TikTok insomnia advice was high quality in only 20 of 127 videos that sleep doctors reviewed

Insomnia advice used to come from a doctor, a pharmacist or a book. Now it also comes from a phone, often in the small hours and often from a stranger. Sleep specialists have checked 127 of those videos on TikTok against clinical guidance, and most of them fell short.

The team, which includes sleep physicians at University Hospitals Leuven in Belgium, published its results in the Journal of Clinical Sleep Medicine in September. Fewer than one video in six cleared the bar: only 20 videos (15.7%) had high educational value. The best-liked videos did no better than the ones nobody watched.

How good was the insomnia advice on TikTok?

Styliani Papadopoulou, Alexandros Kalkanis and their colleagues collected TikTok videos about managing insomnia and graded each one. Their main yardstick was the Global Quality Score, a rating scale that researchers use to judge how useful a piece of health content would be to a patient. They also noted who had posted each video. The sample held 66 videos by general users, 20 by physicians, 32 by other healthcare professionals and 9 by accounts tied to a brand.

Twenty videos earned a high rating, while another 11 (8.7%) had moderate educational value. That leaves 96 videos, roughly three in every four, in the poor category.

The narrower checks came out worse. Only 5 videos received the highest score for consistency with guidelines. Only 5 videos recommended consulting a physician, and only 2 included scientific references. A viewer working through the whole sample would have met a source for a claim about once every 60 videos.

Who was speaking made a difference, up to a point. Approximately 55% of physicians’ videos reached at least a moderate score, against 25% for other healthcare professionals and 18% for general users. None of the nine brand accounts managed it. Even among the doctors, then, close to half of the videos missed a moderate rating.

Popular insomnia videos were no more reliable

Someone scrolling at night has one obvious signal to go on: how many other people watched and liked a video. It turned out to be worthless as a guide. The researchers measured each video’s popularity with a views and engagement index, and the quality score was not correlated with engagement metrics. A widely shared video was as likely to be poor as an ignored one.

Money pointed the wrong way. Sponsored videos were associated with lower-quality content, which fits the zero from the brand accounts.

Sleep is far from the only subject where this happens. A systematic review in the Journal of Medical Internet Research gathered 69 studies of health claims on social platforms and found that posts with misinformation reached 87% in some studies. The worst rates in that review were for smoking products and drugs such as opioids and marijuana, with vaccines close behind. Insomnia now joins the list of topics where the feed and the clinic disagree.

What insomnia guidelines actually recommend

The study judged videos against clinical guidelines, and on chronic insomnia those guidelines agree with each other to an unusual degree. All three of the major ones put the same option first, and it involves no pill.

Cognitive behavioral therapy for insomnia, usually shortened to CBT-I, is a structured program that changes sleep habits and the thoughts that keep people awake. In the 2023 European Insomnia Guideline it is recommended as the first-line treatment for chronic insomnia in adults of any age, whether delivered in person or digitally. The American Academy of Sleep Medicine gives the same advice to clinicians as a strong recommendation: use multicomponent cognitive behavioral therapy for insomnia for the treatment of chronic insomnia disorder in adults. Its guideline also suggests that clinicians use stimulus control as a single-component therapy, along with sleep restriction and relaxation training, which are building blocks of the full program.

The American College of Physicians reached the same position in 2016. It recommends that all adult patients receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia disorder.

Medication comes second in each document. The European guideline says that when CBT-I is not sufficiently effective, a pharmacological intervention can be offered. The American College of Physicians describes a shared decision-making approach, including a discussion of the benefits, harms, and costs of short-term use of medications.

A snapshot of 127 TikTok videos, scored with a borrowed tool

The numbers describe one platform at one moment. TikTok’s catalog changes daily, and 127 videos is a small slice of it. The study also measured the videos themselves. It did not follow viewers, so it says nothing about whether anyone slept better or worse after watching.

The scoring method has known weaknesses, and an independent group has spelled them out. A scoping review in the International Journal of Medical Informatics examined 29 studies that rated health videos on TikTok. It concluded that most of the rating tools were not developed to assess health science-related short videos, lacked credibility tests, and had poor applicability. In that review, fifteen studies did not report the identity of the evaluators, and 12 studies did not report interrater reliability, meaning how closely two raters agreed. A quality score for a short clip is a judgment made with an instrument built for something else.

Those cautions cut both ways. They are a reason not to lean on the exact percentages, and they do not rescue the videos. Whatever the tool, 122 of 127 clips never suggested seeing a doctor about a medical complaint.

For anyone who has taken sleep tips from a feed, the useful part of this study is what it removes. Likes and view counts carried no information about quality here, and a medical title carried only some. The guidelines the videos were measured against are public, they agree with one another, and what they put first is a structured course, delivered in person or digitally.

On this evidence, a video’s popularity says nothing about whether its sleep advice is sound.