CATEGORY: STRESS & MIND-BODY
Middle-aged and older adults with chronic insomnia who took up tai chi ended up sleeping about as well as those given the standard talk therapy—they just took longer to get there. Fifteen months after treatment began, insomnia-severity scores had fallen 9.51 points with tai chi and 10.18 points with cognitive behavioural therapy on a 28-point scale—a gap of just 0.68 points—in a 200-person randomized trial from Hong Kong published in The BMJ.1 Three months in, though, the talk-therapy group had been clearly ahead.
Two Prescriptions That Could Not Look Less Alike
One treatment happens mostly in the head, the other mostly on the feet. Cognitive behavioural therapy for insomnia, or CBT-I, is a structured program that retrains sleep habits and the racing, clock-watching thoughts that keep people awake; it is the treatment sleep specialists reach for first, ahead of medication. Tai chi is a slow, flowing sequence of gentle postures and controlled breathing, often described as a moving meditation. In the trial, both were delivered the same way: one-hour group classes, twice a week for three months—24 sessions in all.
Assigned by Chance, Then Checked a Year After the Classes Ended
Researchers recruited 200 Chinese adults aged 50 and older with chronic insomnia and assigned each by chance to one program or the other—the design that makes the two groups alike in everything but the treatment. Insomnia was scored on a standard questionnaire running from 0 to 28, with higher numbers meaning worse sleep trouble and more daytime fallout. The trial was built as a non-inferiority test: the question was not whether tai chi would beat the established therapy, but whether it would land no worse than a margin the researchers set before the trial began. Scores were taken when the classes ended at three months, and again a full year later.
Slower Off the Mark, Even at the Tape
At the three-month check, tai chi had not kept up: scores had dropped 6.67 points with tai chi against 11.19 with CBT-I, and tai chi failed the no-worse test. A year later the picture had changed. Tai chi’s benefit had kept building while the therapy group held steady, and at fifteen months the reductions—9.51 and 10.18 points—sat less than a point apart, meeting the trial’s bar for non-inferiority. CBT-I worked like a sprinter, tai chi like a distance runner; fifteen months from the start they were stride for stride. No adverse events were reported in either group. One boundary worth knowing: the trial compared two active treatments head to head, so it does not say how either group would have fared with no treatment at all.
Against Doing Nothing, Tai Chi Has Already Been Tested
That last question has been answered elsewhere. An earlier randomized trial by the same research group followed 320 older adults with insomnia and found that tai chi improved objectively measured sleep versus no treatment—about 13 fewer minutes lying awake after first falling asleep and roughly two fewer awakenings a night—with the gains still present two years on.2 And a 2024 pooled analysis of 12 randomized trials covering 1,058 community-dwelling older adults found tai chi improved sleep-quality ratings by about 2 points on a 21-point scale compared with control groups.3 The new trial adds the harder comparison: not tai chi against nothing, but tai chi against the best non-drug treatment insomnia care has.
Key Takeaways
- In a 200-person randomized trial of adults aged 50 and older with chronic insomnia, tai chi lagged behind CBT-I at three months but matched it at fifteen—score drops of 9.51 versus 10.18 points on a 28-point scale.
- Both programs ran as twice-weekly group classes for three months; the difference between them at fifteen months was under one point, within the trial’s pre-set margin.
- Earlier randomized evidence found tai chi improved sleep compared with no treatment in older adults, with benefits lasting up to two years.
- The new trial had no untreated group, so it measures tai chi against the standard therapy rather than against doing nothing.
References
- Siu PM, Yu DJ, Yu AP, et al. Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial. BMJ. 2025;391:e084320. link
- Siu PM, Yu AP, Tam BT, et al. Effects of Tai Chi or Exercise on Sleep in Older Adults With Insomnia: A Randomized Clinical Trial. JAMA Network Open. 2021;4(2):e2037199. link
- Lyu L, Li Y, Fan X, Seo J, Eunna O. The effect of Tai Chi exercise intervention on sleep quality in community residing older adults: a systematic review and meta-analysis. European Geriatric Medicine. 2024;15:381–396. link