 studies, (n=5 131) Interventions: Different interventions in school, community or family targeting physical activity, sedentary behaviour or screen time. Control: TAU, waitlist control	Interventions targeting physical activity with sleep as secondary outcome (7 studies, n=3 179)One study reported significantly longer sleep duration while 6 studies found no difference between intervention and control groups 3 studies included in meta-analysis, n=309) MD=0.78 min (95% CI, –11.95 to 13.51) I2=0% Interventions targeting screen time with sleep as secondary outcome (3 studies, n=1 952) No significant changes in sleep.
Authors' conclusion: “Interventions designed to reduce screen time did not yield concomitant changes in physical activity or sleep. Findings on the overflow effects of sleep interventions on non-targeted behaviours and of physical activity interventions on sleep outcomes were inconclusive.”
Gaskin et al, 2024 [2] Sleep behavioral outcomes of school-based interventions for promoting sleep health in children and adolescents aged 5 to 18 years: a systematic review
21 RCT (22 publications); 19 Cluster-RCT, 2 parallel RCT Setting: Australia (n=3) Brazil (n=2) India (n=2) Japan (n=2)The Netherlands (n=2) USA (n=2) Hong Kong (n=1) Iceland (n=1) Iran (n=1) Israel (n=1) New Zealand (n=1) Singapore (n=1) Switzerland (n=1)	Population: Children and adolescents (n=10 867) 5–10 years (n=3 studies) 11–13 years (n=3 studies) 14–18 years (n=15 studies) Intervention: Sleep education solely (n=13) Sleep education + stress management training (n=2) Bright light therapy (n=1) Health education (n=1) Music education (n=1) Personal development (n=1, study duration 6 years) Physical activity (n=1) Delayed school times (n=1) Duration range 25 minutes to 6 years (median=4 weeks) Control: No treatment (n=13) Wait-list control (n=6) Placebo control (n=2)	Sleep pattern (5 studies measured by actigraphy) Inconsistent effect on wake time, sleep duration or sleep offset time by sleep education, music education or delayed school start time (15 studies self-reported) Inconsistent effect on sleep duration, sleep onset latency by sleep education or combination of sleep education, stress management and bright light therapy, physical activity or personal development Sleep hygiene (14 studies, self-reported) Inconsistent effect on sleep hygiene, bedtime routine, bedtime screen use, substance use (caffein, alcohol, cigarette smoking) by sleep education or sleep education combined with stress management
Authors' conclusion: “The research reviewed shows that efforts to promote longer sleep duration, largely through using education alone to encourage earlier bedtimes and better sleep hygiene in adolescents, are probably ineffective. /…/ Current evidence does not provide school-based solutions for improving sleep health, perhaps highlighting a need for complex, multi-component interventions (e.g. whole-of-school approaches) to be trialed.”
Rodrigo-Sanjoaquin et al, 2025 [3] Effects of school-based interventions on all 24-hour movement behaviours in young people: a systematic review and meta-analysis of randomised controlled trials
7 RCT Setting: Spain (n=3) USA (n=1) Australia (n=1) Scotland (n=1) Switzerland (n=1)	Population: 8 234 healthy young persons (range 121–6 640 per study), age 3–14 (83% adolescents) Intervention: Multicomponent school-based interventions targeting and assessing 24-hour movement behaviours Duration ranging from 2 months to over 6 months Control: No intervention	Sleep duration (7 studies, n=8 234) Small increase in sleep duration Hedge’s g=0.30 (95% CI, 0.16 to 0.43) moderate inconsistency (I2=55.8%). Outcome assessment: Accelerometer (1 study) Questionnaire (6 studies)
Authors' conclusion: "Overall, intervention effects were small on sleep duration and SB-related outcomes, and there was no effect on PA-related outcomes, suggesting that modifying 24-hour movement behaviours through school-based interventions among young people is challenging to date."

