Insomnia has quietly become one of the most pervasive public health challenges of our time. Often described as a global “sleep crisis,” chronic insomnia affects millions of people worldwide, with prevalence rates nearly doubling over the past decade. Middle-aged and older adults are particularly vulnerable, facing not only difficulty falling or staying asleep but also the cascading effects of poor sleep on physical health, cognitive function, and emotional well-being.
Against this backdrop, an important new study “Tai Chi or Cognitive Behavioral Therapy for Treating Insomnia in Middle Aged and Older Adults: Randomized Non-Inferiority Trial “ published in The British Medical Journal (BMJ) has brought renewed attention to an ancient practice: Tai Chi. The research compares Tai Chi with the current gold-standard non-pharmacological treatment for insomnia—Cognitive Behavioral Therapy for Insomnia (CBT-I)—and offers compelling evidence that Tai Chi may serve as a viable, accessible alternative.
Introducing the Research and the Researcher
The study was led by Professor Paco Siu, a professor at the University of Hong Kong—widely recognized as number one university in Asia. Despite his relatively young age, Professor Siu is already an internationally respected researcher and serves as the head of Kinesiology at the university. His work has been cited in the top 1% of scientific literature over recent years, underscoring its impact and credibility.
Professor Siu’s research focuses on how different exercise modalities—particularly mind-body practices—can be used to improve health outcomes. His interest in insomnia stems from both its growing prevalence and the limitations of existing treatments.
Why Study Tai Chi for Insomnia?
Chronic insomnia is especially common among middle-aged and older adults. While pharmacological treatments such as sleeping pills are widely used, they often come with side effects, risks of dependency, and diminishing effectiveness over time. On the other hand, CBT-I is considered the first-line non-pharmacological treatment and has strong evidence supporting its effectiveness.
However, CBT-I also has barriers. It requires trained specialists, involves multiple sessions, and often comes with long waiting times and high costs. In many regions—including Hong Kong and parts of the United States—access to CBT-I is limited, and insurance coverage is inconsistent.
At the same time, preliminary research has suggested that exercise, especially Tai Chi, may improve sleep quality. Tai Chi is a gentle, slow, and mindful form of movement that integrates physical activity, mental focus, and controlled breathing. Yet, until now, the scientific evidence supporting Tai Chi for insomnia had been limited to small-scale or less rigorous studies.
This gap in evidence motivated Professor Siu and his team to design a robust, large-scale clinical trial to rigorously compare Tai Chi with CBT-I.
Understanding CBT-I
Cognitive Behavioral Therapy for Insomnia works by addressing both the cognitive and behavioral factors that disrupt sleep. On the cognitive side, it helps individuals correct misconceptions and anxieties about sleep. On the behavioral side, it focuses on improving sleep hygiene—such as regulating caffeine intake, reducing screen use before bed, and strengthening the association between the bed and sleep rather than work or entertainment.
CBT-I is highly effective and often produces long-lasting benefits without the use of medication. However, it requires time, commitment, and professional guidance, which limits its accessibility for many people. In the U.S., the majority of medical insurance companies do not cover the cost of CBT-I sessions.
Study Design: A Gold-Standard Clinical Trial
The study was designed as a randomized, controlled, non-inferiority trial—one of the most rigorous designs in clinical research. The goal was not to prove that Tai Chi is better than CBT-I, but rather to determine whether it is not inferior, meaning it performs at least comparably within a predefined margin.
Researchers recruited approximately 200 middle-aged and older adults (aged 50 and above) who met the clinical criteria for chronic insomnia as defined by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) or Insomnia Disorder. Participants were randomly assigned to one of two groups regardless their gender, social-economical status, education, age, and other factors:
- CBT-I Group: Participants received standardized CBT-I delivered by trained clinical psychologists.
- Tai Chi Group: Participants practiced the Yang-style 24-form Tai Chi, one of the most widely studied and commonly practiced forms.
Both interventions were conducted in small groups and carefully matched for time and intensity. Participants attended two one-hour sessions per week for 12 weeks, totaling 24 sessions. This ensured that any differences in outcomes could be attributed to the intervention itself rather than differences in attention or contact time.
Sleep outcomes were measured using the Insomnia Severity Index (ISI), a well-validated clinical tool.
