Does a Hot Foot Bath Improve Sleep Quality? - A Systematic Review and Meta-Analysis

Abstract

Background: Hot foot bath (HFB), a simple non-pharmacological intervention and a readily available hydrotherapy application, is often recommended in Naturopathy system of Medicine to improve sleep.

Primary study objectives: The current systematic review and meta-analysis were conducted to update and provide a comprehensive overview of the effect of HFB on sleep quality.

Method: Electronic databases such as PubMed/MEDLINE, Scopus, Web of Science, CINAHL, EBSCO, Cochrane Library, and Google Scholar were searched from inception until May 2024 to identify randomized controlled trials (RCTs) that evaluated the effects of HFB as an intervention to improve sleep quality.

Intervention: Application of a hot foot bath (defined as immersion of both feet in water of temperature ≥40°C).

Primary outcome measures: The primary outcome measures include sleep onset latency (SOL), total sleep time (TST), wake after sleep onset latency (WASOL), and sleep efficiency (SE), measured objectively using polysomnography (PSG).

Results: Following appraisal for risk of bias, extracted data were meta-analyzed using a random-effects model for the sleep outcome parameters. The comprehensive literature search yielded six studies of low methodological quality, with 176 patients. The findings reveal that although HFB may improve sleep quality, the results were statistically insignificant. Subgroup analysis was performed with temperature, duration of HFB, and interval of time between HFB and bedtime (more than 1 hour vs less than 1 hour); however, the parameters showed no significant effects of HFB.

Conclusion: HFB may be a safe and cost-effective modality to enhance sleep quality. However, the number of studies available is limited, with a high risk of bias. More high-quality RCTs with larger sample sizes are required before strongly suggesting HFB as an effective intervention for sleep-related problems.

Keywords: Sleep quality; warm water therapy; hydrotherapy; hot foot bath; sleep disturbance; naturopathy.