Transition ritual into wind-down

Two RCTs plus six before-after studies showed significant SHORT-TERM effectiveness of CBT-I (whose core components include a wind-down/stimulus-control routine and cognitive techniques for intrusive thoughts) in people with ADHD and/or autism, but findings were inconsistent and mostly NOT maintained at follow-up; overall quality moderate (small samples, no blinding).

Uncontrolled pilot (n=19 adults with ADHD) of a 10-week behavioral sleep program that EXPLICITLY included bedtime/wind-down routines, stimulus control, relaxation and cognitive restructuring. Insomnia Severity Index improved markedly (d=0.84 post-treatment, d=1.52 at 3 months; 42% remission). No control group, so causal/specific attribution to the transition-ritual component is unproven.

Across 42 RCTs (n=4,245), sleep-hygiene/wind-down education produced significant pre-post improvement in insomnia severity but was INFERIOR to full CBT-I; 86% of trials had high risk of bias. General population, not ADHD-specific. Indirect support: the wind-down/routine element alone helps but is weaker than the multi-component package.

Up to ~90% of people with insomnia attribute their sleep problems to pre-sleep cognitive arousal (racing thoughts/worry); poor sleepers use dysfunctional control strategies that maintain arousal. Provides the mechanistic rationale for a buffer ritual plus attention-defusion ('notice the thought, don't react'), but is a narrative mechanism review, not a test of the ritual.