References

Feng J, Huang WY, Zheng C, Jiao J, Khan A, Nisar M, et al. The Overflow Effects of Movement Behaviour Change Interventions for Children and Adolescents: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Sports Med. 2024;54(12):3151-67. Available from: https://doi.org/10.1007/s40279-024-02113-1
Gaskin CJ, Venegas Hargous C, Stephens LD, Nyam G, Brown V, Lander N, et al. Sleep behavioral outcomes of school-based interventions for promoting sleep health in children and adolescents aged 5 to 18 years: a systematic review. Sleep advances : a journal of the Sleep Research Society. 2024;5(1). Available from: https://doi.org/10.1093/sleepadvances/zpae019
Rodrigo-Sanjoaquin J, Tapia-Serrano MA, Lopez-Gil JF, Sevil-Serrano J. Effects of school-based interventions on all 24-hour movement behaviours in young people: a systematic review and meta-analysis of randomised controlled trials. BMJ open sport & exercise medicine. 2025;11(2). Available from: https://doi.org/10.1136/bmjsem-2025-002593
Bello B, Mohammed J, Useh U. Effectiveness of physical activity programs in enhancing sleep outcomes among adolescents: a systematic review. Sleep Breath. 2023;27(2):431-9. Available from: https://doi.org/10.1007/s11325-022-02675-2
Bourchtein E, Langberg JM, Eadeh HM. A Review of Pediatric Nonpharmacological Sleep Interventions: Effects on Sleep, Secondary Outcomes, and Populations With Co-occurring Mental Health Conditions. Behav Ther. 2020;51(1):27-41. Available from: https://doi.org/10.1016/j.beth.2019.04.006
France KG, McLay LK, Hunter JE, France MLS. Empirical research evaluating the effects of non-traditional approaches to enhancing sleep in typical and clinical children and young people. Sleep Medicine Reviews. 2018;39. Available from: https://doi.org/10.1016/j.smrv.2017.07.004
Garbers S, Umar NQ, Hand RE, Usseglio J, Gold MA, Bruzzese J-M. Mind–body integrative health (MBIH) interventions for sleep among adolescents: A scoping review of implementation, participation and outcomes. Adolescent Research Review. 2022;7(4). Available from: https://doi.org/10.1007/s40894-021-00176-z
Hall WA, Nethery E. What does sleep hygiene have to offer children's sleep problems? Paediatric respiratory reviews. 2019;31. Available from: https://doi.org/10.1016/j.prrv.2018.10.005
Kanen JW, Nazir R, Sedky K, Pradhan BK. The effects of mindfulness-based interventions on sleep disturbance: A meta-analysis. Adolescent Psychiatry. 2015;5(2):105-15. Available from: https://doi.org/10.2174/2210676605666150311222928
Martin KB, Bednarz JM, Aromataris EC. Interventions to control children's screen use and their effect on sleep: A systematic review and meta-analysis. J Sleep Res. 2021;30(3):e13130. Available from: https://doi.org/10.1111/jsr.13130
Riedy SM, Smith MG, Rocha S, Basner M. Noise as a sleep aid: A systematic review. Sleep Med Rev. 2021;55:101385. Available from: https://doi.org/10.1016/j.smrv.2020.101385
Rigney G, Watson A, Gazmararian J, Blunden S. Update on school-based sleep education programs: how far have we come and what has Australia contributed to the field? Sleep medicine. 2021;80. Available from: https://doi.org/10.1016/j.sleep.2021.01.061

Search strategies

Medline via OvidSP 30 April 2025

Title: Non-pharmacological interventions for sleep wake disorders
Search terms		Items found
Population:
1.	(exp Sleep Wake Disorders/ or exp Sleep/)	188 114
2.	(sleep* OR Dyssomnia* OR Parasomnia* OR Somnolence OR Insomnia* OR hypersomn*).ti,kf.	163 268
3.	OR/1-2	222 750
Intervention:
4.	(exp Sleep hygiene/) OR (sleep hygien*).ti,ab,kf.	6732
5.	(exp Complementary Therapies/ OR exp Sleep phase chronotherapy/ OR exp Exercise/) OR (acupuncture OR relaxation OR yoga OR breathing exercise* OR exercise* OR physical exercise* OR chronotherapy OR “mind body therapy”).ti,ab,kf.	936 670
6.	(exp lighting/ or exp temperature/ OR exp digital media/ OR exp smartphone/ OR OR exp Noise/) OR (blackout OR room temperature OR earplugs OR “noise cancel*”).ti,ab,kf.	612 730
7.	(exp Alcohol drinking/ OR exp Diet, Food, and Nutrition/ OR exp Food and Beverages/) OR (food consumption* OR coffein OR alcohol* OR tobacco OR nicotine OR “fluid intake” OR “energy drink”).ti,ab,kf.	616 651
8.	exp Self care/	66 025
9.	(“Self manag” OR “self-manag” OR “self car” OR “self-car” OR “self-help” OR “self help”).ti,ab,kf.	68 388
10.	OR 4-9/	2 216 403
Study types: systematic reviews and meta-analysis¹
11.	((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys" or metaanalys).ti,bt,ab.) not (editorial/ or letter/ or case reports/))	539 590
Final result
12.	3 AND 10 AND 11	1486
/= Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase

^1. Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: sensitivity- and precision-maximizing version (2008 revision); Ovid format. The Cochrane Collaboration; 2008. Available from: https://training.cochrane.org/handbook/current/chapter-04-technical-supplement-searching-and-selecting-studies#section-3-6-with modifications: the following terms are added: clinical trial, phase iii.pt. ; randomised.ab. ; ("Phase 3" or "phase3" or "phase III" or P3 or "PIII").ti,ab,kw.