Key Findings: Short-Term and Long-Term Effects
At the end of the 12-week intervention, both groups showed improvements in sleep. However, CBT-I produced a larger immediate reduction in insomnia severity than Tai Chi. As expected, Tai Chi did not outperform the first-line clinical treatment in the short term.
The most striking findings emerged during long-term follow-up. Participants were monitored for an additional 12 months after the intervention ended. Over time, the Tai Chi group continued to improve, while the CBT-I group showed a slight rebound in insomnia symptoms.
By the end of the one-year follow-up—15 months from baseline—Tai Chi was found to be non-inferior to CBT-I. In other words, Tai Chi ultimately achieved sleep improvements comparable to those of CBT-I.
Why Did Tai Chi Catch Up Over Time?
Professor Siu offered several possible explanations. Many participants in the Tai Chi group continued practicing on their own after the formal intervention ended. Although they practiced less frequently than during the study period, the habit persisted.
Tai Chi is a skill-based, mind-body practice. As participants became more familiar and comfortable with the movements, the practice became more fluid, relaxing, and mentally engaging. This ongoing refinement may have amplified its benefits over time.
In contrast, CBT-I works by correcting sleep-related thoughts and behaviors. Once those behaviors are corrected, the benefits tend to stabilize. Over time, some participants may experience mild regression, especially under stress.
The sustained and progressive nature of Tai Chi practice may explain why its benefits continued to accumulate long after the formal training ended.
The Role of Instruction and Mind-Body Engagement
The study highlighted the importance of qualified Tai Chi instructors. Although participants were not expected to become experts in just 12 weeks, instructors emphasized mindfulness, mental engagement, and the integration of movement and awareness. Tai Chi was taught not merely as physical exercise, but as a true mind-body practice.
This mental engagement—sometimes described as a “moving meditation”—may be a key mechanism underlying Tai Chi’s long-term impact on sleep.
Implications Beyond Older Adults
While this study focused on middle-aged and older adults, insomnia is increasingly common among younger people, including adolescents. Although Professor Siu emphasized the need for more evidence before drawing firm conclusions, he suggested that Tai Chi could plausibly benefit younger populations as well—particularly by increasing physical activity, reducing stress, and improving overall sleep hygiene. Recently, Tai Chi experts and spacial technology developer have embarked a new venture using Virtual Reality gear to teach people how to learn Tai Chi. Hopefully, it can attract a young generation to study Tai Chi and benefit from the practice.
In mainland China, Tai Chi is already introduced in some schools as a form of martial art and physical education. With thoughtful adaptation and the integration of technology, Tai Chi may become more appealing to younger generations worldwide.
Looking Ahead: Brain Health and Beyond
Professor Siu’s research does not stop with sleep. His team is currently conducting large-scale trials exploring the effects of Tai Chi on brain health, including cognitive decline, mild cognitive impairment, dementia, and mood disorders such as depression.
These ongoing studies aim to further establish Tai Chi as an evidence-based intervention for both physical and mental health across the lifespan.
A Promising, Accessible Option
This landmark study provides strong scientific evidence that Tai Chi is more than a traditional art—it is a clinically meaningful intervention for chronic insomnia. While CBT-I remains the gold standard, Tai Chi offers a low-cost, low-risk, and widely accessible alternative, especially for individuals who face barriers to conventional treatment.
As the world grapples with a growing sleep crisis—one that costs the United States alone more than $400 billion annually in direct and indirect losses—the gentle, mindful movements of Tai Chi may offer a powerful, low-cost path to better sleep, greater resilience, and long-term well-being.
Below you can see the interview that I had with Professor Parco Siu on the topic.
The tai chi “catch-up” over time is interesting. However, if it is indeed due to the fact that “Many participants in the Tai Chi group continued practicing on their own after the formal intervention ended” we need to consider whether this would be likely in the west as opposed to in Hong Kong (where I assume the study was conducted). Pre-existing familiarity with the 24 form, which might exist in Hong Kong, would obviously support continued practice outside of the formal classes. My own experience with students is that 12 weeks is nowhere near enough time for the average student to learn the 24 form well enough to feel comfortable practicing alone.
Cultural context will likely be a topic of discussion at the Harvard meeting this spring.
The study was conducted in Hong Kong. None of the participants had prior experience in Tai Chi. I agree with you it it hard to train people do Tai Chi 24 in 24 sessions unless students are highly motivated. With Continuous practice, people become more fluently with their movements. I believe that’s why their results became better.