Scopus via scopus.com 30 April 2025

Title: Non-pharmacological interventions for sleep wake disorders
Search terms		Items found
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population:
1.	TITLE-ABS-KEY (insomnia* OR dyssomnia* OR parasomnia* OR somnolence OR hypersomn* OR “sleep wake disorder” OR “sleep-wake disorder”)	158 660
Intervention:
2.	TITLE-ABS-KEY “Sleep hygien*”	5188
3.	TITLE-ABS-KEY (“Complementary Therap” OR acupuncture OR relaxation OR yoga OR “breathing exercise” OR exercise* OR “physical exercise*” OR “light therapy” OR chronotherapy OR “alternative medicine” OR “mind body therapy” OR phototherapy)	1 616 169
4.	TITLE-ABS-KEY (lighting OR temperature OR noise OR blackout OR “room temperature” OR earplugs OR “noise cancel” OR “digital media” OR smartphone OR “cell phone use” OR “bedroom environment” OR “home environment”)	8 064 012
5.	TITLE-ABS-KEY (Tobacco OR nicotine OR Alcohol* OR Food OR coffein OR “energy drink”)	3 364 621
6.	TITLE-ABS-KEY ("Self care" OR "self-care" OR "self caring" OR "self-caring" OR "Self manage" OR "Self-manage" OR "self managing" OR "self-managing" OR "self management" OR "self-management" OR "self-help" OR "self help")	149 797
7.	OR 2-6/	12 630 757
Study types: systematic reviews and meta-analysis
8.	TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy" OR metaanaly ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”))	801 779
Final result
9.	1 AND 7 AND 8	2688

PSYCINFO via EBSCO 30 April 2025

Title: Non-pharmacological interventions for sleep wake disorders
Search terms		Items found
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); DE = Exact keyword; TX = All text; MR = Methodology; Nn = Near. Proximity operator retrieving terms within n words from each other; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population:
1.	DE “Sleep Wake Disorders”	16 206
2.	TI (Sleep OR Dyssomnia O Parasomnia OR Somnolence OR Insomnia OR Hypersomn) OR AB (Sleep OR Dyssomnia OR Parasomnia OR Somnolence OR Insomnia OR Hypersomn) OR SU (Sleep OR Dyssomnia OR Parasomnia OR Somnolence OR Insomnia OR Hypersomn*) (exkl AB = 78.885 ref)	113 280
3.	OR 1-2/	113 280
Intervention:
4.	DE “Sleep practices”	96
5.	TI (“Complementary Therap” OR acupuncture OR relaxation OR yoga OR “breathing exercise” OR exercise* OR “physical exercise” OR “light therapy” OR chronotherapy) OR AB (“Complementary Therap” OR acupuncture OR relaxation OR yoga OR “breathing exercise” OR exercise OR “physical exercise” OR “light therapy” OR chronotherapy) OR SU (“Complementary Therap” OR acupuncture OR relaxation OR yoga OR “breathing exercise” OR exercise OR “physical exercise*” OR “light therapy” OR chronotherapy) OR DE (“phototherapy” OR “exercise” OR “mind body therapy” OR “stress management” OR “alternative medicine”)	135 322
6.	TI (lighting OR temperature OR noise OR blackout OR “room temperature” OR earplugs OR “noise cancel” OR “digital media” OR smartphone OR “cell phone use”) OR AB (lighting OR temperature OR noise OR blackout OR “room temperature” OR earplugs OR “noise cancel” OR “digital media” OR smartphone OR “cell phone use”) OR SU (lighting OR temperature OR noise OR blackout OR “room temperature” OR earplugs OR “noise cancel” OR “digital media” OR smartphone OR “cell phone use”) OR DE (“Home Environment” OR “smartphone use” OR “auditory stimulation” OR “illumination” OR “body temperature”)	116 958
7.	TI (Tobacco OR nicotine OR Alcohol* OR Food OR coffein OR “energy drink”) OR AB (Tobacco OR nicotine OR Alcohol* OR Food OR coffein OR “energy drink”) OR SU (Tobacco OR nicotine OR Alcohol* OR Food OR coffein OR “energy drink”) OR DE (“Tobacco smoking” OR “Alcohol use” OR “Food intake” OR “energy drink” OR “fluid intake”)	314 445
8.	TI (“Self care” OR “Self manage”) OR AB (“Self care” OR “Self manage”) OR SU (“Self care” OR “Self manage*” OR "self-help" OR "self help)	43 481
9.	OR 4-8/	584 409
Study types: systematic reviews and meta-analysis / randomized controlled trials²
10.	TI((systematic n3 review) OR "meta analys" OR metaanalys) OR AB((systematic n3 review) OR "meta analys" OR metaanalys) OR SU((systematic n3 review) OR "meta analys" OR metaanalys) OR (MR "Systematic Review" OR MR "meta analysis")	111 153
Final result
11.	3 AND 9 AND 10	780

^2.Glanville J, Dooley G, Wisniewski S, Foxlee R, Noel-Storr A. Development of a search filter to identify reports of controlled clinical trials within CINAHL Plus. Health Info Libr J. 2019;36(1):73-90. Available from: https://doi.org/10.1111/hir.12251.

Page published September 24, 2025

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